Transformação maligna na osteomielite crônica

Texture analysis using short-tau inversion recovery magnetic resonance images to differentiate squamous cell carcinoma of the gingiva from medication-related osteonecrosis of the jaw

OBJECTIVES

Despite the difficulty in distinguishing between squamous cell carcinoma (SCC) and medication-related osteonecrosis of the jaw (MRONJ) on the basis of medical imaging examinations, the two conditions have completely different treatment methods and prognoses. Therefore, differentiation of SCC from MRONJ on imaging examinations is very important. This study aimed to distinguish SCC from MRONJ by performing texture analysis using magnetic resonance imaging (MRI) short-tau inversion recovery images.

METHODS

This retrospective case-control study included 14 patients with SCC of the lower gingiva and 35 with MRONJ of the mandible who underwent MRI and computed tomography (CT) for suspected SCC or MRONJ. SCC was identified by histopathological examination of tissues excised during surgery. The radiomics features of SCC and MRONJ were analyzed using the open-access software MaZda version 3.3 (Technical University of Lodz, Institute of Electronics, Poland). CT was used to evaluate the presence or absence of qualitative findings (sclerosis, sequestrum, osteolysis, periosteal reaction, and cellulitis) of SCC and MRONJ.

RESULTS

Among the 19 texture features selected using MaZda feature-reduction methods, SCC of the gingiva and MRONJ of the mandible revealed differences in two histogram features, one absolute gradient feature, and 16 Gy level co-occurrence matrix features. In particular, the percentile, angular second moment, entropy, and difference entropy exhibited excellent diagnostic performance.

CONCLUSION

Non-contrast-enhanced MRI texture analysis revealed differences in texture parameters between mandibular SCC and mandibular MRONJ. MRI texture analysis can be a new noninvasive quantitative method for distinguishing between SCC and MRONJ.

Malignant transformation of chronic osteomyelitis of mandible: A rare presentation

ABSTRACT

Chronic osteomyelitis is a bone disease that is characterized by inflammatory processes, including necrosis of mineralized and marrow tissues, suppuration, resorption, sclerosis, and hyperplasia. The primary cause of chronic osteomyelitis is usually microbiologic, and it results from an odontogenic infection, postextraction complication, inadequate removal of necrotic bone, early termination of antibiotic therapy, inappropriate selection of antibiotics, diagnostic failure, trauma, inadequate treatment for a fracture, or irradiation to the mandible. The incidence of malignant transformation of chronic osteomyelitis in the head and neck region is very low and rare in developed countries. This is the first case report on the malignant transformation of chronic osteomyelitis of the mandible which discusses its etiopathogenesis and radiographic imaging.

Management of Squamous Cell Carcinoma in Chronic Osteomyelitis: Our Experience, Review of the Literature and Role of MRI in Differential Diagnosis

Background. The authors describe a series of patients with chronic osteomyelitis associated with squamous cell carcinoma, whilst analyzing its incidence in chronic osteomyelitis, surgical options for treatment and focusing on the role of MRI in differential diagnosis. Methods. The authors reviewed 73 cases of chronic osteomyelitis (CO) treated in their department between 1995 and 2019. Six of these patients (8.2%) had a malignant degeneration in squamous cell carcinoma (SCC). All cases with malignancy were evaluated with preoperative gadolinium-enhanced MRI. Results. In this series, the authors observed an incidence rate of 8.2% (6 cases out of 73); all patients were male with a mean age of 63.5 years. The mean time between the occurrence of chronic osteomyelitis and the diagnosis of squamous cell carcinoma was 36 years (range: 21–66). The treatment consisted of amputation in five patients and limb salvage with vascularized fibula autograft in one case. Conclusions. MRI played a key role in the differential diagnosis between infected and tumoral tissue, and was found to be crucial during follow-up. Amputation is the treatment of choice in extended tumoral involvement of bone and soft tissue.

Chondroblastic Osteosarcoma Associated with Previous Chronic Osteomyelitis Caused by Serratia liquefaciens in a German Shepherd Dog

Development of bone tumors as a result of chronic osteomyelitis represents a relatively rare and late complication in humans and animals. We described a malignant transformation (chondroblastic osteosarcoma) in a 7-year-old German shepherd with a history of polyostotic osteomyelitis caused by Serratia liquefaciens when the dog was 15 months old. The tumor developed in the right humeral diaphysis, one of the sites of polyostotic osteomyelitis. To the best of our knowledge this is the first report of polyostotic osteomyelitis caused by Serratia liquefaciens in dogs.

