A novel subchondral bone-grafting procedure for the treatment of giant-cell tumor around the knee: A retrospective study of 27 cases

The vast majority of giant-cell tumors occur around the knee and characteristically affect the subchondral bone. Thermal damage to the articular cartilage arising from the application of polymethylmethacrylate (PMMA) or extensive intralesional curettage presents a challenging problem to orthopedic surgeons and patients due to compliance issues. For this reason, we developed a new subchondral bone-grafting procedure to restore massive bone defects and reduce degenerative changes in the knee.The aim of this study was to describe the novel subchondral bone-grafting procedure and evaluate clinical outcomes in patients with giant-cell tumors around the knee.This retrospective single-center study included a total of 27 patients with giant-cell tumors in the distal femur and proximal tibia admitted to our department from January 2012 to December 2015 and treated with aggressive intralesional curettage. Eleven males and 16 females were included. All cases underwent subchondral autograft bone grafting followed by bone cement reconstruction and instrument internal fixation. The Musculoskeletal Tumor Society (MSTS) score and short form-36 (SF-36) were applied to assess the functional outcome of the knee joint and quality of life. Tumor recurrence, Kellgren and Lawrence (KL) grade, and the distance of the cement to the articular surface were assessed throughout the sample.All cases were followed up after surgery for an average of 32.9 ± 7.1 months (range 25-57 months). At the end of the follow-up period, all patients were alive and free from pulmonary metastasis. Complications associated with this surgery occurred only in 1 patient (3.7%), who presented with an incision infection that resolved with regular dressing and antibiotics. No fractures, instrument breakage, or joint fluid leakage occurred. Local recurrence occurred in 1 case (3.7%) at the distal femur after 23 months and was treated by wide resection followed by prosthesis reconstruction. Twenty-four patients (89%) did not develop radiographic findings of osteoarthritis: at the final follow-up 2 patients (7.4%), had progressed to KL1 and 1 patient had progressed to KL2. According to the MSTS scoring system, the functional score of the affected knee joint at the last follow-up ranged from 80% to 97%, with an average of 87.3%. The quality of life parameters assessed by the SF-36 survey at the last follow-up ranged from 47 to 96, with an average of 77.For patients with giant-cell tumor of bone near the knee, subchondral bone grafting combined with bone cement reconstruction is recommended as a feasible and effective treatment modality.

Primary squamous cell carcinoma of the endometrium in a woman of perimenopausal age: A case report

RATIONALE

Primary squamous cell carcinoma of the endometrium (PSCCE) is a rare entity, and only sporadic cases have been reported in the literature since the 1st report in 1892. This report describes a case of a perimenopausal woman with PSCCE.

PATIENT CONCERNS

A 47-year-old, human papilloma virus type 16-positive, perimenopausal woman was admitted to our hospital with irregular vaginal bleeding for 6 months and secondary anemia.

DIAGNOSES

The patient was diagnosed with stage IIIc primary and moderately differentiated endometrial squamous cell carcinoma.

INTERVENTIONS

The patient underwent diagnostic curettage twice and cold knife conization (CKC). Following this total abdominal hysterectomy combined with bilateral adnexectomy and pelvic lymph node, dissection was performed. After the surgery, the patient was treated with radiotherapy and chemotherapy. Tumor markers were followed up regularly after the operation to monitor tumor recurrence and therapeutic effect.

OUTCOMES

Ninety-two days after the operation, there was tumor recurrence of the left pelvic cavity and the patient died after 11 months of follow-up.

LESSONS

Intrauterine pathology after the 1st diagnostic curettage suggests that high-grade squamous intraepithelial lesion should make the clinician vigilant and investigate the origin of the lesion. Magnetic resonance imaging scans and tumor markers can be used to confirm the diagnosis as soon as possible and avoid unnecessary interventions like CKC.

Laparoscopic Management of an Intrauterine Fallopian Tube Incarceration After Curettage for a Non-progressing Pregnancy

STUDY OBJECTIVE

To report and demonstrate a case of a laparoscopic repair of an intrauterine fallopian tube incarceration as complication of curettage.

