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Todi N, Hiltzik DM, Moore DD. Giant cell tumor of bone and secondary osteoarthritis. Heliyon 2024; 10:e30890. [PMID: 38807896 PMCID: PMC11130671 DOI: 10.1016/j.heliyon.2024.e30890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/30/2024] Open
Abstract
Giant cell tumor of bone is a commonly encountered aggressive epiphyseal bone tumor, most often treated surgically. The natural history and presentation are classically described but the histopathology is poorly understood. Intralesional curettage is the mainstay of treatment, but there is significant variation in the use of adjuvant and cavity filling modalities. No gold standard has been agreed upon for treatment, and a variety of techniques are currently in use. Given its location, secondary osteoarthritis is a known long-term complication. This review examines the natural history of giant cell tumors, treatment options and complications, and subsequent development of osteoarthritis. Arthroplasty is usually indicated for secondary osteoarthritis although data is limited on its efficacy. Further directions will likely center on improved pharmacological treatments as well as improved arthroplasty techniques.
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Affiliation(s)
- Niket Todi
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
| | - David M. Hiltzik
- Northwestern University, Department of Orthopaedic Surgery, 303 E Superior St, Chicago, IL, 60611, USA
| | - Drew D. Moore
- Corewell Health William Beaumont University Hospital, Department of Orthopaedic Surgery, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA
- Oakland University William Beaumont School of Medicine, Department of Orthopaedic Surgery, 586 Pioneer Dr, Rochester, MI, 48309, USA
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Kim H, Kim K, Oh SJ, Lee S, Woo JH, Kim JH, Cha YK, Kim K, Chung MJ. AI-assisted Analysis to Facilitate Detection of Humeral Lesions on Chest Radiographs. Radiol Artif Intell 2024; 6:e230094. [PMID: 38446041 DOI: 10.1148/ryai.230094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Purpose To develop an artificial intelligence (AI) system for humeral tumor detection on chest radiographs (CRs) and evaluate the impact on reader performance. Materials and Methods In this retrospective study, 14 709 CRs (January 2000 to December 2021) were collected from 13 468 patients, including CT-proven normal (n = 13 116) and humeral tumor (n = 1593) cases. The data were divided into training and test groups. A novel training method called false-positive activation area reduction (FPAR) was introduced to enhance the diagnostic performance by focusing on the humeral region. The AI program and 10 radiologists were assessed using holdout test set 1, wherein the radiologists were tested twice (with and without AI test results). The performance of the AI system was evaluated using holdout test set 2, comprising 10 497 normal images. Receiver operating characteristic analyses were conducted for evaluating model performance. Results FPAR application in the AI program improved its performance compared with a conventional model based on the area under the receiver operating characteristic curve (0.87 vs 0.82, P = .04). The proposed AI system also demonstrated improved tumor localization accuracy (80% vs 57%, P < .001). In holdout test set 2, the proposed AI system exhibited a false-positive rate of 2%. AI assistance improved the radiologists' sensitivity, specificity, and accuracy by 8.9%, 1.2%, and 3.5%, respectively (P < .05 for all). Conclusion The proposed AI tool incorporating FPAR improved humeral tumor detection on CRs and reduced false-positive results in tumor visualization. It may serve as a supportive diagnostic tool to alert radiologists about humeral abnormalities. Keywords: Artificial Intelligence, Conventional Radiography, Humerus, Machine Learning, Shoulder, Tumor Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Harim Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Kyungsu Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Seong Je Oh
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Sungjoo Lee
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jung Han Woo
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Jong Hee Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Yoon Ki Cha
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Kyunga Kim
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
| | - Myung Jin Chung
- From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul 06351, South Korea (H.K., J.H.W., J.H.K., Y.K.C., M.J.C.); Medical AI Research Center, Samsung Medical Center, Seoul, South Korea (Kyungsu Kim, M.J.C.); Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea (Kyungsu Kim, Kyunga Kim, M.J.C.); and Department of Health Sciences and Technology (S.J.O.) and Department of Digital Health (S.L., Kyunga Kim), Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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Zhou L, Zuo D, Wen J, Sun W, Cai Z, Zhang W, Zhang Z, Dong Y, Yang Q, Zhu H, Yuan T. Reduced recurrence rate and comparable functionality after wide resection and reverse total shoulder arthroplasty with allograft-prosthetic composite versus curettage for proximal humeral giant cell tumor: a multicenter retrospective study. J Shoulder Elbow Surg 2024; 33:1040-1049. [PMID: 37844829 DOI: 10.1016/j.jse.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Giant cell tumors of bone (GCTBs) are rare, aggressive tumors, and the proximal humerus is a relatively rare location for GCTBs; limited evidence exists on which surgical approaches and reconstruction techniques are optimal. In the largest case series to date, we evaluated the recurrence rate of proximal humeral GCTBs and the functional outcomes of different resection and reconstruction options in this multicenter study. METHODS All 51 patients included in this study received initial surgical treatment for proximal humeral GCTBs from January 2007 to December 2020, with a minimum 2-year follow-up period. Local recurrence and functional outcomes were statistically analyzed in relation to demographic, clinical, and primary surgical variables. Functional outcomes were reported by patients and were assessed by the Musculoskeletal Tumor Society score and QuickDASH instrument (shortened version of the Disabilities of the Arm, Shoulder and Hand instrument). RESULTS The mean follow-up period was 81.5 months (range, 30-191 months), and the overall recurrence rate was 17.6% (9 of 51 patients). The majority of recurrences (n = 7) occurred in the first 2 years of follow-up. The intralesional curettage group (n = 23) showed a statistically significant difference in the recurrence rate compared with the en bloc resection group (n = 28) (34.8% vs. 3.6%, P = .007). Among shoulders receiving en bloc resection, 16 were reconstructed with hemiarthroplasty; 8, reverse total shoulder arthroplasty (rTSA) with allograft-prosthetic composite (APC) reconstruction; and 4, arthrodesis. On the basis of intention-to-treat analysis, the mean functional Musculoskeletal Tumor Society scores of the groups undergoing curettage, rTSA with APC, hemiarthroplasty, and arthrodesis were 26.0 ± 3.1, 26.0 ± 1.7, 20.3 ± 2.8, and 22.5 ± 1.3, respectively (P < .001 [with P < .001 for curettage vs. hemiarthroplasty and P = .004 for rTSA with APC vs. hemiarthroplasty]) and the mean QuickDASH scores were 14.0 ± 11.0, 11.6 ± 4.5, 33.1 ± 11.8, and 21.6 ± 4.7, respectively (P < .001 [with P < .001 for curettage vs. hemiarthroplasty and P = .003 for rTSA with APC vs. hemiarthroplasty]). CONCLUSIONS On the basis of our data, en bloc resection followed by reverse shoulder arthroplasty showed a lower recurrence rate and no significant difference in functional outcome scores for proximal humeral GCTBs compared with intralesional curettage. Therefore, we believe that rTSA with APC may be reasonable for the initial treatment of proximal humeral GCTBs.
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Affiliation(s)
- Lenian Zhou
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongqing Zuo
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junxiang Wen
- Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Sun
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengdong Cai
- Department of Orthopedic Oncology, Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weibin Zhang
- Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhichang Zhang
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Dong
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingcheng Yang
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyi Zhu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Yuan
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Mthethwa PG, Marais LC, Aldous CM. Prognostic factors for overall survival of conventional osteosarcoma of the appendicular skeleton. Bone Jt Open 2024; 5:210-217. [PMID: 38471520 DOI: 10.1302/2633-1462.53.bjo-2023-0159.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Aims The aim of this study is to determine the predictors of overall survival (OS) and predictive factors of poor prognosis of conventional high-grade osteosarcoma of the limbs in a single-centre in South Africa. Methods We performed a retrospective cross-sectional analysis to identify the prognostic factors that predict the OS of patients with histologically confirmed high-grade conventional osteosarcoma of the limbs over ten years. We employed the Cox proportional regression model and the Kaplan-Meier method for statistical analysis. Results This study comprised 77 patients at a three-year minimum follow-up. The predictors of poor OS were: the median age of ≤ 19 years (hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.92 to 0.99; p = 0.021); median duration of symptoms ≥ five months (HR 0.91; 95% CI 0.83 to 0.99; p < 0.037); metastasis at diagnosis (i.e. Enneking stage III) (HR 3.33; 95% CI 1.81 to 6.00; p < 0.001); increased alkaline phosphatase (HR 3.28; 95% CI 1.33 to 8.11; p < 0.010); palliative treatment (HR 7.27; 95% CI 2.69 to 19.70); p < 0.001); and amputation (HR 3.71; 95% CI 1.12 to 12.25; p < 0.032). In contrast, definitive surgery (HR 0.11; 95% CI 0.03 to 0.38; p < 0.001) and curative treatment (HR 0.18; 95% CI 0.10 to 0.33; p < 0.001) were a protective factor. The Kaplan-Meier median survival time was 24 months, with OS of 57.1% at the three years. The projected five-year event-free survival was 10.3% and OS of 29.8% (HR 0.76; 95% CI 0.52 to 1.12; p = 0.128). Conclusion In this series of high-grade conventional osteosarcoma of the appendicular skeleton from South Africa, 58.4% (n = 45) had detectable metastases at presentation; hence, an impoverished OS of five years was 29.8%. Large-scale future research is needed to validate our results.
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Affiliation(s)
- Phakamani G Mthethwa
- Department of Orthopaedic Surgery, Dr Pixley Ka Isaka Seme Memorial Hospital, University of KwaZulu-Natal, Nelson Mandela School of Clinical Medicine, Durban, South Africa
| | - Leonard C Marais
- Academic Head of Department of Orthopaedic Surgery, Nelson Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Collen M Aldous
- Department of Clinical Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Zhang P, Tian W, Li P, Zhang F, Qu G, Du X, Liu G, Niu X. The application of custom 3D-printed prostheses with ultra-short stems in the reconstruction of bone defects: a single center analysis. Front Bioeng Biotechnol 2024; 12:1349819. [PMID: 38333079 PMCID: PMC10850231 DOI: 10.3389/fbioe.2024.1349819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Objective: Considering the advantages and widespread presence of 3D-printing technology in surgical treatments, 3D-printed porous structure prostheses have been applied in a wide range of the treatments of bone tumor. In this research, we aimed to assess the application values of the 3D-printed custom prostheses with ultra-short stems for restoring bone defects and maintaining arthrosis in malignant bone tumors of lower extremities in children. Methods: Seven cases of pediatric patients were included in this study. In all cases, the prostheses were porous titanium alloy with ultra-short stems. MSTS 93 (Musculoskeletal Tumor Society) scores were recorded for the functional recovery of the limbs. VAS (Visual analogue scale) scores were utilized to assess the degree of painfulness for the patients. X-ray and MRI (magnetic resonance imaging) were applied to evaluate the bone integration, prostheses aseptic loosening, prostheses fracture, wound healing, and tumor recurrence during follow-up. Results: During follow-up, none of the patients developed any postoperative complications, including prostheses aseptic loosening, prostheses fracture, or tumor recurrence. Radiological examinations during the follow-up showed that prostheses implanted into the residual bone were stably fitted and bone defects were effectively reconstructed. The MSTS 93 scores were 24.9 ± 2.9 (20-28). VAS scores were decreased to 5.8 ± 1.2 (4.0-7.0). No statistically significant differences in leg length discrepancy were observed at the time of the last follow-up. Conclusion: 3D-printing technology can be effectively applied throughout the entire surgical treatment procedures of malignant bone tumors, offering stable foundations for the initial stability of 3D-printed prostheses with ultra-short stems through preoperative design, intraoperative precision operation, and personalized prosthesis matching. With meticulous postoperative follow-up, close monitoring of postoperative complications was ensured. These favorable outcomes indicate that the utilization of 3D-printed custom prostheses with ultra-short stems is a viable alternative for reconstructing bone defects. However, further investigation is warranted to determine the long-term effectiveness of the 3D-printing technique.
