1
|
Tvrdik T, Gjeorgjievski SG, Wong P, Oskouei S, Read W, Bahrami A. Genomic Insights Into High-Grade Infarct-Associated Bone Sarcomas. Mod Pathol 2024; 37:100572. [PMID: 39033963 DOI: 10.1016/j.modpat.2024.100572] [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: 05/20/2024] [Revised: 07/06/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Sarcomas rarely develop in bones previously compromised by infarcts. These infarct-associated sarcomas often present as undifferentiated pleomorphic sarcomas (UPS), and their genetic characteristics are poorly understood. High-grade UPS of bone are typically treated with a combination of surgery and chemotherapy, similar to osteosarcoma. We conducted a detailed clinicopathologic and genomic analysis of 6 cases of intraosseous sarcomas arising from histologically and radiographically confirmed bone infarcts. We analyzed 523 genes for sequence-level mutations using next-generation sequencing with the TruSight Oncology 500 panel and utilized whole-genome single nucleotide polymorphism Microarray (OncoScan CNV) to detect copy number alterations and loss of heterozygosity (LOH). Genomic instability was assessed through homologous recombination deficiency (HRD) metrics, incorporating LOH, telomeric allelic imbalance, and large-scale state transitions. Fluorescence in situ hybridization and immunohistochemistry validated the findings. The cohort included 3 men and 3 women, with a median age of 70 years, and tumors located in the femur and tibia. Five of the 6 patients developed distant metastases. Treatment involved surgery and chemotherapy or immune checkpoint inhibitors. Genomic analysis revealed significant complexity and high HRD scores, ranging from 32 to 57 (with a cutoff of 32). Chromosome 12 alterations, including segmental amplification or chromothripsis, were observed in 4 cases. Notably, MDM2 amplification, confirmed by fluorescence in situ hybridization, was detected in 2 cases. Homozygous deletion of CDKN2A/B was observed in all six cases. Tumor mutational burden levels ranged from 2.4 to 7.9 mutations per megabase. Notable pathogenic mutations included H3-3A mutations (p.G35R and p.G35W), and mutations in HRAS, DNMT3A, NF2, PIK3CA, POLE, and TP53, each in one case. These results suggest that high-grade infarct-associated sarcomas of bone, whereas sharing high levels of structural variations with osteosarcoma, may exhibit potentially less frequent TP53 mutations and more common CDKN2A/B deletions. This points to the possibility that the mutation spectrum and disrupted pathways could be distinct from conventional osteosarcoma.
Collapse
Affiliation(s)
- Tatiana Tvrdik
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | | | - Philip Wong
- Department of Diagnostic Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Shervin Oskouei
- Department of Orthopedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - William Read
- Department of Hematology Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia.
| |
Collapse
|
2
|
Al-Hassi HO, Ali NM, Cooke H, De Silva S, Brini AT, Babu P, Sumathi V, Morris MR, Niada S. FGF23 Expression Is a Promising Immunohistochemical Diagnostic Marker for Undifferentiated Pleomorphic Sarcoma of Bone (UPSb). Genes (Basel) 2024; 15:242. [PMID: 38397231 PMCID: PMC10887495 DOI: 10.3390/genes15020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Undifferentiated pleomorphic sarcoma of bone (UPSb) is a rare primary bone sarcoma that lacks a specific line of differentiation. Distinguishing between UPSb and other malignant bone sarcomas, including dedifferentiated chondrosarcoma and osteosarcoma, is challenging due to their overlapping features. We have previously identified that UPSb tumours have elevated mRNA levels of Fibroblast Growth Factor 23 (FGF23) transcripts compared to other sarcomas including osteosarcoma. In the present study, we evaluated the specificity and practicality of FGF23 immunoreactivity as a specific diagnostic tool to differentiate UPSb tumours from osteosarcomas and dedifferentiated chondrosarcomas. Methods: A total of 10 UPSb, 10 osteosarcoma, and 10 dedifferentiated chondrosarcoma cases (all high-grade), were retrieved and immunohistochemistry for FGF23 was performed. Results: FGF23 protein was expressed at high levels in 80-90% of undifferentiated pleomorphic sarcoma of the bone cases, whereas it was expressed at significantly lower levels in dedifferentiated chondrosarcoma and osteosarcoma cases. A semiquantitative analysis, considering the intensity of immunoreactivity, confirmed significantly elevated FGF23 expression levels in UPSb tissues compared to those observed in osteosarcoma and dedifferentiated chondrosarcoma tissues. Conclusions: The results we present here suggest that FGF23 immunohistochemistry may be a useful tool to aid in differentiating UPSb from morphologically similar malignant bone sarcomas, especially in situations where sampling is restricted and there is limited clinical information available.
