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Jimenez IA, Pool RR, Gabrielson KL. Canine Idiopathic Arteriopathy, Appendicular Bone Infarcts, and Neoplastic Transformation of Bone Infarcts in 108 Dogs ( Canis lupus familiaris). Comp Med 2022; 72:306-319. [PMID: 36113969 PMCID: PMC9827601 DOI: 10.30802/aalas-cm-22-000037] [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: 04/09/2022] [Revised: 05/27/2022] [Accepted: 07/26/2022] [Indexed: 01/27/2023]
Abstract
Osteosarcoma (OSA) is the most common primary bone tumor in both dogs and humans. The dog is an important research model for OSA, yet dogs have much higher prevalence of bone tumors than do humans, a disparity that has yet to be explained. Neoplastic transformation of cells within or adjacent to bone infarcts into primary bone tumors has been described in humans but only sparsely characterized in the veterinary literature. In this study, 653 cases of canine bone infarcts were received through a referral veterinary osteopathology service over a 14-y period. We identified an idiopathic disorder affecting the nutrient artery, termed canine idiopathic arteriopathy (CIA), which to our knowledge has no direct counterpart in human medicine. This disorder was documented alongside ischemic necrosis of the medullary cavity in 114 bone infarcts in 108 dogs. We hypothesize that CIA precipitated an ischemic environment, resulting in development of a bone infarct down- stream of the abnormal artery. In 52% (59 of 114) of cases, bone infarcts demonstrated evidence of repair (termed reparative bone infarcts [RBI]), while in 48% (55 of 114) of infarcts, a bone tumor was also present, including pleomorphic sarcoma, OSA, fibrosarcoma, and chondrosarcoma. In some cases, a spectrum of tumors was present. We hypothesize that the ischemic infarct environment provoked bone marrow mesenchymal stem cells (MSCs) to attempt repair of the stroma, and in approximately half of cases, MSCs underwent neoplastic transformation (BINT) to produce tumors. The most common sites of bone infarcts were the distal femur, distal radius, proximal humerus, and distal tibia, coinciding with common sites of canine OSA. The authors propose that CIA leading to bone infarcts and infarct-derived tumors, in combination with possible underdiagnosis of canine bone infarcts and misdiagnosis of some RBI as neoplasia, may contribute to the higher reported proportion of bone tumors in dogs compared with humans.
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Affiliation(s)
- Isabel A Jimenez
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland;,
| | - Roy R Pool
- Department of Veterinary Pathobiology, Texas A&M College of Veterinary Medicine & Biomedical Sciences, College Station, Texas
| | - Kathleen L Gabrielson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Konarski W, Poboży T, Hordowicz M, Śliwczyński A, Kotela I, Krakowiak J, Kotela A. Bone Infarcts and Tumorigenesis—Is There a Connection? A Mini-Mapping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159282. [PMID: 35954639 PMCID: PMC9367991 DOI: 10.3390/ijerph19159282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/10/2022]
Abstract
(1) Background: Avascular necrosis (AVN) may affect every part of the bone. Epiphyseal infarcts are likely to be treated early because most are symptomatic. However, meta- and diaphyseal infarcts are silent and are diagnosed incidentally. Sarcomas developing in the necrotic bone are extremely rare, but they have been reported in the literature. (2) Methods: We conducted a mapping review of recent evidence regarding these malignancies. Methods: A mapping review using a systematic search strategy was conducted to answer research questions. We limited our research to the last ten years (2012–2022). (3) Results: A total of 11 papers were identified, including 9 case reports and 3 case series. The pathomechanism of carcinogenesis in AVN was not investigated to date. Histologically, most tumors were malignant fibrous histiocytoma. The prognosis is relatively poor, especially for patients with metastases, but adjuvant chemotherapy may increase short- and long-term survival. (4) Conclusions: Since AVN-related malignancies are sporadic, no prospective studies have been conducted. The majority of evidence comes from small case series. More research is needed to identify the risk factors that would justify follow-up of patients after bone infarcts at higher risk of developing a malignancy.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
- Correspondence: ; Tel.: +48-(50)-2110863
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland;
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland;
| | - Andrzej Śliwczyński
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland;
| | - Jan Krakowiak
- Department of Social and Preventive Medicine, Social Medicine Institute, Medical University of Lodz, 90-647 Lodz, Poland; (A.Ś.); (J.K.)
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland;
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McDonald MD, Sadigh S, Weber KL, Sebro R. A Rare Case of an Osteolytic Bone-infarct-associated Osteosarcoma: Case Report with Radiographic and Histopathologic Correlation, and Literature Review. Cureus 2018; 10:e2777. [PMID: 30112253 PMCID: PMC6089477 DOI: 10.7759/cureus.2777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Benign lesions such as Paget’s disease of the bone, enchondroma, osteochondromas, chronic osteomyelitis/infections and bone infarcts may rarely undergo malignant degeneration/transformation into sarcomas. To date, only 14 prior bone infarct-associated osteosarcomas have been described, with just two being primarily osteolytic. We discuss a case of a patient with a humeral bone-infarct, who presented with a presumed benign pathological fracture of the humerus through the bone infarct. Subsequent imaging and biopsy showed that there was a malignant degeneration into a primarily osteolytic osteosarcoma. We review the patient’s presentation, radiographic and histologic appearance of the osteosarcoma and discuss the epidemiology, surgical and non-surgical treatment and surveillance of bone-infarct-associated osteosarcomas.