DESIGN

A step-by-step explanation of the surgery using video (instructive video) (Canadian Task Force classification III).

SETTING

University Hospital Estaing, Clermont-Ferrand, France.

PATIENT

A 29-year-old woman experiencing a nonevolving pregnancy at 8 weeks underwent curettage. After 9 months, she complained of abnormal vaginal discharge. Ultrasound evaluation showed a right parauterine mass. She reported a maternal medical history of ovarian cancer in a context of Lynch syndrome. Magnetic resonance imaging revealed a right hydrosalpinx 12 mm in diameter, with a suspect fimbriae lesion of the tube and a 7-mm endometriosis nodule of the uterine torus.

INTERVENTION

We decided to explore the fallopian tube by laparoscopy and to perform hysteroscopy. A fallopian tube incarceration was suspected during hysteroscopy: a defect of the uterine wall was observed, through which there was protrusion of a tubal fimbriae. The laparoscopic view of the pelvis confirmed incarceration of the right fallopian tube through the uterine wall. It was carefully extracted out of the uterine defect, and the uterine wall defect was repaired with an X-point using Monocryl 1.

MEASUREMENTS AND MAIN RESULTS

A tubal patency test was performed, which was positive on both sides. Because phimosis responsible for the hydrosalpinx had been treated, salpingectomy was not performed.

CONCLUSION

Curettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.

MRI assessment of the bone adjacent to giant cell tumours and its association with local recurrence after intralesional curettage

AIM

To assess the tumour border surrounding giant cell tumour of the bone (GCTB) using magnetic resonance imaging (MRI) and investigate its association with local recurrence.

MATERIALS AND METHODS

Sixty-nine GCTBs in proximal tibiae and distal femurs were studied. The pathological basis of the paintbrush border sign was explored. Expression of Ki-67, matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), receptor activator of nuclear factor-κ B (RANK), and RANK ligand (RANKL) in GCTBs were investigated using immunohistochemistry. Patients treated with intralesional curettage were analysed retrospectively to investigate the prognostic role of the paintbrush border sign. The differences between rates were tested using the chi-square test or Fisher's exact test, as appropriate.

RESULTS

The paintbrush border sign correlated well with infiltrative margins. The expression of MMP-9 was associated with the paintbrush border sign, and positively correlated with RANKL and VEGF expression. GCTBs with the paintbrush border sign had a higher rate of local recurrence (76.19 versus 20.59%, p<0.05). The paintbrush border sign was more common in proximal tibiae, and positively correlated with cystic change. The paintbrush border signs were detected at T1-weighted imaging, but the sign was only evident in four cases on T2-weighted imaging.

CONCLUSION

Pathologically, the paintbrush border sign correlates well with invasion of the bone around GCTB. MMP-9 might play a key role in the formation of penetrating irregular margins. The paintbrush border sign is revealed as a risk factor for local recurrence of GCTB. Sagittal T1-weighted imaging is crucial to diagnose the paintbrush border sign.

Grafting for bone defects after curettage of benign bone tumor - Analysis of factors influencing the bone healing

BACKGROUND

Simple bone cyst often weaken bone properties and predispose to pathological fractures, requiring tumor excision and the filling of bone defects with grafts to prevent complications. The purpose of this study was to evaluate factors potentially affecting the quality and efficiency of graft healing.

METHODS

This study retrospectively assessed 84 patients with simple bone cysts who had undergone tumor excision and filling of the bone defects with grafts between 2004 and 2014. Various patient-, tumor- and treatment-related factors that could potentially influence radiologic healing status and time to stable healing were evaluated.

RESULTS

Bone healing was not related to gender and age. Graft type was not significantly correlated with both radiologic healing status or time to stable healing. Only two of all variables evaluated were significantly correlated with the prognosis: (1) Tumors location: patients with tumors located at proximal femur were significantly more likely to achieve complete healing (Neer I) (OR = 3.2; 95%CI, 1.29-8.00; p = 0.011). (2) Tumor length: patients with a tumor length less than 6.2 cm, complete healing was nearly five times more likely to occur (OR = 4.84; 95% CI, 1.83-12.84; p = 0.002). Degree of graft filling of the bone defects affected the time to stable healing. The average healing times were 4.86 months for filling degree ≥90% and 5.94 months for filling degrees <90%, respectively (p = 0.009). Postoperative re-fracture occurred in one case.

