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Matcuk GR, Waldman LE, Fields BKK, Colangeli M, Palmas M, Righi A, Filonzi G, Crombé A, Spinnato P. Conventional radiography for the assessment of focal bone lesions of the appendicular skeleton: fundamental concepts in the modern imaging era. Skeletal Radiol 2025; 54:1391-1406. [PMID: 39718620 PMCID: PMC12078366 DOI: 10.1007/s00256-024-04854-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 12/03/2024] [Accepted: 12/04/2024] [Indexed: 12/25/2024]
Abstract
Bone lesions of the appendicular skeleton can be caused by primary benign or malignant tumors, metastases, osteomyelitis, or pseudotumors. Conventional radiography plays a crucial role in the initial assessment of osseous lesions and should not be underestimated even in this era of modern complex and advanced imaging technologies. Combined with patient age, clinical symptoms and biology, and lesion features including location, solitary versus multiplicity, density, margin (transitional zone evaluated with Lodwick-Madewell grading score), and, if present, the type of periosteal reaction and matrix mineralization can narrow the differential diagnosis or offer a likely diagnosis. These radiographic features help guide further follow-up or management.
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Affiliation(s)
- George R Matcuk
- Department of Imaging, S. Mark Taper Foundation Imaging Center, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Ste M-335, Los Angeles, CA, 90048, USA.
| | - Leah E Waldman
- Department of Radiology, Duke University School of Medicine, Durham, NC, 27705, USA
| | - Brandon K K Fields
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Marco Colangeli
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Marco Palmas
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
| | - Giacomo Filonzi
- Department of Radiology, Ospedale Maggiore, 40133, Bologna, Italy
| | - Amandine Crombé
- Department of Musculoskeletal Radiology, Pellegrin Hospital, Bordeaux University, F-33000, Bordeaux, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136, Bologna, Italy
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2
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Diaz-Perez JA, Rosenberg AE. Cartilage Forming Tumors of the Skeleton. Adv Anat Pathol 2025; 32:132-146. [PMID: 39588691 DOI: 10.1097/pap.0000000000000475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
Cartilage-forming tumors are a broad and diverse group of neoplasms frequently affecting the skeleton. Distinguishing between the members of this group is important because of significant differences in treatment and prognosis. Accurate diagnosis can be challenging because of similarities in their clinical, radiographic, and pathologic features. Immunohistochemistry and molecular tools are helpful in select instances. Therefore, careful evaluation and correlation of these features are essential in arriving at the correct diagnosis and appropriate patient management. This review provides an overview of the current literature, emphasizing helpful features in diagnosis.
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Affiliation(s)
- Julio A Diaz-Perez
- Departments of Dermatology and Pathology, Virginia Commonwealth University, Richmond, VA
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami, Miami, FL
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Huguet Carmona JL, De la Calva Ceinos C, González Rojo P, Ortega Yago A, Angulo Sánchez M, Amaya Valero JV, Ferràs Tarragó J, Baixauli García F. [Translated article] Epidemiology of musculoskeletal tumours in a reference unit. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:T158-T166. [PMID: 39622339 DOI: 10.1016/j.recot.2024.11.021] [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: 11/16/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 12/24/2024] Open
Abstract
OBJECTIVE The objective of this study was to perform an epidemiological analysis of patients presented to the Musculoskeletal Tumors Committee of a reference hospital. MATERIAL AND METHOD A retrospective analysis of patients with sarcomas treated in a reference Sarcoma Unit between 2009 and 2022 was carried out. RESULTS A total of 1978 patients were analysed, of which 1477 (74.67%) were diagnosed as sarcomas. They were divided into 446 (30.20%) bone tumours and 1.031 (69.80%) soft tissue tumours. The most common benign bone tumour was enchondroma (27.23%), giant cell tumour (59.21%) was the most common tumour of intermediate malignancy and the malignant one was osteosarcoma (24.78%). The most frequently observed benign soft tissue tumour was lipoma (50.74%), the atypical lipomatous tumour (53.25%) was the most frequent tumour of intermediate malignancy and the malignant one was sarcoma of uncertain differentiation (38.10%). CONCLUSION Our study represents the first work on the epidemiology of sarcomas and other musculoskeletal tumours in our country, being very useful to adapt the resources destined for their diagnosis and treatment.
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Affiliation(s)
- J L Huguet Carmona
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - C De la Calva Ceinos
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | | | - A Ortega Yago
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - M Angulo Sánchez
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J V Amaya Valero
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Ferràs Tarragó
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - F Baixauli García
- Unidad de Sarcomas y Tumores Musculoesqueléticos, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Huguet-Carmona JL, De la Calva-Ceinos C, González-Rojo P, Ortega-Yago A, Angulo-Sánchez M, Amaya Valero JV, Ferràs-Tarragó J, Baixauli-García F. Epidemiology of musculoskeletal tumors in a reference unit. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:158-166. [PMID: 39025360 DOI: 10.1016/j.recot.2024.07.012] [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: 11/16/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE The objective of this study was to perform an epidemiological analysis of patients presented to the Musculoskeletal Tumors Committee of a reference hospital. MATERIAL AND METHOD A retrospective analysis of patients with sarcomas treated in a reference Sarcoma Unit between 2009 and 2022 was carried out. RESULTS A total of 1978 patients were analyzed, of which 1477 (74.67%) were diagnosed as sarcomas. They were divided into 446 (30.20%) bone tumors and 1.031 (69.80%) soft tissue tumors. The most common benign bone tumor was enchondroma (27.23%), giant cell tumor (59.21%) was the most common tumor of intermediate malignancy and the malignant one was osteosarcoma (24.78%). The most frequently observed benign soft tissue tumor was lipoma (50.74%), the atypical lipomatous tumor (53.25%) was the most frequent tumor of intermediate malignancy and the malignant one was sarcoma of uncertain differentiation (38.10%). CONCLUSION Our study represents the first work on the epidemiology of sarcomas and other musculoskeletal tumors in our country, being very useful to adapt the resources destined for their diagnosis and treatment.
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Affiliation(s)
- J L Huguet-Carmona
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - C De la Calva-Ceinos
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - P González-Rojo
- Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - A Ortega-Yago
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M Angulo-Sánchez
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J V Amaya Valero
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Ferràs-Tarragó
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - F Baixauli-García
- Unidad de Ortopedia General, Hospital Universitario y Politécnico La Fe, Valencia, España
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Vom Scheidt A, Pirrung F, Henyš P, Oppelt B, Leithner A, Hammer N, Bergovec M. Plating after tumor curettage in human femora does not efficiently improve torsional stability ex vivo. J Mech Behav Biomed Mater 2025; 161:106798. [PMID: 39504786 DOI: 10.1016/j.jmbbm.2024.106798] [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] [Received: 09/01/2023] [Revised: 12/22/2023] [Accepted: 11/02/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND Surgical treatments of benign primary bone tumors of the femur face the challenge of limiting tissue damage and contamination while providing sufficient stabilization to avoid fracture. While no clear treatment guidelines exist, surgical treatment commonly consists of femoral fenestration and curettage with optional filling and plating of the defect. Mono- or bicortical plating of distal femoral defects aim to reduce fracture risk and have been shown to increase axial stability. However, it remains unclear whether plating increases torsional stability of the affected femur. QUESTIONS/PURPOSES This biomechanical study aimed to determine how much additional stability can be achieved by mono- or bicortical plating of femoral defects after fenestration. The following hypotheses were investigated: 1. Preventive plating of distal femur bone defects enhances torsional stability when compared to femoral fenestration alone. 2. A condition close to the intact (nonpathological) bone can be achieved by bone plating. 3. Defect shape influences torsional stability. PATIENTS AND METHODS Thiel embalmed human femora (n = 24) were left intact or subjected to the following surgical treatments (A) defect creation via fenestration, (B) defect with short monocortical plating, (C) defect with long bicortical plating. All femora were torsion tested in midstance position using pre-cycling and testing until failure. Quantitative computed tomography pre and post testing allowed bone mineral density calculation and crack path analysis. Finite element analysis provided insight into defect shape variations. RESULTS Torsion experiments showed no relevant enhancement of torsional stability due to mono- or bicortical plating. There were no significant differences in maximum torque between unplated and plated femora with defect (defect: 35.38 ± 7.53 Nm, monocortical plating: 37.77 ± 9.82 Nm, bicortical plating: 50.27 ± 9.72 Nm, p > 0.05). Maximum torque for all treatment groups was significantly lower compared to intact femora (155-200 Nm, p < 0.001). Cracks originated predominantly from the proximal posterior corner of the defect and intersected with screw holes in plated femora. The influence of variations of the defect corner shapes had no significant influence on maximum torque and angle. CONCLUSION This biomechanical study shows that mono- or bicortical plating is not an effective preventive treatment against torsional failure of femora with distal defects as the resulting maximum torque was drastically reduced compared to intact femora. Thus, the initial hypotheses have to be rejected. As habitual loading of the femur includes a combination of axial and torsional loading, the observed lack of prevention against torsional failure might help to explain the occurrence of fractures despite plating. Future research towards ameliorating clinical outcome should address the role of defect filling with bone cement or bone grafts regarding the improvement of torsional stability after primary bone tumor treatment in the femur.