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Affiliation(s)
- Peng Zhang
- Department of Orthopedic and Soft Tissue, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Guirguis M, Gupta A, Thakur U, Pezeshk P, Weatherall P, Sharan G, Xi Y, Chhabra A. Diffusion weighted imaging of extremity bone tumors-inter-reader analysis and incremental value over conventional MR imaging. Br J Radiol 2023; 96:20230352. [PMID: 37493234 PMCID: PMC10607398 DOI: 10.1259/bjr.20230352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors. METHODS In this multireader cross-sectional validation study, four musculoskeletal radiologists evaluated osseous tumors blinded to final diagnosis in two rounds-first without DWI or apparent diffusion coefficient (ADC) maps, then months later with these available. Each reader recorded a binary result as to whether the lesion is benign or malignant. Intraclass correlation (ICC) and Conger's κ were used. Diagnostic performance measures including area under the receiver operating curve (AUC) were reported. RESULTS 133 osseous tumors of the extremities (76 benign, 57 malignant) were tested. Blinded to DWI, average reader sensitivity, specificity, positive-predictive value, and negative-predictive value were 0.83, 0.92, 0.94, and 0.82, respectively. With DWI, the values were 0.85, 0.92, 0.94, and 0.83, respectively. Interreader agreement was good for both rounds (0.67 and 0.71, respectively, p-value > 0.05). Average reader confidence was 4.1 and 4.4, respectively (p-value < 0.001). ADC values and DWI/ADC ratios showed significant differences between benign and malignant tumors. CONCLUSION DWI and ADC show statistically significantly different values of benign from malignant osseous tumors and mildly increased radiologist confidence with similar interreader reliability. However, given similar diagnostic accuracy, conventional MR imaging is adequate for bone tumor characterization and incremental value of DWI is limited. ADVANCES IN KNOWLEDGE This paper is the first of its kind to report the use of DWI/ADC ratio for the diagnosis of bone tumors.
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Affiliation(s)
- Mina Guirguis
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anurag Gupta
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Uma Thakur
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parham Pezeshk
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Paul Weatherall
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Gaurav Sharan
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yin Xi
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, Texas, USA
- Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
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Muran A, Fallon J, Jung B, Dzaugis P, Zhang A, Fitzgerald M, Goodman HJ, Kenan S, Kenan S. Treatment trends of benign bone lesions in a suburban New York healthcare system. J Family Med Prim Care 2023; 12:1979-1983. [PMID: 38024888 PMCID: PMC10657113 DOI: 10.4103/jfmpc.jfmpc_5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/26/2023] [Accepted: 06/09/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The management of benign bone lesions is controversial as it is dependent on a multitude of factors such as age, anatomic location, comorbidities, lesion metabolic activity, surgeon preferences, and goals of care, among others. Thus far, many studies have attempted to report on these lesions; however, most are heterogeneous compilations of benign and malignant lesions with nearly all failing to report patient treatment and none of which have originated from a suburban area of the United States. The goal of this study was to establish a modern database dedicated solely to benign bone tumors to reflect current diagnosis and treatment trends in suburban New York. Materials and Methods This was a multicenter retrospective observational study with inclusion criteria limited to benign bone lesions of all ages. Malignant lesions were excluded. Patients were drawn from both primary care provider and surgeon records, with documentation of their associated management. Results A total of 689 patients met inclusion criteria. The overall operative rate for this cohort was 71.6%. In agreement with current literature, aneurysmal bone cysts, giant cell tumors, and osteochondromas underwent surgery more frequently than enchondromas; older patients underwent surgery less frequently; benign bone lesions were more commonly found in younger males, and the distal femur and proximal tibia were the most common locations for lesions (P < .05 for all findings). Conclusion This study demonstrates the management of a globally representative variety of benign bone lesions in a diverse suburban population of New York and should facilitate future research on how lesion type, location, management, and other factors relate to patient outcomes.
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Affiliation(s)
- Andrew Muran
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - John Fallon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Byeongho Jung
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Peter Dzaugis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Aaron Zhang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Michael Fitzgerald
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Howard J. Goodman
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Samuel Kenan
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
| | - Shachar Kenan
- Department of Orthopaedic Surgery, Northwell Health, Long Island Jewish Medical Center, New York, USA
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Song HM, Yan BC, Lu YY, Huang Q, Li ZW, Wu CG. Application of cementoplasty in patients with symptomatic benign osteopathy disease. Acta Radiol 2023; 64:2446-2454. [PMID: 37551019 DOI: 10.1177/02841851231177398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND The optimal treatment for some symptomatic, benign osteopathy lesions is yet to be identified. PURPOSE To investigate the clinical efficiency of cementoplasty in managing symptomatic, benign osteopathy. MATERIAL AND METHODS Between June 2006 and January 2020, we retrospectively enrolled 31 patients (10 men, 21 women; mean age = 46.5 ± 16.6 years; age range = 20-85 years), accounting for 34 treatment sites, who underwent percutaneous osteoplasty (14 treatment sites) and percutaneous vertebroplasty (20 treatment sites) with digital subtraction angiography (DSA) or DSA combined with computed tomography (CT). All the participants experienced different degrees of clinical symptoms with benign osteopathy lesions. The technical success of the procedure and occurrence of complications were recorded. Follow-up examinations were conducted to assess the treatment outcome using the MacNab criteria. RESULTS All the participants had a diagnosis of benign osteopathy lesions before or after the cementoplasty. Surgery was successfully completed in all patients. Cement distributions were diffuse and homogeneous, with the complication of cement leakage occurring in 17.6% (6 of 34) of the lesions. The leakage occurred in the intervertebral disc (n = 1), the intra-articular space (n = 1), and the surrounding soft tissue (n = 4). Analysis of the treatment outcome using the MacNab criteria revealed that all patients showed improvement in their clinical symptoms to some extent and in the quality of life. CONCLUSION Cementoplasty is an effective treatment for symptomatic, benign osteopathy, with the advantage of favorable clinical outcomes, and low complication rate.
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Affiliation(s)
- Hong-Mei Song
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai, PR China
| | - Bi-Cong Yan
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai, PR China
| | - Ying-Ying Lu
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai, PR China
| | - Qin Huang
- Department of Pathology, Shanghai Sixth People's Hospital, Shanghai, PR China
| | - Zuo-Wei Li
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai, PR China
| | - Chun-Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital, Shanghai, PR China
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Hoppe BS, Petersen IA, Wilke BK, DeWees TA, Imai R, Hug EB, Fiore MR, Debus J, Fossati P, Yamada S, Orlandi E, Zhang Q, Bao C, Seidensaal K, May BC, Harrell AC, Houdek MT, Vallow LA, Rose PS, Haddock MG, Ashman JB, Goulding KA, Attia S, Krishnan S, Mahajan A, Foote RL, Laack NN, Keole SR, Beltran CJ, Welch EM, Karim M, Ahmed SK. Pragmatic, Prospective Comparative Effectiveness Trial of Carbon Ion Therapy, Surgery, and Proton Therapy for the Management of Pelvic Sarcomas (Soft Tissue/Bone) Involving the Bone: The PROSPER Study Rationale and Design. Cancers (Basel) 2023; 15:1660. [PMID: 36980545 PMCID: PMC10046156 DOI: 10.3390/cancers15061660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023] Open
Abstract
Surgical treatment of pelvic sarcoma involving the bone is the standard of care but is associated with several sequelae and reduced functional quality of life (QOL). Treatment with photon and proton radiotherapy is associated with relapse. Carbon ion radiotherapy (CIRT) may reduce both relapse rates and treatment sequelae. The PROSPER study is a tricontinental, nonrandomized, prospective, three-arm, pragmatic trial evaluating treatments of pelvic sarcoma involving the bone. Patients aged at least 15 years are eligible for inclusion. Participants must have an Eastern Cooperative Oncology Group Performance Status score of two or less, newly diagnosed disease, and histopathologic confirmation of pelvic chordoma, chondrosarcoma, osteosarcoma, Ewing sarcoma with bone involvement, rhabdomyosarcoma (RMS) with bone involvement, or non-RMS soft tissue sarcoma with bone involvement. Treatment arms include (1) CIRT (n = 30) delivered in Europe and Asia, (2) surgical treatment with or without adjuvant radiotherapy (n = 30), and (3) proton therapy (n = 30). Arms two and three will be conducted at Mayo Clinic campuses in Arizona, Florida, and Minnesota. The primary end point is to compare the 1-year change in functional QOL between CIRT and surgical treatment. Additional comparisons among the three arms will be made between treatment sequelae, local control, and other QOL measures.
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Affiliation(s)
- Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Ivy A. Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin K. Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Todd A. DeWees
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, AZ 85054, USA
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Reiko Imai
- Division of Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Eugen B. Hug
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
| | - Maria Rosaria Fiore
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Hematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Shigeru Yamada
- Division of Radiation Oncology, QST Hospital, National Institutes for Quantum and Radiological Science and Technology, Chiba 263-8555, Japan
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201102, China
| | - Cihang Bao
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai 201102, China
| | - Katharina Seidensaal
- Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Byron C. May
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Anna C. Harrell
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Matthew T. Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Peter S. Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Steven Attia
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas Health Houston Neurosciences-Texas Medical Center, Houston, TX 77030, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Sameer R. Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Eric M. Welch
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mohammed Karim
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Safia K. Ahmed
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
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10
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Xu H, Li Y, Yu F, Liu W, Hao L, Zhang Q, Niu X. GMRS Oncological Prosthesis with a Porous Coating Collar: A Good Option for Revision of Aseptic Loosening in the Lower Extremity. J Clin Med 2023; 12:jcm12030892. [PMID: 36769540 PMCID: PMC9918170 DOI: 10.3390/jcm12030892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Revisions for oncological prosthesis are especially challenging due to the limited bone quantity and poor quality that the patients still possess. The aims of this study were to ask (1) what is the cumulative survival of the Global Modular Replacement System (GMRS) prosthesis after revision? and (2) what are the long-term functional outcomes of these patients? METHODS We retrospectively reviewed 16 patients who developed aseptic loosening of a lower extremity prosthesis. There were nine males and seven females with a mean age of 28 years (range, 14-55 years). The 5-year and 8-year survivorship of the prosthesis were calculated. Function outcome was evaluated according to the score of the Musculoskeletal Tumor Society (MSTS). RESULTS At a mean of 90 months follow-up (range, 52-118 months), the cumulative survival of all revision prosthesis was 94% at both 5 and 8 years. There were two prosthesis failures including one infection and one repeated aseptic loosening. At the last follow-up, except for the infection case, 93.3% (14/15) of the patients did not develop repeated aseptic loosening. The mean MSTS score was 27.7 (range, 24-30). CONCLUSIONS GMRS prosthesis demonstrated significant satisfactory long-term outcomes for revisions of lower extremity oncological prosthesis.
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Affiliation(s)
| | | | | | | | | | | | - Xiaohui Niu
- Correspondence: ; Tel.: +86-10-58516506; Fax: +86-10-58516736
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11
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Liu W, Yang Y, Jin T, Sun Y, Li Y, Hao L, Zhang Q, Niu X. What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm? Front Oncol 2022; 12:822983. [PMID: 35574345 PMCID: PMC9097903 DOI: 10.3389/fonc.2022.822983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives After diagnosing a primary bone tumor involving the forearm, various excision strategies and reconstruction methods must be considered. This study explored the oncological and functional outcomes of limb salvage surgery for primary malignant bone tumors in the forearm. Methods Patients with primary forearm bone tumors (n = 369) were retrospectively analyzed between 2000 and 2017. There were 266 patients with radial tumors, and 46 (17.3%) were malignant, whereas 103 patients had ulnar lesions and 22 (21.4%) were malignant tumors. The oncological results, prognostic factors, and functional results after limb salvage surgery of forearm malignancies were analyzed. Results The follow-up averaged 72.1 (7–192, median 62.5) months. Fifty-six patients who received limb salvage surgery were included in the final evaluation. Radius resection was performed in 38 patients, and distal radius (25 patients) was most frequent. Ulnar resection was performed in 18 patients, and the proximal ulna (13 patients) was most frequent. The surgical margins obtained were intralesional in 3 patients, marginal in 8 patients and wide in 45 patients. Local recurrence occurred in 11 patients (19.6%), and distant metastasis occurred in 14 patients (25%). The 5-year recurrence-free survival rate was 79.8%. Unplanned excision, ulnar involvement, proximal forearm location and inadequate surgical margins were associated with recurrence. The overall 5-year and 10-year survival rates were 83.5 and 71.7%, respectively. Distant metastasis was a poor prognostic factor for the survival rate. Forty-two patients were evaluated by MSTS score with an average of 27.9 ± 1.5. Conclusions The incidence of radial malignant tumors is higher than that of ulnar lesions. The distal radius and the proximal ulna are the most frequently involved sites. Unplanned excisions, ulnar tumors, proximal forearm tumors, and inadequate surgical margin are the risk factors for local recurrence. Distant metastasis is an independent poor prognostic factor of death. The oncology control and functional results of limb salvage surgery were satisfactory.