CONCLUSION

Factors influencing the quality of bone healing following intralesional curettage and bone grafting are proximal femur location and tumor length. A greater degree of graft filling can contribute to higher bone healing efficiency.

Bone combined cement grafting in giant cell tumor around the knee reduces mechanical failure

Objectives

The aims of our study are (1) to explore the risk factors of mechanical failure (MF), (2) to figure out an index to evaluate this risk, and (3) to select an optimal reconstruction strategy to reduce this risk.

Methods

We retrospectively reviewed 104 patients from Dec. 2008 to Mar. 2016, undergone extensive knee curettages in our institution. Radiographs and post-operative interviews were used to classified cases of MF. Relative factors (age, tumor location, the invaded area, etc.) were also collected and analyzed by SPSS software.

Results

Thick subchondral bony layer (p = 0.006) and combined grafting of the cement and bone (p = 0.006) had lower risk of mechanical failure. Mechanical failure appeared to happen in the femur (p = 0.012) more easily. The ROC curve (AUC = 0.722) reveals that less post-operative bony layer (≤ 3.3 mm) is more likely to cause mechanical failure. The Kaplan-Meier survival curve showing increased survival in those patients after a combination grafting surgery (HR, 3.799; p = 0.006).

Conclusion

Based on our study results, combined grafting of the cement and bone reduced the risk of mechanical failure in the knee due to the thin subchondral bone layer (SCB), especially in the femur.

Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors

This study aims to investigate the menstrual recovery outcome of scar pregnancy patients who received uterine artery embolization combined with curettage, and its influencing factors.The data of 119 patients with scar pregnancy, who received uterine artery embolization combined with curettage between December 2012 and December 2016 in Henan Provincival People's Hospital, were collected. The menstruation recovery of these patients was followed up, and factors that have influence on menstrual blood volume were analyzed using SPSS V.17.0.Follow-up data were available in 101/119 (84.9%) women. The median follow-up time was 22.7 months (range: 1.6-50.6 months); 58 (57.4%) patients had reduced menstrual blood volume, and 2 patients (2%) had amenorrhea. The proportion of patients with reduced menstrual blood volume, who were embolized with polyvinyl alcohol (PVA), PVA combined with gelatin sponge, and gelatin sponge between < and ≥33 years old was 41.7% versus 66.7%, 40% versus 57.1% and 60.6% versus 68.0%. The average age of patients with reduced menstrual blood volume (34.3 years) was greater than patients with normal menstrual blood volume (31.4 years), but the difference was not statistically significant (P = .07).Reduced menstrual blood volume can occur in scar pregnancy patients who received uterine artery embolization combined with curettage. The influence of the embolic agent PVA on menstrual blood volume depends on age, but the difference was not statistically significant.

Expression of TP53 and IL-1α in unicystic ameloblastoma predicts the efficacy of marsupialization treatment

In this study, we evaluated the effects of marsupialization in treating unicystic ameloblastoma (UA) and investigated the relationship between TP53 and interleukin 1 α (IL-1α) expression and the clinical outcome of UA treated with marsupialization.Consecutive patients treated with marsupialization and curettage at Shanghai Ninth People's Hospital were included. According to the unified standard, 48 patients were included in this study. Of these, 20 showed a good response, 10 a partial response, and 18 no response, based on the outcome of the marsupialization procedure. The expression of proteins TP53 and IL-1α was detected with immunohistochemistry (IHC). The clinical and pathological characteristics of the patients were analyzed.Analysis of the clinical and pathological characteristics showed that the effects of marsupialization treatment were significantly associated with lesion location (P < .001) and tumor diameter (P = .01). IHC showed that TP53 expression was significantly higher in the good-response group than in the partial- or no-response group (P = .02), and IL-1α expression was significantly higher in the good-response group than in the partial- and no-response groups (P = .03).Marsupialization is an effective preliminary procedure for treating UA before curettage and peripheral ostectomy. The expression of the TP53 and IL-1α proteins correlates directly with the outcome of UA treated with marsupialization.

