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Jing Y, Zhang Z, Mo Y, Wang D, Wu C, Ning B. Correction of anterior bowing complicating tibial osteofibrous dysplasia in preadolescents by osteotomy and telescopic nailing without lesional resection: a preliminary study of four-case reports. BMC Musculoskelet Disord 2024; 25:156. [PMID: 38374120 PMCID: PMC10875843 DOI: 10.1186/s12891-024-07273-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Osteofibrous dysplasia (OFD) occurs most frequently in the tibia and may result in deformity and pathological fracture. Surgical treatment such as curettage or segment excision has been performed but remains controversial due to high complication rates and surgical burden. This study introduces a new method to manage OFD with anterior bowing of the tibia using minimally invasive tibial osteotomy and telescopic rod (TR) osteosynthesis without extensive lesion resection. METHODS A retrospective study of 4 children with OFD and tibia bowing deformity treated with minimally invasive tibial wedge osteotomy and TR fixation between January 2015 and November 2020 was performed. Results including bone healing, complications, function based on MSTS score, and recurrance of deformity were assessed. RESULTS The median follow-up was 29 months. Radiographs showed the median time for union was 3 months. There were no instances of refracture or recurrence of deformity. The mean post-operative MSTS score was significantly higher than preoperative score. CONCLUSIONS This method avoids large bone defects and reconstructive procedures. It is an effective and minimally invasive approach for managing anterior bowing deformity secondary to OFD while improving function and quality of life. LEVEL OF EVIDENCE Level IV; Case Series; Treatment Study.
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Affiliation(s)
- Yanhui Jing
- Department of Orthopaedics Surgery, National children's medical center & Children's Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, 201102, China
| | - Zhiqiang Zhang
- Department of Orthopaedics Surgery, National children's medical center & Children's Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, 201102, China
| | - Yueqiang Mo
- Department of Orthopaedics Surgery, National children's medical center & Children's Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, 201102, China
| | - Dahui Wang
- Department of Orthopaedics Surgery, National children's medical center & Children's Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, 201102, China
| | - Chunxing Wu
- Department of Orthopaedics Surgery, National children's medical center & Children's Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, 201102, China.
| | - Bo Ning
- Department of Orthopaedics Surgery, National children's medical center & Children's Hospital of Fudan University, Wanyuan Road 399, Minhang District, Shanghai, 201102, China.
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Petaros A, Šantić V, Vuković AS, Perić P, Jonjić N. Recurrent Adamantinoma With Fibrous Dysplasia-like Feature. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2024; 17:2632010X241240391. [PMID: 38595806 PMCID: PMC11003218 DOI: 10.1177/2632010x241240391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
Adamantinoma (AD) is a rare, slow-growing primary malignant bone tumor characterized by a biphasic morphology of clusters of epithelial cells and spindle cell osteofibrous components. A strong relationship between AD and osteofibrous dysplasia (OFD) has been proposed, while fibrous dysplasia (FD) has been rarely associated with AD. We present an AD case that was followed and histologically evaluated 3 times over 6 years with different morphological patterns. The tumor in the primary biopsy and after complete resection showed classical features of AD and osteofibrous-like pattern, while the recurrent lesion presented with exclusively spindle cell morphology and was thus diagnosed as FD. However, the extensive immunohistochemical analysis in all 3 lesions revealed strong reactivity for pancytokeratin, vimentin, p63, and podoplanin, which are characteristic for AD. Although, in the FD-like section of the tumor from the first recurrence the positivity of podoplanin was stronger than pancitokeratin, which was variably positive on spindle cells. The present case highlights the problem of diagnosing AD based on a single biopsy with one tumor's component predominating over the other, and at the same time emphasizes the importance of using immunohistochemical staining for keratin and podoplanin when the histopathological features of (osteo)fibrous lesion can be linked to AD.