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Affiliation(s)
- Michael D McDonald
- Department of Anesthesiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Sam Sadigh
- Department of Pathology, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Kristy L Weber
- Department of Orthopaedic Surgery, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Ronnie Sebro
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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Mogler C, Boxberg M, Knebel C, Weichert W, Wörtler K, Specht K. [Spindle-cell osteosclerotic bone lesion with MDM2 amplification]. DER PATHOLOGE 2017; 39:186-190. [PMID: 29209796 DOI: 10.1007/s00292-017-0394-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report presents an osteosclerotic bone lesion in a 49-year-old man with MDM2 amplification. The final diagnosis shows metastasis to the bones from stomach cancer. In primary bone tumours, the MDM2 amplifications observed have been described for many other tumour entities as well, and therefore do not exclude bone metastasis from a carcinoma.
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Affiliation(s)
- C Mogler
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland.
| | - M Boxberg
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - C Knebel
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, München, Deutschland
| | - W Weichert
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - K Wörtler
- Institut für Radiologie, Klinikum rechts der Isar, München, Deutschland
| | - K Specht
- Institut für Pathologie, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
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Tang F, Min L, Zhou Y, Luo Y, Tu C. Low-grade central osteosarcoma in proximal humerus: a rare entity. Onco Targets Ther 2017; 10:5165-5172. [PMID: 29123414 PMCID: PMC5661444 DOI: 10.2147/ott.s142818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Low-grade central osteosarcoma is a rare subtype of tumor with low-grade malignancy. Currently, wide resection with negative resection margin is the standard treatment for this disease. The role of neoadjuvant chemotherapy in low-grade central osteosarcoma was controversial and was mostly considered for tumors containing high-grade focal areas. Local tumor recurrences often exhibited a tumor with higher histologic grade or differentiation with the potential for metastases. In low-grade central osteosarcoma, timely wide resection after definite diagnosis can result in 5-year survival for almost 90%. However, the relatively nonspecific radiological and pathological findings make diagnosis very difficult. MDM2 and CDK4 are specific and provide sensitive markers for the diagnosis of low-grade central osteosarcoma, helping to differentiate low-grade central osteosarcoma from some benign lesions, including fibrous dysplasia, bone giant cell tumor, and chondrosarcoma. Here, we report the case of a 19-year-old woman with low-grade central osteosarcoma located at the proximal humerus. The affected site was rare, but the sensitive biomarkers CDK4 and MDM2 were positive. The patient recovered well after wide tumor resection following a proximal humerus endoprosthesis replacement. Our case highlighted the management strategies in low-grade central osteosarcoma. Being familiar with radiographic features, understanding the biological characteristics, and mastering diagnostic biomarkers can help oncologists avoid embarrassing situations in treatment when this rare tumor is highly suspected, even when located at an uncommon site. The discussion in this report focuses on radiographic and pathological features, advances of biomarkers that help in differential diagnosis, and current treatment options in low-grade central osteosarcoma.
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Affiliation(s)
- Fan Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Sarcoma Biology Laboratory, Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Abstract
OBJECTIVE The objective of our study was to characterize infarct-associated bone sarcoma and its imaging features. MATERIALS AND METHODS Our databases were searched for instances of sarcoma arising in association with osteonecrosis. Demographic and imaging data were recorded. The imaging studies of 258 patients with sarcomas were reviewed to determine whether underlying osteonecrosis was present. Radiographic and MRI studies of patients with bone infarction were reviewed to categorize the various appearances of infarction and to determine if sarcomas tended to arise in a particular pattern. A literature review was performed. RESULTS Nine infarct-associated bone sarcomas were found in eight patients: seven malignant fibrous histiocytomas (MFHs) and two osteosarcomas. All occurred in the femur or tibia; multifocal infarction was documented in all patients except one. Sarcomas were commonly associated with a so-called "mature"-type pattern of osteonecrosis-that is, with well-defined calcified margins. Osteolysis of infarct-associated MFHs was often overlooked at initial presentation and was often detected only after pathologic fracture. CT and MRI revealed cortical penetration in all cases; infarct margin disruption was evident, but preservation of fat within the infarct was typical. Increased radiotracer activity with relative central photopenia was characteristic of large infarct-associated bone sarcomas on scintigraphy. All lesions, including those treated at our institution and those found in the literature, were metaphyseal or diaphyseal, and although epiphyseal extension of sarcoma from a metadiaphyseal infarct was common, no purely epiphyseal lesions were encountered. CONCLUSION Radiologists must remain vigilant for this rare occurrence, especially in patients with new pain in an area of known bone infarction.
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Chondroblastic Osteosarcoma Arising in a Bone Infarct in a Patient with a Prior History of Hodgkin Lymphoma. J Adolesc Young Adult Oncol 2014. [DOI: 10.1089/jayao.2014.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
In this paper we provide an overview of benign and malignant osteogenic bone tumors. We describe the diagnostic features, radiographic findings, and pertinent ancillary studies needed to diagnose these bone-forming lesions. We begin with osteoid osteoma and osteoblastoma, which are histologically bland and eminently benign with rare possible exceptions. On the other end of the behavioral spectrum is osteosarcoma, which encompasses many subtypes ranging from high-grade osteogenic osteosarcoma to less overtly osteogenic lesions such as telangiectatic and small cell osteosarcoma. While classic osteogenic osteosarcoma can be easily recognized by its high grade morphology and formation of extracellular lace-like osteoid, its variants may pose diagnostic dilemmas as their differential diagnoses can include benign, fibrous, and vascular lesions, among others. Recognition of these variants is essential to avoid diagnostic pitfalls. In equivocal cases, some forms of osteosarcoma have shown molecular alterations that may prove diagnostically useful.
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Affiliation(s)
- Jeffery T Green
- Division of Surgical Pathology & Cytopathology, University of Virginia Health System, Charlottesville, Virginia.
| | - Anne M Mills
- Division of Surgical Pathology & Cytopathology, University of Virginia Health System, Charlottesville, Virginia
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