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Yeom A, Yoo SY, Jeon TY, Park J, Kim JH. [MR Imaging Features of Pediatric Bone Marrow]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:505-519. [PMID: 38873387 PMCID: PMC11166593 DOI: 10.3348/jksr.2024.0039] [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: 03/09/2024] [Revised: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024]
Abstract
MRI plays a crucial role in bone marrow (BM) assessment, and has very high sensitivity in diagnosing marrow disorders. However, for radiologists who may not frequently encounter pediatric imaging, distinguishing pathologic BM lesion from normal BM can be challenging. Conditions involving the BM in pediatric patients, such as leukemia and metastatic neuroblastoma, often manifest with diverse musculoskeletal symptoms and may be diagnosed using musculoskeletal MRI examinations. Accurate interpretation of pediatric MRI requires not only an understanding of the normal composition of BM but also an awareness of agerelated developmental changes in the marrow and familiarity with conditions that commonly involve pediatric BM. We aim to describe the composition of normal BM and outline the normal and abnormal MRI findings in pediatric BM. Additionally, we aim to present clinical cases of malignant BM disorders including leukemia, neuroblastoma metastasis, and other malignant BM disorders.
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Kha ST, Sharma J, Kenney D, Daldrup-Link H, Steffner R. Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma. Pediatr Emerg Care 2023; 39:963-967. [PMID: 37567167 DOI: 10.1097/pec.0000000000003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
OBJECTIVES The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis. METHODS We conducted a retrospective review of pediatric patients (aged 1-18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis. RESULTS Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4-18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1-84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0-4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0-493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0-493; P = 0.018). CONCLUSIONS We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.
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Sittiju P, Chaiyawat P, Pruksakorn D, Klangjorhor J, Wongrin W, Phinyo P, Kamolphiwong R, Phanphaisarn A, Teeyakasem P, Kongtawelert P, Pothacharoen P. Osteosarcoma-Specific Genes as a Diagnostic Tool and Clinical Predictor of Tumor Progression. BIOLOGY 2022; 11:biology11050698. [PMID: 35625426 PMCID: PMC9138411 DOI: 10.3390/biology11050698] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/28/2022] [Indexed: 01/15/2023]
Abstract
Simple Summary The standard method for the diagnosis and monitoring of osteosarcoma is biopsy and tumor imaging, which causes discomfort to patients and is difficult to repeat. A blood sample can be used as a non-invasive method for monitoring tumor material. Vimentin and ezrin show clinical significance in samples obtained from OS patients but need circulating tumor cell purification, since they are expressed in leukocytes. Due to the low-temperature storage of the samples, it proved impossible to perform purification to remove the contamination. We propose that novel or OS-specific biomarkers using differential gene expression from the Gene Expression Omnibus (GEO) database is a promising approach for developing diagnostic and tumor progression strategies. Seven genes from the database showed significant expression in OS cell lines/primary cells compared to a normal blood donor, together with ezrin and VIM. The expression of the five candidate genes together with ezrin and vimentin were quantified by qRT-PCR and analyzed using a mathematical model with high efficiency to discriminate between OS patients and normal samples, resulting in the selection of three candidate genes: COL5A2 (one of the five from the database) as well as ezrin and VIM. Our study demonstrates that these genes in retrospective samples could serve as tools of OS detection and predictors of disease progression. Abstract A liquid biopsy is currently an interesting tool for measuring tumor material with the advantage of being non-invasive. The overexpression of vimentin and ezrin genes was associated with epithelial-mesenchymal transition (EMT), a key process in metastasis and progression in osteosarcoma (OS). In this study, we identified other OS-specific genes by calculating differential gene expression using the Gene Expression Omnibus (GEO) database, confirmed by using quantitative reverse transcription-PCR (qRT-PCR) to detect OS-specific genes, including VIM and ezrin in the buffy coat, which were obtained from the whole blood of OS patients and healthy donors. Furthermore, the diagnostic model for OS detection was generated by utilizing binary logistic regression with a multivariable fractional polynomial (MFP) algorithm. The model incorporating VIM, ezrin, and COL5A2 genes exhibited outstanding discriminative ability, as determined by the receiver operating characteristic curve (AUC = 0.9805, 95% CI 0.9603, 1.000). At the probability cut-off value of 0.3366, the sensitivity and the specificity of the model for detecting OS were 98.63% (95% CI 90.5, 99.7) and 94.94% (95% CI 87.5, 98.6), respectively. Bioinformatic analysis and qRT-PCR, in our study, identified three candidate genes that are potential diagnostic and prognostic genes for OS.
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Affiliation(s)
- Pattaralawan Sittiju
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (P.K.)
| | - Parunya Chaiyawat
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Dumnoensun Pruksakorn
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jeerawan Klangjorhor
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
| | - Weerinrada Wongrin
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Phichayut Phinyo
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Rawikant Kamolphiwong
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand;
| | - Areerak Phanphaisarn
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
| | - Pimpisa Teeyakasem
- Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.C.); (D.P.); (J.K.); (P.P.); (A.P.); (P.T.)
| | - Prachya Kongtawelert
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (P.K.)
| | - Peraphan Pothacharoen
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (P.S.); (P.K.)