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Affiliation(s)
- Anja Petaros
- Department of Forensic Medicine and Criminalistics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Veljko Šantić
- University Hospital for Orthopaedic Surgery Lovran, Lovran, Croatia
| | - Anita Savić Vuković
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Petar Perić
- University Hospital for Orthopaedic Surgery Lovran, Lovran, Croatia
| | - Nives Jonjić
- Department of Pathology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
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Oka N, Hashimoto K, Nishimura S, Maenishi O, Akagi M. Secondary osteosarcoma associated with osteofibrous dysplasia: a case report. Skeletal Radiol 2023; 52:263-269. [PMID: 35939070 DOI: 10.1007/s00256-022-04122-5] [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: 02/20/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023]
Abstract
Secondary osteosarcoma is a rare complication of primary malignancies and benign bone lesions. There are various types of diseases that cause secondary osteosarcoma. A 15-year-old male presented at our medical center complaining of pain and redness in the right lower leg. He had been diagnosed with osteofibrous dysplasia in the right tibia when he was 2 years old and since then had been followed up. Although he had a pathological fracture of the right tibia at the age of 7, his fracture healed with a plaster cast and did not require surgery. At the time of the patient's last visit, a radiograph revealed a periosteal reaction as well as erosion of the bone cortex. Magnetic resonance imaging revealed an infiltrative area in the soft tissue surrounding the osteofibrous dysplasia lesion in the tibia. Consequent to pathological examination (through bone biopsy), the patient was diagnosed with secondary osteosarcoma. The patient underwent chemotherapy and extensive resection with liquid nitrogen. He has been progressing satisfactorily after the operation. The present case is the first report of secondary osteosarcoma associated with osteofibrous dysplasia. During the long-term follow-up of osteofibrous dysplasia, oncologists should be aware of the possibility of secondary osteosarcoma.
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Affiliation(s)
- Naohiro Oka
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, 589-8511, Japan.
| | - Kazuhiko Hashimoto
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Shunji Nishimura
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Osamu Maenishi
- Department of Pathology, Kindai University Hospital, Osaka-Sayama City, Osaka, 589-8511, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, 589-8511, Japan
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El Beaino M, Wang WL, Alaraj SF, Gugala Z, Lin PP. Osteofibrous dysplasia and adamantinoma: A summary of diagnostic challenges and surgical techniques. Surg Oncol 2021; 38:101626. [PMID: 34280695 DOI: 10.1016/j.suronc.2021.101626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
Osteofibrous dysplasia is an indolent benign fibro-osseous tumor, while adamantinoma is a locally aggressive biphasic malignancy with epithelial and fibro-osseous components. Predominantly arising in the tibial diaphysis of children and young adults, both tumors are resistant to chemotherapy and radiation. Wide surgical resection is regarded as the mainstay of therapy for adamantinoma, and limb-salvage reconstructive procedures can achieve good functional outcomes, albeit with non-negligible rates of complications. This review discusses emerging advances in the pathogenesis, histogenesis, and diagnosis of these entities and presents advantages and limitations of the most common surgical techniques used for their management.
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Affiliation(s)
- Marc El Beaino
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA; School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Wei-Lien Wang
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sami F Alaraj
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Zbigniew Gugala
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lu Y, Canavese F, Lin R, Wang W, Zhang X, Chen S. Does the management of osteofibrous dysplasia of the tibia and fibula in children should be tailored to the extent and location of the lesion? A case control study investigating different surgical options. Orthop Traumatol Surg Res 2021; 109:102888. [PMID: 33713873 DOI: 10.1016/j.otsr.2021.102888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/27/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteofibrous dysplasia (OFD) is a rare non neoplastic, self-limited intracortical fibro-osseous lesion that most commonly affects the diaphysis of the tibia and fibula of children, the best treatment is still debated. Therefore we performed a