Surgicel use in control of primary postadenoidectomy bleeding

Although postadenoidectomy bleeding is a rare complication, it is serious and potentially fatal. Postnasal packing and cautery of the adenoid bed are the most popular methods of controlling postadenoidectomy bleeding. Many hazards and complications may arise from traditional nasopharyngeal packing and nasopharyngeal cautery. In this case series, oxidized regenerated cellulose (Surgicel Nu-Knit; Ethicon; Somerville, N.J) was inserted and used as postnasal packing to control primary postadenoidectomy bleeding in 9 cases after conventional curettage adenoidectomy. All patients underwent nasophayngoscopic examination with a 0° rigid telescope to re-curette if any remnant was still present, and were repacked with appropriate size ribbon gauzes for at least 15 minutes before applying Surgicel. Surgicel succeeded in controlling primary postadenoidectomy bleeding in all cases, with no need for any further intervention. At the 1-month follow-up, no complications were reported. We conclude that Surgicel postnasal pack effectively controls primary postadenoidectomy bleeding. Its many advantages make it superior to other traditionally used material. It is readily available, tolerable, relatively inexpensive, hemostatic, adhesive, freely reshaped, bactericidal, causes no granulation reaction, has no need to be removed, and the patient does not need to be in the ICU or sedated.

The management and surgical intervention timing of enchondromas: A 10-year experience

Enchondroma, reportedly the most common primary tumor of the long bones of the hand, usually develops during the first till fourth decades of life. However, there has no consensus been reached regarding the surgical intervention timing for these patients. We aim to evaluate the optimal surgical intervention timing for the patients with fractures due to enchondromas, investigate the impact of pathological fractures on the treatment and outcomes in these patients.Medical records and X-rays of patients treated for enchondroma of the hand from 2005 to 2015 were retrospectively reviewed. We collected 148 cases in total and 92 of them had complete information including X-rays, medical records, and files of follow up.There were no significant differences in terms of consolidation time after surgery, recurrence rate, and DASH scores between the groups with and without fractures; the treatment costs were higher in the group with fractures than those without fractures; however, patients without fractures were able to resume work earlier than those with fractures.The pathological fractures associated with enchondromas have no significant impact on the treatment outcomes compared to those with simple nonfractured enchondromas. Although the cost was more expensive for patients treated primarily with pathological fractures due to enchondromas, these patients could resume their work normally much earlier than those treated by delayed surgery. Early surgical intervention is recommended for better results and no increased risks for patients with pathological fractures caused by enchondromas.

Intralesional curettage of central low-grade chondrosarcoma: A midterm follow-up study

BACKGROUND

The aim of this study was to review the experience of surgical treatment of low-grade chondrosarcoma and to assess the long-term oncological and functional outcomes between intralesional curettage and wide excision.

METHODS

We included 11 patients with central low-grade chondrosarcoma lesions treated with intralesional curettage or wide excision from 1998 to 2013. Seven patients were treated with intralesional curettage and local adjuvant treatment (Group A), and four patients were treated with wide excision and reconstructive surgery (Group B). The mean age of patients was 43.8±17.6 years (range, 20-71 years), and the mean duration of follow-up was 84.4±47.6 months (range, 48-194 months).

RESULTS

Group A had a significantly lower complication rate than Group B; three complications were documented in Group B (0% vs. 75%, p=0.024). The operative time (177.1 hours vs. 366.3 hours, p=0.010) and the hospital stay (6.6 days vs. 12.5 days, p=0.010) were significantly shorter in Group A. There was one local recurrence in Group A without statistical significance. Also, there were no differences between intralesional curettage and wide excision with respect to the blood loss. No metastasis disease occurred in either group during the follow-up period. The Musculoskeletal Tumor Society (MSTS) scores in Groups A and B were 99.0±2.5 and 94.2±4.2, respectively, with statistically significant difference (p=0.048).

