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Toepfer A, Potocnik P, Harrasser N, Schubert T, Khan Z, Farei-Campagna JM. Principles of Defect Reconstruction After Wide Resection of Primary Malignant Bone Tumors of the Calcaneus: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241266247. [PMID: 39132497 PMCID: PMC11316265 DOI: 10.1177/24730114241266247] [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] [Indexed: 08/13/2024] Open
Abstract
Visual AbstractThis is a visual representation of the abstract.
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Affiliation(s)
- Andreas Toepfer
- Kantonsspital St. Gallen, Orthopaedics and Traumatology, St. Gallen, Switzerland
| | - Primoz Potocnik
- Kantonsspital St. Gallen, Orthopaedics and Traumatology, St. Gallen, Switzerland
| | - Norbert Harrasser
- ECOM Excellent Center of Medicine, Munich, Germany
- Department of Orthopaedics and Sportorthopaedics, Klinikum rechts der Isar Technical University Munich, München, Germany
| | - Thomas Schubert
- Cliniques universitaires Saint-Luc, Orthopaedics and Traumatology, Brussels, Belgium
| | - Zeeshan Khan
- Rehman Medical Institute, Department of Trauma and Orthopaedic Surgery, Peshawar, KP, Pakistan
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Scheele C, Toepfer A, Beischl S, Dammerer D, Harrasser N, von Eisenhart-Rothe R, Lenze F. Insights into the Distribution Patterns of Foot and Ankle Tumours: Update on the Perspective of a University Tumour Institute. J Clin Med 2024; 13:350. [PMID: 38256484 PMCID: PMC10815983 DOI: 10.3390/jcm13020350] [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: 12/06/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
The rarity of foot and ankle tumours, together with the numerous histological entities, presents a challenge in accumulating sufficient patients to draw reliable conclusions. Therefore, we decided to present an update of a retrospective analysis of their distribution patterns, comprising 536 cases of foot and ankle tumours presented to our tumour board between June 1997 and June 2023. Our aim was to provide a comprehensive overview of the prevalence and distribution patterns of benign and malignant bone and soft tissue tumours of the foot and ankle. A total of 277 tumours involved bone (51.7%). Of these, 242 (87.4%) were benign and 35 (12.6%) were malignant. In addition, 259 soft tissue tumours (48.3%) were found, of which 191 (73.7%) were benign and 68 (26.3%) were malignant. The most common benign bone tumours were simple bone cysts, enchondromas, osteochondromas, aneurysmal bone cysts, and lipomas of bone. Common benign soft tissue tumours included a tenosynovial giant cell tumour, haemangioma, plantar fibromatosis, schwannoma, and lipoma. The most common malignant soft tissue tumours were synovial sarcoma, malignant melanoma, and myxofibrosarcoma. In terms of anatomical location, the hindfoot was the most common site (28.7%), followed by the midfoot (25.9%), ankle (25.4%), and forefoot (20.0%). The distribution of benign entities often follows typical patterns, which may facilitate an early diagnosis even without biopsy (e.g., simple bone cyst, plantar fibromatosis). On the other hand, the distribution patterns of many rare or malignant entities are inconsistent. Individual soft tissue malignancies occur very sporadically, even over long periods of time and in specialized tumour centres. It is therefore important to recognise that any suspicious mass in the foot and ankle must be considered a possible malignancy until proven otherwise.
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Affiliation(s)
- Christian Scheele
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Andreas Toepfer
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland;
| | - Simone Beischl
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria;
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
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Abstract
BACKGROUND Osteoid osteoma is the third most common benign bone tumor and typically induces pain that is worse at night. OBJECTIVE To identify the epidemiological, pathogenetic, histological and radiological characteristics of osteoid osteoma and to present the broad variety of treatment options. MATERIAL AND METHODS This review article summarizes relevant clinical studies and meta-analyses on this topic. RESULTS Osteoid osteoma is characterized by a central nidus smaller than 1.5 cm in diameter with surrounding bone sclerosis. In the majority of cases, the tumor occurs in the long bones of the lower extremities and is predominantly manifested in patients aged between 5 and 25 years. Pain is mediated by prostaglandins, which stimulate afferent peripheral nerve fibers. Besides plain radiographs, thin-section computed tomography represents the gold standard of diagnostics but should be complemented by magnetic resonance or nuclear medicine imaging modalities. The conservative treatment consists of long-term therapy with non-steroidal anti-inflammatory drugs. Minimally invasive radiofrequency ablation of the nidus is the current operative treatment of choice. CONCLUSION Success rates of radiofrequency ablation and other minimally invasive procedures are high while treatment costs and length of hospital stay are low. Thus, open surgical curettage is reserved for rare indications and en bloc excision of the nidus should only be performed in cases of recurrent lesions.