- Correspondence: ; Tel.: +66-53-94-5325 (ext. 206)
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Nazon C, Pierrevelcin M, Willaume T, Lhermitte B, Weingertner N, Marco AD, Bund L, Vincent F, Bierry G, Gomez-Brouchet A, Redini F, Gaspar N, Dontenwill M, Entz-Werle N. Together Intra-Tumor Hypoxia and Macrophagic Immunity Are Driven Worst Outcome in Pediatric High-Grade Osteosarcomas. Cancers (Basel) 2022; 14:cancers14061482. [PMID: 35326631 PMCID: PMC8945994 DOI: 10.3390/cancers14061482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Radiological and immunohistochemical data were correlated with the outcome in a retrospective monocentric cohort of 30 pediatric osteosarcomas (OTS). A necrotic volume of more than 50 cm3 at diagnosis was significantly linked to a worse overall survival (OS). Regarding immunohistochemical analyses, an overexpression of hypoxic markers, such as HIF-1α and anhydrase carbonic IX (CAIX), was significantly linked to a worse OS, while pS6-RP hyperexpression was correlated with a better survival. We also featured that CD68 positive cells, representative of macrophagic M1 polarization, were mostly associated with HIF-1α and CAIX hyperexpressions and that M2-like polarization, mostly related to CD163 positivity, was correlated to mTor activation. These findings, involving clinical, radiological and biology data, allowed us to hypothesize a dual signature association ready to use routinely in future protocols. Abstract Background: Osteosarcomas (OTS) represent the most common primary bone cancer diagnosed in adolescents and young adults. Despite remarkable advances, there are no objective molecular or imaging markers able to predict an OTS outcome at diagnosis. Focusing on biomarkers contributing broadly to treatment resistance, we examine the interplay between the tumor-associated macrophages and intra-tumor hypoxia. Methods: Radiological and immunohistochemical (IHC) data were correlated with the outcome in a retrospective and monocentric cohort of 30 pediatric OTS. We studied hypoxic (pS6, phospho-mTor, HIF-1α and carbonic anhydrase IX (CAIX)) and macrophagic (CD68 and CD163) biomarkers. Results: The imaging analyses were based on MRI manual volumetric measures on axial post-contrast T1 weighted images, where, for each tumor, we determined the necrotic volume and its ratio to the entire tumor volume. When they were above 50 cm3 and 20%, respectively, they correlated with a worse overall survival (p = 0.0072 and p = 0.0136, respectively) and event-free survival (p = 0.0059 and p = 0.0143, respectively). IHC assessments enable a significant statistical link between HIF-1α/CAIX hyper-expressions, CD68+ cells and a worse outcome, whereas activation of mTor pathway was linked to a better survival rate and CD163+ cells. Conclusions: This study evidenced the links between hypoxia and immunity in OTS, as their poor outcome may be related to a larger necrotic volume on diagnostic MRI and, in biopsies, to a specific IHC profile.
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Affiliation(s)
- Charlotte Nazon
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (C.N.); (F.V.)
| | - Marina Pierrevelcin
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
| | - Thibault Willaume
- Radiology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (T.W.); (G.B.)
| | - Benoît Lhermitte
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
- Pathology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Noelle Weingertner
- Pathology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Antonio Di Marco
- Department of Orthopedic Surgery and Traumatology, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Laurent Bund
- Department of Pediatric Surgery, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France;
| | - Florence Vincent
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (C.N.); (F.V.)
| | - Guillaume Bierry
- Radiology Department, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (T.W.); (G.B.)
| | - Anne Gomez-Brouchet
- Department of Pathology, University Hospital of Toulouse, 1 Avenue Irène Joliot Curie, 31100 Toulouse, France;
| | - Françoise Redini
- INSERM UMR1238, PHY-OS, Bone Sarcomas and Remodeling of Calcified Tissues, Nantes University, 44000 Nantes, France;
| | - Nathalie Gaspar
- Department of Oncology for Children and Adolescents, Gustave Roussy, 94805 Villejuif, France;
- INSERM U1015, Gustave Roussy, University of Paris-Saclay, 94805 Villejuif, France
- University of Paris-Saclay, 91400 Orsay, France
| | - Monique Dontenwill
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
| | - Natacha Entz-Werle
- Pediatric Onco-Hematology Unit, University Hospital of Strasbourg, 1 Avenue Molière, CEDEX, 67098 Strasbourg, France; (C.N.); (F.V.)
- CNRS UMR 7021, Laboratory of Bioimaging and Pathologies, Faculty of Pharmacy, 74 Route du Rhin, 67401 Illkirch, France; (M.P.); (B.L.); (M.D.)
- Correspondence: ; Tel.: +33-3-88-12-83-96; Fax: +33-3-88-12-80-92
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Bone Tumors. Radiol Clin North Am 2022; 60:221-238. [DOI: 10.1016/j.rcl.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Clemente EJI, Navarro OM, Navallas M, Ladera E, Torner F, Sunol M, Garraus M, March JC, Barber I. Multiparametric MRI evaluation of bone sarcomas in children. Insights Imaging 2022; 13:33. [PMID: 35229206 PMCID: PMC8885969 DOI: 10.1186/s13244-022-01177-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/07/2022] [Indexed: 12/22/2022] Open
Abstract
Osteosarcoma and Ewing sarcoma are the most common bone sarcomas in children. Their clinical presentation is very variable depending on the age of the patient and tumor location. MRI is the modality of choice to assess these bone sarcomas and has an important function at diagnosis and also for monitoring recurrence or tumor response. Anatomic sequences include T1- and T2-weighted images and provide morphological assessment that is crucial to localize the tumor and describe anatomical boundaries. Multiparametric MRI provides functional information that helps in the assessment of tumor response to therapy by using different imaging sequences and biomarkers. This review manuscript illustrates the role of MRI in osteosarcoma and Ewing sarcoma in the pediatric population, with emphasis on a functional perspective, highlighting the use of diffusion-weighted imaging and dynamic contrast-enhanced MRI at diagnosis, and during and after treatment.
