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Zhang YL, Wu MJ, Hu Y, Peng XJ, Ma Q, Mao CL, Dong Y, Wei ZK, Gao YQ, Yao QY, Yao J, Ye XH, Li JM, Li A. A practical risk stratification system based on ultrasonography and clinical characteristics for predicting the malignancy of soft tissue masses. Insights Imaging 2024; 15:226. [PMID: 39320574 PMCID: PMC11424597 DOI: 10.1186/s13244-024-01802-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
OBJECTIVE To establish a practical risk stratification system (RSS) based on ultrasonography (US) and clinical characteristics for predicting soft tissue masses (STMs) malignancy. METHODS This retrospective multicenter study included patients with STMs who underwent US and pathological examinations between April 2018 and April 2023. Chi-square tests and multivariable logistic regression analyses were performed to assess the association of US and clinical characteristics with the malignancy of STMs in the training set. The RSS was constructed based on the scores of risk factors and validated externally. RESULTS The training and validation sets included 1027 STMs (mean age, 50.90 ± 16.64, 442 benign and 585 malignant) and 120 STMs (mean age, 51.93 ± 17.90, 69 benign and 51 malignant), respectively. The RSS was constructed based on three clinical characteristics (age, duration, and history of malignancy) and six US characteristics (size, shape, margin, echogenicity, bone invasion, and vascularity). STMs were assigned to six categories in the RSS, including no abnormal findings, benign, probably benign (fitted probabilities [FP] for malignancy: 0.001-0.008), low suspicion (FP: 0.008-0.365), moderate suspicion (FP: 0.189-0.911), and high suspicion (FP: 0.798-0.999) for malignancy. The RSS displayed good diagnostic performance in the training and validation sets with area under the receiver operating characteristic curve (AUC) values of 0.883 and 0.849, respectively. CONCLUSION The practical RSS based on US and clinical characteristics could be useful for predicting STM malignancy, thereby providing the benefit of timely treatment strategy management to STM patients. CRITICAL RELEVANCE STATEMENT With the help of the RSS, better communication between radiologists and clinicians can be realized, thus facilitating tumor management. KEY POINTS There is no recognized grading system for STM management. A stratification system based on US and clinical features was built. The system realized great communication between radiologists and clinicians in tumor management.
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Affiliation(s)
- Ying-Lun Zhang
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Ultrasound, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Meng-Jie Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Hu
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Jing Peng
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Ma
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cui-Lian Mao
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ye Dong
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zong-Kai Wei
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ying-Qian Gao
- Department of Ultrasound, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Qi-Yu Yao
- Department of Ultrasound, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Yao
- Department of Ultrasound, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin-Hua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ju-Ming Li
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Ao Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Wehrend J, Gimarc D, Ashwell ZR, Jensen A, Major N, Ho CK. The effect of gadolinium-based intravenous contrast in the initial characterization of musculoskeletal soft tissue tumors. Curr Probl Diagn Radiol 2024; 53:470-476. [PMID: 38480060 DOI: 10.1067/j.cpradiol.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE To determine if gadolinium-based contrast agents increase the sensitivity, specificity or reader confidence of malignant potential in musculoskeletal soft tissue tumors. METHODS Pre- and post-contrast MRI studies from 87 patients were read by three independent radiologists of different experience. Readers noted malignant potential and confidence in their diagnosis based on pre-contrast and post-contrast MRI studies. Statistical models assessed for agreement between MRI reader diagnosis and pathologic results as well as analyzing effects of contrast on reader confidence. Inter- and intra-observer variabilities of malignant potential were also calculated. RESULTS 87 patients (48 benign and 39 malignant; mean [± SD] age 51 ± 17.9 and 57.1 ± 17.1, respectively) were evaluated. For all readers, pre-contrast and post-contrast sensitivities were 68.1 % and 70.6 % while pre-contrast and post-contrast specificities were 84.6 % and 83.8 %, respectively without significant change (p=0.88). There was not a significant association with the use of contrast and prediction of malignant potential with or without the resident reader (p=0.65 and p=0.82). Use of contrast was significantly associated with higher levels of reader confidence (p=0.02) for all readers. Inter- and intra-observer variabilities were in good agreement (W = 0.77 and 0.70). CONCLUSION The addition of a post-contrast sequence increased reader confidence in their diagnosis without a corresponding significant increase in accurate prediction of malignant potential.
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Affiliation(s)
- Jonathan Wehrend
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - David Gimarc
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Zachary R Ashwell
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Alexandria Jensen
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Nancy Major
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Corey K Ho
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA.