CONCLUSION

Extended intralesional curettage has the benefits of good MSTS score, shorter operative time, shorter hospital stay, and lower complication rate without increasing local recurrence in central low-grade chondrosarcoma. For central low-grade chondrosarcoma, we suggest extended curettage to decrease soft tissue damage and surgical risk.

A rare case of aneurymal bone cyst of cuboid bone in a 10-year-old girl

Aneurysmal bone cysts (ABC) are rare and they represent 1- 1.4 % of all primary bone tumors. ABC of cuboid bone are extremely rare, especially in children. Very few cases have been reported in the literature since 1967. We present a case of pathological fracture of cuboid bone due to an aneurysmal cyst in a 10-year-old girl. Surgery was performed, which included open biopsy with aspiration and intralesional curettage . Bone defect was then filled in by fully synthetic cancellous bone graft substitute consisting of pure β-tricalcium phosphate. Aneurysmal cyst of cuboid bone with pathological fracture could be successfully treated with pure β-tricalcium phosphate as a bone graft substitute. This procedure is safe with excellent outcome.Follow up to nearly four years did not show any recurrence.

Primary epiphyseal and metaepiphyseal tubercular osteomyelitis in children A series of 8 case

Clinical series of primary epiphyseal and metaepiphyseal tubercular osteomyelitis are few. The purpose of our study was to retrospectively review the presentation, healing response and functional results of 8 such cases in children.

MATERIAL AND METHODS

The patients were evaluated for pain, deformity, range of motion, limb length discrepancy (if any) and recurrence. Serial radiographs of the region were studied to see remineralization, obliteration of radiological lesions, status of physis and remodeling of the growth plate.

RESULTS

The mean patient age was 7.1 years. Average follow up was 3.7 years. The mean duration of symptom before presentation was 2.9 months (range, 0.5-8 months). Knee region was involved in 4, distal radius in 2, shoulder and distal fibula in 1 patient each. The lesions were either localized or diffuse depending upon physeal involvement and osseous destruction. At the last follow up, the involved joints were painfree and had useful range of motion. Limb length lengthening was seen in all knee patients. The diffuse variety resulted in premature physeal closure. The residual lucencies persisted for several years without any clinical manifestations.

CONCLUSIONS

Primary epiphyseal and metaepiphyseal tuberculosis was relatively uncommon. The clinical outcome was good following curettage and multidrug antitubercular therapy. The epiphyseal and metaphyseal lucencies persisted for several months even after successful treatment. The diffuse variety lead to premature physeal closure. Limb length lengthening was common sequelae of tuberculosis of knee region.

Successful Treatment of a Recurrent Cesarean Scar Pregnancy by Transvaginal Cesarean Scar Pregnancy Lesion Resection: A Case Report

BACKGROUND

Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy with the gestation sac located on a previous cesarean scar. Recurrent CSP (RCSP) is the occurrence of 2 or more consecutive CSPs. Until this case, there have been only 8 previous reported cases of RCSPs in the English-language literature.

CASE

A 30-year-old, Chinese woman was admitted to our hospital for RCSP. We had successfully terminated her first CSP by a series of treatments including uterine arterial embolization with local methotrexate injection, mifepristone, and misoprostol administration, as well as an ultrasound-guided suction curettage evacuation. However, this time we performed only a transvaginal CSP lesion resection, which achieved an improved outcome.

CONCLUSION

This case highlights the likelihood of RCSP and the need for transvaginal CSP lesion resection to decrease the risk of RCSP in CSP patients who desire future pregnancy.