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Affiliation(s)
- Weifeng Liu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Yongkun Yang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Tao Jin
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Yang Sun
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Yuan Li
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Lin Hao
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Qing Zhang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
| | - Xiaohui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China.,Fourth Medical College of Peking University, Beijing, China
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12
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Rajasekaran RB, Ashford R, Stevenson JD, Pollock R, Rankin KS, Patton JT, Gupta S, Cosker TDA. Reconstruction after resection of a proximal humeral tumour : what challenges remain? Bone Joint J 2022; 104-B:3-5. [PMID: 34969269 DOI: 10.1302/0301-620x.104b1.bjj-2021-1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Raja B Rajasekaran
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Robert Ashford
- East Midlands Sarcoma Service, Nottingham University Hospitals, Nottingham, UK
| | | | - Rob Pollock
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Kenneth S Rankin
- North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne University Hospitals, Newcastle upon Tyne, UK
| | | | - Sanjay Gupta
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Thomas D A Cosker
- Department of Orthopaedics, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
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13
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Al-Chalabi MMM, Jamil I, Wan Sulaiman WA. Unusual Location of Bone Tumor Easily Misdiagnosed: Distal Radius Osteosarcoma Treated as Osteomyelitis. Cureus 2021; 13:e19905. [PMID: 34976513 PMCID: PMC8712237 DOI: 10.7759/cureus.19905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 01/10/2023] Open
Abstract
Despite being the most common primary malignant bone tumor in children and adolescents, the presence of osteosarcoma at the wrist is infrequent; only less than 1% of osteosarcomas arise in the distal radius. The clinical presentation may mimic common musculoskeletal problems or benign lesions such as osteomyelitis, and a high index of suspicion is necessary so that the treating surgeon does not miss such lesions. We reported a case treated initially as osteomyelitis before being diagnosed as distal radius osteosarcoma. We conclude that an unusual location of osteosarcoma may be easily misdiagnosed, and therefore, osteosarcoma should be considered one of the main differential diagnosis in such cases until proven otherwise.
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Affiliation(s)
| | - Izzeddin Jamil
- Reconstructive Sciences Unit, Universiti Sains Malaysia (USM), Kota Bharu, MYS
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14
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Muheremu A, Wen T, Niu X. PET-CT for the diagnosis and treatment of primary musculoskeletal tumors in Chinese patients - experience from 255 patients in a single center. Br J Radiol 2021; 94:20210785. [PMID: 34591688 DOI: 10.1259/bjr.20210785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The current study was carried out to assess the value of positron emission tomography (PET)/CT on the diagnosis and staging of primary musculoskeletal tumors. METHODS PET-CT test results and histopathological study reports of all the patients with primary musculoskeletal tumors in our department from January 2006 to July 2015 were retrospectively reviewed. Maximum standardized uptake value (SUVmax) in these PET-CT reports were recorded and analyzed respectively for each type of sarcoma. RESULTS A total of 255 patients were included in the final analysis. Sensitivity of SUVmax based diagnosis was 96.6% for primary malignant osseous sarcomas and 91.2% for soft tissue sarcomas. SUVmax of high-grade osseous sarcomas (average 8.4 ± 5.5) was significantly higher (p < 0.001) than low-grade osseous sarcomas (average 3.9 ± 1.8); based on current case series, SUVmax of high-grade soft tissue sarcomas (7.5 ± 5.1) was not significantly different (p = 0.229) from that of low-grade soft tissue sarcomas (5.3 ± 3.7). Significant decrease of SUVmax value after chemotherapy was associated with favorable prognosis in patients with osteosarcoma. CONCLUSION Results of the current study indicate that, the SUVmax based application of PET-CT can be a valuable supplementary method to histopathological tests regarding the diagnosis and staging of primary musculoskeletal sarcomas. ADVANCES IN KNOWLEDGE SUVmax based application of PET-CT is a highly sensitive method in diagnosis of primary osseous and soft tissue sarcomas in Chinese patients.
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Affiliation(s)
- Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hosptial of Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Tianlin Wen
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, China
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15
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Surgical Management of Benign Tumors of the Proximal Fibula. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202109000-00009. [PMID: 34515668 PMCID: PMC8439992 DOI: 10.5435/jaaosglobal-d-21-00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
Benign tumors of the proximal fibula are clinically notable, often resulting in pain, cosmetic defects, and potential neurovascular compromise. These symptomatic lesions warrant surgical consultation, but specific procedure selection remains a topic of ongoing discussion. The fibula is widely considered an expendable bone, which permits a greater variety of surgical options relative to other skeletal locations. As a result, some authors suggested en bloc resections without reconstruction as a viable first-line option to decrease tumor recurrence risk. However, wide resections may still result in diminished postoperative functionality compared with the standard intralesional and marginal approaches. Thus, surgical management remains a multifactorial decision, and often orthopaedic surgeons rely on past clinical experience or surgical preference within this unique tumor location. This detailed review will summarize the published literature and discuss the outcomes and indications of various surgical approaches for benign tumors of the proximal fibula. Emphasis will be placed on balancing tumor recurrence risk and postoperative functionality within the context of histologic diagnoses and surgical approaches.
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16
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Nazarizadeh A, Alizadeh-Fanalou S, Hosseini A, Mirzaei A, Salimi V, Keshipour H, Safizadeh B, Jamshidi K, Bahrabadi M, Tavakoli-Yaraki M. Evaluation of local and circulating osteopontin in malignant and benign primary bone tumors. J Bone Oncol 2021; 29:100377. [PMID: 34235049 PMCID: PMC8246632 DOI: 10.1016/j.jbo.2021.100377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The development of novel and efficient biomarkers for primary bone cancers is of grave importance. Methods The expression pattern of osteopontin (OPN) was investigated in the 153 patients with benign (n = 72) and malignant (n = 81) primary bone cancers. Both local and circulating OPN mRNA expression levels and their protein concentration in serum and tumor site were assessed using real-time qRT-PCR, ELISA, and immunohistochemistry techniques, respectively. As a control, 29 healthy individuals were considered. The number of 153 tumor tissue specimens and the 153 paired margins were taken on surgical resection from the patients. 153 blood samples were also drained from all participants, then peripheral blood mononuclear cells (PBMC) and sera were separated. Results The mean mRNA expression was significantly higher in all of the cancerous tissues than the paired margins and the PBMC of the patients than the controls. Consistently, the protein concentrations of OPN in serum and tumor tissues were significantly higher in the patients. Furthermore, the malignant cases had significantly elevated the mRNA levels and the protein compared to the benign cases. OPN could potentially differentiate the patients from the controls with 100% sensitivity and specificity in serum. Moreover, OPN could predict some of the malignant cases' clinicopathological features, including metastasis, recurrence, grade, and response to chemotherapy. Conclusions In conclusion, OPN might be involved in the pathogenesis of primary bone tumors and can be considered as a potential biomarker to bone cancer diagnosis.
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Key Words
- ANOVA, One-way analysis of variance
- AUC, area under the curve
- Bone tumors
- CI, confidence interval
- Chondrosarcoma
- DAPI, 4′,6-Diamidine-2′-phenylindole dihydrochloride
- ELISA, Enzyme-linked immunosorbent assay
- EMT, epithelial-mesenchymal transition
- Ewing Sarcoma
- HIF-1α, hypoxia-inducible factor-1 alpha
- HRP, horseradish peroxidase
- MMP9, Matrix metallopeptidase 9
- OCT, Optimal Cutting Temperature
- OPN, Osteopontin
- Osteopontin
- Osteosarcoma
- PBMC, Peripheral blood mononuclear cells
- PBS, phosphate-buffered saline
- ROC, receiver operating characteristic
- S100A8, S100 calcium-binding protein A8
- SOX9, SRY-Box Transcription Factor 9
- cDNA, Complementary DNA
- qRT-PCR, Quantitative Real-time transcription-polymerase chain reaction
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Affiliation(s)
- Ali Nazarizadeh
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahin Alizadeh-Fanalou
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ameinh Hosseini
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Salimi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Keshipour
- Department of Epidemiology, Faculty of Veterinary Sciences, University of Tehran, Tehran, Iran
| | - Banafsheh Safizadeh
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Bahrabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Tavakoli-Yaraki
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Zhu X, Huang R, Hu P, Yan P, Zhai S, Zhang J, Zhuang J, Yin H, Meng T, Yang D, Huang Z. Prognostic Factors for Survival in Patients with Malignant Giant Cell Tumor of Bone: A Risk Nomogram Analysis Based on the Population. Med Sci Monit 2021; 27:e929154. [PMID: 33594036 PMCID: PMC7899048 DOI: 10.12659/msm.929154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Malignant giant cell tumor of bone (MGCTB) is a rare histological type of malignant tumor that has a high tendency for local relapse and distant metastasis and ultimately leads to a poor prognosis. The purpose of this study was to describe the epidemiological features, identify the prognostic factors, and construct nomograms for patients with MGCTB. Material/Methods Patients with MGCTB that was histologically diagnosed between 1973 and 2014 were selected from the Surveillance, Epidemiology, and End Results (SEER) database as a training set. Survival analysis, Lasso regression, and random forests were used to identify the prognostic variables and establish the nomograms for patients with MGCTB, while an external cohort of 37 patients from our own institution and an external cohort of 163 patients from the SEER database in 2016 were used to validate the generalization performance of the nomograms. Results In total, univariate and multivariable analysis indicated that age, International Classification of Diseases for Oncology, historical stage, primary site, surgery information, radiotherapy, and chemotherapy were independent prognostic variables for overall survival or cause-specific survival. Nomograms based on the multivariable models were built to predict survival, and we achieved a higher C-index in subsequent multidimensional validation. Conclusions Age, historical stage, and chemotherapy were independent prognostic variables for overall survival and cause-specific survival of MGCTB patients, and radiotherapy and primary site were independent prognostic variables for overall survival. Nomograms based on significant clinicopathological features and clinical experience can be effective in predicting the probability of survival for MGCTB patients.
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Affiliation(s)
- Xiaolong Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Runzhi Huang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).,Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Peng Hu
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Penghui Yan
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Suna Zhai
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Jie Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Junwei Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Huabin Yin
- Department of Orthopedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Tong Meng
- Department of Orthopedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Daoke Yang
- Department of Radiotherapy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Zongqiang Huang
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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18
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Yang Y, Li Y, Liu W, Niu X. Mesh patch and anchors can improve clinical results of prosthetic replacement after resection of primary proximal humerus malignant tumor. Sci Rep 2021; 11:734. [PMID: 33436664 PMCID: PMC7804124 DOI: 10.1038/s41598-020-78959-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the functional results, complications and related factors of prosthesis reconstruction after malignant tumor resection of primary proximal humeral, and also evaluate whether soft tissue reconstruction with mesh patch and anchors can improve clinical results. From 2002 to 2016, forty-one patients were enrolled in this study. The pathological diagnosis contained 27 cases of osteosarcoma, 7 cases of chondrosarcoma and other primary malignant bone tumors. Both mesh patch and anchors were used in the reconstruction of joint capsule and the surrounding soft tissues in 27 cases. The mean postoperative follow-up was 60.6 months. The average active abduction angle and passive abduction angle was 33.5 (5–71) degrees and 72.4 (52–104) degrees. The prosthetic humeral head displacement was over 2 cm in 5 cases (12.2%). The average MSTS score was 23.1. The overall 5-year survival rate of prosthesis was 88.2%. The length of osteotomy, whether preserving deltoid muscle, whether applying mesh patch and anchors had significant effects on the abduction angle of shoulder joint; the length of osteotomy, whether applying mesh patch and anchors had significant effects on the degree of upward displacement of prosthesis. The application of both mesh patch and anchors in prosthesis reconstruction achieved more stable result and better function of shoulder joint. To ensure the stability of shoulder joint and the firm wrapping of surrounding soft tissue are key factors affecting the postoperative function.
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Affiliation(s)
- Yongkun Yang
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China
| | - Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China
| | - Weifeng Liu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, People's Republic of China.
