Calcaneal Bone Tumors

Bone tumors of the foot are an uncommon finding. Most tumors are found incidentally on imaging and are benign. Care must be taken although due to the aggressive nature of malignant bone tumors that can occur in the calcaneus. Malignant lesions will more commonly present with symptoms of pain and swelling. Often misdiagnosed as soft tissue injuries, it is critical to be able to diagnose and treat these lesions early. Imaging plays an important role with plain films and advanced imaging. Surgical treatments can range from curettage with grafting to amputation for more aggressive lesions.

[A motorcyclist with hematomas and tingling in his leg]

A 30-year-old man presented with recurrent hematomas and tingling in his left leg, caused by a large femoral neck osteochondroma that induced multiple muscle ruptures and compressed the ischiadic nerve. There were no radiological signs of malignant transformation and symptoms disappeared without intervention. Hence, we chose a 'wait and see' approach instead of surgical removal of the osteochondroma.

Costal chondrosarcoma. Report of five cases

We report five cases of coastal chondrosarcoma (CS) in four women and one man between 28 and 49 years of age. In four cases, the tumor had spread and infiltrated the adjacent structures (soft tissues, thoracic vertebrae, mediastinum, etc.). CS was diagnosed based either on wide surgical resection specimens in three patients, or on tumor biopsies in two cases. The CS was grade I in one patient, grade II in three cases, and grade III in one case. Wide surgical resection which was performed in three patients was associated in one case with adjuvant radiotherapy and chemotherapy. In the three cases, the disease natural history appeared favorable after a follow-up duration ranging from 1 month to 4 years. Two patients died, one after radiotherapy and chemotherapy done immediately after diagnosis as a result of the large size and invasive nature of the tumor. Coastal CS is characterized by a distinct potential for locoregional and distant metastasis. Diagnosis remains anatomopathological. Wide surgical resection is the only demonstrated curative treatment, even for high-grade CS.

Osteochondromas: review of the clinical, radiological and pathological features

Osteochondroma is the most common benign bone tumor and usually occurs in the metaphyseal region of the long bones. This tumor takes the form of a cartilage-capped bony outgrowth on the surface of the bone. The vast majority (85%) of osteochondromas present as solitary, nonhereditary lesions. Approximately 15% of osteochondromas occur as multiple lesions in the context of hereditary multiple osteochondromas (HMOs), a disorder that is inherited in an autosomal dominant manner. Most lesions appear in children and adolescents as painless, slow-growing masses. However, depending on the location of the osteochondroma, significant symptoms may occur as a result of complications such as fracture, bony deformity, mechanical joint problems and vascular or neurologic compromise. Malignant transformation of osteochondromas can occur later in adulthood but rarely metastasize. The treatment of choice for osteochondroma is surgical unless the skeleton is still immature. Pathogenetic analysis showed that HMOs are caused by mutations in either of two genes: exostosis (multiple)-1 (EXT1), which is located on chromosome 8q24.11-q24.13 or exostosis (multiple)-2 (EXT2), which is located on chromosome 11p11-12. Recently, biallelic inactivation of the EXT1 locus was described in nonhereditary osteochondromas. The EXT1 and EXT2 proteins function in the biosynthesis of heparin sulfate proteoglycans (HSPGs) which are multifunctional proteins involved in several growth signaling pathways in the normal epiphyseal growth plate. Reduced EXT1 or EXT2 expression in osteochondromas is associated with disordered cellular distribution of HSPGs, resulting in defective endochondral ossification which is likely to be involved in the formation of osteochondromas. Here the clinical, radiological, pathological and pathogenetic features and the treatment modalities of osteochondroma are reviewed.

Radiology-pathology conference: osteosarcoma in a cartilaginous exostosis of the femur

Osteochondromas are common lesions in the metaphyseal segments of the long bones and are known to be able to degenerate into chondrosarcoma. We present the case of a 20-year-old patient with an osteosarcoma at the base of a cartilaginous exostosis and discuss the causal relationship between the two lesions on the basis of the radiologic and pathologic findings.

Pseudoaneurysm and deep vein thrombosis complicating femoral osteochondroma: Multimodality imaging

A case of a femoral osteochondroma complicated by pseudoaneurysm and deep venous thrombosis is presented. Multimodality imaging contributed crucial information to allow successful diagnosis and preoperative planning.

Femur ostochondroma and secondary pseudoaneurysm of the popliteal artery

Osteochondroma is the most common skeletal benign tumour. It may present in a solitary form or as part of an autosomal dominant hereditary syndrome affecting several bones simultaneously. It is found most often in the knee region. It is generally asymptomatic although it may cause complications, including vascular disorders. In view of anatomical circumstances, the popliteal artery is most frequently involved in this type of complication. This is a case report of a 9-year-old boy who referred with pain in the distal third of his femur. Osteochondroma was initially diagnosed through plain X-ray. In view of worsening symptoms, an ultrasound and magnetic resonance imaging were performed and the patient was diagnosed with pseudoaneurysm of the popliteal artery.

