Intralesional Versus Wide Resection of Low-Grade Chondrosarcomas of the Hand

Multi-modality management of chondrosarcoma of scapula: A case report and review of literature

Chondrosarcoma are malignant tumours in which neoplastic cells produce cartilage. The most commonly affected sites are pelvis, femur, humerus and ribs. Scapula involvement is relatively rare. Surgery remains the primary modality of treatment for chondrosarcoma. Radiotherapy is used as an adjuvant therapy in high grade tumours and in cases of residual disease. Present study reports a rare case of scapular chondrosarcoma in a 37 year old male, managed with multimodality treatment and discusses briefly the prognostic parameters and treatment modalities. Only few studies have discussed about scapular chondrosarcoma and more studies with larger number of patients are needed to develop an evidence-based treatment and follow-up protocol for these patients.

The need for improved patient reported outcome measures in patients with extremity sarcoma: A narrative review

BACKGROUND

Extremity sarcoma causes impairments to functionality and quality of life. Patient-reported outcome measures (PROMS) assess patient perspectives relating to domains of health and quality of life.

METHODS

To describe PROMs utilised in extremity sarcoma, the available literature was screened for studies that utilised PROMs to evaluate outcomes in extremity sarcoma following surgery.

RESULTS

Seventy articles met eligibility criteria; six PROMs were identified. The Toronto Extremity Salvage Score, The Short-Form 36, The EORTC QLQ-C30, The Disabilities of the Arm, Shoulder and Hand questionnaire, the Reintegration to Normal Living index and the Patient-Reported Outcomes Measurement Information System. Most sarcoma patients score well in these tools, with bone sarcoma, and extent of resection being predictors of poor outcomes.

CONCLUSION

TESS is the only sarcoma-specific PROM, and though a valid assessment of functionality, it has difficulty differentiating patients with minor functional impairments. The absence of a disease-specific measure of health is concerning, as generic tools do not account for the unique experiences sarcoma patients face and may impair their accuracy in analysing intervention effectiveness.

Multifocal chondrosarcoma of the hand: Case report and review of the literature

Few multifocal hand chondrosarcomas have been reported. To our knowledge, this report is the first to describe multifocal hand chondrosarcoma in a patient with no evidence of prior enchondroma, Ollier's disease, or Maffucci syndrome.

Pathologic Fractures in Benign Neoplasms of the Fingers

Background: To describe the rate and predictors of pathologic fractures in benign neoplasms of the finger, as variables from prediction models for pathologic fractures of the long bones of the extremities are not necessarily applicable to the bones of the hand. Methods: In this retrospective chart review, 69 histologically confirmed neoplasms affecting the bones of the fingers, 49 phalanges and 20 metacarpals, were identified in patients presenting at 2 urban hospitals over a 24-year period. Different variables were studied as possible predictors of pathologic fractures. Results: Forty-nine percent of the tumors presented as a pathologic fracture. The small finger was independently associated with pathologic fractures compared to the other fingers. Tumors of the metacarpal bones were the least likely to fracture compared to other bones. Conclusions: Almost half of neoplasms affecting the bones of the fingers presented initially with a pathologic fracture, most commonly the small finger. Therefore, a lower threshold for surgical treatment of a bone neoplasm affecting the small finger may be reasonable.

Chondrosarcomas of the small bones: analysis of 44 patients

BACKGROUND

Chondrosarcomas of the small bones of the hands and feet are uncommon and account for less than 2% of all chondrosarcomas in the skeleton; a 4.2% rate of malignant degeneration of enchondromas to secondary chondrosarcomas has been reported. We performed this study to assess the outcome of the patients with chondrosarcomas of the small bones. We hypothesized that the presumed better prognosis of chondrosarcomas in these locations could be biased as the majority of these tumors tend to be of lower grades and are removed when still small sized, and that less aggressive surgery has an adverse effect on local control MATERIALS AND METHODS: We retrospectively studied the files of 44 patients with chondrosarcomas of the small bones of the hands and feet. There were 23 female and 21 male patients with a mean age of 50.9 years (range, 6-86 years). The mean follow-up was 13 years (range, 5-40 years). We recorded the patients' details including gender and age at diagnosis, type and duration of symptoms, tumor location and histology, type of surgery and complications, and outcome (local recurrences and metastases).

RESULTS

The most common anatomical location for chondrosarcomas of the hands was the metacarpals and proximal phalanges. The most common presenting symptom was a slowly enlarging palpable mass. Overall, 36 chondrosarcomas were secondary to a pre-existing cartilaginous tumor. Patients with syndromes were affected in younger age compared to the others. The mean age at diagnosis was higher for higher grade chondrosarcomas. Overall, 13 patients (29.5%) experienced a local recurrence; the rate of local recurrence was higher after curettage regardless the histological grade of the tumors. After wide resection of the first local recurrence, five patients experienced local re-recurrence. Five patients (11.4%) experienced lung metastases, two patients at presentation. All these patients had a high grade chondrosarcomas. At the last follow-up, one patient with lung metastases died from disease, and another patient died from unrelated cause.