retrospective study in children mostly under 10 years old with OFD aiming to determine whether early surgery is necessary and which is the best treatment. HYPOTHESIS Symptomatic OFD lesions should be treated proactively, and appropriate treatment can achieve favorable outcome. METHODS We retrospectively reviewed 23 patients with OFD of the tibia (n=22) and fibula. Management varied according to the severity of symptoms (deformity, pain or pathological fracture) and the extent of the lesion. Cases were divided into four groups (Gr.): Gr. 1: observation (n=4); Gr. 2: curettage and allograft (n=6); Gr. 3: curettage, allograft and elastic stable intramedullary nailing (ESIN) fixation (n=9); Gr. 4: extra-periosteal resection and bone transport (n=5). One patient received two different treatments successively (23 patients and 24 cases). All patients had regular clinical and radiographic follow-up to assess bone consolidation and complications. RESULTS In Gr. 1, four asymptomatic patients underwent observation after open biopsy. Gr. 4 had the lowest local recurrence rate: 0 cases (0%) vs. 4 (66.7%; Gr. 2) vs. 1 (11.1%; Gr. 3) (p=0.002), incidence of deformity: 0 case (0%) vs. 0 (0%; Gr. 2) vs. 3 (50%; Gr. 3) (p=0.023), and pathological fracture: 0 case (0%) vs. 0 (0%; Gr. 2) vs. 1 (16.7%; Gr. 3) (p=0.006), although the consolidation time was longer: 6.8 vs. 2 (Gr. 2) vs. 2.7 months (Gr. 3) (p=0.017) and the rate of complication was higher than those of Gr. 2 and Gr. 3 (p<0.05). Gr. 3 had a lower local recurrence rate: 1 case (11.1%) vs. 4 cases (66.7%) (p=0.002), incidence of deformity: 0 case (0%) vs. 3 cases (50%) (p=0.023), and pathological fracture: 0 case vs. 1 case (16.7%) (p=0.006) than Gr. 2. DISCUSSION Open biopsy is an important step in the management of patients with imaging suggestive of OFD in order to rule out Adamantinoma and other bone tumors or infection. Observation should be reserved for asymptomatic patients, while surgical treatment is indicated in patients with persistent pain, pathological fracture or significant deformity of the tibia. ESIN is a valid option to preserve the anatomical axis of the tibia in symptomatic patients with lesions of limited size; large circumferential lesions or recurrence can be managed by extra-periosteal resection and bone transport, although the complication rate can be relatively high. LEVEL OF EVIDENCE III; case control study.
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Affiliation(s)
- Yunan Lu
- Department of Pediatric Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, Fujian Province, China
| | - Federico Canavese
- Department of pediatric orthopedic surgery, Lille university centre, Jeanne de Flandre hospital, rue Eugène-Avinée, 59000 Lille, France
| | - Ran Lin
- Department of Pediatric Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, Fujian Province, China
| | - Wentao Wang
- Department of Pediatric Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, Fujian Province, China
| | - Xinzhao Zhang
- Department of Pediatric Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, Fujian Province, China
| | - Shunyou Chen
- Department of Pediatric Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, 47th Shangteng Road of Cangshan District, Fuzhou 350007, Fujian Province, China.
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Schutgens EM, Picci P, Baumhoer D, Pollock R, Bovée JVMG, Hogendoorn PCW, Dijkstra PDS, Rueten-Budde AJ, Jutte PC, Traub F, Leithner A, Tunn PU, Funovics P, Sys G, San-Julian M, Schaap GR, Dürr HR, Hardes J, Healey J, Capanna R, Biau D, Gomez-Brouchet A, Wunder J, Cosker TDA, Laitinen MK, Niu X, Kostiuk V, van de Sande MAJ. Surgical Outcome and Oncological Survival of Osteofibrous Dysplasia-Like and Classic Adamantinomas: An International Multicenter Study of 318 Cases. J Bone Joint Surg Am 2020; 102:1703-1713. [PMID: 33027124 PMCID: PMC8569856 DOI: 10.2106/jbjs.19.01056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteofibrous dysplasia-like adamantinoma (OFD-AD) and classic adamantinoma (AD) are rare, neoplastic diseases with only limited data supporting current treatment protocols. We believe that our retrospective multicenter cohort study is the largest analysis of patients with adamantinoma to date. The primary purpose of this study was to describe the disease characteristics and evaluate the oncological outcomes. The secondary purpose was to identify risk factors for local recurrence after surgical treatment and propose treatment guidelines. METHODS Three hundred and eighteen confirmed cases of OFD-AD and AD for which primary treatment was carried out between 1985 and 2015 were submitted by 22 tertiary bone tumor centers. Proposed clinical risk factors for local recurrence such as size, type, and margins were analyzed using univariable and multivariate Cox regression analysis. RESULTS Of