Tumor thrombus arising from osteosarcoma is rare. We report the case of a 20-year-old man with proximal humerus osteosarcoma, accompanied by an extensive intravascular tumor thrombus extending into the heart. Our review of the literature found 14 previous reports on osteosarcoma with tumor thrombus. The combination of positron emission tomography and computed tomography is very useful in differentiating tumor thrombus from vascular thrombus, thereby avoiding unnecessary anticoagulation therapy. This same imaging combination can also be used to evaluate the response to treatment. Surgical resection of the tumor thrombus is highly recommended. The effect of tumor thrombus on survival is still unknown.
Keywords: Bone neoplasms/complications; chondrosarcoma; humerus/pathology; neoplasm invasiveness; osteosarcoma/diagnosis/pathology/therapy; positron-emission tomography; thrombosis; tomography, x-ray computed; vascular neoplasms.