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Iida K, Matsumoto Y, Nabeshima A, Fujiwara T, Setsu N, Endo M, Nakashima Y. The Difference in Clinical Features between Small-Sized Soft Tissue Sarcomas and Benign Tumors. Kurume Med J 2023; 69:65-73. [PMID: 37793890 DOI: 10.2739/kurumemedj.ms69120015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Small-sized tumors tend to be resected without thorough assessment and are often managed in a sarcoma center after a malignancy is diagnosed. The lack of knowledge about the features of smallsized sarcomas may lead to unplanned resection. The features of small-sized soft tissue sarcomas were investigated by comparing them with those of small benign soft tissue tumors. METHODS We included 17 soft tissue sarcoma cases (7 on the hands and feet and 10 on the limbs and trunk) with a diameter of under 2 cm. The features of small-sized sarcomas were compared to those of 39 benign soft tissue tumors with a diameter of under 2 cm and non-specific imaging findings (30 on the hands and feet and 9 on the limbs and trunk). The investigated features were age, sex, presence of pain, subjective increasing tumor size, and duration of observation. RESULTS When we compared the tumors in the hands and feet, those <40 years of age (5/7 [71%] vs. 8/30 [27%], p=0.03) experiencing pain (7/7 [100%] vs. 13/30 [43%], p=0.007) were more common in patients with sarcomas than in patients with benign tumors. When we compared the tumors in the limbs and trunk, there was no significant difference in all investigated features. CONCLUSION Although clinical features were ineffective in distinguishing malignancy in most small-sized soft tissue tumors, we should pay attention to painful tumors of the hands and feet in younger patients.
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Affiliation(s)
- Keiichiro Iida
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Akira Nabeshima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Toshifumi Fujiwara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Nokitaka Setsu
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Makoto Endo
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University
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Mihara A, Iwanaga R, Muramatsu K, Ihara K, Sakai T. Oncological and functional outcomes of planned and unplanned excision of soft tissue sarcoma: A retrospective study. J Orthop Sci 2023; 28:867-873. [PMID: 35491297 DOI: 10.1016/j.jos.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/25/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In soft tissue sarcomas, the oncological and functional outcomes between planned excision and unplanned excision with additional wide resection remains controversial. The purpose of this study is to determine the impact of unplanned excision on oncological and functional outcomes. METHODS A retrospective single-center study was performed. Patients with soft tissue sarcoma surgically treated in 2005-2019 were included in this study. A total of 120 patients consisting of planned excision (PE) group (n = 88), and unplanned excision (UE) group (n = 32) were included. Overall-survival (OS), local recurrence-free survival (LRFS), metastasis-free survival (MFS), disease-free survival (DFS), incidence rate of reconstructive surgery and musculoskeletal tumor society (MSTS) score were assessed. Propensity score matching method was used in statistical analysis. RESULTS The 5-year survival rate of OS, LRFS, MFS, and DFS did not differ between the PE and UE groups, however, rates of reconstructive surgery were higher in the UE group (PE: 48% vs. UE: 84%, p < 0.001). These results did not differ (PE: 41% vs. UE: 82%, p = 0.012) after propensity score matching was performed to align the backgrounds with difference in tumor size and depth. For MSTS score, the total score and "pain" and "emotional acceptance" scores were higher in the PE group before propensity score matching. The "pain" and "emotional acceptance" scores were higher in the PE group after propensity score matching also. CONCLUSIONS Unplanned excision did not deteriorate oncological outcomes, however unplanned excision lead to unnecessary reconstructive surgery. Unplanned excision adversely affected patient-reported outcomes without worsening pure functional outcomes.
