D0328 - Gone to Guts: A Case of Osteosarcoma With Metastasis to Upper and Lower Gastrointestinal Tract Presenting as Recurring Bleeding

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Prateek S. Harne, MBBS, MD

University of Texas Rio Grande Valley at Doctors Hospital at Renaissance
Edinburg, TX

Award: Presidential Poster Award

Prateek S. Harne, MBBS, MD, Ans Albustamy, MD, Arturo Suplee Rivera, MD, Carlos Cardenas, MD, FACG, Asif Zamir, MD, FACG
University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX

Introduction: Osteosarcomas are the most common bone tumors in children and adolescents. They are notoriously known to metastasize to lungs, however metastasis to gastrointestinal tract is extremely rare and only reported in sparse case reports.^1–5 To our knowledge, we present one of the first cases of osteosarcoma that metastasized to the upper and lower GI tract presenting as recurrent bleeding.

Case Description/Methods: A 43-year-old man with medical history of metastatic osteosarcoma to the lungs and brain, initially diagnosed at the age of 20 years in the femur, presented to the hospital after a syncopal episode. Patient had been having intermittent melena for a month prior to presentation. Oncological treatments included ifosfamide, doxorubicin, carboplatin, and etoposide. On presentation, his vitals were significant for HR 102, and BP 85/40mmHg. Physical exam revealed a non-tender abdomen and rectal exam was positive for melena. His labs are outlined in Table 1. Chest X-ray revealed metastatic lung nodules. Enteroscopy showed no bleeding up to proximal jejunum. A 2cm ulcerated nodule was noted in the jejunum which was not actively bleeding (Image A). Colonoscopy with deep cannulation of terminal ileum (40cm) revealed old blood throughout. Again, similar 2-3cm ulcerated transverse and hepatic colon nodules were noted which were biopsied (Images B). Pathology revealed spindle-shaped cells with marked nuclear atypia with poor immunoreactions indicating poorly differentiated sarcoma. CT angiography of the abdomen showed evidence of metastatic nodules in the small and large bowel. Patient’s family opted for comfort measures given his poor surgical candidacy and overall prognosis.

Discussion: In line with other sparsely reported cases, our case presented with luminal bleeding from multiple ulcerated nodules.^1,3,4To our understanding, this was one of the first cases that had simultaneous involvement of both upper and lower GI tract. With the growing incidence of osteosarcoma, it would aid gastroenterologists in understanding clinical presentation and endoscopic appearance to timely recognize this condition and thereby impact outcomes.

Figure: A) EGD image showing a 2cm ulcerated jejunal nodule. B,C) Colonoscopy images showing 2-3cm ulcerated nodules in the hepatic and transverse colon

Lab parameter	Value	Units	Reference range
WBC count	17.70	X 1000 cells/uL	4-10
RBC count	2.28	Million/uL	3.5-5.5
Hemoglobin	5.3	g/dL	12-16
Hematocrit	18.3	%	35-45
MCV	80.3	fL	84-96
Platelet count	257	X 1000/uL	150-400
RDW	19.40	%	12-15
Sodium	135	mmol/L	132-143
Potassium	4.2	mmol/L	3.5-5.1
Chloride	102	mmol/L	98-107
Carbon dioxide	26	mmol/L	21-31
BUN	33	mg/dL	7-25
Creatinine	0.8	mg/dL	0.7-1.3
BUN/Cr ratio	34		6-22
AST	22	IU/L	13-39
ALT	10	IU/L	7-52
ALP	49	IU/L	34-104
Albumin	3.0	g/dL	3.7-4.9
Total Bilirubin	1.1	mg/dL	0.2-1.2
INR	1.32		0.90-1.10
Lactic acid	3.07	mmol/L	0.5-1.99

Table: Table 1. Laboratory values with reference range on presentation

Disclosures:

Prateek Harne indicated no relevant financial relationships.

Ans Albustamy indicated no relevant financial relationships.

Arturo Suplee Rivera indicated no relevant financial relationships.

Carlos Cardenas indicated no relevant financial relationships.

Asif Zamir indicated no relevant financial relationships.

Prateek S. Harne, MBBS, MD, Ans Albustamy, MD, Arturo Suplee Rivera, MD, Carlos Cardenas, MD, FACG, Asif Zamir, MD, FACG. D0328 - Gone to Guts: A Case of Osteosarcoma With Metastasis to Upper and Lower Gastrointestinal Tract Presenting as Recurring Bleeding, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.