Surface Aneurysmal Bone Cyst: Clinical and Imaging Features in 10 New Cases

Aneurysmal bone cyst originating from the surface of the bone, either within the cortex or subperiosteally, is an uncommon anatomic subtype. This article reports the clinical and radiologic evaluations and treatment outcomes of 10 patients with surface aneurysmal bone cysts that were surgically treated between 1982 and 2014. Mean age at the time of surgery was 22.4 years (range, 11-44 years). According to Capanna's radiographic evaluation criteria, 6 of the lesions were classified as type V and 4 were classified as type IV. Radiographically, periosteal shell formation was observed to be complete in 4 patients, partial in 3, and absent in 3, and 6 patients had Codman's angle or buttress formation. In 1 patient, computed tomography scan showed birdcage-like ossification attached to the surface of bone. Magnetic resonance imaging showed fluid-fluid levels in 5 patients. All of the patients had standard curettage and high-speed burr application as an adjuvant. No patient had local recurrence at the end of the follow-up period of 98.4 months (range, 13-288 months). These findings show the importance of careful radiologic evaluation and biopsy to better plan a treatment strategy when surface aneurysmal bone cyst is included in the differential diagnosis. The finding of fluid-fluid levels on magnetic resonance imaging or computed tomography is not pathognomonic for primary aneurysmal bone cyst; however, the absence of this finding does not rule out the diagnosis. The rate of local recurrence after curettage plus high-speed burr is reasonably low, and other adjuvant procedures should be used whenever needed. [Orthopedics. 2016; 39(5):e897-e903.].

Study of clinical diagnosis of cervical glandular intraepithelial neoplasia

OBJECTIVE

To preliminarily evaluate the clinical significance of different methods in diagnosis of cervical glandular intraepithelial neo- plasia (CGIN).

MATERIALS AND METHODS

Clinical manifestations, ThinPrep cytologic test (TCT), cervical biopsy, and pathological features of 106 patients with CGIN admitted to Beijing Obstetrics and Gynecology Hospital between 2008 and 2011 were retrospectively analyzed.

RESULTS

Among 146 cases diagnosed with CGIN, 87 (59.6%) had L-CGIN and 59 (40.4%) H-CGIN. Thirty-seven patients (25.6%) were found to have simple CGIN and 109 (74.6%) had CGIN complicated with cervical intraepithelial neoplasia (CIN). TCT revealed atypical glandular cells (AGC) in 20 patients (13.7%), six of whom had L-CGIN (6.9%) and 14 (23.7%) had H-CGIN with statistical significance between two groups (p < 0.05). TCT detected AGC in 13 cases (35.1%) with simple CGIN and seven with mixed CGIN (6.4%) (P<0.05). Endocervical curettage (ECC) revealed AGC abnormality in ten cases (25.6%). Cervical biopsy under colposcope revealed 32 patients (22.9%) had CGIN, including 15 L-CGIN (18.3%), and 17 H-CGIN (29.3%) with no statistical significance (p > 0.05). Among those diagnosed with CGIN by colposcope-assisted cervical biopsy, 19 (51.4%) had simple CGIN and 13 (11.9%) mixed CGIN (p < 0.05).

CONCLUSION

Preoperative diagnostic rate of simple CGIN was higher than CGIN complicated with CIN.

"Three-in-One minimally invasive approach to surgical treatment of pediatric pathological fractures with wide bone loss through bone cysts: ESIN, curettage and packing with injectable HA bone substitute. A retrospective series of 116 cases."

INTRODUCTION

The outcome of pathological fracture due to large aggressive benign stage 3 Dormans and Flynn lesions [6] is often unsatisfactory and the rate of recurrence is high. No single technique has been considered safe and successful. Many Authors suggested curettage and bone grafting as the unique effective treatment in cases of large defect but, because of the invasive and complex nature of the operation (it needs a double-step procedure), it is not preferred. The purpose of this study is to examine the effectiveness of a minimally invasive treatment in one step through ESIN, curettage and packing with self-setting calcium phosphate cement.

PATIENTS AND METHODS

This is a retrospective study of 116 children admitted at the Division of Pediatric Orthopaedics Surgery of Santobono Children Hospital between 2006 and 2014 with a diagnosis of pathological fracture due to large aggressive ostheolytic benign lesions (stage 3 Dormans and Flynn). The size of bone loss was measured on the AP and ML radiographs and all the cysts with a caudo cranial extension from 5 to 8cm and with a medio lateral extension from 3 to 5cm were included. Mean time follow up 24 months was performed.