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19
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Proximal Humerus Tumors: Higher-than-Expected Risk of Revision With Constrained Reverse Shoulder Arthroplasty. Clin Orthop Relat Res 2020; 478:2585-2595. [PMID: 32281773 PMCID: PMC7571930 DOI: 10.1097/corr.0000000000001245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of proximal humerus tumors with endoprostheses is associated with a high risk of implant-related surgical complications. Because of extensive soft-tissue resection and muscular detachment during surgery, instability is the most common serious complication. A reverse total shoulder arthroplasty with a highly constrained design is one option to mitigate instability, but few studies have reported the results of this prosthesis for proximal humerus tumor resections. QUESTIONS/PURPOSES (1) What are the short-term functional results of the constrained reverse total shoulder prosthesis in terms of Musculoskeletal Tumor Society (MSTS), DASH, and Constant-Murley scores and ROM values? (2) What is the frequency of revision, using a competing-risks estimator to assess implant survival, and what were the causes of the revisions that occurred? (3) What proportion of patients experienced dislocations at short-term follow-up? METHODS Between January 2014 and June 2017, we treated 55 patients with proximal humeral resections and reconstructions for malignant tumors. Of those, 33% (18) of patients were treated with the constrained, reverse total shoulder arthroplasty implant under study here. During that period, no other constrained reverse total shoulder implant was used; however, 13% (seven) of patients were treated with conventional (unconstrained) reverse total shoulder implants, 27% (15) had hemiarthroplasties, 15% (eight) of patients had biologic reconstructions with auto- or allografts and 13% (seven) underwent amputation. During the period in question, our general indications for use of the constrained device under study here were resection of the deltoid muscle/axillary nerve or the deltoid insertion on the humerus due to tumor invasion, or extensive rotator cuff and surrounding soft tissue resection that might result in shoulder instability. During this period, these indications were adhered to consistently. Four of 18 patients treated with the study implant died (three died with the implant intact) and none were lost to follow-up before 2 years, leaving 14 patients (seven women and seven men) for study at a median (range) follow-up of 35 months (25 to 65). Two authors evaluated the clinical and functional status of each patient with ROM (flexion, extension, internal and external rotation, abduction, and adduction) and MSTS, (range 0% to 100%), Constant-Murley (range 0% to 100%), and DASH (range 0 points to 100 points) scores. For the MSTS and Constant-Murley scores, higher percentage scores mean better functional outcome; and for the DASH score, a higher score means more severe disability. Radiographs were obtained at each visit and were used to look for signs of loosening, which we defined as progressive radiolucencies between visits, prosthetic component migration, and fragmentation/fracture of the cement. The Sirveaux classification was used to determine scapular notching. A competing risks analysis with 95% confidence intervals was performed to estimate the cumulative incidence of revision surgery, which we defined as any reoperation in which the implant was removed or changed for any reason, with patient mortality as a competing event. RESULTS At the most recent follow-up, the median (range) MSTS score was 78% (50 to 90), the DASH score was 20 (8 to 65), and the Constant-Murley score was 53% (26 to 83). The median ROM was 75° in forward flexion (40 to 160), 78° in abduction (30 to 150), 35° in internal rotation (10 to 80), and 33° in external rotation (0 to 55). Postoperatively, two of 14 patients underwent or were supposed to undergo revision surgery, and the cumulative incidence of revision surgery was 18% for both 30 and 48 months (95% CI 2 to 45). During the study period, no patients reported instability, and no dislocations occurred. CONCLUSIONS Our findings are concerning because the revision risk with this constrained reverse total shoulder implant was higher than has been reported by others for other proximal humerus prostheses. The highly constrained design that helps prevent instability might also transmit increased stresses to the humeral component-bone interface, therefore making it susceptible to loosening. We believe that any other implant with a similar degree of constraint will have the same problem, and changing the indications for patient selection may not solve this issue. These theories need to be tested biomechanically, but our desire is to warn surgeons that while trying to prevent instability, one might trade one complication (instability) for another: aseptic loosening. LEVEL OF EVIDENCE Level IV, therapeutic study.
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French J, Epelman M, Jaramillo D, Johnson CM, Stinson ZS, Meyers AB. Magnetic resonance imaging evaluation of osteoid osteoma: utility of the dark rim sign. Pediatr Radiol 2020; 50:1742-1750. [PMID: 32845349 DOI: 10.1007/s00247-020-04780-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/09/2020] [Accepted: 07/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND While typical patterns of osteoid osteoma have been described on CT, MRI findings can overlap among different diseases, and atypical patterns exist. In this study, we assessed the presence of a novel dark rim sign and its utility in the MRI diagnosis of osteoid osteoma. OBJECTIVE The purpose of this retrospective study was to assess the utility of the dark rim sign seen on MRI in children with osteoid osteoma. MATERIALS AND METHODS MRI studies from 36 pediatric patients with osteoid osteoma and a control group of patients with either osteomyelitis or stress fracture were analyzed and then compared for the presence of the dark rim sign. Patients from the osteoid osteoma group were further divided based on nidus location and evaluated for the presence of the dark rim sign. RESULTS The relationship between the dark rim sign and osteoid osteoma was statistically significant (P<0.001). A dark rim sign was identified in 25 of the 36 patients with osteoid osteoma. None of the control patients had a dark rim sign. The dark rim sign had 69.4% sensitivity, 100% specificity, 100% positive predictive value and 72.5% negative predictive value for detecting osteoid osteoma. The relationship between dark rim sign and nidus location was statistically significant (P<0.001) such that endosteal and medullary osteoid osteomas were more likely to have a dark rim sign than intracortical osteoid osteomas. CONCLUSION When the nidus of an osteoid osteoma is in an endosteal or medullary location, the dark rim sign may aid in the diagnosis.
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Affiliation(s)
- Jerry French
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Monica Epelman
- Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA
| | - Diego Jaramillo
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Craig M Johnson
- Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA
| | - Zachary S Stinson
- Department of Radiology, Nemours Children's Hospital, Orlando, FL, USA
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave., Cincinnati, OH, 45229, USA.
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Gong L, Bui MM, Zhang W, Sun X, Zhang M, Yi D. H3F3A G34 mutation DNA sequencing and G34W immunohistochemistry analysis in 366 cases of giant cell tumors of bone and other bone tumors. Histol Histopathol 2020; 36:61-68. [PMID: 33021329 DOI: 10.14670/hh-18-264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
H3F3A mutations and the expression of glycine 34 to tryptophan (G34W) mutants in giant cell tumors of bone (GCTBs) and other bone tumors were detected to compare H3F3A mutation types and the expression of G34W-mutant protein in order to provide a theoretical basis for using H3F3A mutations as a diagnostic and differential-diagnostic tool for GCTBs. A total of 366 bone tumor cases were investigated. The cases involved 215 men and 151 women, whose median age was 29 years (3-84). The cases included GCTB (n=180), recurrent GCTB (n=19), GCTB with lung metastasis (n=5), pediatric GCTB (n=15), primary malignant GCTB (n=5), chondroblastoma (CB, n=61), chondrosarcoma grade II (n=15), dedifferentiated chondrosarcoma (n=17), chondromyxoid fibroma (n=9), aneurysmal bone cyst (n=9), nonossifying fibroma (n=9), osteosarcoma (n=16), and undifferentiated sarcoma (n=6). Sanger DNA sequencing analysis was used to detect H3F3A mutations. Immunohistochemistry was used to assess the expression of the G34W-mutated protein in these bone tumors. DNA sequencing results revealed H3F3A mutations in 95.00% of GCTBs (171/180), including glycine 34 to tryptophan (G34W, 163/180, 90.56%), glycine 34 to leucine (G34L, 3/180, 1.67%), glycine 34 to valine (G34V, 3/180, 1.67%), and glycine 34 to arginine (G34R, 2/180, 1.11%). Recurrent GCTBs mostly had the H3F3A G34W mutation (18/19, 94.74%), and GCTBs with lung metastasis all had the H3F3A G34W mutation (5/5, 100%). Pediatric GCTBs had a mutation rate of 93.33% (14/15), including one case with G34L. Four cases of primary malignant GCTB showed the H3F3A G34W mutation (4/5, 80.00%), and the classical GCTB component and malignant component showed consistent mutation types. Immunohistochemistry showed that GCTBs harboring G34W also expressed the mutant protein in tumor cell nuclei. Furthermore, one case of GCTB and one case of recurrent GCTB showed positive G34W immunostaining results despite being negative for the genetic mutation. Other bone tumors all showed wild-type expression in both DNA sequencing and immunohistochemistry. Our large-sample DNA sequencing analysis detected four different forms of mutations in GCTBs, including three rare mutation forms. The most common mutation of H3F3A was G34W, which was in accordance with the expression of G34W in GCTBs detected by immunohistochemistry. Although DNA sequencing analysis detected rare mutation types of H3F3A, false-negative results were also present due to the small number of cells in the samples. Detection of the most common (G34W) mutant protein by immunohistochemistry was more convenient. Given the high prevalence of these driver mutations, the detection of H3F3A mutant proteins can assist in the diagnosis of GCTB and its differential diagnosis from other bone tumors.
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Affiliation(s)
- Lihua Gong
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Marilyn M Bui
- Department of Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wen Zhang
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Xiaoqi Sun
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Ming Zhang
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China
| | - Ding Yi
- Department of Pathology, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, Beijing, China.
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Wu MH, Xiao LF, Zhang C, Lei J, Deng ZM. The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study. J Bone Oncol 2020; 24:100313. [PMID: 32817813 PMCID: PMC7426450 DOI: 10.1016/j.jbo.2020.100313] [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: 05/29/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
Symptomatic benign bone lesions may cause pain and refractory limp. Conventional open surgery usually involves high risks of complications, which may greatly compromise the overall efficacy of surgery in the long term. This single-institution retrospective study of 34 patients with symptomatic benign bone lesions. All surgical procedures were performed under endoscopic guidance for direct visualization followed by complete curettage of tumor tissue. Patients reported significant improvements in pain, quality of life and functional recovery without complications or need for secondary interventions. Study limitations included a relatively small population of Chinese patients and the lack of a comparative surgical or other minimally invasive techniques. The procedure described may be a valuable alternative to open surgery for symptomatic benign bone lesions.
Objective The present study aimed to evaluate the short-term clinical feasibility and efficacy of the minimally invasive endoscopic technique (MIET) for the treatment of symptomatic benign bone lesions. Materials and methods This single-institution retrospective study investigated 34 patients with symptomatic benign bone lesions from December 2015 to June 2017. Patients involved in this study presented with definite indications for surgical intervention. All procedures were performed under endoscopic guidance for direct visualization followed by complete curettage of tumor tissue. There were 19 males and 15 females, with a mean age of 33.3 ± 12.7 years (range, 17–68 years). The lesions were located in the upper extremities (20, 58.8%), lower extremities (9, 26.5%) and pelvis (5, 14.7%). Primary outcomes were measured before and after intervention using the visual analog scale (VAS), the Musculoskeletal Tumor Society (MSTS) stage and the 36-item Short-Form Health Survey (SF-36) scoring system. Results Of the 34 patients included in this study, all completed follow-up examinations, with a mean follow-up duration of 22.4 ± 7.6 months (range, 13–35 months). Significantly improved VAS, MSTS and SF-36 scores were observed at 3 months after the initial treatment (P < 0.001), suggesting enhanced pain relief and improved functional recovery and quality of life following surgery. All procedures were technically successful, with the exception of 3 cases (8.8%) manifesting access site numbness; these patients recovered within the follow-up period through symptomatic treatment alone. Only 2 patients (5.9%; one osteoblastoma and one enchondroma) experienced local recurrence and underwent standard open curettage within the follow-up period. All patients showed functional stability without any major complications. Conclusion The MIET is an effective and safe alternative treatment for symptomatic benign bone lesions. The short-term efficacy of MIET was favorable and associated with improved pain palliation, quality of life and functional recovery.
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Key Words
- ABC, Aneurysmal bone cyst
- Benign bone lesion
- CT, Computed tomography
- Clinical efficacy
- Endoscopy
- GCTB, Giant cell tumor of bone
- MDT, Multidisciplinary team
- MIET, Minimally invasive endoscopic technique
- MRI, Magnetic resonance imaging
- MSTS, Musculoskeletal Tumor Society
- MWA, Microwave ablation
- Minimally invasive
- PKP, Percutaneous kyphoplasty
- PPSF, Percutaneous pedicle screw fixation
- PVP, Percutaneous vertebroplasty
- RFA, Radiofrequency ablation
- SF-36, 36-item Short-Form Health Survey
- STIR, Short tau inversion recovery
- Surgical intervention
- VAS, Visual analog scale
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Affiliation(s)
- Min-Hao Wu
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, 168 Donghu Street, Wuchang District, Wuhan 430071, Hubei, People's Republic of China
| | - Ling-Fei Xiao
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, 168 Donghu Street, Wuchang District, Wuhan 430071, Hubei, People's Republic of China
| | - Chong Zhang
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, 168 Donghu Street, Wuchang District, Wuhan 430071, Hubei, People's Republic of China
| | - Jun Lei
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, 168 Donghu Street, Wuchang District, Wuhan 430071, Hubei, People's Republic of China
| | - Zhou-Ming Deng
- Department of Spine Surgery and Musculoskeletal Tumor, Zhongnan Hospital of Wuhan University, 168 Donghu Street, Wuchang District, Wuhan 430071, Hubei, People's Republic of China
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Yamaga K, Kuwamoto S, Mukunoki D, Osaki M, Nagashima H. Successful Treatment with Denosumab of a Giant Cell Tumor of Bone in the Iliac Bone of an 84-Year-Old Man. Yonago Acta Med 2020; 63:228-233. [PMID: 32884443 DOI: 10.33160/yam.2020.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/12/2020] [Indexed: 11/05/2022]
Abstract
We report a case of GCTB in an 84-year-old Japanese man who had a tumor in his left iliac bone and was treated safely with denosumab. The patient noticed a painful mass, with gradual enlargement, in his left low back next to the iliac region. Magnetic resonance imaging revealed that the tumor measured 94 × 66 × 90 mm and was located in the left iliac bone. Histologically, the tumor was composed of proliferative oval-shaped mononuclear cells, admixed with large number of osteoclast-like giant cells. Immunohistochemically, a strong positivity for histone 3.3 G34W mutant protein was observed in the nuclei of the mononuclear cells, confirming the diagnosis of GCTB. Because it was considered as unresectable tumor, the patient was treated with denosumab without any side effects.
