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Al-Dasuqi K, Cheng R, Moran J, Irshaid L, Maloney E, Porrino J. Update of pediatric bone tumors: osteogenic tumors and osteoclastic giant cell-rich tumors. Skeletal Radiol 2023; 52:671-685. [PMID: 36326880 DOI: 10.1007/s00256-022-04221-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
There are numerous bone tumors in the pediatric population, with imaging playing an essential role in diagnosis and management. Our understanding of certain bone tumors has rapidly evolved over the past decade with advancements in next-generation genetic sequencing techniques. This increased level of understanding has altered the nomenclature, management approach, and prognosis of certain lesions. We provide a detailed update of bone tumors that occur in the pediatric population with emphasis on the recently released nomenclature provided in the 5th edition of the World Health Organization Classification of Soft Tissue and Bone Tumours.
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Affiliation(s)
- Khalid Al-Dasuqi
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ryan Cheng
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Jay Moran
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Lina Irshaid
- Pathology Associates at Beverly Hospital, 85 Herrick Street, Beverly, MA, 01915, USA
| | - Ezekiel Maloney
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Jack Porrino
- Yale Radiology and Biomedical Imaging, 330 Cedar Street, New Haven, CT, 06520, USA.
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2
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Savvidou O, Papakonstantinou O, Lakiotaki E, Zafeiris I, Melissaridou D, Korkolopoulou P, Papagelopoulos PJ. Surface bone sarcomas: an update on current clinicopathological diagnosis and treatment. EFORT Open Rev 2021; 6:905-917. [PMID: 34760290 PMCID: PMC8559567 DOI: 10.1302/2058-5241.6.210064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surface bone sarcomas are rare malignant bone tumours. Osseous and cartilaginous surface bone sarcomas are the most common, with parosteal and periosteal osteosarcomas, periosteal chondrosarcomas and secondary peripheral chondrosarcomas being the most frequent. Their clinical symptoms are non-specific and include pain for several months, swelling and limited range of motion of the adjacent joints. Prompt diagnosis is important, as biological behaviour, imaging and histopathologic characteristics, treatment and prognosis differ considerably from their conventional intramedullary counterparts. Moreover, their imaging characteristics are not infrequently non-characteristic and may be misinterpreted as juxtacortical benign lesions leading to incorrect diagnosis and treatment, with life-threatening repercussions. Molecular studies and histopathological sampling are essential for accurate diagnosis. There are still numerous issues regarding the biology, pathophysiology and treatment options of these entities due to their rarity.
Cite this article: EFORT Open Rev 2021;6:905-917. DOI: 10.1302/2058-5241.6.210064
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Affiliation(s)
- Olga Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.,These authors contributed equally to this manuscript
| | - Olympia Papakonstantinou
- Second Department of Radiology, National and Kapodistrian University of Athens, Medical School, Attikon University General Hospital, Athens, Greece.,These authors contributed equally to this manuscript
| | - Eleftheria Lakiotaki
- First Department of Pathology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,These authors contributed equally to this manuscript
| | - Ioannis Zafeiris
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece
| | - Pinelopi Korkolopoulou
- First Department of Pathology, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Co-senior authors
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Athens, Greece.,Co-senior authors
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3
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Osteosarcoma: An Evolving Understanding of a Complex Disease. J Am Acad Orthop Surg 2021; 29:e993-e1004. [PMID: 34623342 DOI: 10.5435/jaaos-d-20-00838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023] Open
Abstract
Osteosarcoma is the most common primary bone sarcoma and affects both children and adults. The cornerstone of treatment for patients with localized and oligometastatic disease remains neoadjuvant chemotherapy, surgical resection of all sites of disease, followed by adjuvant chemotherapy. This approach is associated with up to an 80% 5-year survival. However, survival of patients with metastatic disease remains poor, and overall, osteosarcoma remains a challenging disease to treat. Advances in the understanding of molecular drivers of the disease, identification of poor prognostic factors, development of risk-stratified treatment protocols, successful completion of large collaborative trials, and surgical advances have laid the ground work for progress. Advances in computer navigation, implant design, and surgical techniques have allowed surgeons to improve patients' physical functional without sacrificing oncologic outcomes. Future goals include identifying effective risk stratification algorithms which minimize patient toxicity while maximizing oncologic outcomes and continuing to improve the durability, function, and patient acceptance of oncologic reconstructions.