RESULTS

The three-in-one procedure was applied in all 116 patients. After two years of follow up, 113 patients were classified as healed and just 3 required 3 years to complete heal. No severe life threatening adverse effects or complications associated with the use of ESIN and injectable HA were recorded during the follow up period of 24-36 months. Fracture healing occurred in all cases within 4-6 weeks with adequate periosteal and endosteal callus formation. No second pathological fractures occurred in our series as well as no cysts reoccurred. Patients with humeral localizations showed a more rapid regain of muscular function and reestablishment of a complete range of motion.

CONCLUSIONS

The proposed three-in-one procedure has shown to be efficient, cost-effective, associated to high rates of definitive bone healing and low incidence of adverse effects.

Operative treatment of chondroblastoma: a study of 11 cases

Aim of the study was to review the radiological, clinical results of 11 chondroblastoma cases treated at our institute between 2003-2013. All patients with chondroblastoma included in this study underwent intra-lesional curettage+/-bone grafting. Follow up for healing of chondroblastoma lesions and detection of any local recurrence was assessed on clinical and radiological bases. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. The mean follow-up period was 6.1 years. There were three recurrences (two femoral head, one proximal tibia). The mean Musculoskeletal Tumour Society functional score was 21. First line aggressive treatment seems appropriate for chondroblastoma especially when localized at lower extremities.

[Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius: A Meta-analysis]

OBJECTIVE

To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours (GCT) of the distal radius and analyze them which were in high quality by means of Meta analysis, in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery.

METHODS

Cochrane central register of controlled trials(Issue 8 2014), PubMed(1970-01-01/2013-01-01), Ovid (1970-01-01/2013- 01-01), Elsevier (1970-01-01/2013-01-01), CNKI (1970-01-01/2013-01-01) were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors (GCTs) of the distal radius in the literatures, selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta-analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally, the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated.

RESULTS

Seven relevant articles were identified involving total 163 cases. Among them, 92 cases were intralesional curettage (PMMA, n = 54; bone graft, n = 33; no PMMA or bone grafts, n = 5) and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR = 3.87, 95% CI (1.42, 10.53)],especially for Campanacci grade 3 GCTs [OR = 10.12, 95% CI (1.57, 65.27)], yet fewer major complications [OR = 0.13, 95% CI (0.04, 0.40)] than the wide excision group. The use of PMMA versus bone graft did not affect the recur- rence rate [OR = 0.96, 95% CI (0.26, 3.56)]. By selecting the system evaluation of MSTS, the VAS and dynamometer, the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.

CONCLUSION

Based on data obtained from the limited number of studies available, intralesional curettage appears to be moreappropriate for the treatment of local lesions (Grade 1 and 2) than Grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant, the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation.

Extranodal Rosai-Dorfman Disease as Isolated Lesion of the Tibia Diagnosed by Fine-Needle Aspiration Cytology: A Case Report

Few studies have used fine-needle aspiration cytology for the purpose of isolated skeletal Rosai-Dorfman diseases (RDDs) diagnosis.Herein, we described an extremely rare case of a 56-year-old woman who presented to our hospital with an insidious onset of pain in the right proximal tibia.The provisional cytologic diagnosis of RDDs was confirmed by a computer tomography-guided core needle biopsy of the lesion. Subsequently, curettage and autogenous iliac crest bone graft were performed successfully. At the 4th year of follow-up her clinical symptoms disappeared, and there was no clinical evidence of lesion recurrence.Our case highlighted the role of fine-needle aspiration cytology with immunohistochemical studies in the diagnosis of RDDs and the characteristic features of isolated skeletal RDDs in an unusual location, the knowledge of which would help avoid missed or delayed diagnosis in the future.

Laparoscopic hepatectomy by curettage and aspiration: a report of 855 cases

BACKGROUND

In 1998, the technique of laparoscopic hepatectomy by curettage and aspiration was developed and a special instrument, laparoscopic multifunctional operative dissector (LPMOD), was designed for this procedure. In the past 17 years, this procedure was developed gradually and had become the routine procedure for laparoscopic hepatectomy in local area. This paper is to report results of 17-year practice of this procedure.