CONCLUSIONS

The patients with chondrosarcomas of the small bones of the hands and feet may have a dismal outcome if treated improperly. A careful treatment planning is required to avoid unnecessary amputations. Curettage is associated with a high rate for local recurrence that should be treated with a more aggressive surgical resection to avoid re-recurrences. Although the risk is low, the patients may develop lung metastases, especially those with higher grade chondrosarcomas, therefore, they should be staged and followed closely.

The usefulness of a three-dimensional printed segmental scapula prosthesis for recovering shoulder function in a patient with scapula chondrosarcoma: A case report

RATIONALE

Localized chondrosarcoma of the scapula has a favorable long-term survival outcome. Therefore, recovery of shoulder function after surgery is important in middle-aged patients. Currently, three-dimensional (3-D) printing implants can be applied for personalized limb salvage surgery.

PATIENT CONCERNS

A 41-year-old woman with a palpable scapular area presented with shoulder pain for 3 months, which was aggravated during shoulder exercise.

DIAGNOSES

Chondrosarcoma at left scapular (Malawer S1, Enniking II B, and grade II chondrosarcoma).

INTERVENTIONS

Wide excision for a localized chondrosarcoma at the infrascapular lesion was performed and the resected muscles around the scapula were repaired with a 3-D printed segmental scapula prosthesis for recovery of shoulder function.

OUTCOMES

The affected shoulder achieved satisfactory function after operation using the 3-D printed segmental scapula prosthesis at 1 year 6 months after the operation.

LESSONS

The 3-D printed segmental scapula prosthesis is a useful method for shoulder functional recovery in patients with scapula chondrosarcoma.

Low-Grade Chondrosarcoma of the Proximal Phalanx: A Rare Presentation

CASE

Chondrosarcomas are the second most common primary malignant sarcoma of the bone, though it is overall a rare tumor. Our case presents a 36-year-old Caucasian male who complained of an enlarging mass at his third finger MCP joint. After assessing the full clinical scenario, it was determined that wide excision with ray resection would provide the best result for this patient.

CONCLUSION

This study explains a rare malignancy presenting in the proximal phalanx of the hand. The following report will review chondrosarcomas involving the hands, help differentiate between low-grade chondrosarcomas and enchondromas, and briefly cover treatment modalities.

Chondrosarcoma of the Hand Bones: A Report of 6 Cases and Review of the Literature

BACKGROUND

Primary malignant tumours of the hand are extremely rare, with chondrosarcoma being the most common. We describe six consecutive cases of chondrosarcoma (CS) of the hand, with a follow-up of 12 months to 10 years after surgical intervention.

METHODS

Five cases were primary tumors and one was secondary to Ollier's disease. Mean age at diagnosis was 67.5 years (range 46 to 85 years) and three patients were males. The bone most commonly affected was the proximal phalanx (in 4 patients), followed by the metacarpal bone (3 cases in the other 2 patients). The first symptom was an increase in volume in five cases and a pathological fracture in one. The x-ray study showed signs of malignancy in two cases only. In the other four cases, CT and MRI studies were necessary to complete the diagnosis.

RESULTS

Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. Primary amputation was performed in two cases and intralesional curettage and cancellous bone autograft in four. We found three grade I/III CS and three grade II/III CS in the histological study. Local recurrences occurred in three patients, two being grade II/III CS. One of the three had undergone an initial amputation and underwent re-amputation, another had had curettage of the lesion and was amputated, and the third patient decided not to undergo the procedure due to her age. A pulmonary nodule was suspected at the most recent follow up in a fourth patient, who had been diagnosed with a grade II/III CS.

CONCLUSIONS

Although CS of the hand bones behaves as a locally aggressive lesion, it rarely metastasizes. Intralesional curettage with a cancellous bone autograft appears to be a good option in low-grade CS to preserve the function, keeping in mind the high rate of recurrence. Wide excision or amputation is recommended when severe joint deformity or soft tissue involvement interferes with hand function.

Is intralesional resection suitable for central grade 1 chondrosarcoma: A systematic review and updated meta-analysis

BACKGROUND

The surgical choice for grade 1 chondrosarcoma has been debated for decades. Intralesional resection can minimize the damage caused by surgery and offer better functional outcome. However, controversy remains about whether it will result in higher rates of local recurrence and metastasis, fewer complications, and better functional outcome compared with resection with wide margin. This systematic review and updated meta-analysis therefore compared intralesional resection and resection with wide margin in terms of local recurrence, metastasis, complications, and functional outcome.

METHODS

Medline, Embase, and the Cochrane Library were comprehensively searched in December 2016 to identify studies comparing intralesional resection and resection with wide margin for central grade 1 chondrosarcoma. Data of interest were extracted and analyzed using Review Manager 5.3.

RESULTS

Ten studies involving 394 patients were included, with 214 patients who had intralesional resection and 180 patients who had resection with wide margin for grade 1 chondrosarcoma. Intralesional resection was associated with lower complication rates (P < 0.0001) and better Musculoskeletal Tumor Society score (MSTS). There were no significant differences in terms of overall local recurrence (P = 0.27), local recurrence based on adjuvant therapies (P = 0.22), local recurrence in studies that included lesions of the hand, foot, pelvis, and axial skeleton (P = 0.55), and metastasis (P = 0.74) between groups.

CONCLUSION

Intralesional resection provides lower complications and better functional outcome with no significant increase in the risk of recurrence and metastasis. We think it is a suitable treatment for central grade 1 chondrosarcoma.