Pediatric Osteosarcoma
Case #115
A 12-year-old boy developed neck pain over the course of several months.
He was taken to his pediatrician several times, but conservative treatment was unsuccessful.
An MRI was ultimately ordered that revealed a C3 vertebral body lesion.
He was referred to a large academic hospital.
A pediatric neurosurgeon saw him, and suspected cancer.
He recommended an open biopsy and fusion.
The intraoperative pathology report suggest osteoblastoma as opposed to the more serious alternative, osteosarcoma.
A C3 laminectomy and C2-C4 fusion was performed.
Unfortunately the child had worsening pain in the weeks and months following the operation.
He was seen at various other well-respected academic institutions, and ultimately was diagnosed with osteosarcoma.
He was treated with multiple subsequent surgeries and chemotherapy.
He tragically passed away several months after the initial operation.
His family filed a lawsuit against the neurosurgeon and multiple pathologists.
They allege that the tumor was misdiagnosed, robbing the patient of the opportunity to have his osteosarcoma treated appropriately.
They note that the autografting done during his original procedure likely seeded osteosarcoma throughout the entire surgical area, causing rapid progression of the cancer.
Part of the allegations against the neurosurgeon include that he misrepresented his expertise:
Notably, the neurosurgeon completed a pediatric neurosurgery fellowship and is the chair of pediatric neurosurgery at an Ivy League institution.
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An expert witness wrote the following opinion:
Several pathologists who reviewed the slides were also named as defendants.
The family has offered to settle the case against numerous defendants (the neurosurgeon, multiple pathologists, the hospital where this occurred, and the affiliated medical school).
They are requesting a total of $8 million from all parties.
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MedMalReviewer Opinion:
This is a very difficult case to defend given the optics associated with a child dying a painful death, coupled with the fact that the neurosurgeon may have accidentally worsened the disease. I am not in a place to lecture subspecialists with some of the most impressive academic credentials in the world, but obviously it is imperative to make sure that the autografted tissue does not contain aggressive neoplastic cells.
It is unclear if the family was made aware of the possibility of osteoblastoma vs. osteosarcoma. Having a frank discussion with them about the equivocal nature of the pathology report and documenting their involvement in this extremely risky decision could have made a big difference.
This lawsuit is bigger than most malpractice cases just involving one or two doctors. It now involves the hospital itself and the affiliated medical school. Given the dramatic nature, sad outcome, and massive settlement request, it will probably find media coverage when it resolves. I’ll send an update via email when the lawsuit is over.
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This is a freak case to be honest. Osteosarcoma in cervical spine that did not burst out of the vertebra for months (assuming this because otherwise it would look more malignant in the imaging, ringing alarm bells. I don't know if closing the patient at that point would make any difference. Sad case for both parties.
The only slides mentioned are frozen sections…those preparations have poor cell morphology and are suboptimal for a definitive diagnosis. There must have been other slides made, as well as additional stains and molecular testing. The pathology section seems sparse… There’s no way the final diagnosis was made from a frozen section!!