Collapse
Affiliation(s)
- Hafid O. Al-Hassi
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Naser M. Ali
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
- Department of Medical Laboratories, General Ahmadi Hospital (KOC Hospital), Ahmadi 61008, Kuwait
| | - Hannah Cooke
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Shamini De Silva
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Anna T. Brini
- Laboratory of Biotechnological Applications, IRCCS Orthopedic Institute Galeazzi, 20157 Milan, Italy;
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy
| | - Pavithra Babu
- Acute Medicine, Birmingham Heartlands Hospital, University Hospital Birmingham, Birmingham B9 5SS, UK;
| | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, University Hospital of Birmingham, Birmingham B15 2TT, UK;
| | - Mark R. Morris
- Research Institute of Healthcare Science, Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK; (H.C.); (M.R.M.)
| | - Stefania Niada
- Laboratory of Biotechnological Applications, IRCCS Orthopedic Institute Galeazzi, 20157 Milan, Italy;
| |
Collapse
|
3
|
Vijayakumar G, Steffer EM, Buac NP, Colman MW, Gitelis S, Blank AT. Evaluation of Absolute Neutrophil Count in the Perioperative Setting of Sarcoma Resection. Adv Orthop 2024; 2024:4873984. [PMID: 38298807 PMCID: PMC10830284 DOI: 10.1155/2024/4873984] [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] [Received: 02/16/2023] [Revised: 12/06/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Introduction Limb salvage surgery (LSS) is the preferred surgical treatment for bone sarcomas. Preoperatively, many patients receive chemotherapy and may develop neutropenia. No study has evaluated the effect of a low preoperative absolute neutrophil count (ANC) on postoperative outcomes following LSS. Methods This was a retrospective review of 114 patients who underwent LSS for bone sarcoma from 2010 to 2020. Preoperative lab values were analyzed by logistic regression to identify the risk of developing surgical complications within 30 days, surgical site infection (SSI), and reoperation. Results Three (2.6%) patients experienced a surgical complication within 30 days. Twelve (10.53%) patients experienced postoperative SSI. Twenty-nine (25.4%) required reoperation. Preoperative ANC was not a significant predictor of surgical complications within 30 days, SSI, or reoperation. The only independent predictor of worse overall survival was the presence of a pathologic fracture at the time of surgery. Conclusion This is the first study to evaluate preoperative ANC on postoperative outcomes following LSS. We report no significant differences in surgical complications within 30 days, SSI, or reoperation with low preoperative ANC. Future studies with larger cohorts of neutropenic patients are needed to evaluate these outcomes, as our cohort had very few neutropenic patients due to selection bias.
Collapse
Affiliation(s)
- Gayathri Vijayakumar
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Emma M. Steffer
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Neil P. Buac
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Matthew W. Colman
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan T. Blank
- Department of Orthopedic Surgery, Division of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
4
|
Yuan LL, Chen Z, Qin J, Qin CJ, Bian J, Dong RF, Yuan TB, Xu YT, Kong LY, Xia YZ. Single-cell sequencing reveals the landscape of the tumor microenvironment in a skeletal undifferentiated pleomorphic sarcoma patient. Front Immunol 2022; 13:1019870. [PMID: 36466840 PMCID: PMC9709471 DOI: 10.3389/fimmu.2022.1019870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/25/2022] [Indexed: 09/12/2024] Open
Abstract
Skeletal undifferentiated pleomorphic sarcoma (SUPS) is an invasive pleomorphic soft tissue sarcoma with a high degree of malignancy and poor prognosis. It is prone to recur and metastasize. The tumor microenvironment (TME) and the pathophysiology of SUPS are barely described. Single-cell RNA sequencing (scRNA-seq) provides an opportunity to dissect the landscape of human diseases at an unprecedented resolution, particularly in diseases lacking animal models, such as SUPS. We performed scRNA-seq to analyze tumor tissues and paracancer tissues from a SUPS patient. We identified the cell types and the corresponding marker genes in this SUPS case. We further showed that CD8+ exhausted T cells and Tregs highly expressed PDCD1, CTLA4 and TIGIT. Thus, PDCD1, CTLA4 and TIGIT were identified as potential targets in this case. We applied copy number karyotyping of aneuploid tumors (CopyKAT) to distinguish malignant cells from normal cells in fibroblasts. Our study identified eight malignant fibroblast subsets in SUPS with distinct gene expression profiles. C1-malignant Fibroblast and C6-malignant Fibroblast in the TME play crucial roles in tumor growth, angiogenesis, metastasis and immune response. Hence, targeting malignant fibroblasts could represent a potential strategy for this SUPS therapy. Intervention via tirelizumab enabled disease control, and immune checkpoint inhibitors (ICIs) of PD-1 may be considered as the first-line option in patients with SUPS. Taken together, scRNA-seq analyses provided a powerful basis for this SUPS treatment, improved our understanding of complex human diseases, and may afforded an alternative approach for personalized medicine in the future.