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Affiliation(s)
- Annika Vom Scheidt
- Department of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria.
| | - Felix Pirrung
- Department of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria.
| | - Petr Henyš
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies, Technical University of Liberec, Studentská 1402/2, Liberec, 461 17, Czech Republic.
| | - Birgit Oppelt
- Division for Pediatric Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Niels Hammer
- Department of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Auenbruggerplatz 25, 8036, Graz, Austria.
| | - Marko Bergovec
- Department of Orthopedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
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Ramadan ZA, Elmorsy AH, Taman SE, Denewar FA. Inter-observer and intra-observer agreement of bone reporting and data system (Bone-RADS) in the interpretation of bone tumors on computed tomography. Clin Imaging 2025; 117:110367. [PMID: 39602845 DOI: 10.1016/j.clinimag.2024.110367] [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] [Received: 10/03/2024] [Revised: 11/17/2024] [Accepted: 11/18/2024] [Indexed: 11/29/2024]
Abstract
OBJECTIVE To assess inter-observer & intra-observer agreement of the American College of Radiology (ACR) bone reporting and data system (Bone-RADS) in the interpretation of bone tumors on computed tomography (CT). METHODS This retrospective study included 273 bone tumors 184 (67.4 %) benign and 89 (32.6 %) malignant. Two blinded radiologists independently reviewed the CT images to assess the defined CT features of bone lesions and assign a bone-RADS category. A third observer reviewed the CT images twice with one month interval and reported the specified CT features and final bone-RADS category for bone lesions. Inter-observer and intra-observer agreement of bone-RADS were analyzed. RESULTS There was almost perfect inter-observer agreement between the two reviewers for all defined variables as well as bone-RADS categories (Kappa = 92.2 %). Overall intra-observer agreement was also perfect for all defined CT features and bone RADS categories with higher percentage than inter-observer one (κ = 98.3 %). CONCLUSION Bone-RADS is an effective clinical tool for practicing radiologists in the risk assessment and management of bone tumors with perfect agreement among observers. To our knowledge, no studies have been conducted for assessing reliability or validity of the recent ACR Bone-RADS using CT. Hence, this study could serve as a cornerstone for further upcoming studies to assess the reproducibility and validity of the ACR Bone-RADS.
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Affiliation(s)
- Zainab Ahmad Ramadan
- Department of Radiology, Faculty of Medicine, Mansoura University, El-Mansoura 35516, Egypt.
| | - Amel Helmy Elmorsy
- Department of Radiology, Faculty of Medicine, Mansoura University, El-Mansoura 35516, Egypt.
| | - Saher Ebrahim Taman
- Department of Radiology, Faculty of Medicine, Mansoura University, El-Mansoura 35516, Egypt.
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Uldin H, Kanbour I, Patel A, Botchu R. Image-Guided Musculoskeletal Interventional Radiology in the Personalised Management of Musculoskeletal Tumours. J Pers Med 2024; 14:1167. [PMID: 39728079 DOI: 10.3390/jpm14121167] [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: 11/07/2024] [Revised: 12/15/2024] [Accepted: 12/18/2024] [Indexed: 12/28/2024] Open
Abstract
Musculoskeletal image-guided interventional radiology plays a key role in diagnosing and treating a range of conditions. Recent advances have yielded a wide variety of procedures that can be applied selectively and enable the personalisation of patient care. This review aims to outline the indications, applications, and techniques of subspecialist musculoskeletal oncology interventional procedures that were used at our tertiary referral centre with a focus on how these may be used to personalise patient management. The applications of a range of diagnostic and therapeutic image-guided interventional procedures including different methods of bone and soft tissue sampling, ablation, and augmentation procedures across different types of patients and pathologies are reviewed. To supplement the reviewed literature, we included our own experience and radiology images retrospectively collected from our Picture Archiving and Communication System (PACS). We demonstrate how the range of musculoskeletal image-guided interventions provide flexibility in the diagnosis and management of different tumours across different patient populations. This study provides the musculoskeletal interventional radiologist with insight into how to appropriately utlilise different techniques to optimise the diagnosis, treatment and palliation of tumours.
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Affiliation(s)
- Hasaam Uldin
- Royal Orthopedic Hospital, Birmingham B31 2AP, UK
| | | | - Anish Patel
- Royal Orthopedic Hospital, Birmingham B31 2AP, UK
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8
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Kachuee MA, Mohseni I, Emtiazi N, Sharifi Y. Ankle synovial chondromatosis: Clinical, radiological, and surgical findings: A case report. Radiol Case Rep 2024; 19:3227-3230. [PMID: 38800078 PMCID: PMC11126875 DOI: 10.1016/j.radcr.2024.04.048] [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: 12/14/2023] [Revised: 04/01/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Synovial chondromatosis is a rare benign condition defined by the presence of cartilaginous lesions in the synovium of joints, tendon sheaths, and bursae. It most typically affects large joints, such as the knee, hip, and shoulder, but it is also reported in smaller joints. Nonetheless, ankle involvement is relatively uncommon. A complete history and clinical, physical, and radiographic examinations are usually used to determine the diagnosis. Hence, we reported a case of a young patient with left ankle primary synovial chondromatosis who presented with a left ankle mass and chronic pain.