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Affiliation(s)
- Atsushi Mihara
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Ryuta Iwanaga
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Keiichi Muramatsu
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Koichiro Ihara
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan
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Wang Z, Wang F, Xing Y, Jiang X, Ding Z, Li Y, Tang L. Efficacy of nitrous oxide in adults undergoing puncture biopsy: A systematic review and meta-analysis of randomized controlled trials. PLoS One 2023; 18:e0286713. [PMID: 37279243 DOI: 10.1371/journal.pone.0286713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Nitrous oxide (N2O) with rapid analgesic effect is often used to relieve pain induced by diagnostic procedures. This review was conducted to evaluate the efficacy and safety of N2O in patients undergoing puncture biopsy. METHODS We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, Scopus and the ClinicalTrials.gov up to March, 2022. Randomized controlled trials (RCTs) were included if they investigated the effect of N2O in adults undergoing puncture biopsy. The primary outcome was pain score. Secondary outcomes included anxiety score, patient satisfaction and side effects. RESULTS Twelve RCTs with 1070 patients were included in the qualitative review, of which eleven RCTs were included in the meta-analysis. Pooled analysis suggested that compared with the controls (placebo, lidocaine and midazolam), N2O had better analgesic effect (MD -1.12, 95% CI -2.12 to -0.13, P = 0.03; I2 = 94%). In addition, N2O significantly alleviated patient anxiety (MD = -1.79, 95% CI -2.41 to -1.18, P<0.00001; I2 = 0%) and improved patient satisfaction (MD 1.81, 95% CI 0.11 to 3.50, P = 0.04; I2 = 92%). There was no significant difference regrading the risk of nausea (RR 2.56; 95% CI 0.70 to 9.31, P = 0.15; I2 = 0%), headache (RR 0.62, 95% CI 0.17 to 2.33, P = 0.48; I2 = 46%), dizziness (RR 1.80, 95% CI 0.63 to 5.13, P = 0.27; I2 = 0%) or euphoria (RR 2.67, 95% CI 0.81 to 8.79, P = 0.11; I2 = 8%) between the N2O group and the control group. CONCLUSION The present review suggested that N2O might be effective for pain management in patients undergoing puncture biopsy.
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Affiliation(s)
- Ziyang Wang
- School of Nursing, Weifang Medical University, Weifang, China
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Fei Wang
- Department of Anesthesiology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Yihui Xing
- School of Nursing, Weifang Medical University, Weifang, China
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Xiaochen Jiang
- School of Nursing, Weifang Medical University, Weifang, China
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
| | - Zhiguo Ding
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Yuxiang Li
- Ningxia Medical University, Yinchuan, China
| | - Lu Tang
- Department of Stomatology, The 960th Hospital of People's Liberation Army of China (PLA), Jinan, China
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Kawai A, Araki N, Ae K, Akiyama T, Ozaki T, Kawano H, Kunisada T, Sumi M, Takahashi S, Tanaka K, Tsukushi S, Naka N, Nishida Y, Miyachi M, Yamamoto N, Yoshida A, Yonemoto T, Yoshida M, Iwata S. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of soft tissue tumors 2020 - Secondary publication. J Orthop Sci 2022; 27:533-550. [PMID: 35339316 DOI: 10.1016/j.jos.2021.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND These clinical practice guidelines are intended to provide recommendations based on the best evidence obtained to date on key issues in clinical practice to improve the prognosis, diagnostic and therapeutic processes for patients with soft tissue tumors. METHODS The Guidelines Development Committee and Systematic Review Committee were composed of a multidisciplinary team of specialists who play an important role in soft tissue tumor care. Clinical questions (CQs) were determined by choosing key decision-making points based on Algorithms for the diagnosis and treatment of soft tissue tumors. The guidelines were developed according to the "Medical Information Network Distribution Service (Minds) Handbook for Clinical Practice Guideline Development 2014" and "Minds Manual for Clinical Practice Guideline Development 2017." Recommendation strength was rated on two levels and the strength of evidence was rated on four levels. The recommendations were decided based on agreement by 70% or more voters. RESULTS Twenty-two CQs were chosen by the Guidelines Development Committee. The Systematic Review Committee reviewed the evidence concerning each CQ, a clinical value judgment was added by experts, and the text of each recommendation was determined. CONCLUSION We established 22 CQs and recommendations for key decision-making points in the diagnosis and treatment of soft tissue tumors according to the Minds Clinical Practice Guideline development methods. We hope that these guidelines will assist the decision-making of all medical staff engaged in the treatment and diagnosis of soft tissue tumors, and eventually lead to improved soft tissue tumor care in the country.
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Affiliation(s)
- Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan.