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Affiliation(s)
- Emilio J Inarejos Clemente
- Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Oscar M Navarro
- Department of Medical Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Maria Navallas
- Department of Diagnostic Imaging, Hospital 12 de Octubre, Madrid, Spain
| | - Enrique Ladera
- Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
| | - Ferran Torner
- Department of Orthopaedics, Hospital Sant Joan de Déu. Av, Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
| | - Mariona Sunol
- Department of Pathology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Moira Garraus
- Department of Oncology, Hospital Sant Joan de Déu. Av, Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
| | - Jordi Català March
- Department of Radiology, Instituto de Resonancia Magnetica Guirado, C/Muntaner, 531, CP:08022, Barcelona, Spain
| | - Ignasi Barber
- Department of Diagnostic Imaging. Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP:08950, Esplugues de Llobregat, Barcelona, Spain
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Menendez N, Epelman M, Shao L, Douglas D, Meyers AB. Pediatric Osteosarcoma: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:97-114. [PMID: 35164914 DOI: 10.1053/j.sult.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osteosarcoma is a malignant bone tumor most commonly presenting in children. It has a bimodal distribution with a peak incidence occurring during the ages of 10-14 years old and in adults greater than age 65. The first peak of osteosarcoma correlates with the increased proliferation of bone during the pubertal growth period. Osteosarcoma most frequently presents with localized bone pain, swelling, and an antalgic gait. The patient may attribute symptoms to trauma or strenuous exercise, causing the patient to be managed conservatively. In these cases, the pain persists and eventually leads to further evaluation. The most common type of osteosarcoma is the conventional high-grade osteosarcoma. For conventional osteosarcoma, the diagnosis is typically made or strongly suggested based upon the initial radiographic appearance. Other types of osteosarcomas include low grade central, telangiectatic, small-cell, surface and intracortical. Consequently, it is important for radiologists to be aware of these subtypes and the imaging features that differentiate them from other etiologies to prevent a delay in treatment.
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Affiliation(s)
- Nelson Menendez
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- University of Central Florida College of Medicine, Orlando, FL; Department of Radiology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Lei Shao
- University of Central Florida College of Medicine, Orlando, FL; Department of Pathology and Lab Medicine, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Dorothea Douglas
- University of Central Florida College of Medicine, Orlando, FL; Department of Pediatrics, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Dept. of Radiology, Cincinnati, OH.
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Chaib B, Malhotra K, Khoo M, Saifuddin A. Pathological fracture in paediatric bone tumours and tumour-like lesions: A predictor of benign lesions? Br J Radiol 2021; 94:20201341. [PMID: 34319796 DOI: 10.1259/bjr.20201341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine the incidence and causes of pathological fractures in paediatric bone tumours and tumour-like lesions, and to determine if they are predictive of benign lesions. METHODS AND MATERIALS Retrospective review of children with suspected bone tumours referred to a specialist musculoskeletal oncology service between September 2019 and August 2020. Data recorded included patient age and gender, lesion location, the presence of a pathological fracture on the initial plain radiograph, and the final diagnosis made either by image-guided biopsy/curettage or based on typical imaging features. RESULTS 231 patients were included with 233 lesions (138 males and 93 females with mean age 10.5 years, range 3 months-18 years). Final diagnosis was based on histology in 85 (36.5%) cases and imaging in 148 (63.5%) cases, 52 (22.3%) lesions classed as non-neoplastic, 139 (59.7%) as benign and 42 (18%) as malignant. Pathological fractures were seen in 41 cases (17.6%) at presentation, involving the humerus in 19 (46.3%), the femur in 14 (34.1%), the tibia in 3 (7.3%), the fibula and radius in two each (4.9%) and the second toe proximal phalanx in 1 (2.4%) (p < 0.001). The commonest underlying lesions included simple bone cyst (n = 17; 41.5%) and non-ossifying fibroma (n = 10; 24.4%). Only 4 cases (9.75%) were malignant, one case each of osteosarcoma, Ewing sarcoma, leukaemia and BCOR undifferentiated round cell sarcoma. Pathological fracture occurred in 27.7% of non-malignant lesions and 9.5% of malignant lesions, this difference being statistically significant (p < 0.001). CONCLUSION Pathological fractures were seen in 17.6% of paediatric bone tumours, tumour-like lesions, being significantly associated with humeral location and non-malignant diagnosis. ADVANCES IN KNOWLEDGE Demonstrates the frequency, location and underlying diagnosis of pathological fractures in paediatric bone tumour and tumour-like lesions.
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Affiliation(s)
- Boussad Chaib
- Department of General Medicine, Maidstone Hospital, Kent, UK
| | - Karan Malhotra
- Department of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Michael Khoo
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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[Conventional epiphyseal chondrosarcoma of childhood and adolescence: a case report]. Unfallchirurg 2021; 124:738-746. [PMID: 34236448 DOI: 10.1007/s00113-021-01040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Conventional chondrosarcoma is the second most common primary malignant bone tumor and usually occurs at older adult ages. It is rare in childhood and adolescence. CASE HISTORY This case report presents the treatment course of a 13-year-old boy with a symptomatic chondrogenic tumor of the right distal femur. Histopathologically, an epiphyseal intermediate-grade chondrosarcoma (G2) was diagnosed. DISCUSSION Based on the following case, potential radiological and histopathological differential diagnoses, such as chondroblastoma or chondroblastic osteosarcoma, are discussed against the background of current standards in orthopedic oncology.
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Tomsan H, Grady MF, Ganley TJ, Nguyen JC. Pediatric Elbow: Development, Common Pathologies, and Imaging Considerations. Semin Roentgenol 2021; 56:245-265. [PMID: 34281678 DOI: 10.1053/j.ro.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hanna Tomsan
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA
| | - Matthew F Grady
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Theodore J Ganley
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jie C Nguyen
- University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.
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Zöllner SK, Amatruda JF, Bauer S, Collaud S, de Álava E, DuBois SG, Hardes J, Hartmann W, Kovar H, Metzler M, Shulman DS, Streitbürger A, Timmermann B, Toretsky JA, Uhlenbruch Y, Vieth V, Grünewald TGP, Dirksen U. Ewing Sarcoma-Diagnosis, Treatment, Clinical Challenges and Future Perspectives. J Clin Med 2021; 10:1685. [PMID: 33919988 PMCID: PMC8071040 DOI: 10.3390/jcm10081685] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.