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Affiliation(s)
- Manizhe A. Kachuee
- Department of Radiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Iman Mohseni
- Department of Radiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nikoo Emtiazi
- Department of Pathology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yasaman Sharifi
- Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Behrendt P, Grunow T, K-H F, Krause M, Fahlbusch H, Priemel M. Not every knee tumour is a ganglion - retrospective analysis of benign and malign tumour entities around the knee. Arch Orthop Trauma Surg 2024; 144:3227-3234. [PMID: 38904683 PMCID: PMC11417069 DOI: 10.1007/s00402-024-05401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Due to a lack of routine, there is often uncertainty regarding diagnostics of tumours around the knee joint. This study aimed to provide knowledge about the frequency, distribution and diagnostic algorithm of different bone and soft tissue tumour entities of the knee at a large referral university hospital in Germany. METHODS Retrospective, longitudinal, single-centre study that reviewed adult patients from 2010 until 2020 with a suspected tumours diagnosis around the knee at a university cancer centre. Inclusion criteria were adults with true bone or soft-tissue tumours in the knee joint and in its adjacent compartments. Suspected diagnosis, histological tumour entity, localization and its surgical treatment by biopsy, resection, osteosynthesis or tumour endoprosthesis were investigated. RESULTS A total number of 310 adult patients were included with a mean age of 54.2 ± 18.8 years. In total 160 (51.6%) soft-tissue tumours (69/43.1% benign; 74/46.2% malignant; 17/10.6% intermediate), 92 (29.6%) primary bone tumours (46/50% benign; 39/42.3% malignant; 7/7.6% intermediate), 36 (11.6%) metastases and 22 (7.1%) lymphomas were detected. 171 (55.1%) tumours were classified as malignant. Suspected diagnosis was matched with histology in 74.5% (231/310) of all cases. In 6 cases a primarily suspected benign diagnosis turned out to be malignant. The majority of primary bone tumours was cartilage derived (63.1%;58/92) and located in the distal 2/3 of the femur, whereas intracapsular tumours of the knee joint were rare (13.0%). Soft-tissue tumours were located primarily in the middle third of the thigh (36.8%). The MRI was the diagnostic tool of choice in 98.1% of soft tissue tumours and 82.6% bone tumours. CONCLUSION Awareness is crucial for detecting rare and malignant tumours around the knee, with adipocytic tumours being the most common soft tissue tumour and chondrogenic tumours as the most prevalent malignant bone tumour. Accurate diagnosis of bone tumours necessitates radiographs and frequently an additional MRI scan, while soft tissue tumours require mandatory MRI scans. Incorrectly diagnosing a tumour can have severe consequences, emphasizing the need for histological confirmation in all cases. Additionally, malignant tumours within joint capsules in adults are infrequent.
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Affiliation(s)
- Peter Behrendt
- Department of Orthopedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
- Department of Anatomy, Christian-Albrechts- University, Kiel, Germany.
| | - T Grunow
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frosch K-H
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Fahlbusch
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Priemel
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ma Y, Liu Y, Liu X, Li M, Cui J, Guan Z, Pei J, Gao Y. Fluoride exposure and prevalence of osteochondroma in drinking water Endemic fluorosis areas of Heilongjiang Province, China: a cross-sectional study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:2863-2876. [PMID: 37921081 DOI: 10.1080/09603123.2023.2277336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
To investigate the relationship between fluoride exposure and Osteochondroma (OC) prevalence, a cross-sectional study was conducted in drinking water endemic fluorosis areas of Heilongjiang Province, China. Our study first reported that the prevalence of OC was 2.3% in drinking water endemic fluorosis areas of Heilongjiang Province, China, and no difference in gender. Logistic regression analysis found that compared to 1st quartile participants, the prevalence of OC was 73% lower in the 2nd quartile participants of WF (Water fluoride), and 3.4 times higher among the 2nd quartile UF (Urinary fluoride) participants. Our study suggests that 0.259-0.420 mg/L of WF may be considered an appropriate level for reducing OC prevalence, while UF (≥0.750 mg/L) could slightly increase the prevalence of OC. In summary, the link between fluoride and OC prevalence is complicated and needs to be further investigated in a cohort population.
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Affiliation(s)
- Yongzheng Ma
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yang Liu
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xiaona Liu
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Mang Li
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Jing Cui
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Zhizhong Guan
- Department of Pathology and Key Lab of Endemic and Ethnic Diseases, Ministry of Education, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Junrui Pei
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yanhui Gao
- Key Laboratory of Etiology and Epidemiology, National Health Commission & Education Bureau of Heilongjiang Province (23618504), Harbin Medical University, Harbin, Heilongjiang Province, China
- Heilongjiang Provincial Key Laboratory of Trace Elements and Human Health, Harbin Medical University, Harbin, Heilongjiang Province, China
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, Heilongjiang Province, China
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Li Z, Lu M, Zhang Y, Gong T, Wang J, Luo Y, Zhou Y, Chang Q, Lin J, Min L, Tu C. Reconstruction of the proximal radius with 3D-printed personalized prosthesis after tumor resection: case series. J Shoulder Elbow Surg 2024; 33:556-563. [PMID: 37783308 DOI: 10.1016/j.jse.2023.08.032] [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: 05/14/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Giant cell tumor of bone (GCTB) (Campanacci III) or malignant tumors extend to the epiphyseal region of the proximal radius, and intra-articular resection of the proximal radius is often needed. In the present study, we present the patients who underwent reconstruction of the proximal radius with 3D-printed personalized prosthesis after tumor resection, aiming to describe the prosthesis design and surgical technique and evaluate the clinical outcomes of this method. METHODS Between November 2018 and January 2021, 9 patients received radial hemiarthroplasty with 3D-printed personalized prostheses after tumor resection. The pathologic diagnosis was GCTB (Campanacci III) in 7 patients, osteosarcoma (IIB) in 1 patient, and synovial sarcoma (IIB) in 1 patient. The range of motion (ROM) and strength in terms of elbow flexion/extension and forearm supination/pronation were evaluated. Pain was assessed by the visual analog scale (VAS) preoperatively and at each follow-up visit. To evaluate the functional outcome, the Mayo Elbow Performance Score (MEPS) system and the Musculoskeletal Tumor Society (MSTS) scoring system were administered at each follow-up visit. Complications and oncological outcomes were recorded. RESULTS The patients were followed from 24 to 51 months, with a median follow-up of 35 months. No patients were lost to follow-up. During the follow-up, local recurrence and metastasis were not observed. The VAS score improved from a median of 5 points (range 4-7) preoperatively to 1 point (range 0-2) at the last follow-up visit. The mean MEPS score was 88.5% (83-93), and the mean MSTS score was 25.3 (24-27) at the last follow-up visit. No complications such as infection and aseptic loosening were detected. CONCLUSIONS The implantation of a 3D-printed personalized prosthesis after proximal radial resection showed excellent oncologic outcomes and postoperative function at short-term follow-up and is a viable alternative method for reconstruction of the proximal radius bone defect after tumor resection.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Minxun Lu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuqi Zhang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie Wang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Luo
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qing Chang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingqi Lin
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China; Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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12
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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
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13
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Daher M, Zalaquett Z, Mekhael E, Aoun M, Chalhoub R, Abdo M, Aoude M, Farraj SA, Ghoul A, Tarchichi J, Rassi J, Sebaaly A, Trak-Smayra V, Kesrouani C, Kourie HR, Ghanem I. Epidemiology of bone tumors in Lebanon: a retrospective study from 2000 to 2022 at a tertiary center. Future Sci OA 2023; 9:FSO886. [PMID: 37752923 PMCID: PMC10518824 DOI: 10.2144/fsoa-2023-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Aim Bone tumors are rare and have an uneven geographic distribution. Methods 730 patients diagnosed with bone tumors were included in this retrospective analysis. Results With a 64% rate of malignancy, the most common tumors were metastasis (40%) mostly in the axial skeleton, Osteosarcoma (9%) mostly in the femur, Osteochondroma (8%) mostly in the femur, giant cell tumors (7%) mostly in the knee, and Ewing's sarcoma (6%) mostly in the axial skeleton. Conclusion Even though a some of the tumors have a predilection for certain localizations in the human body, they may differ in the middle-eastern population. One must also pay attention to the higher rates of malignancies as compared with other cohorts.
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Affiliation(s)
- Mohammad Daher
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Ziad Zalaquett
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Elio Mekhael
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Marven Aoun
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Ralph Chalhoub
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Majd Abdo
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Marc Aoude
- Hôtel Dieu de France, Hematology-Oncology Department, Beirut, Lebanon
| | - Sami Abi Farraj
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Ali Ghoul
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Jean Tarchichi
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Joe Rassi
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | - Amer Sebaaly
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
| | | | | | | | - Ismat Ghanem
- Hôtel Dieu de France, Orthopedic Department, Beirut, Lebanon
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14
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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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Kedra A, Dohan A, Biau D, Belbachir A, Dautry R, Lucas A, Aissaoui M, Feydy A, Soyer P, Barat M. Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience. Cancers (Basel) 2023; 15:cancers15092657. [PMID: 37174122 PMCID: PMC10177012 DOI: 10.3390/cancers15092657] [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: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.
