ANOMIA: AN UNCOMMON PRESENTING SYMPTOM OF BRAIN METASTATIC OSTEOSARCOMA. (CASE REPORT)

Objectives: To report an uncommon onset of CNS metastatic osteosarcoma, and describe different early clinical features in this condition.

Methods: We report the case of an 18-year old right-handed male who, at the age of 13 was diagnosed and treated for distal thigh primary osteosarcoma with lung metastases. New lung metastases were found in a later follow-up visit. A new thoracotomy and adjuvant chemotherapy were completed, and the patient remained tumor-free during a five year period. The patient was referred to Neuropediatrics presenting anomic aphasia with selective impairment in naming common nouns. CT and MRI scans showed a three-cm node located in the left temporal lobe. Following neurosurgery, a metastatic osteosarcoma was confirmed by histology.

Results: Incidence of brain metastases in pediatric oncology patients with solid tumors was estimated at 4.5%, predominantly in males. The risk of involvement of CNS for osteosarcoma is 10–15 percent in relapsing patients. The early clinical features were: headache, endocranial hypertension, motor impairment and sensory loss, headache being the most common. So far, we have not found any other report of anomia as a presenting symptom of metastatic osteosarcoma.

Conclusion: The involvement of CNS is infrequent in osteosarcoma. In this case, the anomia suggested both the existence of brain involvement and the lesion location in the left perisylvian area. The highest survival rate as a result of therapeutical advances has been linked to pattern changes in brain metastases. Therefore, we believe that the recommendation to include neuro-images in the follow-up of osteosarcoma relapsing patients is appropriate.