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Affiliation(s)
- Stefan K. Zöllner
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
| | - James F. Amatruda
- Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA;
| | - Sebastian Bauer
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Medical Oncology, Sarcoma Center, University Hospital Essen, 45147 Essen, Germany
| | - Stéphane Collaud
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Thoracic Surgery, Ruhrlandklinik, University of Essen-Duisburg, 45239 Essen, Germany
| | - Enrique de Álava
- Institute of Biomedicine of Sevilla (IbiS), Virgen del Rocio University Hospital, CSIC, University of Sevilla, CIBERONC, 41013 Seville, Spain;
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Jendrik Hardes
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk Institute of Pathology, University Hospital Münster, 48149 Münster, Germany;
- West German Cancer Center (WTZ), Network Partner Site, University Hospital Münster, 48149 Münster, Germany
| | - Heinrich Kovar
- St. Anna Children’s Cancer Research Institute and Medical University Vienna, 1090 Vienna, Austria;
| | - Markus Metzler
- Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, 91054 Erlangen, Germany;
| | - David S. Shulman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA 02215, USA; (S.G.D.); (D.S.S.)
| | - Arne Streitbürger
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Musculoskeletal Oncology, Sarcoma Center, 45147 Essen, Germany
| | - Beate Timmermann
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre, 45147 Essen, Germany
| | - Jeffrey A. Toretsky
- Departments of Oncology and Pediatrics, Georgetown University, Washington, DC 20057, USA;
| | - Yasmin Uhlenbruch
- St. Josefs Hospital Bochum, University Hospital, 44791 Bochum, Germany;
| | - Volker Vieth
- Department of Radiology, Klinikum Ibbenbüren, 49477 Ibbenbühren, Germany;
| | - Thomas G. P. Grünewald
- Division of Translational Pediatric Sarcoma Research, Hopp-Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany;
- Division of Translational Pediatric Sarcoma Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Core Center, 69120 Heidelberg, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, 45147 Essen, Germany;
- West German Cancer Center (WTZ), University Hospital Essen, 45147 Essen, Germany; (S.B.); (S.C.); (J.H.); (A.S.); (B.T.)
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
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12
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Andronikou S, Kraft JK, Offiah AC, Jones J, Douis H, Thyagarajan M, Barrera CA, Zouvani A, Ramanan AV. Whole-body MRI in the diagnosis of paediatric CNO/CRMO. Rheumatology (Oxford) 2021; 59:2671-2680. [PMID: 32648576 DOI: 10.1093/rheumatology/keaa303] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/16/2020] [Accepted: 05/02/2020] [Indexed: 11/13/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disorder affecting the skeleton of children and adolescents. Whole-body MRI (WBMRI) is key in the diagnosis and follow-up of CRMO. Imaging protocols should include sagittal short Tau inversion recovery of the spine, imaging of the hands and feet, and T1 images for distinguishing normal bone marrow. CRMO lesions can be metaphyseal, epiphyseal and physeal-potentially causing growth disturbance and deformity. Spinal lesions are common, important and can cause vertebral collapse. Lesion patterns include multifocal tibial and pauci-focal patterns that follow a predictable presentation and course of disease. Common pitfalls of WBMRI include haematopoietic marrow signal, metaphyseal signal early on in bisphosphonate therapy and normal high T2 signal in the hands and feet. Pictorial reporting assists in recording lesions and follow-up over time. The purpose of this paper is to review the different WBMRI protocols, imaging findings, lesion patterns and common pitfalls in children with CRMO.
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Affiliation(s)
- Savvas Andronikou
- Department of Radiology, The Children's Hospital of Philadelphia.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeannette K Kraft
- Clarendon Wing Radiology Department, Leeds Children's Hospital at The Leeds General Infirmary, Leeds
| | - Amaka C Offiah
- Department of Radiology, Academic Unit of Child Health, University of Sheffield, Sheffield Children's NHS Foundation Trust, Sheffield.,Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield
| | - Jeremy Jones
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh
| | - Hassan Douis
- Department of Radiology, University Hospital Birmingham NHS Foundation Trust, Birmingham
| | - Manigandan Thyagarajan
- Department of Radiology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham
| | | | - Andrea Zouvani
- School of Clinical Sciences, School of Medicine, University of Glasgow, Glasgow
| | - Athimalaipet V Ramanan
- School of Clinical Sciences, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, UHB Education Centre, Bristol.,School of Clinical Sciences, University of Bristol, Bristol, UK
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13
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Pediatric Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00075-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Siwillis EM, Dharse NJ, Scanlan T, Ngoma M, Abraham ZS, Kahiu JWN, Million L. Pediatric Soft Tissue and Bone Sarcomas in Tanzania: Epidemiology and Clinical Features. J Glob Oncol 2020; 5:1-6. [PMID: 30917068 PMCID: PMC6449074 DOI: 10.1200/jgo.18.00258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Pediatric sarcomas represent an important group of childhood tumors that require treatment at Muhimbili National Hospital (MNH), the largest pediatric oncology center in Tanzania. Treatment is often adapted from established childhood protocols validated in clinical trials from the United States and the United Kingdom. There are no studies describing the types of pediatric sarcomas most commonly seen in Tanzania to understand similarities and disparities with other countries and which sarcomas to prioritize in adapting treatment protocols. The objective of this study was to establish a baseline of the epidemiologic and clinical features of pediatric sarcomas diagnosed at MNH. METHODS Information was collected on clinical and tumor features of all children seen at MNH pediatric oncology unit between 2011 and 2016 with a confirmed histologic diagnosis of either bone or soft tissue sarcoma (STS). RESULTS A total of 135 cases were analyzed; 89 (66%) were STS and 46 (34%) were bone sarcomas. There was a slight female predominance (n = 69; 51%), and the mean age (SD) of patients was 6.3 (5.1) years. Greater than 90% (n = 123) of the cases presented with a painless swelling. The commonest STS, accounting for almost three-fourths of the cases (n = 66) was rhabdomyosarcoma (RMS), with embryonal subtype being the most common RMS (n = 49; 74%). Osteosarcoma was the most common bone sarcoma, accounting for greater than 80% (n = 40) of the cases. Ewing sarcoma accounted for less than 15% (n = 6). Most of the patients presented with stage IV disease (n = 57; 87%) and lung was the commonest metastatic site. CONCLUSION To our knowledge, this report is the first study documenting the epidemiologic and clinical features of pediatric sarcomas in a modern Tanzanian pediatric hospital. Embryonal RMS and osteosarcomas should be prioritized for adapting treatment protocols from other countries.