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Affiliation(s)
- Alice Kedra
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - David Biau
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anissa Belbachir
- Department of Anesthesiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Raphael Dautry
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Alexandre Lucas
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Mathilde Aissaoui
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Antoine Feydy
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Musculoskeletal Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Philippe Soyer
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Maxime Barat
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
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16
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Guirguis M, Gupta A, Thakur U, Pezeshk P, Weatherall P, Sharan G, Xi Y, Chhabra A. Osseous-Tissue Tumor Reporting and Data System With Diffusion-Weighted Imaging of Bone Tumors-An Interreader Analysis and Whether It Adds Incremental Value on Tumor Grading Over Conventional Magnetic Resonance Imaging. J Comput Assist Tomogr 2023; 47:255-263. [PMID: 36877760 DOI: 10.1097/rct.0000000000001415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The aim of the study is to determine whether the use of diffusion-weighted imaging (DWI) provides incremental increase in performance in the osseous-tissue tumor reporting and data system (OT-RADS) with the hypothesis that use of DWI improves interreader agreement and diagnostic accuracy. METHODS In this multireader cross-sectional validation study, multiple musculoskeletal radiologists reviewed osseous tumors with DW images and apparent diffusion coefficient maps. Four blinded readers categorized each lesion using the OT-RADS categorizations. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. These measures were then compared with the previously published work that validated OT-RADS but did not include incremental value assessment of DWI. RESULTS One hundred thirty-three osseous tumors of the upper and lower extremities (76 benign, 57 malignant) were tested. Interreader agreement for OT-RADS with DWI (ICC = 0.69) was slightly lower (not statistically different) from the previously published work that did not incorporate DWI (ICC = 0.78, P > 0.05). The mean sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating curve including DWI of the 4 readers were 0.80, 0.95, 0.96, 0.79, and 0.91, respectively. In the previously published work without DWI, the mean values of the readers were 0.96, 0.79, 0.78, 0.96, and 0.94, respectively. CONCLUSIONS The addition of DWI to the OT-RADS system does not allow significantly improved area under the curve diagnostic performance measure. Conventional magnetic resonance imaging can be prudently used for OT-RADS for reliable and accurate characterization of bone tumors.
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Affiliation(s)
| | | | | | | | | | | | - Yin Xi
- From the Departments of Radiology
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17
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Abstract
BACKGROUND Chondrosarcoma (CS) epidemiology has been studied by a number of authors using national cancer registry cohorts. Many reports share the common findings of a slight increase in incidence, but not all. The patterns and causes for these changes are divergent while reflection concerning methodological challenges are often missing. METHOD We have performed a structured literature review to find national analyses of CS incidence published from 2010 to 2020. We included eight studies of national incidence of CS, summarise their findings and patterns of change. We further discuss explanations given for these changes to better understand the real patterns and raise awareness in their interpretation. RESULTS Reported crude incidence ranges from 0.27 per million per year overall in Saudi Arabia to 5.4 in the Netherlands. Four studies from the USA, England, Switzerland and France report age standardised rates of 2.0-4.1 per million per year overall. While some countries report stable patterns, most report a slight increase. The Netherlands is the only country reporting a large increase, driven by a 10-fold increase in the incidence of ACT/grade 1 CS during the study period. We challenge the explanations given for this and suggest that this most likely is a result of variable interpretation and definition of CS at the lower levels of disease aggressiveness. This should raise awareness to possible over-treatment of CS in the Netherlands. CONCLUSION The most likely national incidence of CS of bone is between 2-4 per million per year. Three modern reports present an incidence of 3.4-4.1 per million per year.
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Affiliation(s)
- Joachim Thorkildsen
- Division of Orthopaedic Surgery, Oslo University Hospital, Nydalen, Oslo, Norway.,Department of Registration, Cancer Registry of Norway, Majorstuen, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Majorstuen, Oslo, Norway.,Department of Research, Møre & Romsdal Hospital Trust, Ålesund, Norway
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18
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Benign Bone Lesions Found in Childhood. Orthop Clin North Am 2023; 54:59-74. [PMID: 36402511 DOI: 10.1016/j.ocl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Benign bone tumors are a wide variety of usually asymptomatic neoplasms, which in most cases are diagnosed due to secondary causes. As such, their real incidence is unknown. In the majority of cases, plain radiographs are enough for diagnosis; more advanced imaging, such as CT scan or MRI is sometimes performed for equivocal lesions. Treatment approach depends on whether the lesion is symptomatic and the risk of further progression, or development of secondary malignancies. When non expectant management is decided, treatment options include minimally invasive methods and surgery.
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Ntontis Z, Koutserimpas C, Chaniotakis K, Stavrakakis I, Samonis G, Alpantaki K. Treatment of Pathological Fracture of Radius due to Multiple Myeloma with Elastic Intramedullary Nail and Cement Augmentation: Expanding the Indications of Elastic Nails. J Long Term Eff Med Implants 2023; 33:67-70. [PMID: 36734928 DOI: 10.1615/jlongtermeffmedimplants.2022044050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pathological fractures of the proximal radius are exceedingly rare. Here, a case of an 81-year-old female diagnosed with multiple myeloma 15 years ago who suffered a pathological fracture of her left proximal radius is presented. Due to the fracture's proximity to the elbow joint and the lack of adjacent healthy bone tissue, a resourceful surgical intervention was implemented using a pediatric flexible nail supplemented by polymethacrylate cement injection. Six weeks post-operatively, the patient had alleviation of the pain with fully functional forearm. This novel approach could possibly aid in the treatment of other long bone pathological fractures due to neoplastic metastases.
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Affiliation(s)
- Zisis Ntontis
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, 251 Hellenic Air Force General Hospital of Athens, Greece
| | - Konstantinos Chaniotakis
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - Ioannis Stavrakakis
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
| | - George Samonis
- Department of Medicine, University of Heraklion, Crete, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, Venizeleion General Hospital of Heraklion, Crete, Greece
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20
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Killick L, D'Arcy M, Coates M, Beadel G. Pinpoint accuracy: guided core biopsy diagnostic accuracy in musculoskeletal lesions. ANZ J Surg 2022; 92:2672-2675. [DOI: 10.1111/ans.17970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/21/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Killick
- Department of Orthopaedic Surgery Christchurch Hospital Christchurch New Zealand
| | - Matt D'Arcy
- Department of Orthopaedic Surgery Christchurch Hospital Christchurch New Zealand
| | - Mark Coates
- Department of Orthopaedic Surgery Christchurch Hospital Christchurch New Zealand
| | - Gordon Beadel
- Department of Orthopaedic Surgery Christchurch Hospital Christchurch New Zealand
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21
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Kubota Y, Tanaka K, Hirakawa M, Iwasaki T, Kawano M, Itonaga I, Tsumura H. Patellar dislocation following distal femoral replacement after extra-articular knee resection for bone sarcoma: A case report. World J Clin Cases 2022; 10:3561-3572. [PMID: 35611187 PMCID: PMC9048549 DOI: 10.12998/wjcc.v10.i11.3561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/09/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For the treatment of bone sarcoma in the distal femur, wide-margin resection and knee reconstruction with tumor endoprosthesis are standard therapies. Extra-articular knee resection is required in cases of tumor invasion of the knee joint; however, the incidence of complications, such as aseptic loosening, prosthesis infection, and implant failure, is higher than that following intra-articular knee resection. To the best of our knowledge, there are three reports of patellar dislocations after replacement of a tumor endoprosthesis.