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Affiliation(s)
- Kensaku Yamaga
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Satoshi Kuwamoto
- Department of Pathology, Tottori University Hospital, Yonago 683-8504, Japan
| | - Daichi Mukunoki
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Mari Osaki
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hideki Nagashima
- Division of Orthopedic Surgery, Department of Sensory and Motor Organs, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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MONTIEL-JARQUÍN ÁLVAROJOSÉ, ETCHEGARAY-MORALES IVET, ROMERO-FIGUEROA MARÍADELSOCORRO, AMARO-BALDERAS EILEEN, CASTILLO-PÉREZ JOSÉJUAN, BLANCO-OCHOA LUISCARLOS, OSORIO-GARCÍA YONY, VÁZQUEZ-CRUZ EDUARDO, BARRAGÁN-HERVELLA RODOLFOGREGORIO. INCIDENCE OF SPINAL CANCER IN A TERTIARY CARE HOSPITAL IN MEXICO. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201902191844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective To determine the incidence of primary malignant bone tumors of the spine in a High Specialty Orthopedics and Traumatology Medical Unit. Methods Review study. The study included patients receiving benefits from the Mexican Social Security Institute of all ages and both sexes with malignant spinal bone tumors during the period from 2010 to 2017. The descriptive statistics used were central tendency measures and dispersion in the SPSS v. 22 program from IBM. The results are presented in tables and figures. Results There were 107 patients, 56 (52.34%) men, 51 (47.66%) women with a mean age of 59.75 + 10.76 years (minimum 35, maximum 88). There were 46,840 hospital discharges during the period, for an annual average of 5,855 and a monthly average of 487.91. Of the 107 study cases, 78 (72.89%) were in the lumbosacral, 15 (14.01%) in the cervical, and 14 (13.08%) in the thoracic region. The incidence for the period was 1.9/1000 discharges, 1.38in 2010 increasing to 2.32 in 2017. Conclusions The behavior of primary malignant spinal tumors has increased its presentation from 2010 to 2017 . Level of evidence III; Non-analytical, descriptive study.
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Abstract
AIM The aims of this study were to assess survival outcome of pediatric patients with localized osteosarcoma of the extremities in Upper Egypt, identify factors of prognostic significance for survival, and to determine factors predictive of surgical methods used in these patients, as well as developing a clinical model for risk prediction. PATIENTS AND METHODS A retrospective analysis of data assembled from medical records of 30 pediatric patients with a histologically verified nonmetastatic osteosarcoma of the extremities treated at South Egypt Cancer Institute with a unified chemotherapy protocol between January 2001 and December 2015 was carried out. Prognostic factors were determined using univariable and multivariable methods. A model for surgical outcomes in these patients based on the baseline clinical factors, and the parameters predictive of their tumor response to chemotherapy, was developed. RESULTS With a median follow-up of 63 months for the study population, the estimates for event-free survival and overall survival (OS) at 3 and 5 years were 69.5% and 79% and 65.2% and 65.3%, respectively. Age 16 years or above was independently associated with both worse metastasis-free survival (hazard ratio [HR]=6.05, 95% confidence interval [CI]: 1.43-25.6, P=0.015) and OS (HR=7.9, 95% CI: 1.71-36.2, P=0.008). In the multivariable analysis, a proximal location within the limb gained a statistical significance to be independently associated with worse OS (HR=2.4, 95% CI: 1.13-22.1, P=0.003). Poor response to chemotherapy was marginally associated with worse metastasis-free survival (HR=4.9, 95% CI: 1.02-23.8, P=0.047) only in the univariable analysis. The patients found to be more likely to undergo an amputation surgery (odds ratio=14.1, 95% CI: 1.34-149.4, P=0.028) were those in whom a tumor was poorly responding to chemotherapy. CONCLUSION In Upper Egypt, despite the reasonable survival outcomes in nonmetastatic osteosarcoma, a relatively high limb amputation rate has been encountered. The development of a clinical prediction model for future planning of possible outcome improvement in these patients, however, is still feasible.
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Lau CPY, Fung CSH, Wong KC, Wang YH, Huang L, Tsui SKW, Lee OK, Kumta SM. Simvastatin Possesses Antitumor and Differentiation-Promoting Properties That Affect Stromal Cells in Giant Cell Tumor of Bone. J Orthop Res 2020; 38:297-310. [PMID: 31471919 DOI: 10.1002/jor.24456] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/23/2019] [Indexed: 02/04/2023]
Abstract
Giant cell tumor of bone (GCTB) is a locally aggressive destructive bone lesion. The management of pulmonary metastasis and local recurrence after the surgical treatment of GCTB remains a challenge. Pathologically, stromal cells in GCTB are known as primary neoplastic cells and are recognized as incompletely differentiated preosteoblasts. Therefore, inducing GCTB stromal cells to differentiate into cells with a mature osteoblastic phenotype may stop tumor growth and recurrence. In this study, we aimed to investigate how simvastatin, a clinically approved and commonly used statin that has been known to promote the maturation of cells of the osteogenic lineage, affects GCTB stromal cells. We found that simvastatin effectively inhibited cell viability by suppressing proliferation and by inducing apoptosis in GCTB stromal cells. Moreover, simvastatin treatment upregulated the expression of genes related to osteogenic maturation, such as runt-related transcription factor 2, osteopontin, and osteocalcin, and increased the mineralization of the extracellular matrix in GCTB stromal cells. Ingenuity pathway analysis was used to discover that the vitamin D receptor pathway was involved in the simvastatin-induced osteogenic differentiation of GCTB stromal cells by upregulating the 1,25-dihydroxyvitamin D metabolism. Taken together, this in vitro study demonstrates the antitumor and differentiation-promoting effects of simvastatin on GCTB stromal cells and suggests the possibility of using simvastatin as an adjuvant therapy for GCTB. These findings support further clinical investigation of the efficacy of using simvastatin as an adjuvant therapy for GCTB to reduce recurrence and distant metastasis after surgical treatment. © 2019 Orthopedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:297-310, 2020.
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Affiliation(s)
- Carol P Y Lau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.,Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong.,The Sir Yue-kong Pao Cancer Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cathy S H Fung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Kwok Chuen Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Yu-Hsuan Wang
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.,Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Lin Huang
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Stephen K W Tsui
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Oscar K Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.,Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong.,Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Shekhar M Kumta
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong.,The Sir Yue-kong Pao Cancer Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Wu H, Wu H, He M. [Application of pasteurized tumor-bearing bone replantation for primary malignant bone tumor of extremities]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1532-1537. [PMID: 31823553 DOI: 10.7507/1002-1892.201811053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To assess the effectiveness of the pasteurized tumor-bearing bone replantation in treatment of primary malignant bone tumor of extremities. Methods Between February 2012 and June 2016, 13 patients with primary malignant bone tumor of extremities were treated with pasteurized tumor-bearing bone replantation after extensive excision. There were 8 males and 5 females, aged from 11 to 27 years, with an average of 17.4 years. Tumors were located at the mid-upper humerus in 2 cases, the mid-upper femur in 2 cases, the mid-lower femur in 6 cases, the mid-upper tibia in 2 cases, and the middle tibia in 1 case. According to Enneking staging system, 3 patients were classified as stage ⅠB, 5 patients as stage ⅡA, and 5 patients as stage ⅡB. There were 11 cases of osteosarcoma and 2 cases of chondrosarcoma. The disease duration ranged from 3 to 8 months, with an average of 4.8 months. The length of the tumor-bearing bone ranged from 8 to 16 cm, with an average of 12.5 cm. Postoperative follow-up was conducted regularly to evaluate the status of inactivated bone and complications. The limb function was assessed by the Musculoskeletal Tumor Society 93 (MSTS-93) scoring system. Results All 13 patients were followed up 26-79 months, with an average of 50.5 months. Eleven patients survived without tumors. Two patients had local soft tissue recurrence and underwent amputation, 1 had lung metastasis after amputation and died. All patients had no complications of bone resorption, shortening, and internal fixation disorder. The nonunion of osteotomy occurred in 4 cases. Among them, 3 cases were successfully healed after autologous iliac bone grafting, and 1 case was treated conservatively. The healing time of metaphyseal osteotomy end was 10-15 months (mean, 12.6 months), the healing rate was 90.9% (10/11); the healing time of diaphyseal osteotomy end was 12-21 months (mean, 17.0 months), the healing rate was 72.7% (8/11); and the total healing rate of osteotomy end was 81.8% (18/22). One case had inactivated bone fracture and 1 case had incision dehiscence and infection after operation. At last follow-up, the MSTS-93 score of affected limb ranged from 21 to 28, with an average of 25.3. Conclusion The procedure of the pasteurized tumor-bearing bone replantation is an effective, simple, and economic way in repair of massive segmental bone defect to save limb function for primary malignant bone tumor of extremities.
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Affiliation(s)
- Hao Wu
- Department of Spine & Osteopathy Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - Hanhua Wu
- Department of Spine & Osteopathy Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021,
| | - Maolin He
- Department of Spine & Osteopathy Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
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Arikan Y, Misir A, Ozer D, Kizkapan TB, Yildiz KI, Saygili MS, Incesoy MA, Dincel YM, Gursu SS, Sahin V. The incidence and distribution of primary fibula tumors and tumor-like lesions: A 35-year experience. J Orthop Surg (Hong Kong) 2019; 26:2309499018798180. [PMID: 30189775 DOI: 10.1177/2309499018798180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Primary bone tumors of the fibula are rare. There are only a few studies reporting the incidence, histologic, and anatomic distribution of primary fibula tumors. This study aimed to comprehensively report the incidence, presenting symptoms, and histologic tumor types with the anatomic and histologic distribution of primary bone tumors of the fibula. METHODS Between January 1983 and December 2017, 6457 primary bone tumors and tumor-like lesions were diagnosed and treated in our musculoskeletal oncology surgery clinic. Of these, 264 (4.08%) were primary bone tumors and tumor-like lesions of the fibula. We retrospectively reviewed patients' records, histopathology records, and radiologic images regarding age, gender, anatomic localization, histopathologic diagnosis, and treatment methods. RESULTS There were 209 (79.2%) benign and 55 (20.8%) malignant lesions. The most common benign and malignant tumors were osteochondroma (51 of 209; 24.4%) and chondrosarcoma (16 of 55; 29.1%). The proximal fibula was the most common location for both benign and malignant tumors (141 of 209; 67.5% and 45 of 55; 81.8%, respectively), followed by the distal fibula (52 of 209; 24.9% and 8 of 55; 14.5%, respectively) and the diaphysis (17 of 209; 8.14% and 2 of 55; 3.64%, respectively). CONCLUSION The incidence of primary bone tumors is higher than that reported in previous studies. Benign lesions constitute the majority of cases. One-fifth of all cases are malignant. The most common anatomic site involving the primary fibula tumors is the proximal fibula. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yavuz Arikan
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Abdulhamit Misir
- 2 Department of Orthopaedics and Traumatology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Devrim Ozer
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Turan Bilge Kizkapan
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kadir Ilker Yildiz
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Selcuk Saygili
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Alper Incesoy
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yasar Mahsut Dincel
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Sukru Sarper Gursu
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Vedat Sahin
- 1 Department of Orthopaedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
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Differential Diagnosis: Orthopedic Injury or Oncologic Process—A Case Report. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dîrzu DS, Dicu C, Dîrzu N. Urinary retention: a possible complication of unilateral continuous quadratus lumborum analgesia - a case report. Rom J Anaesth Intensive Care 2019; 26:75-78. [PMID: 31111099 PMCID: PMC6502277 DOI: 10.2478/rjaic-2019-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/19/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Continuous quadratus lumborum (QL) analgesia is a new option for proximal femur surgery considered safe and effective. The purpose of this report was to show that we may not be aware of all the possible complications of this technique, and urinary retention may occur even when the block is performed unilaterally. CASE REPORT To an obese, intubated, mechanically ventilated, female patient, operated in prone position for removal of a femur tumour, we performed a trans-muscular quadratus lumborum block (TQL). We mounted a catheter and administered continuous infusion of local anaesthetic in the postoperative period. The patient experienced urinary retention. A urinary catheter was placed and it was maintained for the entire period of local anaesthetic infusion. When the catheter was removed, 72 hours after the surgery, the patient resumed normal bladder functions. CONCLUSION Urinary retention is a possible complication when continuous quadratus lumborum analgesia is used, even when performed unilaterally.