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Affiliation(s)
- E Mithe Siwillis
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nazima J Dharse
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Trish Scanlan
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Lynn Million
- Stanford University School of Medicine, Stanford, CA
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15
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Imaging mimics of chronic recurrent multifocal osteomyelitis: avoiding pitfalls in a diagnosis of exclusion. Pediatr Radiol 2020; 50:124-136. [PMID: 31901992 DOI: 10.1007/s00247-019-04510-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/19/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a pediatric autoinflammatory disorder that is characterized by multiple sterile inflammatory bone lesions with a relapsing and remitting course. CRMO belongs to the autoinflammatory family of rheumatologic disorders based on absence of significant titers of autoantibodies and autoreactive T-lymphocytes. In absence of pathognomonic clinical, radiographic or pathological features, diagnosis can be challenging. CRMO shares imaging features with other diseases. It is important for radiologists to be able to differentiate other diseases from CRMO because prognosis varies from completely benign to frankly malignant. In this article we first present the clinical and imaging features of CRMO to help readers gain an understanding of the disease process, then discuss our imaging approach to CRMO and review other disease processes that sometimes share similar imaging findings to CRMO and review differentiating features to help avoid misdiagnoses.
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16
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Vieth V. [The importance of radiology in bone sarcoma diagnostics : Initial and advanced diagnostics]. DER ORTHOPADE 2019; 48:727-734. [PMID: 31392388 DOI: 10.1007/s00132-019-03786-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Reliable diagnostic assessment of malignant bone lesions remains a challenge in all the medical disciplines involved. The high incidence of benign (mainly pediatric) bone lesions needs to be distinguished from the rare malignant counterparts. If clinical presentation and patient history are unable to exclude a malignant tumour, adequate imaging of the affected region is necessary. OBJECTIVES This article focuses on giving implementable advice in dealing with problems and questions arising in the diagnostic process of treating patients with suspected or confirmed bone sarcoma. Also, follow-up recommendations from a radiological point of view are presented. METHODS Review and discussion of relevant literature against personal experiences in the medical imaging of patients with bone sarcomas. RESULTS Interpretation of projection radiographic images usually succeeds in assessing a bone tumour's dignity by evaluating periosteal reaction, the formation of a tumour matrix and consideration of the Lodwick classification. A current adaptation of the classic Lodwick classification incorporates diagnostic possibilities of more recent imaging techniques (magnetic resonance imaging (MRI), positron emission tomography (PET)) and is presented in this article. Plain radiographs are superseded by MRI as the primary imaging performed when depicting bone lesions with increasing frequency. The role of MRI in terms of primary diagnostics, staging, planning of biopsy tracts and tumour resections, evaluation of treatment response and follow-up are discussed. All diagnostic imaging techniques, including whole-body imaging methods, relevant in the diagnosis and therapy of bone sarcomas are presented in the sequence in which they appear during treatment. CONCLUSIONS Radiological imaging and expertise are important pillars in diagnosis and treatment of bone sarcomas. A variety of complementing imaging techniques provide a treatment-relevant basis significant for all medical disciplines involved.
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Affiliation(s)
- Volker Vieth
- Klinik für Radiologie, Klinikum Ibbenbüren, Große Straße 41, 49477, Ibbenbüren, Deutschland.
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17
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Saifuddin A, Sharif B, Gerrand C, Whelan J. The current status of MRI in the pre-operative assessment of intramedullary conventional appendicular osteosarcoma. Skeletal Radiol 2019; 48:503-516. [PMID: 30288560 DOI: 10.1007/s00256-018-3079-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/08/2018] [Accepted: 09/16/2018] [Indexed: 02/08/2023]
Abstract
Osteosarcoma is the commonest primary malignant bone tumour in children and adolescents, the majority of cases being conventional intra-medullary high-grade tumours affecting the appendicular skeleton. Treatment is typically with a combination of neo-adjuvant chemotherapy, tumour resection with limb reconstruction and post-operative chemotherapy. The current article reviews the role of magnetic resonance imaging (MRI) in the pre-operative assessment of high-grade central conventional osteosarcoma.