CASE SUMMARY A 36-year-old man with no significant past medical history was admitted to our institution with continuous pain in his left knee for 4 mo. An open biopsy was performed, and the patient was diagnosed with a left distal femoral malignant bone tumor. Extra-articular knee resection and knee reconstruction with a tumor endoprosthesis were performed. Although the alignment of the tumor prosthesis was acceptable, knee instability was noticed postoperatively. The axial radiographic view of the patellar and computed tomography showed lateral patellar dislocation at 4 wk postoperatively. The patient had to undergo a lateral release and proximal realignment. He could perform his daily activities at 9 mo postoperatively. Radiography revealed no patellar re-dislocation.
CONCLUSION Proximal realignment may be considered during primary surgery if there is an imbalance in the forces controlling the patellar tracking.
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Affiliation(s)
- Yuta Kubota
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Kazuhiro Tanaka
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Masashi Hirakawa
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Tatsuya Iwasaki
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Masanori Kawano
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Ichiro Itonaga
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
| | - Hiroshi Tsumura
- Orthopaedic Surgery, Oita University, Yufu City 879-5593, Oita, Japan
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22
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Musculoskeletal Tumor Registry, Time to Act and Take Steps Forward. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.119280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Rodríguez-Nogales C, Desmaële D, Sebastián V, Couvreur P, Blanco-Prieto MJ. Decoration of Squalenoyl-Gemcitabine Nanoparticles with Squalenyl-Hydroxybisphosphonate for the Treatment of Bone Tumors. ChemMedChem 2021; 16:3730-3738. [PMID: 34581019 PMCID: PMC9298071 DOI: 10.1002/cmdc.202100464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/30/2021] [Indexed: 12/17/2022]
Abstract
Therapeutic perspectives of bone tumors such as osteosarcoma remain restricted due to the inefficacy of current treatments. We propose here the construction of a novel anticancer squalene‐based nanomedicine with bone affinity and retention capacity. A squalenyl‐hydroxybisphosphonate molecule was synthetized by chemical conjugation of a 1‐hydroxyl‐1,1‐bisphosphonate moiety to the squalene chain. This amphiphilic compound was inserted onto squalenoyl‐gemcitabine nanoparticles using the nanoprecipitation method. The co‐assembly led to nanoconstructs of 75 nm, with different morphology and colloidal properties. The presence of squalenyl‐hydroxybisphosphonate enhanced the nanoparticles binding affinity for hydroxyapatite, a mineral present in the bone. Moreover, the in vitro anticancer activity was preserved when tested in commercial and patient‐treated derived pediatric osteosarcoma cells. Further in vivo studies will shed light on the potential of these nanomedicines for the treatment of bone sarcomas.
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Affiliation(s)
- Carlos Rodríguez-Nogales
- Chemistry and Pharmaceutical Technology, Faculty of Pharmacy, Universidad de Navarra-IdisNA, Irunlarrea 1, 31008, Pamplona, Spain
| | - Didier Desmaële
- Institut Galien Paris-Sud UMR CNRS 8612, Université Paris-Saclay, Jean Baptiste Clément 5, 92290, Châtenay-Malabry Cedex, France
| | - Víctor Sebastián
- Instituto de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad de Zaragoza, Mariano Esquillor López, 50008, Zaragoza, Spain
| | - Patrick Couvreur
- Institut Galien Paris-Sud UMR CNRS 8612, Université Paris-Saclay, Jean Baptiste Clément 5, 92290, Châtenay-Malabry Cedex, France
| | - María J Blanco-Prieto
- Chemistry and Pharmaceutical Technology, Faculty of Pharmacy, Universidad de Navarra-IdisNA, Irunlarrea 1, 31008, Pamplona, Spain
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Tay AYW, Tay KS, Thever Y, Hao Y, Yeo NEM. An epidemiological review of 623 foot and ankle soft tissue tumours and pseudo-tumours. Foot Ankle Surg 2021; 27:400-404. [PMID: 32605767 DOI: 10.1016/j.fas.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/28/2020] [Accepted: 05/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In evaluating foot and ankle soft tissue masses, comprehensive epidemiological data, especially clinical predictors of malignancy, is essential knowledge. Our aim was to assess these data in a cohort of patients that have undergone surgical excision of foot and ankle soft tissue tumours and pseudo-tumours over a 10-year period. METHODS A retrospective review of foot and ankle soft tissue tumours and pseudo-tumours excised in a tertiary hospital from 1 Jan 2006 to 31 Dec 2016 was performed. Uni- and multivariable analyses via logistic regression were conducted for all independent variables to identify their relationship with malignancy. Applying receiver operating characteristic (ROC) curves and Youden's Index to significant variables, we attempted to identify optimal threshold values to predict malignancy of the soft tissue mass. RESULTS A total of 623 tumours and pseudo-tumours were analysed, and majority were benign (n = 605, 97.1%). The most common pseudo-tumour, benign, and malignant tumours were ganglion cysts (n = 289, 90.3%), plantar fibromas (n = 54, 18.9%) and pleomorphic undifferentiated sarcomas (n = 4, 22.2%), respectively. Increasing age (P = 0.036), larger size of mass (P < 0.001) and male gender (P = 0.017) were significant predictors of malignancy. ROC and Youden's Index analyses identified optimal threshold values of 4.0 cm (area under curve [AUC] = 87.6%) for size of mass and 66 years (AUC = 60.7%) for age. CONCLUSION Majority of foot and ankle soft tissue masses are benign. Increasing age, larger size of mass and male gender are significant predictors of malignancy. The threshold value in predicting malignancy is 4.0 cm for size of mass and 66 years for age.
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Affiliation(s)
- Adriel You Wei Tay
- Singapore General Hospital, Academia, Level 4, Department of Orthopaedic Surgery, 20 College Road, 169865, Singapore.
| | - Kae Sian Tay
- Singapore General Hospital, Academia, Level 4, Department of Orthopaedic Surgery, 20 College Road, 169865, Singapore.
| | - Yogen Thever
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore.
| | - Ying Hao
- Health Services Research Centre (HSRC), Singhealth Services, 20 College Road, The Academia, Discovery Tower, Level 6, 169856, Singapore.
| | - Nicholas Eng Meng Yeo
- Singapore General Hospital, Academia, Level 4, Department of Orthopaedic Surgery, 20 College Road, 169865, Singapore.
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Thromboembolism in Malignant Musculoskeletal Tumour: A Literature Review. Adv Orthop 2021; 2021:6678167. [PMID: 33688439 PMCID: PMC7910073 DOI: 10.1155/2021/6678167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/03/2022] Open
Abstract
Malignant musculoskeletal tumour may cause considerable burden to general health. The fast growth combined with the tumour characteristics and its invasion capability resulted in the poor prognosis of malignant musculoskeletal tumour. Malignant musculoskeletal tumour may cause significant disability by destroying normal tissue that plays important role in body kinematics. Thromboembolism, including deep vein thrombosis, pulmonary embolism, and other kinds of venous thromboembolism, is one of the most underestimated complications of musculoskeletal tumour. Normally, thrombosis ensues when pathologic factors overcame the body hemostatic regulatory capabilities, which will predispose the body to the formation of thrombus. Venous thromboembolism in musculoskeletal tumour may develop as a result of interaction between the tumour pathologic capabilities and its interaction with normal bodily functions. In this study, we reviewed the burden of musculoskeletal tumour and its complication on global health. Then, the review will focus on the pathologic and clinical aspect of thromboembolism in malignant musculoskeletal tumour, including pathophysiology, diagnosis, and treatment based on recent findings and literature.