METHODS

Patients who underwent laparoscopic hepatectomy from August 1998 to March 2015 were reviewed. Hepatectomies were performed using the technique of laparoscopic hepatectomy by curettage and aspiration. By using the LPMOD, liver parenchyma was crashed and aspirated immediately and the intrahepatic ducts and small vessels were preserved and were safely dissected for ligation. Laparoscopic selective hepatic flow occlusion was performed routinely for hemi-hepatectomies to control intraoperative blood loss.

RESULTS

A total of 855 cases underwent laparoscopic hepatectomy by curettage and aspiration. No perioperative death, 105 patients were converted to open operation, and 84 of them were converted before liver transection without any emergency. Postoperative bleeding occurred in three patients (0.4 %), and bile leakage occurred in seven patients (0.8 %).

CONCLUSION

Laparoscopic hepatectomy by curettage and aspiration is a safe procedure for liver resection with acceptable morbidity and mortality.

Current Understanding of Seborrheic Keratosis: Prevalence, Etiology, Clinical Presentation, Diagnosis, and Management

Seborrheic keratosis (SK) is among the most common cutaneous lesions, affecting some 83 million Americans. Biologically benign, SK lesions do not require removal for medical reasons unless histologic confirmation of the clinical diagnosis is required or the lesions are traumatized and/or become symptomatic. These macular or popular pigmented lesions are often of cosmetic concern to patients. In addition, their natural history of gradually increasing in size, thickness, and/or pigmentation often serves as the impetus compelling patients to present to a dermatologist for evaluation and skin cancer screening; SK is diagnosed and managed primarily by dermatologists. Data regarding SK prevalence and management from a survey of 594 practicing, board-certified dermatologists are summarized herein: Dermatologists report they diagnose an average of 155 patients per month with SK. Among SK patients presenting to dermatologists, 33% have more than 15 SK lesions and 67% have 15 or fewer SK lesions. On average, dermatologists treat 43% of their SK patients to remove lesions. Cryosurgery is the most common removal method. Other commonly employed removal methods include shave excision, electrodessication, curettage or a combination of these. While these procedures can be used to remove SK lesions effectively, each has potential drawbacks and careful patient selection is required to optimize cosmetic results particularly in skin of color patients and patients with thick or numerous lesions. While there is great interest from both patients and providers in a topical non-invasive treatment for SK, no effective topical therapeutic agent has been developed, and this remains an area of unmet need.

Giant Cell Tumor of the Talus: 19-Year Follow-Up of a Patient

Giant cell tumor in small bones is a rare condition characterized by extensive bony destruction and a high recurrence rate. Intralesional excision with curettage and autologous bone grafting has been used as a standard treatment method for giant cell tumor of the bones. We report the case of a 30-year-old female with giant cell tumor of the talar body. She was followed up for 19 years after intralesional curettage and autologous bone grafting treatment.

Reliability of Endocervical Curettage in the Diagnosis of High-grade Cervical Neoplasia and Cervical Cancer in Selected Patients

AIM

To analyze the reliability of endocervical curettage (ECC) in the diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer, and to identify risk factors associated with diagnostic underestimation.

MATERIALS AND METHODS

A retrospective study was carried-out involving 445 patients who underwent ECC for: endocervical lesion incompletely visible on colposcopy or inaccessible to biopsy; atypical glandular cells on smear, or discrepancy between colposcopic impression and cytological abnormalities.

RESULTS

Comparison between ECC and final diagnosis showed a perfect match in 362 patients (81.3%). For 189 patients with pre-cancerous or cancerous endocervical lesions, the sensitivity, specificity, and positive and negative predictive values were 87.3%, 96.9%, 95.4% and 91.9%, respectively. No clinical, cytological or colposcopic characteristics were associated with significantly increased risk of diagnostic underestimation with ECC.

CONCLUSION

ECC is a very reliable tool for reducing the number of unnecessary treatments, without increasing the risk of allowing some lesions to evolve into cancer.