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Affiliation(s)
- Dan Sebastian Dîrzu
- Department of Anaesthesiology and Intensive Care, University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca, Romania
| | - Cosmin Dicu
- Department of Orthopedy, Emergency County Hospital Cluj-Napoca, Romania
| | - Noémi Dîrzu
- Research Center for Advanced Medicine Medfuture, University of Medicine and Pharmacy “Iuliu Haţieganu” Cluj-Napoca, Romania
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Primary Bone Tumors in Children and Adolescents Treated at a Referral Center in Northern Tanzania. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e045. [PMID: 31157317 PMCID: PMC6484668 DOI: 10.5435/jaaosglobal-d-17-00045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bone tumors account for a small fraction of childhood cancers. Most published reports are from developed countries. The purpose of this study was to review the primary bone tumors in children and adolescents treated at a referral center in Northern Tanzania. We completed a 10-year hospital-based cross-sectional study in which all patients younger than 20 years diagnosed with a primary bone tumor at the Kilimanjaro Christian Medical Center Orthopaedic Department from January 2006 to December 2015 were identified and reviewed. Of the 80 identified patients, 15 (18.8%) were aged 5 to 8 years, and 65 (81%) were aged 9 to 19 years. Forty-seven males (59%) and 33 females (41%) were identified. The most common tumor locations were the femur, tibia, and humerus. Osteosarcoma was the most common malignant diagnosis (49 patients, 61%). No cases of Ewing sarcoma were reported. The most common tribal origins of the patients were Chagga and Maasai. Most primary bone tumors treated at a referral center in Northern Tanzania are malignant, with osteosarcoma representing the vast majority. No cases of Ewing sarcoma were identified in this tertiary referral hospital-based database.
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Li Y, Xu H, Shan H, Sun Y, Huang Z, Niu X. [Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:131-137. [PMID: 30739403 DOI: 10.7507/1002-1892.201810022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma. Methods Between 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively. Results All patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively. Conclusion The proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
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Affiliation(s)
- Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Hairong Xu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Huachao Shan
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Yang Sun
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Zhen Huang
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035, P.R.China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, 100035,
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Majeed SS, Muhammad HA, Ali JS, Khudhair HH, Said A, Arif SO, Murad KM, Gendari AH, Muhsin BM, Mohammed SA, Mula-Hussain L. Treatment Outcomes of Pediatric Patients With Ewing Sarcoma in a War-Torn Nation: A Single-Institute Experience From Iraq. J Glob Oncol 2019; 5:1-9. [PMID: 30707662 PMCID: PMC6426536 DOI: 10.1200/jgo.18.00122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Ewing sarcoma (ES) is a relatively rare, highly malignant tumor of the musculoskeletal system. It is the second most common malignant bone tumor in children and adolescents in the age group of 5 to 20 years. The aim of this study was to identify the treatment outcomes of pediatric patients with ES in Sulaimani governorate, Iraq. PATIENTS AND METHODS This was a retrospective study that reviewed the medical records of pediatric patients with ES who were managed between 2009 and 2015, with follow-up until late 2017. Patient- and tumor-related factors were correlated with clinical outcomes. RESULTS A total of 31 pediatric patients with ES were included in this study. All the patients received chemotherapy and radiotherapy, whereas only 14 patients underwent surgical resection and just eight had free surgical margins. The median age at diagnosis was 13 years, 58% were male, and 42% were female. The presenting symptoms at diagnosis were mostly pain (67.7%) and palpable mass (25.8%). The primary tumor was located in the extremities (51.6%), the thoracic cage (19.4%), the pelvis (16.1%), and the lumbar vertebrae (12.9%). Approximately two thirds of the patients (61.3%) had localized disease at the time of presentation. The 5-year overall survival was 19%, and the 5-year recurrence-free survival was 34%. CONCLUSION Clinical outcomes of ES in pediatric patients in our war-torn nation, Iraq, are still markedly inferior to the published outcomes from stable, developed nations. Additional large and multicenter national studies are required. Diagnostic and therapeutic measures need improvement, and multidisciplinary and comprehensive cancer-integrated approaches are vital for better outcomes.
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Affiliation(s)
| | - Hawzheen A Muhammad
- Komar University of Science and Technology, Sulaimani, Kurdistan, Iraq.,University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Jalil S Ali
- Zhianawa Cancer Center, Sulaimani, Kurdistan, Iraq
| | | | - Ayah Said
- University of Toronto, Toronto, Ontario, Canada
| | - Shkar O Arif
- Zhianawa Cancer Center, Sulaimani, Kurdistan, Iraq
| | | | - Ali H Gendari
- Mosul Oncology and Nuclear Medicine Hospital, Mosul, Ninevah, Iraq
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Xia L, Zheng R, Xu Y, Xu X, Zhang S, Zeng H, Lin L, Chen W. Incidence and mortality of primary bone cancers in China, 2014. Chin J Cancer Res 2019; 31:135-143. [PMID: 30996571 PMCID: PMC6433577 DOI: 10.21147/j.issn.1000-9604.2019.01.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective In this study, we aimed to estimate the updated incidence and mortality of primary bone cancers based on population-based cancer registration data in 2014, collected by the National Central Cancer Registry of China (NCCRC). Methods In 2017, 339 registries' data were qualified based on data quality criteria set down by the NCCRC. Cases of primary bone cancers were retrieved from the national database. We estimated numbers of primary bone cancer cases and deaths in China using age-specific rates and corresponding national population stratified by area, sex, age-group (0, 1-4, 5-9, 10-14, …, 85+). Chinese standard population in 2000 and Segi's World population were applied for the calculation of age-standardized incidence and mortality rates. Results In 2014, 24,000 primary bone cancer cases and 17,200 deaths attributable to primary bone cancers were estimated to have occurred in China. The crude incidence rate of primary bone cancers was 1.76/100,000, with age-standardized incidence rate by Chinese standard population (ASIRC) and by World standard population (ASIRW) being 1.35/100,000 and 1.32/100,000, respectively. The crude mortality rate of primary bone cancers was 1.26/100,000, with age-standardized mortality rate by Chinese standard population (ASMRC) and by World standard population (ASMRW) being 0.88/100,000 and 0.86/100,000, respectively. Age-specific incidence curve was bimodally distributed with age, with the first peak occurring in the second decade of the life and the second peak in the elderly. Males had higher crude and age-standardized rates for both incidence and mortality compared with females. Both crude and age-standardized incidence rates were higher in rural areas than in urban areas, so were the crude and age-standardized mortality rates. Conclusions This population-based study presents the most recently available estimates on primary bone cancers in China, revealing that the males are 1.34 times as much as females suffering from primary bone cancers and the adolescents in puberty and the elderly are predominantly affected groups by these cancers. High-quality cancer registration data are a prerequisite for undertaking further study for gaining insight into the causes and risk factors for primary bone cancers in China.
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Affiliation(s)
- Liang Xia
- Institute of Non-communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Rongshou Zheng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Yanjun Xu
- Institute of Non-communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Xiaojun Xu
- Institute of Non-communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Siwei Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Hongmei Zeng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
| | - Lifeng Lin
- Institute of Non-communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
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Macías-Jara LA, Palacios-Silva K, Polit-Zambrano F, Gagliardo-Cadena E, Macías-Jara B. Giant cell tumor of the dorsal vertebrae. Case report. CASE REPORTS 2019. [DOI: 10.15446/cr.v5n1.75276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Giant cell tumors are rarely observed in the thoracic vertebrae. They appear between the ages of 20 and 50, more often in women. The purpose of this case report is to make known the clinical characteristics, the presentation and the treatment used to solve this pathology.Case presentation: 37-year-old female patient who presented a clinical picture of seven days of dyspnea, cough with white expectoration, high temperature, paraparesis, loss of control in the sphincters and weight loss. High-resolution computed tomography of the thorax showed a right paraspinal mass located in posterior mediastinum at T8-T9 level. Surgical excision of the tumor was decided by right posterolateral thoracotomy at the seventh intercostal space and free surgical margins. The histopathology report described giant cell tumor grade II. The patient did not require chemotherapy and had a satisfactory evolution.Discussion: This case has a non-specific presentation, as it shows evidence of pain, tumor and functional impotence of the involved region. Surgery is the best treatment and consists of tumor excision, leaving wide margins to prevent recurrences.Conclusions: Giant cell tumors involving the lungs and thoracic vertebrae are underdiagnosed due to their nonspecific symptoms and the limited literature currently available.
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Çomunoğlu N, Kepil N, Dervişoğlu S. Histopathology of giant cell tumors of the bone: With special emphasis on fibrohistiocytic and aneurysmal bone cyst like components. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:35-39. [PMID: 30392920 PMCID: PMC6424663 DOI: 10.1016/j.aott.2018.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/13/2018] [Accepted: 10/08/2018] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to define histopathological features of giant cell tumor of bone, especially accompanying fibrohistiocytic or aneurysmal bone cyst like components, in the light of our institutions experience. Methods A total of 120 cases (64 females and 56 males; mean age: 36.2 (12–80)) with ‘GCT’ diagnosed between the years 1996–2016 were included in this retrospective analysis. Cases were evaluated according to clinical features such as age, gender, localization, recurrence, metastasis and histopathological features. Results Tumors were localized most frequently at proximal tibia and distal femur, respectively. In 11 cases areas rich in fibrohistiocytic component and in 20 cases aneurysmal bone cyst like component were observed. In 2 cases both components were present. Twenty three cases recurred. In 1 case which was primarily located at calcaneus, tumor metastasized to lung 4 years later during follow-up. Conclusion GCT can be confused with other tumor or tumor-like lesions involving giant cells. Secondary changes such as fibrohistiocytic or aneurysmal bone cyst-like components and coagulation necrosis were frequently seen in conventional giant cell tumor of bone. For tumors having prominent fibrohistiocytic and/or aneurysmal bone cyst-like components, in order to detect characteristic areas representing GCT, additional sampling is essential. Although secondary histopathological changes do not appear to affect clinical outcome, these features are important in differential diagnosis. Approximately one fifth of GCT cases show recurrence and sacrum and foot bones were the most frequent sites for recurrence. Level of evidence Level IV, diagnostic study.
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Vimentin, osteocalcin and osteonectin expression in canine primary bone tumors: diagnostic and prognostic implications. Mol Biol Rep 2018; 45:1289-1296. [PMID: 30066297 DOI: 10.1007/s11033-018-4285-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/26/2018] [Indexed: 12/14/2022]
Abstract
Canine primary bone tumors have a plastic radiographic image, demanding histopathological confirmation. Bone tumors are characterized by the type and amount of extracellular matrix produced what cannot be easily recognized, especially in biopsy samples. Identifying cellular markers that could aid diagnosis has supported various studies in oncological pathology. This study aimed to evaluate 22 canine primary bone neoplasms, establishing their histopathological diagnosis and evaluated vimentin, osteonectin and osteocalcin expression and their implication in diagnosis and prognosis. There were 12 productive osteoblastic osteosarcomas, six minimally productive osteoblastic osteosarcoma, two chondrosarcomas, one fibrosarcoma and one hemangiosarcoma. Immunostaining was cytoplasmatic in all cases, with average percentage of 87.9% for vimentin, 98.0% for osteonectin and 99.9% for osteocalcin. In this last case, only osteosarcomas were considered. Intensity was higher in vimentin labeling (+++), followed by osteonectin (++) and osteocalcin (+). One osteosarcoma showed negative immunostaining for vimentin and of samples submitted to anti-osteocalcin immunostaining, three osteosarcomas and one fibrosarcoma had negative staining. Besides identifying mesenchymal origin, vimentin elevated expression in canine bone tumors can be related to epithelial-mesenchymal transition, leading to more aggressive tumoral phenotypes and metastasis development. Similarly, high osteonectin expression is implicated in neoplastic cell invasion and is also related to metastasis spread. Decreased osteocalcin expression was found in some osteosarcoma samples and can be related to poor prognosis, as in human osteosarcomas. Our findings suggest that vimentin, osteonectin and osteocalcin not only aid diagnosis but can be related to prognosis in canine primary bone tumors, especially osteosarcomas and its osteoblastic subtype.