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Affiliation(s)
- Asif Saifuddin
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ban Sharif
- Department of Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Craig Gerrand
- Department of Orthopaedic Oncology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Jeremy Whelan
- Medical Oncology, University College London Hospital, 235 Euston Rd, London, NW1 2BU, UK
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18
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Kubo T, Furuta T, Sakuda T, Ochi M, Adachi N. Conventional 99mTc-(hydroxy) methylene diphosphate remains useful to predict osteosarcoma response to neoadjuvant chemotherapy: Individual patient data and aggregate data meta-analyses. Medicine (Baltimore) 2018; 97:e13308. [PMID: 30572434 PMCID: PMC6320105 DOI: 10.1097/md.0000000000013308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The current standard of chemotherapy response evaluation holds the most important prognostic factor to be the histological assessment of the tumor necrosis of the excised lesion, but the major challenge is to find an early prognostic factor that will allow the adjuvant treatment regimen to be adjusted. The objective of this systematic review is to provide an up-to-date and unprecedented summary of the value of Technetium-methylene diphosphate or -hydroxymethylene diphosphate (Tc-MDP/HMDP) scintigraphy for the preoperative evaluation of osteosarcoma response to chemotherapy. METHODS Studies evaluating the alteration ratio (percentage change of the Tc-99m -MDP/HMDP uptake between before and after neoadjuvant chemotherapy) to predict the histological response of osteosarcoma to chemotherapy were searched for in MEDLINE, EMBASE, and Web of Science. A meta-analysis of individual patient data (IPD) was performed to determine the optimal cut-off point from the receiver operating characteristic (ROC) curve. Additionally, aggregate data (AD) meta-analysis was performed to compare the value of Tc-MDP/HMDP scintigraphy with that of other quantitative modalities, such as dynamic magnetic resonance imaging (MRI), Tl scintigraphy, and F-FDG PET-CT. RESULTS Seven studies with 154 patients were included for the IPD meta-analysis. The optimal cut-off point of the alteration ratio was 31.0%. Five studies with 123 patients were considered for the AD meta-analysis. The pooled sensitivity and specificity were 0.76 (95% CI, 0.63-0.86) and 0.89 (95% CI, 0.79-0.95), respectively. There was a significant difference between the good and poor responders in terms of the diagnostic odds ratio. The summary ROC curve demonstrated that the area under curve (AUC) was 0.892, indicating excellent diagnostic accuracy. CONCLUSION Our findings have suggested that conventional Tc-MDP/HMDP scintigraphy remains as useful as recent quantitative modalities to predict the histological response of osteosarcoma to neoadjuvant chemotherapy.
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19
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Madej T, Flak-Nurzyńska J, Dutkiewicz E, Ciechomska A, Kowalczyk J, Wieczorek AP. Ultrasound image of malignant bone tumors in children. An analysis of nine patients diagnosed in 2011-2016. J Ultrason 2018; 18:103-111. [PMID: 30335918 PMCID: PMC6440508 DOI: 10.15557/jou.2018.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: The diagnostic process of bone tumors, including malignant ones, is based on conventional radiological methods, such as radiography and computed tomography, and with precise assessment of local advancement in magnetic resonance imaging. Ultrasonography is not included in the diagnostic algorithms as a tool suitable to detect this type of pathology. More and more frequent usage of musculoskeletal ultrasound in children as the first imaging method or, in some cases, as the only diagnostic method, makes it necessary to be familiar with sonographic presentation of bone tumors to suggest this diagnosis early enough and, after its verification, start treatment without a significant delay. Aim: The aim of this study was to determine changes in the sonographic image that might indicate a bone malignancy and suggest the need to extend the diagnostic process in this direction. Material and method: This article discusses 10 bone tumors in 9 children who had an ultrasound scan performed at the beginning of the diagnostic process before the histopathological diagnosis was established and treatment initiated. The assessment involved ultrasonographic features indicating the presence of a tumor. Results: In the group of 9 patients, 8 malignant bone tumors were diagnosed in ultrasonography and later verified histopathologically: 4 osteosarcomas and 4 Ewing’s sarcomas. In one case, two bone tumors were detected in ultrasonography without specification of their nature (malignant/benign, primary/secondary). Conclusions: In the analyzed cases, ultrasonography enabled the correct diagnosis of a focal bone lesion, and in most cases (8/9) it presented an image that suggested its malignant nature and the necessity of further diagnosis and treatment.
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Affiliation(s)
- Tomasz Madej
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland ; Department of Imaging, University Pediatric Hospital in Lublin, Lublin, Poland
| | - Joanna Flak-Nurzyńska
- Department of Pediatric Hematology, Oncology and Transplantology, University Pediatric Hospital in Lublin, Lublin, Poland
| | - Ewa Dutkiewicz
- Department of Pediatric Hematology, Oncology and Transplantology, University Pediatric Hospital in Lublin, Lublin, Poland
| | | | - Jerzy Kowalczyk
- Department of Pediatric Hematology, Oncology and Transplantology, University Pediatric Hospital in Lublin, Lublin, Poland
| | - Andrzej Paweł Wieczorek
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland ; Department of Imaging, University Pediatric Hospital in Lublin, Lublin, Poland
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20
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Smith-Guzmán NE, Toretsky JA, Tsai J, Cooke RG. A probable primary malignant bone tumor in a pre-Columbian human humerus from Cerro Brujo, Bocas del Toro, Panamá. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2018; 21:138-146. [PMID: 29778411 DOI: 10.1016/j.ijpp.2017.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/29/2017] [Accepted: 05/14/2017] [Indexed: 06/08/2023]
Abstract
We present a rare case of primary bone cancer principally affecting the right humerus of a skeleton from the pre-Columbian site of Cerro Brujo (1265-1380 CE) in Bocas del Toro, on the Caribbean coast of Panamá, excavated in the early 1970s. The humerus contains a dense, calcified sclerotic mass with associated lytic lesions localized around the midshaft of the diaphysis. Evidence of systemic inflammation and anemia, likely caused by the cancer, are visible in the form of severe porotic hyperostosis of the cranial vault and bilateral periosteal reactions in the tibiae. Differential diagnosis and future probes of the tumor are discussed. A tooth from the individual yielded a radiocarbon date 150 years later than those of the domestic occupation at the site. Given that it was the only formal burial recovered from the site, and as the individual had such a visible, painful, and rare pathology, this likely constitutes a ritual burial.