the 318 cases, 128 were OFD-AD and 190 were AD. The mean age at diagnosis was 17 years (median, 14.5 years) for OFD-AD and 32 years (median, 28 years) for AD; 53% of the patients were female. The mean tumor size in the OFD-AD and AD groups combined was 7.8 cm, measured histologically. Sixteen percent of the patients sustained a pathological fracture prior to treatment. Local recurrence was recorded in 22% of the OFD-AD cases and 24% of the AD cases. None of the recurrences in the OFD-AD group progressed to AD. Metastatic disease was found in 18% of the AD cases and fatal disease, in 11% of the AD cases. No metastatic or fatal disease was reported in the OFD-AD group. Multivariate Cox regression analysis demonstrated that uncontaminated resection margins (hazard ratio [HR] = 0.164, 95% confidence interval [CI] = 0.092 to 0.290, p < 0.001), pathological fracture (HR = 1.968, 95% CI = 1.076 to 3.600, p = 0.028), and sex (female versus male: HR = 0.535, 95% CI = 0.300 to 0.952, p = 0.033) impacted the risk of local recurrence. CONCLUSIONS OFD-AD and AD are parts of a disease spectrum but should be regarded as different entities. Our results support reclassification of OFD-AD into the intermediate locally aggressive category, based on the local recurrence rate of 22% and absence of metastases. In our study, metastatic disease was restricted to the AD group (an 18% rate). We advocate wide resection with uncontaminated margins including bone and involved periosteum for both OFD-AD and AD. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- E M Schutgens
- Departments of Orthopedic Surgery (E.M.S., P.D.S.D., and M.A.J.v.d.S.), Histopathology (J.V.M.G.B.), and Pathology (P.C.W.H.), Leiden University Medical Center, Leiden, the Netherlands
- London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - P Picci
- Medical Oncology, Musculoskeletal Oncology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Baumhoer
- Bone Tumour Reference Centre, Institute of Pathology, University Hospital and University of Basel, Basel, Switzerland
| | - R Pollock
- London Sarcoma Service, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - J V M G Bovée
- Departments of Orthopedic Surgery (E.M.S., P.D.S.D., and M.A.J.v.d.S.), Histopathology (J.V.M.G.B.), and Pathology (P.C.W.H.), Leiden University Medical Center, Leiden, the Netherlands
| | - P C W Hogendoorn
- Departments of Orthopedic Surgery (E.M.S., P.D.S.D., and M.A.J.v.d.S.), Histopathology (J.V.M.G.B.), and Pathology (P.C.W.H.), Leiden University Medical Center, Leiden, the Netherlands
| | - P D S Dijkstra
- Departments of Orthopedic Surgery (E.M.S., P.D.S.D., and M.A.J.v.d.S.), Histopathology (J.V.M.G.B.), and Pathology (P.C.W.H.), Leiden University Medical Center, Leiden, the Netherlands
| | - A J Rueten-Budde
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - P C Jutte
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - F Traub
- Orthopedic Surgery, University of Tübingen, Tübingen, Germany
| | - A Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria
| | - P-U Tunn
- Orthopedic Surgery, Helios-Clinics, Berlin, Germany
| | - P Funovics
- Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
| | - G Sys
- Orthopedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - M San-Julian
- Orthopedic Surgery, University of Navarra, Pamplona, Spain
| | - G R Schaap
- Orthopedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - H R Dürr
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, Essen, Germany
| | - J Hardes
- Musculoskeletal Oncology, Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Munich, Germany
| | - J Healey
- Orthopedic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Capanna
- Department of Orthopaedics, S. Chiara University Hospital, University of Pisa, Italy
| | - D Biau
- Orthopedic Surgery, Cochin Hospital, Paris, France
| | - A Gomez-Brouchet
- Department of Histopathology, University Medical Center, Toulouse, France
| | - J Wunder
- University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - T D A Cosker
- Orthopedic Surgery, Nuffield Orthopedic Center, Oxford, United Kingdom
| | - M K Laitinen
- Orthopedic Surgery, Helsinki University Hospital, Helsinki, Finland
| | - X Niu
- Department of Orthopedic Oncology, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - V Kostiuk
- Orthopedic Surgery, National Cancer Institute Ukraine, Kiev, Ukraine
| | - M A J van de Sande
- Departments of Orthopedic Surgery (E.M.S., P.D.S.D., and M.A.J.v.d.S.), Histopathology (J.V.M.G.B.), and Pathology (P.C.W.H.), Leiden University Medical Center, Leiden, the Netherlands