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Cook MR, Lorbach J, Husbands BD, Kisseberth WC, Samuels S, Silveira C, Wustefeld-Janssens BG, Wouda R, Keepman S, Oblak ML, Selmic LE. A retrospective analysis of 11 dogs with surface osteosarcoma. Vet Comp Oncol 2021; 20:82-90. [PMID: 34033204 DOI: 10.1111/vco.12741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023]
Abstract
While the majority of canine osteosarcomas (OSA) arise from the medullary cavity, a subset arises from the surface of bone. In humans, surface OSA often has a more indolent disease course with better outcomes than medullary OSA. The aim of this retrospective case series was to evaluate the clinical outcome and potential prognostic factors of dogs with surface OSA. Medical records from 11 dogs previously diagnosed with surface OSA were included. Histopathology of cases was evaluated during case review by two veterinary anatomic pathologists. Median progression free interval (PFI) and overall median survival time (OST) were estimated using Kaplan-Meier methods. Intergroup comparisons were performed using log-rank tests. Six dogs were diagnosed with periosteal OSA, 4 dogs with parosteal OSA, and one dog with an unclassified surface OSA. Two dogs were found to have metastatic disease at the time of diagnosis and four developed metastatic lesions after treatment. The median PFI and median OST for all dogs with surface OSA was 425 and 555 days, respectively. The 6 dogs diagnosed with periosteal OSA had a median PFI of 461 days and median OST of 555 days, while the 4 dogs with parosteal OSA had a PFI of 350 days and the OST could not be calculated. Multiple prognostic factors (surgery, systemic adjunctive therapy, elevated alkaline phosphatase at diagnosis, appendicular vs axial location, mitotic count, and tumour grade) were evaluated and none were prognostic for PFI or OST. Dogs with surface OSA appear to have prolonged PFI and OST, consistent with humans with surface OSA.
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Affiliation(s)
- Matthew R Cook
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Joshua Lorbach
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brian D Husbands
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - William C Kisseberth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sarah Samuels
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Catrina Silveira
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Brandan G Wustefeld-Janssens
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Raelene Wouda
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Samuel Keepman
- Department of Clinical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Michelle L Oblak
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
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5
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Tran V, Slavin J. Bone Tumour Pathology. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Harper K, Sathiadoss P, Saifuddin A, Sheikh A. A review of imaging of surface sarcomas of bone. Skeletal Radiol 2021; 50:9-28. [PMID: 32681279 DOI: 10.1007/s00256-020-03546-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
Surface lesions of bone are uncommon. Although their imaging features generally mirror those of their intramedullary counterparts, surface lesions may demonstrate distinct characteristics which along with their unusual location present a diagnostic challenge. Surface sarcomas are usually of a lower grade compared with intramedullary variants, leading to differences in management. Osteosarcoma arising from the cortical surface of the bone is termed juxtacortical or surface osteosarcoma and includes three distinct entities: parosteal, periosteal, and high-grade surface osteosarcoma. We also review the features intracortical osteosarcoma, which some authors include under the umbrella term surface osteosarcoma. These lesions exhibit biologic features distinct from those of conventional intramedullary osteosarcoma, which underlines the importance of accurate imaging diagnosis. Periosteal chondrosarcoma and periosteal Ewing sarcoma also have distinctive imaging appearances. The purpose of this article is to review surface sarcomas of bone with regard to their clinical and radiological features and to discuss the differential diagnosis for each condition.
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Affiliation(s)
- Kelly Harper
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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7
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Deng Z, Huang Z, Ding Y, Su Y, Chan CM, Niu X. High-Grade Surface Osteosarcoma: Clinical Features and Oncologic Outcome. J Bone Oncol 2020; 23:100288. [PMID: 32953434 PMCID: PMC7486478 DOI: 10.1016/j.jbo.2020.100288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/26/2020] [Accepted: 04/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background High-grade surface osteosarcoma is an extremely rare subtype of osteosarcoma. The treatment outcome for this tumor varies in different centers. Methods This was a retrospective study of high-grade surface osteosarcoma; clinical, radiological, and histological materials were reviewed. Results We studied 23 patients (16 males, seven females); median age was 24 years old. All the tumors involved the lower limb, located at the diaphysis in 11 patients and at the metaphysis in 12 patients. Even though the majority of tumors were located at the surface of the bone, the medullary canal was involved in 10 patients. The microscopic findings were indistinguishable from conventional central osteosarcoma. All the patients were treated with a combination of surgery and systemic chemotherapy. Follow-up data were completed in 20 patients; follow-up duration ranged from 27 months to 182 months or until the patient died of the disease (5–104 months). Of the 20 patients, 12 died of the disease, and eight patients were alive at the time of the last follow-up. The 5-year overall survival rate was 37.6%. Conclusions Our study revealed that the treatment outcome for this tumor shows a poor survival rate.