Dysplasia epiphysealis hemimelica of the talus: two case reports

Trevor's disease, also known as dysplasia epiphysealis hemimelica, is an uncommon skeletal developmental disorder representing an osteochondroma occurring in one or more epiphyses. We present 2 cases of dysplasia epiphysealis hemimelica in an 8-year-old female and a 12-year-old male who suffered from a hard swelling of the ankle joint. The female patient was treated by surgical excision and the male patient conservatively.

Genetics of chondrosarcoma and related tumors

PURPOSE OF REVIEW

The burgeoning body of information on the genetic changes present in and underlying the development and biology of human cancers has carried implications regarding the possible genetic events that are responsible for not only the genesis of these cancers but also the hope of the cure for these cancers. Chondrosarcomas are a group of tumors that fall into this category. The purpose of this review is to summarize the genetic findings in these tumors.

RECENT FINDINGS

The histopathologic variability of chondrosarcomas is reflected in the complexity and lack of specificity of their cytogenetic and molecular genetic findings, except for extraskeletal myxoid chondrosarcomas. These are characterized in the preponderant number of cases by a translocation, t(9;22)(q22;q12), and in a small number of cases by variant translocations t(9;17)(q22;q11) and t(9;15)(q22;q21). These translocations lead to the formation of abnormal fusion genes and gene products (proteins). In each of these translocations, the CHN gene is involved, resulting in the chimeric fusion genes EWS/CHN, RBP56/CHN, and TCF12/CHN, respectively. The specific translocations and their associated molecular genetic changes are diagnostic of extraskeletal myxoid chondrosarcomas. The abnormal proteins resulting from these fusion genes aberrantly affect gene transcription and cellular signaling pathways thought to be responsible for initiating sarcoma formation. In skeletal (central) chondrosarcomas of varying histopathologic types, the cytogenetic and molecular genetic findings are variable, complex, and apparently lacking in specificity. These changes may reflect a stepwise process (or processes) of oncogenesis involving an array of genes.

SUMMARY

Although some cartilaginous tumors are characterized by specific or recurrent chromosome alterations and molecular genetic changes, much is yet to be learned about the nature and sequence of these genetics events and about their unique role in the stepwise process involved in the development and biology of each tumor type, both malignant and nonmalignant. Until such time, some of the genetic changes, particularly the presence of specific translocations, can be of definite diagnostic value.

Benign and malignant cartilage tumors of the hand

Primary bone tumors of the hand and wrist are unusual but if present are frequently chondrogenic in origin. Enchondroma is the most common primary bone tumor of the hand and can be treated by curettage and bone grafting. Chondrosarcoma is rare and most likely the result of malignant degeneration of a pre-existing lesion. Wide en bloc resection is appropriate for chondrosarcoma and typically involves ray resection or partial hand amputation.

Malignant transformation of a multiple cartilaginous exostosis--a case report

A patient is reported who had multiple cartilaginous exostoses with malignant transformation of a pelvic osteochondroma.

Popliteal artery pseudoaneurysm caused by an osteochondroma--a traditional medicine massage sequelae

We report an unusual case of a popliteal aneurysm complicating a distal femoral osteochondroma caused by the repeated massages of a traditional medicine practitioner (sinseh). Management was by excision of the exostosis and reconstruction of the damaged arterial segment by a reversed long saphenous vein graft. We advice against massage over an osteochondroma on the distal medial aspect of the femur and suggest prophylactic removal of such lesions because of this potential complication.

[Clinical study of intraspinal neoplasms in children]

The authors report a series of 10 children under 15 years of age with primary intraspinal neoplasm who underwent surgical resection from 1981 to 1994. The tumors consisted of 4 intramedullary tumors (myxopapillary ependymoma, pilocytic astrocytoma, subpial liporna, cavernous angioma), 2 intradural extramedullary tumors (2 neurinomas), and 4 extradural tumors (ganglioneuroma, chordoma, osteochondroma, rhabdomyosarcoma). The initial symptoms in these patients were gait disturbance (50%), weakness of lower extremities (50%), pain (40%), weakness of upper extremities (10%), and tetraparesis (10%). The neurological findings on admission in these patients revealed motor paresis (90%), sensory disturbance (60%), abnormality of deep tendon reflex (60%), pathological reflex (30%), neurogenic bladder (30%), and Lasegue's sign (10%). All patients were treated surgically; laminectoy was performed in 8 patients, laminoplasty in one patient, and transoral approach in one patient. Five patients (50%) underwent a grossly total resection, 3 (30%) had a subtotal resection, and 2 (20%) had a partial resection. Mean follow-up period was 5.6 years. One (10%) patient died due to recurrence and dissemination of the tumor at eight months after surgery in a case of rhabdomyosarcoma. 9 (90%) have had no recurrent tumor and have improved neurologically. In 4 patients (40%) spinal deformity developed, and 2 patients required operative treatment for the spinal deformity. We emphasized the advantage of laminoplasty to prevent postoperative spinal deformity in children.