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26
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Fowler J, Takayanagi A, Fiani B, Cathel A, Sarhadi KJ, Arshad M, Lau S, Siddiqi I, Ghanchi H, Wolberg A, Hariri O. Diagnosis, Management, and Treatment Options: A Cervical Spine Osteochondroma Meta-Analysis. World Neurosurg 2021; 149:215-225.e6. [PMID: 33561553 DOI: 10.1016/j.wneu.2021.01.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. Although osteochondromas most often involve the appendicular skeleton, many involve the spine, with many cases located in the cervical spine. When osteochondromas involve the spine, they can present with a variety of symptoms, including pain, radiculopathy, and myelopathy, which may necessitate surgical treatment. Spinal osteochondromas can be classified into 2 types: multiple osteochondromas in the context of patients with multiple hereditary exostosis (MHE) and solitary osteochondroma or solitary exostosis (SE). Previous reviews have captured only some of the available literature on cervical osteochondromas and have generally focused on either SE or those associated with MHE. The purpose of our review was to provide an extensive review of all previously reported cervical osteochondromas and to compare osteochondroma characteristics, clinical presentation, and outcomes in the context of MHE and SE.
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Affiliation(s)
- James Fowler
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA.
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | | | - Mohammad Arshad
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Sean Lau
- Department of Pathology, Kaiser Permanente, Anaheim, California, USA
| | - Imran Siddiqi
- Western University of Health Sciences College of Osteopathic Medicine, Pomona, California, USA
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | - Adam Wolberg
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Omid Hariri
- Department of Neurosurgery, Kaiser Permanente Orange County, Anaheim, California, USA
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Aljuhani WS, Alanazi AM, Alghafees MA. Primary bone sarcomas in KSA: A Saudi tumor registry review. J Taibah Univ Med Sci 2020; 16:77-85. [PMID: 33603635 PMCID: PMC7858035 DOI: 10.1016/j.jtumed.2020.11.001] [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: 06/29/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives The geographical incidence of tumours is usually influenced by the environment, race, and culture. This study aimed to report the incidence and differences in tumour type, site of origin, and mortality across gender, regions, age, and the different characteristics of tumour types. Methods This retrospective cohort study included all patients diagnosed with primary bone sarcomas from January 1, 2013, to December 31, 2017. Frequencies and percentages were generated for categorical variables. Means and standard deviations were calculated for quantitative variables. A chi-squared test was used to detect differences among categorical variables. Student-t, ANOVA, and Tukey tests were used to detect differences among quantitative variables. Lastly, we calculated the incidence of each tumour type. Results Of 451 patients, 248 (55%) had osteosarcomas; 160 (35.5%) had Ewing's sarcoma, and 43 (9.5%) had chondrosarcoma. The incidence was 1.56 cases per 1,000,000 per year for osteosarcoma, 0.95 cases per 1,000,000 per year for Ewing's sarcoma, and 0.27 cases per million per year for chondrosarcoma. The three-year survival rate was 82.30%. Significant differences in tumour type, origin site, and three-year survival across age and gender were detected. Similarly, significant differences were also noted in origin site, grade, basis of diagnosis, and lateralisation across tumour types. Conclusions In our study, the observed bone sarcoma incidence rates were lower than the ones reported worldwide. Understanding the pattern of tumour behaviour in the region will help develop a risk and response-based treatment plan for early decision-making.
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Affiliation(s)
- Wazzan S Aljuhani
- Department of Orthopedic Surgery, National Guard Hospital, Riyadh, KSA
| | - Abdullah M Alanazi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
| | - Mohammad A Alghafees
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA
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Neyisci C, Erdem Y. Battle Against Musculoskeletal Tumors: Descriptive Data of Military Hospital Experience. Front Public Health 2020; 8:97. [PMID: 32269986 PMCID: PMC7109251 DOI: 10.3389/fpubh.2020.00097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 03/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Management of musculoskeletal tumors remains challenging for orthopedic surgeons. The aim of this cross-sectional study was to present the prevalence and localization of musculoskeletal disorders diagnosed and treated at a tertiary referral military hospital. Method: A total of 552 patients' medical records who presented to our clinic between 2009 and 2014 with the diagnosis of musculoskeletal tumors were retrospectively analyzed according to age, gender, bone/soft tissue localization, histopathological diagnosis, incidence, and treatment. Results: Of the cases diagnosed with tumor, 225 were soft tissue localized, 317 bone localized, and 10 tumor-like lesions. The most common primary benign soft tissue tumors were lipoma, ganglion, and giant cell tumor of tendon sheath, while the most common malignant soft tissue tumors were liposarcoma and synovial sarcoma, respectively. The most common primary bone tumors were osteochondroma, enchondroma, and simple bone cyst, while the most common malignant bone tumors were osteosarcoma, Ewing sarcoma and chondrosarcoma, respectively. Myositis ossificans was found as the most common tumor-like lesion. Conclusion: Descriptive data in musculoskeletal tumors is crucial in terms of improving treatment and reducing mortality. In this study, no significant difference was found between the data of tertiary military hospital regarding epidemiology of musculoskeletal system tumors and those from the literatures around Turkey.
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Affiliation(s)
- Cagri Neyisci
- Department of Orthopaedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Yusuf Erdem
- Department of Orthopaedics and Traumatology, Gulhane Training and Research Hospital, Ankara, Turkey
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Zhang S, Xing M, Li B. Recent advances in musculoskeletal local drug delivery. Acta Biomater 2019; 93:135-151. [PMID: 30685475 PMCID: PMC6615977 DOI: 10.1016/j.actbio.2019.01.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/18/2018] [Accepted: 01/22/2019] [Indexed: 12/17/2022]
Abstract
Musculoskeletal disorders are a significant burden on the global economy and public health. Advanced drug delivery plays a key role in the musculoskeletal field and holds the promise of enhancing the repair of degenerated and injured musculoskeletal tissues. Ideally, drug delivery should have the ability to directly deliver therapeutic agents to the diseased/injured sites with a desirable drug level over a period of time. Here, we present a mini-review of the current state-of-the-art research associated with local drug delivery and its use for the treatment of musculoskeletal disorders. First, an overview of drug delivery strategies, with a focus on issues related to musculoskeletal pathology, potential therapeutic strategies, conventional and non-conventional drugs, and various delivery systems, is introduced. Then, we highlight recent advances in the emerging fields of musculoskeletal local drug delivery, involving therapeutic drugs (e.g., genes, small molecule therapeutics, and stem cells), novel delivery vehicles (e.g., 3D printing and tissue engineering techniques), and innovative delivery approaches (e.g., multi-drug delivery and smart stimuli-responsive delivery). The review concludes with future perspectives and associated challenges for developing local drug delivery for musculoskeletal applications. STATEMENT OF SIGNIFICANCE: Three important aspects are highlighted in this manuscript: 1) The advanced musculoskeletal drug delivery is introduced from the aspects ranging from musculoskeletal disorders, potential therapeutic solutions, and various drug delivery systems. 2) The recent advances in the emerging fields of musculoskeletal local drug delivery, involving therapeutic drugs (e.g., genes, small molecule therapeutics, and stem cells), novel delivery vehicles (e.g., 3D printing and tissue engineering technique), and innovative delivery approaches (e.g., multi-drug delivery and smart stimuli-responsive delivery), are highlighted. 3) The challenges and perspectives of future research directions in the development of musculoskeletal local drug delivery are presented.
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Affiliation(s)
- Shichao Zhang
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506-9196, United States
| | - Malcolm Xing
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Bingyun Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506-9196, United States.