Collapse
Affiliation(s)
- Liu-Liu Yuan
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Zhong Chen
- Department of Orthopedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Jian Qin
- Department of Orthopedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Cheng-Jiao Qin
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jing Bian
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Rui-Fang Dong
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Tang-Bo Yuan
- Department of Orthopedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Yi-Ting Xu
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Ling-Yi Kong
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Yuan-Zheng Xia
- Jiangsu Key Laboratory of Bioactive Natural Product Research and State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, China
- Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education and Guangxi Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Nanning, China
| |
Collapse
|
5
|
Kobayashi H, Zhang L, Hirai T, Tsuda Y, Ikegami M, Tanaka S. Clinical characteristics of undifferentiated pleomorphic sarcoma of bone and the impact of adjuvant chemotherapy on the affected patients: a population-based cohort study. Jpn J Clin Oncol 2022; 52:589-598. [DOI: 10.1093/jjco/hyac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Clinical characteristics of undifferentiated pleomorphic sarcoma of bone are not elucidated. Herein, we clarify its clinical features and analyze the efficacy of adjuvant chemotherapy in patients with undifferentiated pleomorphic sarcoma of bone.
Methods
Prognostic factors and estimated disease-specific survival in 247 patients with primary undifferentiated pleomorphic sarcoma of bone were identified from a registry in Japan. The effect of adjuvant chemotherapy was evaluated in localized resectable cases, and the characteristics of the two groups treated with or without chemotherapy were adjusted using propensity score matching.
Results
The 5-year disease-specific survival rates were 47.4% in the entire cohort and 56.4 and 16.9% in the M0 and M1 groups, respectively. Multivariate disease-specific survival analysis revealed that metastasis on initial presentation and age ≥ 65 years were poor prognostic factors. Overall, 132 localized and resectable primary lesions were extracted. Adjuvant chemotherapy administration was a favorable prognostic factor (hazard ratio: 0.43, P = 0.04), and it significantly prolonged disease-specific survival compared with no adjuvant chemotherapy (5-year disease-specific survival: 78.8% vs. 51.8%, P = 0.008). Adjuvant chemotherapy prolonged disease-specific survival in patients with tumor size <8 cm (5-year disease-specific survival: 100% vs. 54.6%, P = 0.02); however, its efficacy decreased in those with tumor size ≥8 cm (5-year disease-specific survival: 68.7% vs. 42%, P = 0.09). After propensity score matching, adjuvant chemotherapy was significantly associated with good disease-specific survival (P = 0.02).
Conclusions
Metastasis in the initial presentation was the poorest prognostic factor. On evaluating localized and resectable cases only, adjuvant chemotherapy significantly improved disease-specific survival, although its effect decreased in cases with large tumors.