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Ashiya Municipal Hospital, Hyogo, Japan
| | - Keisuke Ae
- Department of Musculoskeletal Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Japan
| | - Toshiyuki Kunisada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Minako Sumi
- Radiation Oncology Department, Tokyo Metropolitan Geriatric Hospital, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Japan
| | | | - Norifumi Naka
- Department of Orthopedic Surgery, NachiKatsuura Town Onsen Hospital, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Japan
| | - Mitsuru Miyachi
- Department of Pediatrics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Japan
| | - Akihiko Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masahiro Yoshida
- International University of Health and Welfare, Japan Council for Quality Health Care, Japan
| | - Shintaro Iwata
- Department of Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center Hospital, Tokyo, Japan
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Lazerges C, Degeorge B, Coulet B, Chammas M. Diagnosis and treatment of hand tumors. Orthop Traumatol Surg Res 2022; 108:103153. [PMID: 34838755 DOI: 10.1016/j.otsr.2021.103153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 06/23/2021] [Indexed: 02/03/2023]
Abstract
Hand tumors are a very common problem in hand surgery. While these lesions are most often benign, malignant lesions often have an atypical presentation and are discovered late, very often during an inappropriate treatment. To optimize the care of hand tumors and to reduce diagnostic and treatment errors, we will review the broad diagnostic and therapeutic principles and the most common clinical presentations.
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Affiliation(s)
- Cyril Lazerges
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France.
| | - Benjamin Degeorge
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - Bertrand Coulet
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - Michel Chammas
- Orthopedic surgery department, hand and upper limb and peripheral nerve surgery unit, CHU Montpellier, 191, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
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Yonezawa H, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Igarashi K, Langit MB, Kimura H, Shimozaki S, Kato T, Morinaga S, Araki Y, Asano Y, Ikeda H, Nojima T, Tsuchiya H. Low-grade myofibroblastic sarcoma of the levator scapulae muscle: a case report and literature review. BMC Musculoskelet Disord 2020; 21:836. [PMID: 33302922 PMCID: PMC7731512 DOI: 10.1186/s12891-020-03857-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Low-grade myofibroblastic sarcoma (LGMS) is described as a distinct atypical myofibroblastic tumor often with fibromatosis-like features and predilection for the head and neck, especially the oral cavity and larynx. LGMS arising in the levator scapulae muscle is extremely rare. CASE PRESENTATION A 69-year-old woman was admitted to our hospital because she noticed a hard mass in her left neck six months prior. Magnetic resonance images (MRI) showed a soft tissue tumor of the left levator scapulae muscle. A core needle biopsy showed cellular fascicles or a storiform growth pattern of spindle-shaped tumor cells with minimally atypia. Immunohistochemistry revealed focally positive for α-smooth muscle actin (α-SMA), negative for S-100, and a low-grade spindle cell sarcoma was suspected. Following a biopsy, the tumor was resected with a wide surgical margin. Immunohistochemical staining was a positive for vimentin and α-SMA and negative for desmin, CD34, nuclear β-catenin, and h-caldesmon. LGMS diagnosis was determined based on the histopathological findings. The patient was alive with no evidence of disease eight years after the surgery. CONCLUSIONS To the best of our knowledge, this is the first case report of LGMS arising in the levator scapulae muscle. In addition to the case report, 48 reports with 103 LGMS cases are reviewed and discussed. In previous reports of LGMS, there were 43 females and 60 males, with a mean age of 43.0 years (range, 2-75). There were 13 (12.6%) patients aged < 18 years, 67 (65.1%) patients aged 18 to 59 years, and 23 (22.3%) patients aged ≥60 years. The average tumor size was 4.4 cm (range: 0.4-22.0). The commonest sites of LGMS was the tongue. Tumor growth patterns were evaluated in 52 cases, and 44 cases (84.6%) showed infiltrative growth patterns. Local recurrence was 26.7%, and distant metastasis was 4.4%. Because of the locally aggressive feature, it is important to diagnose LGMS with biopsy and to excise the tumor with an adequately wide margin.