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Affiliation(s)
- Zhiping Deng
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Zhen Huang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Yi Ding
- Department of Pathology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Chung Ming Chan
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Xiaohui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
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Gholamrezanezhad A, Basques K, Kosmas C. Peering beneath the surface: juxtacortical tumors of bone (part II). Clin Imaging 2018; 50:113-122. [PMID: 29353715 DOI: 10.1016/j.clinimag.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 01/26/2023]
Abstract
Juxtacortical or surface tumors of bone are neoplasms arising from or just outside the cortex, and are composed of different histologic types. Although the imaging appearances of these lesions have similarities to their intramedullary counterparts, their location alters their radiographic and MR characteristics, creating difficulties in diagnosis. Meanwhile, several non-neoplastic lesions, such as stress reaction/stress fracture and indolent infectious processes, compound the differential diagnosis. Neoplastic juxtacortical lesions of bone have been classified into five categories: cartilaginous, fibrous, lipomatous, osseous, and metastatic tumors. Our goal in part two of this review is to illustrate the characteristic radiographic, CT and MR imaging features of various juxtacortical neoplasms, including pathognomonic imaging findings that can aid in diagnosis, and to develop an appropriate differential diagnosis for surface lesions based on imaging characteristics, lesion location and patient age.
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Affiliation(s)
- Ali Gholamrezanezhad
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Kyle Basques
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Christos Kosmas
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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Abstract
In this paper we provide an overview of benign and malignant osteogenic bone tumors. We describe the diagnostic features, radiographic findings, and pertinent ancillary studies needed to diagnose these bone-forming lesions. We begin with osteoid osteoma and osteoblastoma, which are histologically bland and eminently benign with rare possible exceptions. On the other end of the behavioral spectrum is osteosarcoma, which encompasses many subtypes ranging from high-grade osteogenic osteosarcoma to less overtly osteogenic lesions such as telangiectatic and small cell osteosarcoma. While classic osteogenic osteosarcoma can be easily recognized by its high grade morphology and formation of extracellular lace-like osteoid, its variants may pose diagnostic dilemmas as their differential diagnoses can include benign, fibrous, and vascular lesions, among others. Recognition of these variants is essential to avoid diagnostic pitfalls. In equivocal cases, some forms of osteosarcoma have shown molecular alterations that may prove diagnostically useful.
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Affiliation(s)
- Jeffery T Green
- Division of Surgical Pathology & Cytopathology, University of Virginia Health System, Charlottesville, Virginia.
| | - Anne M Mills
- Division of Surgical Pathology & Cytopathology, University of Virginia Health System, Charlottesville, Virginia
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10
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Abstract
Surface osteosarcomas are a rare form of osteosarcomas accounting for around 3-6% of all osteosarcomas. Three major groups of surface osteosarcomas are parosteal, periosteal and the high grade surface osteosarcomas. Of these, the parosteal osteosarcoma is the most common. Parosteal and periosteal osteosarcomas are distinct clinical entities and it is important to identify the clinicoradiological differences between the two types. Surface osteosarcomas occur at a later age as compared to conventional osteosarcomas. The classical site is the lower end of the femur followed by the upper end of the tibia and upper end of humerus, in that order. The periosteal variant affects the tibia more commonly than the parosteal variety. Neo-adjuvant chemotherapy is the standard of care for high grade surface osteosarcomas. Parosteal osteosarcomas, being low grade lesions, can be treated by upfront wide excision without adjuvant systemic therapy. Controversy prevails over the need for chemotherapy in periosteal osteosarcomas, which are intermediate grade lesions.