Collapse
Affiliation(s)
- Hiroshi Kobayashi
- The University of Tokyo, Department of Orthopaedic Surgery, Bunkyo-ku, Tokyo, Japan
| | - Liuzhe Zhang
- The University of Tokyo, Department of Orthopaedic Surgery, Bunkyo-ku, Tokyo, Japan
| | - Toshihide Hirai
- The University of Tokyo, Department of Orthopaedic Surgery, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Tsuda
- The University of Tokyo, Department of Orthopaedic Surgery, Bunkyo-ku, Tokyo, Japan
| | - Masachika Ikegami
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Department of Musculoskeletal Oncology, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- The University of Tokyo, Department of Orthopaedic Surgery, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
6
|
Gusho CA, Lee L, Guntin J, Blank AT. Comparison of Features and Outcomes of Undifferentiated Pleomorphic Sarcoma of Bone and Soft Tissue. J Surg Res 2021; 270:313-320. [PMID: 34731728 DOI: 10.1016/j.jss.2021.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This investigation compared outcomes of patients with undifferentiated pleomorphic sarcoma of soft tissue (UPS-S) to UPS of bone (UPS-B). METHODS The Surveillance, Epidemiology, and End Results database was reviewed from 1975-2016. Disease-specific survival (DSS) was estimated using Kaplan-Meier, and a multivariable Cox regression model identified factors prognostic of DSS. The UPS-S cohort consisted of 4529 patients and the UPS-B cohort consisted of 200 patients. The smaller UPS-B cohort was bootstrapped to create a size-matched cohort of 4500 patients. RESULTS The median age of patients with UPS-S was 67 (54;78) y compared to 55 (40;69) y for UPS-B patients (P < 0.001). For UPS-S, the median DSS was 317 mo compared to 70 for UPS-B (P = 0.020). On multivariable analysis for UPS-S, age (HR, 1.018; 95% CI, 1.01-1.03; P < 0.001), non-extremity tumors (HR, 1.490; 95% CI 1.14-1.95; P = 0.004), and AJCC Stage III (HR, 2.238; 95% CI 1.2-4.17; P = 0.011), and Stage IV (HR, 9.388; 95% CI 4.69-18.79; P < 0.001) disease were negative prognostic factors, while surgery (HR 0.234; 95% CI, 0.16-0.34; P < 0.001) was a positive prognostic factor. For UPS-B, tumor size > 8 cm (HR, 3.101; 95% CI, 1.09-8.75; P = 0.033) was the only prognostic factor identified. CONCLUSIONS The current study found a strong association between surgery and survival for UPS-B patients on a univariable analysis, but no treatment type was associated with survival in a multivariable model. Further research is needed to reliably inform the optimal treatment of these patients.
Collapse
Affiliation(s)
- Charles A Gusho
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
| | - Linus Lee
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois.
| | - Jonathan Guntin
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
| | - Alan T Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
7
|
Berkeley R, Andrei V, Saifuddin A. The rare primary bone sarcomas: imaging-pathological correlation. Skeletal Radiol 2021; 50:1491-1511. [PMID: 33410967 DOI: 10.1007/s00256-020-03692-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
Rare primary bone sarcomas are challenging entities both radiologically and pathologically. These include the diagnoses of spindle cell sarcoma (leiomyosarcoma, fibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor), pleomorphic liposarcoma, and undifferentiated pleomorphic sarcoma. The radiographic and cross-sectional imaging features of each of these tumors are presented, along with current key pathological concepts. Frequently non-specific, the radiological appearances must be correlated with all clinical and pathological information available to enable an accurate diagnosis.
Collapse
Affiliation(s)
- Rupert Berkeley
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Vanghelita Andrei
- Department of Pathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| |
Collapse
|
8
|
Brčić I, Rosenberg AE. Pathology of pleomorphic/undifferentiated and dedifferentiated bone neoplasms. Semin Diagn Pathol 2021; 38:163-169. [PMID: 34049746 DOI: 10.1053/j.semdp.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022]
Abstract
Primary malignant bone tumors are uncommon and their accurate classification requires careful correlation of clinical, radiological, and pathologic findings. It is a heterogeneous group of tumors with a wide spectrum of morphology and their biological potential can be of low- or high-grade, depending on their risk for developing metastases. Over the past several decades, the classification of bone sarcomas has remained largely constant. However, some of the tumors have been reclassified and several new entities have emerged. In this review, we will focus on pleomorphic fibrosarcoma/UPS and dedifferentiated bone tumors, discuss their key diagnostic features, differential diagnosis, and their relation to prognosis.
Collapse
Affiliation(s)
- Iva Brčić
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, Division of Bone and Soft tissue, University of Miami, Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospitals, Miami, FL, USA.
| |
Collapse
|
9
|
Humeral Shaft Fracture With Placement of an Intramedullary Nail Through an Unrecognized Sarcoma. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202102000-00009. [PMID: 33620175 DOI: 10.5435/jaaosglobal-d-20-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
CASE A 72-year-old man underwent intramedullary nailing of a humeral diaphysis fracture with passage through an unrecognized pathologic fracture. Four months later, a biopsy of a soft-tissue mass in the arm revealed pleomorphic undifferentiated sarcoma. Only after local recurrence and forequarter amputation was the story of a pathologic fracture through undifferentiated pleomorphic sarcomas of bone clear. The patient developed metastatic disease and died after 2 years postoperatively. DISCUSSION Orthopaedic surgeons should consider sarcoma when assessing patients with fractures of unknown etiology and an inappropriate mechanism because the placement of an intramedullary device through a sarcoma of bone has consequences.
Collapse
|