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Toepfer A, Harrasser N, Recker M, Lenze U, Pohlig F, Gerdesmeyer L, von Eisenhart-Rothe R. Distribution patterns of foot and ankle tumors: a university tumor institute experience. BMC Cancer 2018; 18:735. [PMID: 30001718 PMCID: PMC6043962 DOI: 10.1186/s12885-018-4648-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bone and soft tissue masses of the foot and ankle are not particularly rare but true neoplasia has to be strictly differentiated from pseudotumorous lesions. Diagnosis is often delayed as diagnostic errors are more common than in other regions. Awareness for this localization of musculoskeletal tumors is not very high and neoplasia is often not considered. The purpose of this study is to provide detailed information on the incidence and distribution patterns of foot and ankle tumors of a university tumor institute and propose a simple definition to facilitate comparison of future investigations. METHODS As part of a retrospective, single-centre study, the data of patients that were treated for foot and ankle tumors between June 1997 and December 2015 in a musculoskeletal tumor centre were analyzed regarding epidemiologic information, entity and localization. Included were all cases with a true tumor of the foot and ankle. Exclusion criteria were incomplete information on the patient or entity (e.g. histopathological diagnosis) and all pseudotumoral lesions. RESULTS Out of 7487 musculoskeletal tumors, 413 cases (5,52%) of tumors of the foot and ankle in 409 patients were included (215 male and 198 female patients). The average age of the affected patients was 36 ± 18y (min.3y, max.92y). Two hundred sixty-six tumors involved the bone (64%), among them 231 (87%) benign and 35 (13%) malignant. There were 147 soft tissue tumors (36%), 104 (71%) were benign, 43 (29%) malignant. The most common benign osseous tumor lesions included simple bone cysts, enchondroma and osteochondroma. By far the most common malignant bone tumor was chondrosarcoma. Common benign soft tissue tumors included pigmented villo-nodular synovitis, superifcial fibromatosis and schwannoma whereas the most common malignant members were synovial sarcoma and myxofibrosarcoma. Regarding anatomical localization, the hindfoot was affected most often. CONCLUSIONS Knowledge of incidence and distribution patterns of foot and ankle tumors will help to correctly assess unclear masses and initiate the right steps in further diagnostics and treatment. Unawareness can lead to delayed diagnosis and inadequate treatment with serious consequences for the affected patient.
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Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany. .,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany. .,Kantonspital St. Gallen, Klinik für Orthopädische Chirurgie und Traumatologie, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Maximiliane Recker
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany
| | - Ulrich Lenze
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Florian Pohlig
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Ludger Gerdesmeyer
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Sektion für Onkologische und Rheumatologische Orthopädie in der Klinik für Unfallchirurgie, Arnold Heller Strasse, D-24105, Kiel, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
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Toepfer A. Ossoskopie gutartiger osteolytischer Läsionen des Kalkaneus. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-017-0172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Toepfer A. [Foot and ankle tumors: a closure look at indistinct masses of the foot and ankle]. MMW Fortschr Med 2016; 158:67-70. [PMID: 27966125 DOI: 10.1007/s15006-016-9107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Andreas Toepfer
- Zentrum für Fuß und Sprunggelenkchirurgie, Schön Klinik München Harlaching, FIFA Medical Centre, Harlachinger Straße 51, D-81547, München, Deutschland.
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Lenze U, Stolberg-Stolberg J, Pohlig F, Lenze F, von Eisenhart-Rothe R, Rechl H, Toepfer A. Unicameral Bone Cyst in the Calcaneus of Mirror Image Twins. J Foot Ankle Surg 2014; 54:754-7. [PMID: 25435010 DOI: 10.1053/j.jfas.2014.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Indexed: 02/03/2023]
Abstract
Unicameral bone cysts (UBCs) are benign tumor-like lesions that commonly occur in the diaphyseal or metaphyseal region of the long bones within the first 2 decades of life. Until today, the pathogenesis of UBC has been unclear, but mechanisms such as vascular occlusion or a response to trauma have been supposed. During the past decade, in particular, the genetic aspects of the development of this rare lesion have been discussed. We present the first case of mirror image monozygotic twins with a mirror image UBC of the calcaneus. Our findings reinforce the importance of additional studies to understand the significance of cytogenetic factors in the etiology of UBC.
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Affiliation(s)
- Ulrich Lenze
- Resident, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany.
| | - Josef Stolberg-Stolberg
- Registrar, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany
| | - Florian Pohlig
- Resident, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany
| | - Florian Lenze
- Resident, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Professor, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany
| | - Hans Rechl
- Professor, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany
| | - Andreas Toepfer
- Surgeon, Department of Orthopedics and Orthopedic Sports Medicine, Klinikum rechts der Isar, Technische Universtät München, Munich, Germany
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