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Liede A, Hernandez RK, Tang ET, Li C, Bennett B, Wong SS, Jandial D. Epidemiology of benign giant cell tumor of bone in the Chinese population. J Bone Oncol 2018; 12:96-100. [PMID: 30148063 PMCID: PMC6107898 DOI: 10.1016/j.jbo.2018.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022] Open
Abstract
Background Quantifying the incidence of giant cell tumor (GCT) of bone is challenging because it is a rare, histologically benign bone tumor for which population-level statistics are unavailable in most countries. We estimated the 2017 incidence of GCT in China using a direct (registry-based) approach with available population-based data. Materials and Methods The most recent age- and sex-specific incidence rates of GCT recorded in the Bone Tumor Registry in Japan (2015) were applied to 2017 age- and sex-matched populations projected by the United Nations for China in order to estimate 2017 incidence. An adjustment factor calculated using registry data suggesting that GCT may represent a greater proportion of bone tumors in China than in Japan (Guo, 1999) was applied to provide secondary estimates. Results Annual GCT incidence was estimated to be 1.49 per million population or 2094 new cases in China for 2017. A comparison of this estimated incidence with Japan (1.25 per million) and the United States (1.38 per million) indicates that the incidence is somewhat higher in China using identical methods. Secondary estimates suggest that GCT incidence in China may be as high as 2.57 per million or 3625 new cases in 2017. The corresponding 3-year limited-duration prevalence of GCT in China using a registry-based approach and general age-specific mortality is 6276 (secondary estimate: 10,876). Conclusions Leveraging unique population-based registry data, we estimated that GCT is a rare disease in the Chinese population with an incidence ranging between 1.49 and 2.57 cases per million persons per year. Possible differences in diagnostic classification of GCT, urban-rural demographics, and the younger demographic distribution of the Chinese population may underlie observations that GCT, a condition that primarily affects young individuals (20-40 years of age), accounts for a higher proportion of skeletal tumors in China than in other regions.
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Affiliation(s)
- Alexander Liede
- Center for Observational Research, Amgen, 1120 Veterans Boulevard, ASF3, Thousand Oaks and South San Francisco, CA, USA
| | - Rohini K Hernandez
- Center for Observational Research, Amgen, 1120 Veterans Boulevard, ASF3, Thousand Oaks and South San Francisco, CA, USA
| | - En-Tzu Tang
- Oncology, R&D, Amgen China, RM. 1501∼1506, 15F of Platinum Tower, No. 233 Taicang Road, HuangPu District, Shanghai 200020 PR China
| | - Chuang Li
- Oncology, R&D, Amgen China, RM. 1501∼1506, 15F of Platinum Tower, No. 233 Taicang Road, HuangPu District, Shanghai 200020 PR China
| | - Brian Bennett
- Plan A Inc., 759 Villa Street, Suite A, Mountain View, CA 94041, USA
| | - Steven S Wong
- Plan A Inc., 759 Villa Street, Suite A, Mountain View, CA 94041, USA
| | - Danielle Jandial
- Global Development (Oncology), Amgen Inc., One Amgen Center Drive, MS 38-2-B, Thousand Oaks, CA 91320-1799, USA
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Deng ZP, Liu BY, Sun Y, Jin T, Li B, Ding Y, Niu XH. Transition from Tumor Tissue to Bone Marrow in Patients with Appendicular Osteosarcoma after Neoadjuvant Chemotherapy. Chin Med J (Engl) 2018; 130:2215-2218. [PMID: 28875957 PMCID: PMC5598334 DOI: 10.4103/0366-6999.213960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Limb-salvage surgery is the standard procedure for the treatment of appendicular osteosarcoma. Precise resection is the trend in limb-salvage surgery. The aim of this study was to evaluate a large series of cases to identify the histological relationship between the tumor and marrow and determine the intramedullary transition type and width from the tumor to normal marrow in patients with osteosarcoma after neoadjuvant chemotherapy. Methods: One hundred and six osteosarcoma specimens were evaluated. The tissue specimens were sectioned through the coronal axis by an electronic saw. The tissue was immersed in formalin solution for fixation and subsequently decalcified. The interface between the tumor and normal bone marrow was grossly determined and submitted for microscopic evaluation to detect the relationship between the tumor and bone marrow and identify the transition type and width. All histological slides were examined by experienced orthopedic pathologists. Results: Histologically, the interface between the tumor and normal bone marrow was classified into two patterns: “clear” and “infiltrated.” The clear pattern, characterized by a clear boundary between the tumor and marrow, was identified in sixty cases (56.6%). A subtype of the clear type, characterized by fibrous bands between the tumor and marrow, was found in 13 cases (12.3%). The infiltrated pattern, characterized by a boundary with tumor cell clusters embedded in the marrow, was found in 46 cases (43.4%). The infiltrating depth varied from 1 to 4 mm (mean, 2.6 ± 0.7 mm). No tumor cells were observed in the normal bone marrow areas next to the interface. Conclusions: The transition from osteosarcoma tissue to bone marrow after neoadjuvant chemotherapy can be divided into two histological patterns: clear and infiltrated. The greatest infiltration width was 4 mm from tumor to normal marrow in this study. This depth should be considered in the presurgical plan.
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Affiliation(s)
- Zhi-Ping Deng
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Bao-Yue Liu
- Department of Pathology, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Yang Sun
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Tao Jin
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Bin Li
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Yi Ding
- Department of Pathology, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
| | - Xiao-Hui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Beijing 100035, China
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Broehm CJ, Inwards CY, Al-Ibraheemi A, Wenger DE, Jenkins SM, Jin L, Oliveira AM, Zreik RT, Carter JM, Boland JM, Fritchie KJ. Giant Cell Tumor of Bone in Patients 55 Years and Older: A Study of 34 Patients. Am J Clin Pathol 2018; 149:222-233. [PMID: 29425276 DOI: 10.1093/ajcp/aqx155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Most giant cell tumors of bone (GCTs) occur in patients aged 20 to 40 years. We analyzed features of GCT in patients 55 years or older. METHODS GCTs were examined for fibrosis, matrix, cystic change, histiocytes, mitoses, and necrosis. Clinical/radiologic data were collected. RESULTS Thirty-four (5%) of 710 GCTs occurred in patients older than 55 years (14/20 male/female; 56-83 years) in long bones (n = 24), vertebrae (n = 6), pelvis (n = 3), and metacarpal (n = 1). Imaging was classic in 26 of 27 cases; one case appeared malignant. Morphologic patterns included fibrosis (n = 29), bone formation (n = 19), cystic change (n = 8), necrosis (n = 8), foamy histiocytes (n = 7), and secondary aneurysmal bone cyst formation (n = 1). Mitoses ranged from 0 to 18 per 10 high-power fields. Six recurred; one patient developed metastasis. Four of five cases harbored H3F3A mutations. CONCLUSIONS GCTs in patients 55 years or older share pathologic characteristics with those arising in younger adults. Fibrosis and reactive bone are common, potentially leading to diagnostic confusion in this population. No histologic features correlate with adverse outcome.
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Affiliation(s)
- Cory J Broehm
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Carrie Y Inwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Alyaa Al-Ibraheemi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Long Jin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andre M Oliveira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Riyam T Zreik
- Department of Pathology, Baylor Scott & White Health, Temple, TX
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Karen J Fritchie
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Treatment of giant cell tumor of distal radius with limited soft tissue invasion: Curettage and cementing versus wide excision. J Orthop Sci 2018; 23:174-179. [PMID: 29110910 DOI: 10.1016/j.jos.2017.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intralesional curettage and adjuvant versus wide en bloc excision (WEE) as the best treatment method of giant cell tumor (GCT) of distal radius with limited soft tissue extension is a controversial topic. METHODS Prospectively, 13 patients who had GCT of distal radius with perforation of either volar or dorsal cortex of the bone and soft tissue extension which was confined to one plane were enrolled in the study. Six patients treated with ICC and seven cases cured by WEE technique and proximal fibular arthroplasty. The results were evaluated based on recurrence, range of motion of the wrist joint, rotation of the forearm, grip and pinch power. RESULTS The mean age of the patients treated with ICC and WEE techniques were 32.7 (range: 23-43) and 34.5 (range: 28-44), respectively. Mean follow-up period was 72 months (range: 28-148). Local recurrence was seen in 4 of 6 patients (66.7%) underwent ICC technique but in none of the 7 subjects treated with WEE technique (P value = 0.021). The overall range of flexion/extension and supination/pronation in the WEE group were 83% and 92% of the ICC group, respectively. Both of pinch and grip power were 14% less in the WEE group compared to the ICC group. CONCLUSIONS In GCT lesion of distal radius even with limited soft tissue extension, WEE and proximal fibular arthroplasty may be a more reasonable suggestion when the patient seeks a one-shot surgery.
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Wang B, Chen W, Xie X, Tu J, Huang G, Zou C, Yin J, Wen L, Shen J. Development and validation of a prognostic index to predict pulmonary metastasis of giant cell tumor of bone. Oncotarget 2017; 8:108054-108063. [PMID: 29296223 PMCID: PMC5746125 DOI: 10.18632/oncotarget.22478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/29/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose Giant cell tumor of bone (GCTB) is an intermittent tumor with a low probability of pulmonary metastasis. Our aim was to investigate the risk factors and establish a nomogram predictive model for GCTB pulmonary metastasis. Methods We retrospectively evaluated GCTB patients at our center from 1991 to 2014. The cohort was randomized into training and validation sets. Univariate and multivariate analyses were used to evaluate the risk factors of pulmonary metastasis. A nomogram was established. Internal validation was achieved based on ROC curve and C-index values in the validation set. Decision curve analysis was performed to assess the clinical performance of the nomogram. Results 417 patients were studied, including benign and malignant GCTBs. The average follow up was 79 months. Pulmonary metastases were observed in 27 cases. Four independent risk factors were identified: malignancy, tumor bearing time, times of recurrence and tumor size. A nomogram was developed to predict pulmonary metastasis with C-index values of 0.857 and 0.785 in the training and validation groups. In the decision curve analysis, patients could benefit from the nomogram, which differentiates patients at high risk for pulmonary metastasis and avoids unnecessary examination. According to the nomogram, patients with final risks of more than 0.06 should be scheduled for further chest scans. Conclusion Malignancy, tumor bearing time, times of recurrence and tumor size were independent risk factors for pulmonary metastasis in GCTB patients. The nomogram can accurately predict the risk of pulmonary metastasis and help doctors to make clinical decisions for further chest examinations.
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Affiliation(s)
- Bo Wang
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei Chen
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xianbiao Xie
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Tu
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Huang
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Changye Zou
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Junqiang Yin
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Lili Wen
- Department of Anesthesiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jingnan Shen
- Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Inuwa MM, Zakariyau LY, Ismail DI, Friday ES, Ibrahim AA, Mohammed AA. Overview of extremity musculoskeletal neoplasms at the Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Ann Afr Med 2017; 16:141-144. [PMID: 28671156 PMCID: PMC5579899 DOI: 10.4103/aam.aam_5_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The burden of managing patients with musculoskeletal neoplasms in the West African sub-region is quite significant. This is largely due to late presentation, delay in making diagnosis, and failure of obtaining consent to certain surgical procedures. Improvements in diagnosis and treatment over the years have however increased life and limb survival for many patients. This study was aimed at evaluating the clinicopathologic pattern of neoplasm as it affects the upper and lower limbs with a view to determining the most common types, the most involved sites of the body and the age at presentation of these tumors. Materials and Methods: A total of 65 patients with histologically confirmed neoplasm of the upper and lower limbs arising from bone, cartilage, skeletal muscle, synovium, and tendon sheath were retrospectively selected 7 years from January 2008 to 2015. Results: Forty-one (63.1%) patients were males, whereas 24 (36.9%) were females. Age range is between 5 and 75 years, average of 30.8 years. Lower limb involvement was recorded in 40 (61.5%) patients, with remaining 25 (38.5%) patients in upper limbs. 28 (43.1%) patients had benign lesion, whereas 37 (56.9%) were malignant. Giant cell tumor (GCT) was the most frequent benign tumor (50%) while osteogenic sarcomas top the list on the malignant variety (32.4%). The most commonly affected bones were tibia, carpal-metacarpal, and femur in that order. Conclusion: In our center, GCT and osteogenic sarcoma are the most frequently encountered benign and malignant musculoskeletal extremity neoplasms, respectively, with the tibial bone being most commonly affected.