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Affiliation(s)
| | - Jeffrey A Toretsky
- Departments of Oncology and Pediatrics, Georgetown University, Washington, D.C. 20057, USA
| | - Jason Tsai
- Division of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, D.C. 20010, USA; Departments of Pediatrics and Radiology, George Washington University School of Medicine, Washington, D.C. 20037, USA
| | - Richard G Cooke
- Smithsonian Tropical Research Institute, Ancón, Panamá, Panama
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21
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Raimondi L, De Luca A, Costa V, Amodio N, Carina V, Bellavia D, Tassone P, Pagani S, Fini M, Alessandro R, Giavaresi G. Circulating biomarkers in osteosarcoma: new translational tools for diagnosis and treatment. Oncotarget 2017; 8:100831-100851. [PMID: 29246026 PMCID: PMC5725068 DOI: 10.18632/oncotarget.19852] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/25/2017] [Indexed: 12/24/2022] Open
Abstract
Osteosarcoma (OS) is a rare primary malignant bone tumour arising from primitive bone-forming mesenchymal cells, with high incidence in children and young adults, accounting for approximately 60% of all malignant bone tumours. Currently, long-term disease-free survival can be achieved by surgical treatment plus chemotherapy in approximately 60% of patients with localized extremity disease, and in 20-30% of patients with metastatic lung or bone disease. Diagnosis of primary lesions and recurrences is achieved by using radiological investigations and standard tissue biopsy, the latter being costly, painful and hardly repeatable for patients. Therefore, despite some recent advances, novel biomarkers for OS diagnosis, prediction of response to therapy, disease progression and chemoresistance, are urgently needed. Biological fluids such as blood represent a rich source of non-invasive cancer biomarkers, which allow to understand what is really happening inside the tumour, either at diagnosis or during disease progression. In this regard, liquid biopsy potentially represents an alternative and non-invasive method to detect tumour onset, progression and response to therapy. In this review, we will summarize the state of the art in this novel area, illustrating recent studies on OS. Although the data reported in literature seem preliminary, liquid biopsy represents a promising tool with the potential to be rapidly translated in the clinical practice.
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Affiliation(s)
- Lavinia Raimondi
- Rizzoli Orthopedic Institute, Bologna, Italy
- Rizzoli Orthopedic Institute, Innovative Technology Platforms for Tissue Engineering, Theranostic and Oncology, Palermo, Italy
| | - Angela De Luca
- Rizzoli Orthopedic Institute, Bologna, Italy
- Rizzoli Orthopedic Institute, Innovative Technology Platforms for Tissue Engineering, Theranostic and Oncology, Palermo, Italy
| | - Viviana Costa
- Rizzoli Orthopedic Institute, Bologna, Italy
- Rizzoli Orthopedic Institute, Innovative Technology Platforms for Tissue Engineering, Theranostic and Oncology, Palermo, Italy
| | - Nicola Amodio
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Valeria Carina
- Rizzoli Orthopedic Institute, Bologna, Italy
- Rizzoli Orthopedic Institute, Innovative Technology Platforms for Tissue Engineering, Theranostic and Oncology, Palermo, Italy
| | - Daniele Bellavia
- Rizzoli Orthopedic Institute, Bologna, Italy
- Rizzoli Orthopedic Institute, Innovative Technology Platforms for Tissue Engineering, Theranostic and Oncology, Palermo, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Stefania Pagani
- Rizzoli Orthopedic Institute, Laboratory of Preclinical and Surgical Studies, Bologna, Italy
| | - Milena Fini
- Rizzoli Orthopedic Institute, Laboratory of Preclinical and Surgical Studies, Bologna, Italy
| | - Riccardo Alessandro
- Biology and Genetics Unit, Department of Biopathology and Medical Biotechnology, University of Palermo, Palermo, Italy
- Institute of Biomedicine and Molecular Immunology (IBIM), National Research Council, Palermo, Italy
| | - Gianluca Giavaresi
- Rizzoli Orthopedic Institute, Innovative Technology Platforms for Tissue Engineering, Theranostic and Oncology, Palermo, Italy
- Rizzoli Orthopedic Institute, Laboratory of Preclinical and Surgical Studies, Bologna, Italy
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22
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Sun Y, Liu X, Pan S, Deng C, Li X, Guo Q. Analysis of imaging characteristics of primary malignant bone tumors in children. Oncol Lett 2017; 14:5801-5810. [PMID: 29113210 PMCID: PMC5661490 DOI: 10.3892/ol.2017.6939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/11/2017] [Indexed: 12/30/2022] Open
Abstract
The present study aimed to investigate the imaging characteristics of primary malignant bone tumors in children. The imaging results of 34 children with primary malignant bone tumors confirmed by histopathological diagnosis between March 2008 and January 2014 were retrospectively analyzed. In total, 25 patients had osteosarcoma, with radiography and computed tomography (CT) showing osteolytic bone destruction or/and osteoblastic bone sclerosis, an aggressive periosteal reaction, a soft-tissue mass and cancerous bone. The tumors appeared as mixed magnetic resonance imaging (MRI) signals that were inhomogeneously enhanced. A total of 5 patients presented with Ewing sarcoma, with radiography and CT showing invasive bone destruction and a soft-tissue mass. Of the 5 cases, 2 showed a laminar periosteal reaction. The tumors were shown to have mixed low signal on T1-weighted images (T1WI) and high signal on T2-weighted images (T2WI); 1 case showed marked inhomogeneous enhancement. Another 3 patients exhibited chondrosarcoma. Of these cases, 1 was adjacent to the cortex of the proximal tibia, and presented with local cortical bone destruction and a soft-tissue mass containing scattered punctate and amorphous calcifications. MRI revealed mixed low T1 signal and high T2 signals. Another case was located in the medullary cavity of the distal femur, with radiography revealing a localized periosteal reaction. The tumor appeared with mixed MRI signals, and with involvement of the epiphysis and epiphyseal plates. Radiography and CT of the third case showed bone destruction in the right pubic ramus, with patchy punctate, cambered calcifications in the soft-tissue mass. MRI of the soft-tissue mass revealed isointensity on T1WI and heterogeneous hyperintensity on T2WI. Ossifications and the septum appeared as low T1WI and T2WI. Of the 34 patients, 1 patient presented with lymphoma involving the T12, L1 and L2 vertebrae. CT showed vertebral bone destruction, a soft-tissue mass and a compression fracture of L1. MRI showed a soft-tissue mass with low T1 signal and high T2 signal and marked inhomogeneous enhancement. Overall, osteosarcoma was the most common primary malignant bone tumor, followed by Ewing sarcoma, chondrosarcoma and lymphoma. Osteoblastic or osteolytic bone destruction, an invasive periosteal reaction, soft-tissue masses, a tumor matrix and inhomogeneous enhancement were important imaging features of malignant bone tumors.