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Öztürk R, Arıkan ŞM, Bulut EK, Kekeç AF, Çelebi F, Güngör BŞ. Distribution and evaluation of bone and soft tissue tumors operated in a tertiary care center. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:189-194. [PMID: 30982757 PMCID: PMC6599414 DOI: 10.1016/j.aott.2019.03.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 12/23/2017] [Accepted: 03/17/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively evaluate the patients who were operated in our orthopedics and traumatology clinic with the suspection of bone and soft tissue tumors. METHODS A total of 3133 patients (1146 (46.5%) female and 1318 (53.5%) male) who presented to our tertiary clinic from different regions of Turkey between January 2002 and July 2013 with the presumed diagnosis of bone and soft tissue tumors were analyzed according to age, gender, bone/soft tissue localization, tumoral localization, histopathological diagnosis, tumor size and incidence. RESULTS Of all operated patients, 2464 (78%) were diagnosed with tumor, while non-tumoral causes were found in 669 (22%) patients. Of the cases diagnosed with tumor, 1139 were bone localized, 1004 soft tissue localized, and 321 metastasis. The most common benign bone tumors were osteochondroma (130, 20%), enchondroma (96, 15%), and simple bone cysts (90, 14%), while the most common malignant bone tumors were osteosarcoma (241, 44%), ewing's sarcoma (89, 16%), and chondrosarcoma (77, 14%); respectively. The most common benign soft tissue tumors were lipoma (141, 22%), giant cell tumors (108, 16%) and ganglion (107, 16%), while the most common malignant soft tissue tumors were liposarcoma (55, 16%), synovial sarcoma (53, 16%) and malignant mesenchymal tumors (45, 13%); respectively. CONCLUSION Musculoskeletal tumors are rare, but descriptive data in any region are important in order to reduce mortality and improve treatment. No significant difference was found between the data of our hospital regarding epidemiology of the musculoskeletal system tumors and those from the other regions around the world. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Recep Öztürk
- Department of Orthopaedics and Traumatology, Dr Abdurrahan Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Şefik Murat Arıkan
- Department of Orthopaedics and Traumatology, Gazi University Hospital, Ankara, Turkey
| | - Emin Kürşat Bulut
- Department of Orthopaedics and Traumatology, Dr Abdurrahan Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ahmet Fevzi Kekeç
- Department of Orthopaedics and Traumatology, Necmettin Erbakan University Hospital, Konya, Turkey
| | - Fener Çelebi
- Department of Orthopaedics and Traumatology, Memorial Dicle Hospital, Diyarbakır, Turkey
| | - Bedii Şafak Güngör
- Department of Orthopaedics and Traumatology, Dr Abdurrahan Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, 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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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: 0.3] [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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Rodríguez-Nogales C, González-Fernández Y, Aldaz A, Couvreur P, Blanco-Prieto MJ. Nanomedicines for Pediatric Cancers. ACS NANO 2018; 12:7482-7496. [PMID: 30071163 DOI: 10.1021/acsnano.8b03684] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Chemotherapy protocols for childhood cancers are still problematic due to the high toxicity associated with chemotherapeutic agents and incorrect dosing regimens extrapolated from adults. Nanotechnology has demonstrated significant ability to reduce toxicity of anticancer compounds. Improvement in the therapeutic index of cytostatic drugs makes this strategy an alternative to common chemotherapy in adults. However, the lack of nanomedicines specifically for pediatric cancer care raises a medical conundrum. This review highlights the current state and progress of nanomedicine in pediatric cancer and discusses the real clinical challenges and opportunities.
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Affiliation(s)
- Carlos Rodríguez-Nogales
- Pharmacy and Pharmaceutical Technology Department , University of Navarra , Pamplona 31008 , Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona 31008 , Spain
| | | | - Azucena Aldaz
- Department of Pharmacy , Clínica Universidad de Navarra , Pamplona 31008 , Spain
| | - Patrick Couvreur
- Institut Galien Paris-Sud, UMR CNRS 8612, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry Cedex 92296 , France
| | - María J Blanco-Prieto
- Pharmacy and Pharmaceutical Technology Department , University of Navarra , Pamplona 31008 , Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA) , Pamplona 31008 , Spain
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Osteochondromas of the proximal humerus. Diagnostic and therapeutic management. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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35
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Ramos-Pascua LR, Sánchez-Herraéz S, Casas-Ramos P, Mora-Fernández M, Izquierdo-García FM. Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:168-177. [PMID: 29572078 DOI: 10.1016/j.recot.2017.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/04/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. METHODS Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months. RESULTS Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. DISCUSSION Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. CONCLUSIONS Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.
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Affiliation(s)
- L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España.
| | - S Sánchez-Herraéz
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España
| | - P Casas-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España
| | - M Mora-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Burgos, Burgos, España
| | - F M Izquierdo-García
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León, León, España
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Acute Isolated Paraplegia Revealing an Ewing Sarcoma of the Thoracic Spine. J Pediatr Hematol Oncol 2017; 39:e479-e482. [PMID: 28582275 DOI: 10.1097/mph.0000000000000878] [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: 11/26/2022]
Abstract
Ewing sarcoma (ES) infrequently affects the spine. Diagnosis is usually made several weeks following growing symptoms. In this report, we present the case of a child with ES localized at the upper thoracic level. ES was revealed by isolated acute complete paraplegia mimicking medullary stroke. The girl was operated for decompressive laminectomy and tumor removal. Afterwards, she received adjuvant therapy. Subsequently, the child showed a slow improvement of her leg sensitivity associated with a partial motor recovery. ES can affect the mobile spine. Acute symptomatology due to intratumoral hemorrhage and sudden spinal cord compression may suggest the diagnosis. Neurological outcomes following ES are generally poor.
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Bergovec M, Friesenbichler J, Scheipl S, Gilg MM, Leithner A. Extremitätenerhaltende Chirurgie bei Tumoren im Kindesalter. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
RATIONALE Chondrosarcoma, characterized by the production of cartilage matrix, is a common bone tumor, accounting for 20% to 27% of all malignant bone tumors. It often occurs in the cartilage of the pelvis, femur, tibia, and humerus. However, chondrosarcoma of the patella is extremely rare. PATIENT CONCERNS The present study describes a case of chondrosarcoma affecting the right patella in a 68-year-old woman. The chief complaints were painful swelling and limitation of motion of the right knee for about half a year. The pain was a kind of dull ache. The skin around the right knee was red and hot. Moreover, she had a claudication gait due to the symptoms. DIAGNOSES Irregular lytic lesions with ill-defined margins in the patella were determined through computed tomography and magnetic resonance imaging. The diagnosis of primary grade II chondrosarcoma was finally confirmed on the basis of postoperative pathological examination. INTERVENTIONS The patient underwent an open surgery named extensive resection of patellar tumor to remove the tumor tissue completely. OUTCOMES The patient was discharged without any complications 1 week after the surgery. At the 3-month follow-up, the patient was completely free from pain during daily activities, and normal range of motion of the right knee was achieved. Her gait was normal. There was no evidence of recurrence. LESSONS We believe that an extensive resection is suitable for treating chondrosarcoma to avoid as far as possible local recurrence. An awareness of the potential for chondrosarcoma to present in the patella is crucial for both orthopedic surgeons and radiologists when confronted with similar cases. Besides, as reports of chondrosarcoma of the patella are rare, this study adds a better understanding of this rare condition to the medical literature.