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Deng Z, Gong L, Zhang Q, Hao L, Ding Y, Niu X. Outcome of osteofibrous dysplasia-like versus classic adamantinoma of long bones: a single-institution experience. J Orthop Surg Res 2020; 15:268. [PMID: 32677983 PMCID: PMC7367244 DOI: 10.1186/s13018-020-01769-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background The clinical and molecular characteristics of osteofibrous dysplasia (OFD)-like adamantinoma (AD) differ from those of classic AD. Most reports about OFD-like AD are case reports or small case series. More cases from different centers are still warranted. Methods The orthopedic oncology database of our institution was searched to identify patients with AD. The cases of OFD-like and classic AD of the long bones were retrospectively analyzed. Between December 1999 and August 2016, 23 patients were treated for AD, comprising seven with OFD-like AD and 16 with classic AD. The outcomes were compared between AD subtypes. Results In the OFD-like AD group, four lesions were treated with extensive curettage, while three were treated with wide resection. The median follow-up duration in the OFD-like AD group was 66 months (range 43–131 months). At the end of follow-up, there was only one case of local recurrence (LR) in the OFD-like AD group, giving a LR rate of 14.3% (1/7). No distant metastasis or progression to classic AD was detected in the OFD-like AD group. In the classic AD group, the treatments were below-the-knee amputation in one patient with extensive tibial and fibular lesions, curettage with a bone graft in one patient who was diagnosed with OFD based on a core needle biopsy, hemi-cortical excision and reconstruction in two patients, and segmental resection and reconstruction in 12 patients. At the end of follow-up, there were three cases of LR in the classic AD group, giving a LR rate of 18.8% (3/16); two patients developed lung metastasis after LR and died of the disease at 88 and 126 months after the first surgery in our hospital, respectively. The classic AD group had a metastatic rate of 12.5% (2/16), a final limb salvage rate of 75%, and estimated 5- and 10-year survival rates of 88.9% and 77.1%, respectively. Conclusions OFD-like AD has a better outcome than classic AD. For OFD-like AD, extensive curettage is suggested if the tumor extent allows. For classic AD, aggressive resection with wide margins is essential to achieve local control. A long-term follow-up is necessary due to the possibility of late complications.
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Affiliation(s)
- Zhiping Deng
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Number 31, Xinjiekoudongjie Street, Xicheng District, Beijing, 100035, China
| | - Lihua Gong
- Department of Pathology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Qing Zhang
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Number 31, Xinjiekoudongjie Street, Xicheng District, Beijing, 100035, China
| | - Lin Hao
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Number 31, Xinjiekoudongjie Street, Xicheng District, Beijing, 100035, China
| | - Yi Ding
- Department of Pathology, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Xiaohui Niu
- Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Peking University, Number 31, Xinjiekoudongjie Street, Xicheng District, Beijing, 100035, China.
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Schwarzkopf E, Tavarez Y, Healey JH, Hameed M, Prince DE. Adamantinomatous tumors: Long-term follow-up study of 20 patients treated at a single institution. J Surg Oncol 2020; 122:273-282. [PMID: 32334443 DOI: 10.1002/jso.25950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/13/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES Adamantinomas are primary, low-grade malignant tumors of the bone that have metastatic potential to the lungs, lymph nodes, and other regions. The rarity of this disease and its nonspecific symptoms complicate diagnosis. MATERIALS AND METHODS Records for 20 patients who underwent treatment for adamantinoma from 1975 to 2018 were reviewed for demographic, clinical, and pathological data, treatment details, postoperative complications, and outcomes. RESULTS Patients presented at a median age of 22 years (1-79 years): 14 patients had a localized primary tumor, three presented with local recurrence, and three with metastatic disease. Median tumor size was 5.7 cm (0.5-15.5 cm). Wide excision was performed primarily in 15 cases; the remaining five patients underwent intralesional curettage. At a median follow-up of 7.3 years, 14 patients had no evidence of disease; two patients were alive with disease, and four patients died from the disease. Local recurrence and distant metastasis occurred at a median of 11.4 years (6 month-19 years) and 15.8 years (4 month-23 years) after diagnosis. CONCLUSIONS Adequate histopathological diagnosis is crucial to avoid misdiagnosis of this rare tumor. Local and distant recuAbs_Para_meprrence can occur more than 20 years after the initial diagnosis. Life-long follow-up with clinical examination and imaging is required.