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Affiliation(s)
- Hirotaka Yonezawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Mickhael Bang Langit
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.,Department of Orthopedics, Philippine Orthopedic Center, Quezon City, Manilla, Philippines
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Shingo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Takashi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Sei Morinaga
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yohei Asano
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Takayuki Nojima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan.,Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
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Lee JH, Kim HS, Yoon YC, Seo SW, Cha MJ, Jin W, Cha JG. Characterization of small, deeply located soft-tissue tumors: Conventional magnetic resonance imaging features and apparent diffusion coefficient for differentiation between non-malignancy and malignancy. PLoS One 2020; 15:e0232622. [PMID: 32379793 PMCID: PMC7205250 DOI: 10.1371/journal.pone.0232622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/18/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To compare magnetic resonance imaging (MRI) parameters of small, deeply located non-malignant and malignant soft-tissue tumors (STTs). METHODS Between May 2011 and December 2017, 95 MRIs in 95 patients with pathologically proven STTs of small size (<5 cm) and deep location (66 non-malignant and 29 malignant) were identified. For qualitative parameters, consensus reading was performed by three radiologists for presence of necrosis, infiltration, lobulation, and the tail sign. Apparent diffusion coefficient (ADC) was analyzed by two other radiologists independently. Univariable and multivariable analyses were performed to determine the diagnostic performances of MRI parameters in differentiating non-malignancy and malignancy, and for non-myxoid, non-hemosiderin STTs and myxoid STTs as subgroups. Interobserver agreement for ADC measurement was calculated with the intraclass correlation coefficient. RESULTS Interobserver agreement on ADC measurement was almost perfect. On univariable analysis, the malignant group showed a significantly larger size, lower ADC, and higher incidence of all qualitative MRI parameters for all STTs. Size (p = 0.012, odds ratio [OR] 2.57), ADC (p = 0.041, OR 3.85), and the tail sign (p = 0.009, OR 6.47) were independently significant on multivariable analysis. For non-myxoid, non-hemosiderin STTs, age, size, ADC, frequency of infiltration, lobulation, and the tail sign showed significant differences between non-malignancy and malignancy on univariable analysis. Only ADC (p = 0.032, OR 142.86) retained its independence on multivariable analysis. For myxoid STTs, only size and tail sign were significant on univariable analysis without independent significance. CONCLUSIONS Size, ADC, and incidence of qualitative MRI parameters were significantly different between small, deeply located non-malignant and malignant STTs. Only ADC was independently significant for both overall analysis and the non-myxoid, non-hemosiderin subgroup.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Wook Jin
- Department of Radiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jang Gyu Cha
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Simidjiiska‐Belyaeva M, Belyaev O, Lehnhardt M, Harati K, Stricker I, Nicolas V, Daigeler A. Use of a self‐contained vacuum‐assisted biopsy system in the assessment of soft tissue tumors. J Surg Oncol 2019; 120:740-745. [DOI: 10.1002/jso.25609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/16/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Maria Simidjiiska‐Belyaeva
- Department of Plastic and Reconstructive Surgery, Sarcoma Reference CenterBG‐University Hospital Bergmannsheil Bochum Germany
| | - Orlin Belyaev
- Department of SurgerySt Josef‐University Hospital Bochum Germany
| | - Marcus Lehnhardt
- Department of Plastic and Reconstructive Surgery, Sarcoma Reference CenterBG‐University Hospital Bergmannsheil Bochum Germany
| | - Kamran Harati
- Department of Plastic and Reconstructive Surgery, Sarcoma Reference CenterBG‐University Hospital Bergmannsheil Bochum Germany
| | - Ingo Stricker
- Institute of PathologyRuhr‐University Bochum Bochum Germany
| | - Volkmar Nicolas
- Institute of RadiologyBG‐University Hospital Bergmannsheil Bochum Germany
| | - Adrien Daigeler
- Department of Plastic and Reconstructive Surgery, Sarcoma Reference CenterBG‐University Hospital Bergmannsheil Bochum Germany
- BG‐University Hospital Bergmannsheil Tübingen Germany
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11
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MacGillis KJ, Heaberlin J, Mejia A. Clinical Decision Making for a Soft Tissue Hand Mass: When and How to Biopsy. J Hand Surg Am 2018; 43:1123-1129. [PMID: 29908925 DOI: 10.1016/j.jhsa.2018.03.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/23/2018] [Indexed: 02/02/2023]
Abstract
Evaluation of a hand mass and subsequent surgical treatment is a frequent clinical encounter for the practicing hand surgeon. The clinical evaluation of benign and malignant hand tumors has traditionally focused on diagnosis, surgical excision, and reconstruction. There is a paucity of literature discussing the determining factors for a hand mass biopsy, its appropriate technique, and postbiopsy preparation and handling. This review discusses the approaches of the hand surgeon and orthopedic oncologist to a soft tissue mass in the hand and clarifies the term biopsy. Special attention is focused on preoperative decisions and indications for core needle, incisional, and excisional biopsies of hand masses. In addition, we include a discussion of surgical technique for obtaining a specimen, processing a specimen, and sending a specimen for pathological evaluation. This highlights specimen labeling and type of fixative utilized for pathological evaluation. This review features a section detailing clinical strategies to reduce morbidity associated with evaluation and treatment of benign and malignant hand masses and is based on recommendations from a synopsis of expert opinion and literature review.
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Affiliation(s)
- Kyle J MacGillis
- Department of Orthopaedic Surgery, Stony Brook University, Stony Brook, NY.
| | - James Heaberlin
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Alfonso Mejia
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
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