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Affiliation(s)
| | - Lawal Yau Zakariyau
- Department of Traumatic and Orthopedic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Dahiru I Ismail
- Department of Traumatic and Orthopedic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Ejagwulu S Friday
- Department of Traumatic and Orthopedic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Aniko A Ibrahim
- Department of Traumatic and Orthopedic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Abdulmalik A Mohammed
- Department of Traumatic and Orthopedic Surgery, Ahmadu Bello University, Zaria, Nigeria
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Associations between inflammatory gene polymorphisms (TNF-α 308G/A, TNF-α 238G/A, TNF-β 252A/G, TGF-β1 29T/C, IL-6 174G/C and IL-10 1082A/G) and susceptibility to osteosarcoma: a meta-analysis and literature review. Oncotarget 2017; 8:97571-97583. [PMID: 29228633 PMCID: PMC5722585 DOI: 10.18632/oncotarget.18813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/12/2017] [Indexed: 12/18/2022] Open
Abstract
Associations between inflammatory gene polymorphisms (TNF-α 308G/A, TNF-α 238G/A, TNF-β 252A/G, TGF-β1 29T/C, IL-6 174G/C and IL-10 1082A/G) and osteosarcoma (OS) risk remain unclear. We conducted a systematic search to retrieve studies that investigated associations between inflammatory gene polymorphisms and OS risk. Nine studies that met the inclusion criteria were finally recruited in this meta-analysis. Overall, there was a significant association between TNF-α 308G/A, IL-10 1082A/G and OS risk, while there was no significant association between TNF-α 238G/A, TNF-β 252A/G and IL-6 174G/C and OS risk. Our subgroup analysis showed a significant association between IL-6 174G/C and IL-10 1082A/G and OS risk in Asians, while no such significant correlation was observed with TNF-α 308G/A, TNF-α 238G/A, TNF-β 252A/G and TGF-β1 29T/C polymorphisms. In Caucasians, there was a significant association between TNF-α 238G/A and the decreased incidence of OS. In conclusion, inflammatory gene polymorphisms play a key role in the occurrence and progression of OS. IL-6 174G/C polymorphism was obviously associated with OS risk in Asians, while TNF-α 238G/A polymorphism seemed to be associated with the decreased susceptibility to OS in Caucasians as Altman and Bland test indicated. Although controversial results were observed between IL-10 1082A/G and OS risk in Asians and Caucasians, it is difficult to make a definite conclusion about the role of IL-10 1082A/G polymorphism in the etiology of OS because our Altman and Bland test showed no good evidence to support a different effect in Asians and Caucasians.
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Tian K, Wang L, Ma J, Wang K, Li D, Du J, Jia G, Wu Z, Zhang J. MR Imaging Grading System for Skull Base Chordoma. AJNR Am J Neuroradiol 2017; 38:1206-1211. [PMID: 28428207 DOI: 10.3174/ajnr.a5152] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/22/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Skull base chordoma has been widely studied in recent years, however, imaging characteristics of this tumor have not been well elaborated. The purpose of this study was to establish an MR imaging grading system for skull base chordoma. MATERIALS AND METHODS In this study, 156 patients with skull base chordomas were retrospectively assessed. Tumor-to-pons signal intensity ratios were calculated from pretreatment MR images RT1 (ratio of tumor to pons signal intensity in T1 FLAIR sequence), RT2 (ratio of tumor to pons signal intensity in T2 sequence) and REN (ratio of tumor to pons signal intensity in enhanced T1 FLAIR sequence), and significant ratios for overall survival and progression-free survival were selected to establish a grading system. Clinical variables among different MR imaging grades were then analyzed to evaluate the usefulness of the grading system. RESULTS RT2 (P < .001) and REN (P = .04) were identified as significant variables affecting progression-free survival. After analysis, the classification criteria were set as follows: MR grade I, RT2 > 2.49 and REN ≤ 0.77; MR grade II, RT2 > 2.49 and REN > 0.77, or RT2 ≤ 2.49 and REN ≤ 0.77; and MR grade III, RT2 ≤ 2.49 and REN > 0.77. MR grade III tumors had a more abundant tumor blood supply than MR grade I tumors (P < .001), and the intraoperative blood loss of MR grade III tumors was higher than that of MR grade I tumors (P = .002). Additionally, skull base chordoma progression risk increased by 2.071 times for every single MR grade increase (P < .001). CONCLUSIONS A higher RT2 value was a negative indicator of tumor progression, whereas a higher REN value was a positive risk factor of tumor progression. MR grade III tumors showed a more abundant blood supply than MR grade I tumors, and the risk of skull base chordoma progression increased with every single MR grade increase.
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Affiliation(s)
- K Tian
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - L Wang
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - J Ma
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - K Wang
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - D Li
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - J Du
- Department of Neuropathology (J.D), Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (J.D.), Center of Brain Tumor, Beijing, China.,Institute for Brain Disorders (J.D.), Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - G Jia
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - Z Wu
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
| | - J Zhang
- From the Department of Neurosurgery (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China.,Center of Brain Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Brian Tumor (K.T., L.W., J.M., K.W., D.L., G.J., Z.W., J.Z.), Beijing, China
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Drazin D, Bhamb N, Al-Khouja LT, Kappel AD, Kim TT, Johnson JP, Brien E. Image-guided resection of aggressive sacral tumors. Neurosurg Focus 2017; 42:E15. [PMID: 28041320 DOI: 10.3171/2016.6.focus16125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.
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Affiliation(s)
| | - Neil Bhamb
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Ari D Kappel
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York; and
| | - Terrence T Kim
- Departments of 1 Neurosurgery and.,Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - J Patrick Johnson
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, University of California, Davis, Sacramento, California
| | - Earl Brien
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Scheinfeld MH, Moon JY, Fagan MJ, Davoudzadeh R, Wang D, Taragin BH. MRI usage in a pediatric emergency department: an analysis of usage and usage trends over 5 years. Pediatr Radiol 2017; 47:327-332. [PMID: 28083700 DOI: 10.1007/s00247-016-3764-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/08/2016] [Accepted: 12/05/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) usage has anecdotally increased due to the principles of ALARA and the desire to Image Gently. Aside from a single abstract in the emergency medicine literature, pediatric emergency department MRI usage has not been described. OBJECIVE Our objective was to determine whether MRI use is indeed increasing at a high-volume urban pediatric emergency department with 24/7 MRI availability. Also, we sought to determine which exams, time periods and demographics influenced the trend. MATERIALS AND METHODS Institutional Review Board exemption was obtained. Emergency department patient visit and exam data were obtained from the hospital database for the 2011-2015 time period. MRI usage data were normalized using emergency department patient visit data to determine usage rates. The z-test was used to compare MRI use by gender. The chi-square test was used to test for trends in MRI usage during the study period and in patient age. MRI usage for each hour and each weekday were tabulated to determine peak and trough usage times. RESULTS MRI usage rate per emergency department patient visit was 0.36%. Headache, pain and rule-out appendicitis were the most common indications for neuroradiology, musculoskeletal and trunk exams, respectively. Usage in female patients was significantly greater than in males (0.42% vs. 0.29%, respectively, P<0.001). Usage significantly increased during the 5-year period (P<0.001). Use significantly increased from age 3 to 17 (0.011% to 1.1%, respectively, P<0.001). Sixty percent of exams were performed after-hours, the highest volume during the 10 p.m. hour and lowest between 4 a.m. and 9 a.m. MRI use was highest on Thursdays and lowest on Sundays (MRI on 0.45% and 0.22% of patients, respectively). CONCLUSION MRI use in children increased during the study period, most notably in females, on weekdays and after-hours.
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Affiliation(s)
- Meir H Scheinfeld
- Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E. 210 Street, Bronx, NY, 10467, USA.
| | - Jee-Young Moon
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michele J Fagan
- Department of Pediatrics, Division of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Dan Wang
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin H Taragin
- Department of Radiology, Division of Pediatric Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Surgery methods and soft tissue extension are the potential risk factors of local recurrence in giant cell tumor of bone. World J Surg Oncol 2016; 14:114. [PMID: 27094617 PMCID: PMC4837597 DOI: 10.1186/s12957-016-0871-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 04/12/2016] [Indexed: 12/30/2022] Open
Abstract
Background Various treatments of giant cell tumor of bone (GCTB) included in curettages and resections and with adjuvant are exerted, but the best treatment is controversial. The aim of the study was the identification of individual risk factors after various treatments in GCTB. Methods A total of 179 patients treated for GCTB between 1998 and 2010 were concluded in the retrospective study. All patients were treated with intralesional curettage, extensive curettage, or wide resection. Mean follow-up was 60.2 ± 18.7 months (36~112 months). Age, gender, tumor location, Campanacci grade, soft tissue extension, pathological features, and surgical methods were performed to univariate Kaplan-Meier survival analysis and multivariate Cox regression analysis. Results The local recurrence rates of intralesional curettage (41.9 %) and extensive curettage (19.0 %) were significantly higher than that of wide resection (7.7 %). The higher risk of local recurrence was found for soft tissue extension (hazard = 7.921, 95 % CI 1.107~56.671), compared with no statistical significances between gender, location, Campanacci grade, pathologic fracture, and local recurrences, which were shown by Kaplan-Meier analysis. However, recurrence-free survival (RFS) of patients younger than 30 was significantly lower than that of patients older than 30. The RFS of pathologic fracture patients with soft tissue extension was significantly lower than that of pathologic fracture patients without soft tissue extension. Multivariate Cox regression analysis indicated that the independent variable that contributed to recurrence-free survival was soft tissue extension and surgical methods. The RFS of extensive curettage had no statistically significant difference with wide resection and was significantly higher than that of intralesional curettage. Use of high-speed burring and bone cement significantly decreased the local recurrence rate. Conclusions Age (below 30 years), gender, tumor location, Campanacci grade, and pathologic fracture have no statistically significant influence on local recurrences. Soft tissue extension and intralesional curettage of surgical methods increased the RFS. The results of the present study suggested that compared with curettage and wide section, treatment of GCTB by extensive curettage could provide the favorable local control and functional recovery. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-0871-z) contains supplementary material, which is available to authorized users.
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Yang G, Zhang P, Lv A, Liu Y, Wang G. MiR-205 functions as a tumor suppressor via targeting TGF-α in osteosarcoma. Exp Mol Pathol 2015; 100:160-6. [PMID: 26708425 DOI: 10.1016/j.yexmp.2015.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022]
Abstract
Osteosarcoma (OS) is the most common primary bone cancer, and it is most prevalent in children and young adults. The prognosis of OS remains poor, and survival of OS reached a plateau. The discovery of microRNAs (miRNAs) provides a new possibility for the early diagnosis and treatment of OS. In this study, we detected the expression level of miR-205 and Transforming growth factor-alpha (TGF-α) in 15 cases of clinical OS tissues and adjacent normal bone tissues. We found that the expression of miR-205 was significantly lower in OS tissues than in normal bone tissues; the expression of TGF-α mRNA was significantly increased in OS tissues than in normal bone tissues, the miR-205 was negatively correlated with TGF-α levels in both OS and normal bone tissues. Functional studies demonstrated that miR-205 significantly decreased the capability of cell proliferation, invasion and migration and induced G0/G1 growth arrest and apoptosis in OS cells. By using bioinformatics analytic tool (Targetscan), the 3'UTR of TGF-α gene was found to be a target of miR-205. Luciferase report assay further confirmed that TGF-α 3'UTR is a direct target of miR-205. We also found that the expression of TGF-α mRNA and protein was significantly down-regulated or up-regulated after miR-205 mimic or miR-205 inhibitor transfection. TGF-α knockdown study further showed that miR-205 regulated cell proliferation, invasion and migration by targeting TGF-α in OS. Enforced expression of TGF-α sufficiently restore the effects of miR-205 on cell proliferation, invasion and migration. In conclusion, our study suggested that miR-205 may function as a tumor suppressor via targeting TGF-α in OS, and the abnormal expression of miR-205 might be a key factor in OS progression.
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Affiliation(s)
- Guojin Yang
- Department of Orthopedics, the Second People's Hospital of Taizhou City, Jiangsu Province, China.
| | - Peng Zhang
- Department of Orthopedics, Jiangsu Province Geriatric Institute, Jiangsu Province, China.
| | - Aibin Lv
- Clinical Laboratory, the Second People's Hospital of Taizhou City, Jiangsu Province, China.
| | - Yulin Liu
- Department of Orthopedics, the Second People's Hospital of Taizhou City, Jiangsu Province, China.
| | - Guoxi Wang
- Department of Orthopedics, the Second People's Hospital of Taizhou City, Jiangsu Province, China.
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The Establishment and Utility of a Free Online Database of Primary Bone Tumors. Pathol Oncol Res 2015; 22:129-33. [PMID: 26377426 DOI: 10.1007/s12253-015-9982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
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