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Affiliation(s)
| | - Nilesh Barwar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Shah Alam Khan, Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029, India. E-mail:
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11
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Katonis P, Datsis G, Karantanas A, Kampouroglou A, Lianoudakis S, Licoudis S, Papoutsopoulou E, Alpantaki K. Spinal osteosarcoma. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2013; 7:199-208. [PMID: 24179411 PMCID: PMC3813616 DOI: 10.4137/cmo.s10099] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although osteosarcoma represents the second most common primary bone tumor, spinal involvement is rare, accounting for 3%–5% of all osteosarcomas. The most frequent symptom of osteosarcoma is pain, which appears in almost all patients, whereas more than 70% exhibit neurologic deficit. At a molecular level, it is a tumor of great genetic complexity and several genetic disorders have been associated with its appearance. Early diagnosis and careful surgical staging are the most important factors in accomplishing sufficient management. Even though overall prognosis remains poor, en-block tumor removal combined with adjuvant radiotherapy and chemotherapy is currently the treatment of choice. This paper outlines histopathological classification, epidemiology, diagnostic procedures, and current concepts of management of spinal osteosarcoma.
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Affiliation(s)
- P Katonis
- Department of Orthopaedics, University Hospital, University of Crete, Heraklion, Greece
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12
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Marais LC, Ferreira N. Osteosarcoma in Adult Patients Living with HIV/AIDS. ISRN ONCOLOGY 2013; 2013:219369. [PMID: 23762607 PMCID: PMC3612482 DOI: 10.1155/2013/219369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/21/2013] [Indexed: 11/17/2022]
Abstract
Background. HIV infection has reached epidemic proportions in South Africa, with an estimated prevalence of 21.5% in adults living in the province of KwaZulu-Natal. Several malignancies have been identified as part of the spectrum of immunosuppression-related manifestations of HIV infection. Very few reports, however, exist regarding the occurrence of non-AIDS-defining sarcomas in the extremities or limb girdles. Methods. A retrospective review was performed on all adult patients, between the ages of 30 and 60 years, with histologically confirmed osteosarcomas of the appendicular skeleton referred to a tertiary-level orthopaedic oncology unit. Results. Five out of the nine patients (62.5%) included in the study were found to be HIV positive. The average CD4 count of these patients was 278 (237-301) cells/mm(3), indicating advanced immunological compromise. Three of the malignancies in HIV-positive patients occurred in preexisting benign or low-grade tumours. Conclusion. A heightened index of suspicion is required in HIV patients presenting with unexplained bone and joint pain or swelling. Judicious use of appropriate radiological investigation, including magnetic resonance imaging of suspicious lesions and timely referral to an appropriate specialized orthopaedic oncology unit, is recommended.
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Affiliation(s)
- Leonard C. Marais
- Tumour, Sepsis and Reconstruction Unit, Grey's Hospital, Townbush Road, Pietermaritzburg 3201, KwaZulu-Natal, South Africa
| | - Nando Ferreira
- Tumour, Sepsis and Reconstruction Unit, Grey's Hospital, Townbush Road, Pietermaritzburg 3201, KwaZulu-Natal, South Africa
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Yarmish G, Klein MJ, Landa J, Lefkowitz RA, Hwang S. Imaging characteristics of primary osteosarcoma: nonconventional subtypes. Radiographics 2011; 30:1653-72. [PMID: 21071381 DOI: 10.1148/rg.306105524] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Osteosarcoma (OS) is a common primary malignant tumor of bone that produces osteoid matrix. According to the World Health Organization, OS of bone is classified into eight subtypes with distinct biologic behaviors and clinical outcomes: conventional, telangiectatic, small cell, low-grade central, secondary, parosteal, periosteal, and high-grade surface. Imaging plays a crucial role in the diagnosis of each subtype of OS and ultimately in patients' survival because the diagnosis is based on a combination of histopathologic and imaging features. Conventional OS is the most common subtype of OS and is readily identified at radiography as an intramedullary mass with immature cloudlike bone formation in the metaphyses of long bones. The imaging features of less common subtypes of primary OS are variable and frequently overlap with those of multiple benign and malignant entities, creating substantial diagnostic challenges. For accurate diagnosis, it is important to be aware of radiographic and cross-sectional imaging features that allow differentiation of each nonconventional subtype of OS from its mimics.
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Affiliation(s)
- Gail Yarmish
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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14
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Wang GD, Zhao YF, Liu Y, Jiang L, Jiang XZ. Periosteal osteosarcoma of the mandible: case report and review of the literature. J Oral Maxillofac Surg 2011; 69:1831-5. [PMID: 21272969 DOI: 10.1016/j.joms.2010.07.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/28/2010] [Accepted: 07/16/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Guo Dong Wang
- Department of Stomatology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
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