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Affiliation(s)
| | - Yoely Tavarez
- Department of Surgery, Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - John H Healey
- Department of Surgery, Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel E Prince
- Department of Surgery, Orthopaedic Service, Memorial Sloan-Kettering Cancer Center, New York, New York
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Abstract
BACKGROUND The proposed association between osteofibrous dysplasia and adamantinoma has led some to advocate resection of the entire lesion, which can require major subsequent reconstruction. However, this link remains unproven and there is some support in more recent literature for a less aggressive approach. This study aims to describe our experience managing pediatric tibial osteofibrous dysplasia with such an approach and to report functional outcomes in children treated thus. METHODS A total of 28 cases of osteofibrous dysplasia in 25 patients were managed at a referral center for pediatric bone tumors with observation in the first instance, then limited surgical intervention if required to address pain and deformity. Surgery aimed to restore stability and alignment without excising the lesion. Clinical records provided basic clinical outcome measures involving walking, recreation, orthoses and school/work participation and patients provided a Musculoskeletal Tumour Society score (MSTS) where contactable. RESULTS Mean age at presentation was 6.0 years and mean follow-up was 8.3 years. Only 8 patients required surgery. According to basic outcome measures, 13 patients were symptom-free. About 15 patients (17 cases) provided a MSTS and the mean score was 24 of 30. No transformation to adamantinoma was observed. Those who presented at a younger age and with bilateral disease more often required surgery and remained symptomatic. CONCLUSIONS A less aggressive approach to pediatric tibial osteofibrous dysplasia achieves good functional outcomes and patient satisfaction in most cases. Surgery is required in the minority of cases. Transformation to adamantinoma was not observed in this series. We recommend patient education, clinical observation and reactive intervention if required, rather than proactive resection and reconstruction. LEVEL OF EVIDENCE Level IV-case series.
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Comprehensive Molecular Characterization of Adamantinoma and OFD-like Adamantinoma Bone Tumors. Am J Surg Pathol 2019; 43:965-974. [DOI: 10.1097/pas.0000000000001251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Schwarzkopf E, Klima M, Trabulsy A, Prince D. Reconstruction of massive tibial defects after resection of adamantinoma with double-level distraction osteogenesis. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2019. [DOI: 10.4103/jllr.jllr_13_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Long-Term Follow-Up of Adamantinoma of the Tibia Complicated by Metastases and a Second Unrelated Primary Cancer: A Case Report and Literature Review. Case Rep Orthop 2018; 2018:5493750. [PMID: 29770232 PMCID: PMC5889869 DOI: 10.1155/2018/5493750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/13/2018] [Indexed: 12/02/2022] Open
Abstract
Adamantinoma is a rare, low-grade malignant tumor of the bone which grows slowly and typically occurs in the diaphysis of long bones, particularly in the tibia. Adamantinomas have the potential for local recurrence and may metastasize to the lungs, lymph nodes, or bone. We report a case of a 14-year-old female with a tibial adamantinoma who underwent wide resection with limb salvage and has subsequently been followed up for 18 years. The patient went on to have both a local soft tissue recurrence 5 years after the resection and metastases to both an inguinal lymph node and the right lower lobe of the lung 8 years after that recurrence, all of which have been treated successfully with marginal resections. Unique to this case, the patient was also incidentally found to have chromophobe-type renal cell carcinoma when undergoing a partial nephrectomy to resect a presumed metastasis of her adamantinoma. Genetic testing has not revealed any known genetic predisposition to cancer.
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