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Affiliation(s)
- Conglin Ye
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Jiangxi
| | - Zhiping Luo
- Department of Orthopaedics, Shenzhen Hospital, Southern Medical University, Shenzhen City, China
| | - Jin Zeng
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Jiangxi
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Jiangxi
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Tong K, Liu H, Wang X, Zhong Z, Cao S, Zhong C, Yang Y, Wang G. Osteochondroma: Review of 431 patients from one medical institution in South China. J Bone Oncol 2017; 8:23-29. [PMID: 28932679 PMCID: PMC5587240 DOI: 10.1016/j.jbo.2017.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The geographic distribution of osteochondroma (OC) varies greatly around the world. There has been no recent report on OC in a large Chinese population. The aim of this study was to characterize OC by an epidemiological analysis of the clinical data from one medical institution in South China. METHODS We searched medical electronic records from January 2001 to January 2016 in one large hospital in South China to identify patients with a definite diagnosis of OC. Their epidemiological data were collected and analyzed statistically, including gender, tumor site, age at first diagnosis and symptoms, local recurrence and malignant transformation. Differences between genders and between solitary osteochondroma (SO) and multiple osteochondroma (MO) were particularly analyzed. RESULTS A total of 431 OC patients (291 males and 140 females; 329 SOs and 102 MOs) were identified. The gender ratio was 2.08 with a male predominance. OCs were mostly located around the knee (250 cases). 280 patients were in their 0s to 20s upon first diagnosis. The average age at the time of first diagnosis was 20.63 years for all, 18.47 years for males and 25.11 years for females (P=0.000). OC recurred locally in 35 patients (15 SOs and 20 MOs), with a significant difference between SO/MO (P=0.000) but not between genders (P=0.100). The average interval from the primary surgery to local or malignant recurrence was 37.41 months. Malignant transformation was found in 5 patients (4 males and 1 female), showing no gender difference (P=0.549). CONCLUSIONS OC may have a male predominance in Chinese population. It mostly occurred at 0-20 years of age and around the knee. Upon the first diagnosis of OC, the males tended to be younger than the females, and so did the MO patients than the SO ones. In addition, MO had a higher incidence of local recurrence. Intervals from primary surgery to local recurrence or malignant transformation in MO patients were longer than in SO patients.
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Affiliation(s)
- Kai Tong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Hongzhe Liu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Xiang Wang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Ziyi Zhong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Shenglu Cao
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Chengjie Zhong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - YunPing Yang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Gang Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
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40
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Zhu B, Yang J, Cheng D, Yin X, Yang Q. Reconstruct the proximal radius with iliac graft and elastic intramedullary nail fixation after tumor resection. World J Surg Oncol 2016; 14:210. [PMID: 27503010 PMCID: PMC4977868 DOI: 10.1186/s12957-016-0964-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/29/2016] [Indexed: 01/04/2023] Open
Abstract
Background This study aims to introduce a novel technique in treating benign bone tumors of the proximal radius by elastic intramedullary nail fixation and iliac graft after tumor resection. Method In this retrospective case series, the treatment outcomes of 17 patients with benign bone tumor involving the proximal radius were reported from January 2010 to August 2014. All the patients received reconstruction surgery with iliac graft and elastic intramedullary nail fixation after tumor resection. Pain scoring was assessed using the 0 to 10 numerical rating scale. The quality of life scoring was assessed using the SF-30 scoring system. In addition, functional outcome was assessed with the Musculoskeletal Tumor Society score and the Disabilities of the Arm, Shoulder, and Hand score. Results The mean follow-up was 16 months (range, 10–22). The average bone consolidate time was 19.2 weeks (range, 16–24 weeks). The pre- and postoperative pain scores were 5.47 ± 1.58 and 1.18 ± 0.39, respectively. The pain symptom was significantly ameliorated after the operation (t = 13.50, p < 0.01). The pre- and postoperative and the quality of life scores were 48.29 ± 6.58 and 77.47 ± 5.89, respectively; the quality of life score was dramatically improved (t = −20.11, p < 0.01). The mean Musculoskeletal Tumor Society score was 83.41 % (range, 63–93 %) and the mean Disabilities of the Arm, Shoulder, and Hand score was 14.1 (range, 5.8–38.3). Conclusion Taken together, the application of iliac graft and elastic intramedullary nail fixation after excision of lesions might be associated to a significant reduction of the pain and improvement of QOL (quality of life) and limb function of patients with benign bone tumors of proximal radius.
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Affiliation(s)
- Bin Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Jielai Yang
- Department of Orthopedics, Minhang Hospital, Fudan University, No.170 Xinsong Road, Shanghai, 201199, China
| | - Dongdong Cheng
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Xiaofan Yin
- Department of Orthopedics, Minhang Hospital, Fudan University, No.170 Xinsong Road, Shanghai, 201199, China.
| | - Qingcheng Yang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China.
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Gerrand C, Athanasou N, Brennan B, Grimer R, Judson I, Morland B, Peake D, Seddon B, Whelan J, On behalf of the British Sarcoma Group. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016; 6:7. [PMID: 27148438 PMCID: PMC4855334 DOI: 10.1186/s13569-016-0047-1] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/09/2016] [Indexed: 01/02/2023] Open
Abstract
This document is an update of the British Sarcoma Group guidelines published in 2010. The aim is to provide a reference standard for the clinical care of patients in the UK with bone sarcomas. Recent recommendations by the European Society of Medical Oncology, The National Comprehensive Cancer Network and The National Institute for Health and Care Excellence have been incorporated, and the literature since 2010 reviewed. The standards represent a consensus amongst British Sarcoma Group members in 2015. It is acknowledged that these guidelines will need further updates as care evolves. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and that patients with clinico-radiological findings suggestive of a primary bone tumour at any site in the skeleton should be referred to a specialist centre and managed by a fully accredited bone sarcoma multidisciplinary team. Treatment recommendations are provided for the major tumour types and for localised, metastatic and recurrent disease. Follow up schedules are suggested.
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Affiliation(s)
- Craig Gerrand
- />Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
| | | | | | - Robert Grimer
- />Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
| | | | - Bruce Morland
- />Birmingham Children’s Hospital, Birmingham, B4 6NH UK
| | - David Peake
- />Queen Elizabeth Hospital, Birmingham, B15 2TH UK
| | | | | | - On behalf of the British Sarcoma Group
- />Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
- />Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
- />Royal Manchester Children’s Hospital, Manchester, M13 9WL UK
- />Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
- />The Royal Marsden, Sutton, SM2 5PT UK
- />Birmingham Children’s Hospital, Birmingham, B4 6NH UK
- />Queen Elizabeth Hospital, Birmingham, B15 2TH UK
- />University College Hospital, London, NW1 2PG UK
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Roos E, van Coevorden F, Verhoef C, Wouters MW, Kroon HM, Hogendoorn PCW, van Houdt WJ. Prognosis of Primary and Recurrent Chondrosarcoma of the Rib. Ann Surg Oncol 2015; 23:811-7. [PMID: 26498768 DOI: 10.1245/s10434-015-4932-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chondrosarcoma of the rib is a rare disease. Although surgery is the only curative treatment option, rib resection with an adequate margin can be challenging and local recurrence is a frequent problem. In this study, the prognosis of primary and recurrent chondrosarcoma of the rib is reported. METHODS Retrospective analysis was performed of patients treated for chondrosarcoma of the rib between 1984 and 2014 in three major tertiary referral centers in The Netherlands. Clinical and histopathological features were analyzed for their prognostic value using Kaplan-Meier and Cox proportional hazard analysis. Endpoints were set at local recurrent disease, metastasis rate, or death. RESULTS Overall, 76 patients underwent a resection for a primary chondrosarcoma, and 26 patients underwent a resection for a recurrent chondrosarcoma. Five-year overall survival in the primary group was 90%, local recurrence rate was 17%, and metastasis rate was 12%. The 5-year outcome after recurrent chondrosarcoma was lower, with an overall survival of 65%, local recurrence rate of 27%, and metastasis rate of 27%. For primary chondrosarcoma, tumor size >5 cm and a positive resection margin were correlated with worse overall survival [hazard ratio (HR) 3.28, 95% confidence interval (CI) 1.03-10.44; HR 2.92, 95% CI 1.03-8.25). A higher histological grade was correlated with a higher local recurrence and metastasis rate (HR 5.92, 95% CI 1.11-31.65; HR 6.96, 95% CI 1.15-42.60). CONCLUSION Surgical resection of both primary and recurrent chondrosarcoma of the rib is an effective treatment strategy. The oncological outcome after surgery is worse in tumors >5 cm, in tumors with positive resection margins and grade 3 chondrosarcoma.
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Affiliation(s)
- Eva Roos
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frits van Coevorden
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Centre-Daniel den Hoed, Rotterdam, The Netherlands
| | - Michel W Wouters
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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