Squamous cell carcinoma complicating chronic osteomyelitis: A systematic review and case series

INTRODUCTION

Squamous cell carcinoma (SCC) is a rare but serious complication of chronic osteomyelitis. This study aimed to determine an optimum approach to diagnosis and management.

METHODS

A systematic review was performed using Medline, Embase, CINAHL and Web of Science, from 1999-present. Additional cases, meeting the eligibility criteria, were added from our hospital database. Patient demographics (age, gender, co-morbidities), osteomyelitis diagnosis (location, duration), diagnosis of SCC (method, imaging, extent of disease) and management (amputation versus wide local excision versus palliation) as well as outcome at one and five years were collected.

RESULTS

Nineteen studies involving 106 patients met strict inclusion criteria. All published studies were case reports or case series. Chronic osteomyelitis had been present for a mean of 31 years (range 3-67) prior to SCC diagnosis. SCC was most commonly treated by amputation (81%). A poorer outcome occurred in those with metastatic disease (p = 0.006 at one year; p = 0.032 at five years), an incidental diagnosis at surgery for osteomyelitis (p = 0.052; p = 0.021) and SCC after pelvic osteomyelitis (p < 0.001; p = 0.002).

CONCLUSIONS

SCC should be suspected in all cases of chronic osteomyelitis with skin changes, particularly if the duration of sinus drainage exceeds 3 years. Histological biopsy for malignancy should be taken in all suspected cases, as well as routinely during excision of osteomyelitis when chronic skin changes are present. Staging computed tomography (CT) scanning is recommended to guide adjunctive therapy. Amputation, where possible, may be considered as the definitive surgical management, after discussion with the patient.

Carcinogenesis and precancerosis transformation of chronic osteomyelitis: 6 cases report and literature review

BACKGROUND

Malignant transformation is a rare and late complication of chronic osteomyelitis. This study presented the results of six cases of carcinogenesis and precancerosis transformations arising from chronic osteomyelitis.

METHODS

Patients who were diagnosed as chronic osteomyelitis and treated in our division were retrospectively retrieved from electronic case system of our hospital. A total of six cases of chronic osteomyelitis patients, confirming with pathological results were included. Not only the characteristics and causes of chronic osteomyelitis, but also time from diagnosis to malignancy, histological types, therapeutic choices and results of treatment were fully incorporated to further study this disease.

RESULTS

All 6 cases with chronic osteomyelitis included in the study were male, with average age of 55.67 year-old (ranging from 48 to 66). The average time from onset of osteomyelitis to carcinomatous change was 31 years (ranging from 9 to 50). Two thirds of patients had explicit infection source of trauma, whereas the rest cases had no obvious culprits before osteomyelitis emerging. All 3 patients diagnosed as carcinoma were performed with proximal limb amputation, but therapy strategies varied in the remaining 3 patients in precancerosis stage. After amputation, 1 patient had carcinoma relapsed at the lower portion of his femur.

CONCLUSION

Although carcinomatous degeneration exists as a rare complication in chronic osteomyelitis, some suspicious conditions such as failure treatment of refractory ulcer and bulking of cauliflower-like mass should be taken cautiously. Early diagnosis and proximal amputation are essential for prognosis and clinical results.

Potential interaction of inflammatory hyperemia and hyperphosphatemia in tumorigenesis

The present article proposes that the association of inflammation with cancer is potentially mediated by the interaction of inflammatory hyperemia and hyperphosphatemia. Hyperemia increases blood flow rate and blood volume, and hyperphosphatemia is caused by elevated serum levels of dysregulated inorganic phosphate. It is hypothesized that the interaction of inflammatory hyperemia and hyperphosphatemia circulates increased amounts of inorganic phosphate to the tumor microenvironment, where increased uptake of inorganic phosphate through sodium-phosphate cotransporters is sequestered in cells. Elevated levels of intracellular phosphorus increase biosynthesis of ribosomal RNA, leading to increased protein synthesis that supports tumor growth. The present article also proposes that the interaction of inflammatory hyperemia and hyperphosphatemia may help explain a chemopreventive mechanism associated with NSAIDs.