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Affiliation(s)
- Yingwei Sun
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Xueyong Liu
- Department of Orthopedics, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Chunbo Deng
- Department of Orthopedics, Central Hospital, Shenyang Medical College, Shenyang, Liaoning 110024, P.R. China
| | - Xiaohan Li
- Department of Pathology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Qiyong Guo
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, P.R. China
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Sanli Y, Yilmaz E, Subramaniam RM. Precision Medicine and PET-Computed Tomography in Pediatric Malignancies. PET Clin 2017; 12:423-435. [PMID: 28867113 DOI: 10.1016/j.cpet.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fluorine-18 fluorodeoxyglucose (18F-FDG) PET-computed tomography (CT) plays a significant role in diagnosis, staging, therapy selection, and therapy assessment of multiple pediatric malignancies and facilitating precision medicine delivery in pediatric patients. In patients with Hodgkin lymphoma, interim fludeoxyglucose 18F-FDG PET/CT is highly sensitive and specific for predicting survival and multiple trials with FDG PET/CT-based adaptive therapies are currently ongoing. It is superior to iodine-131 metaiodobenzylguanidine (131I-MIBG) scintigraphy and bone scintigraphy for detecting metastases in neuroblastoma patients and sarcoma patients. It may predict histologic differentiation and neoadjuvant therapy assessment in Wilms tumor.
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Affiliation(s)
- Yasemin Sanli
- Department of Nuclear Medicine, Medical Faculty of Istanbul, Istanbul University, Sehremini, Istanbul 34370, Turkey; Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA.
| | - Ebru Yilmaz
- Department of Nuclear Medicine, Medical Faculty of Istanbul, Istanbul University, Sehremini, Istanbul 34370, Turkey
| | - Rathan M Subramaniam
- Department of Radiology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Clinical Sciences, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Department of Biomedical Engineering, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA; Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8896, USA
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Brady JS, Chung SY, Marchiano E, Eloy JA, Baredes S, Park RCW. Pediatric head and neck bone sarcomas: An analysis of 204 cases. Int J Pediatr Otorhinolaryngol 2017; 100:71-76. [PMID: 28802390 DOI: 10.1016/j.ijporl.2017.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/31/2017] [Accepted: 06/09/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To analyze the demographics, survival, and treatment efficacy of pediatric sarcomas of the facial skeleton and skull. METHODS Retrospective study of cases from the US National Cancer Institute's Surveillance, Epidemiology, and End Results database. Pediatric patients between the ages of 0 and 18 diagnosed with a malignant sarcoma of either the mandible or the bones of skull, face, and associated joints from 1973 to 2013 were studied. RESULTS In total, 204 patients were included in the analysis. The average age at diagnosis was 11.39 (±5.15) years with a male-to-female ratio of 1.4:1. Whites were the most commonly affected race (76.0%). Malignant mandible sarcomas accounted for 29.9% of the cohort (n = 61). The most common pathology was osteosarcoma, which accounted for 43.6% of the cohort (n = 89). Among patients with known histologic grade (n = 95), 26.0% were AJCC stage III or IV. Overall, 5-year disease-specific survival (DSS) was 80.6%. When stratified by treatment modality, 5-year DSS was 86.0% for surgery alone, 67.9% for radiation alone, and 75.3% for surgery with adjuvant radiotherapy (p = 0.041). CONCLUSIONS Osteosarcoma, Ewing's sarcoma, and chondrosarcoma are the most common subtypes of pediatric head and neck bone sarcoma. Such sarcomas more commonly affect whites and males during pubertal ages. Disease-specific survival is not affected by primary site. Surgery alone is the mainstay of treatment, and demonstrates higher 5-year disease-specific survival compared to radiotherapy alone. Adjuvant radiotherapy does not seem to increase survival, but further investigation is warranted.
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Affiliation(s)
- Jacob S Brady
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sei Y Chung
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Emily Marchiano
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Richard Chan Woo Park
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
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Ishibashi M, Tanabe Y, Fujii S, Ogawa T. Pictorial review of 18F-FDG PET/CT findings in musculoskeletal lesions. Ann Nucl Med 2017; 31:437-453. [PMID: 28585058 DOI: 10.1007/s12149-017-1182-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/27/2017] [Indexed: 11/26/2022]
Abstract
We herein reviewed 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) findings in a number of musculoskeletal lesions including malignant tumors, benign tumors, and tumor-like lesions with correlations to other radiographic imaging modalities, and described the diversity of the 18F-FDG PET/CT findings of this entity. Malignant primary musculoskeletal tumors are typically 18F-FDG avid, whereas low-grade malignant tumors show mild uptake. Benign musculoskeletal tumors generally show a faint uptake of 18F-FDG, and tumor-like conditions also display various uptake patterns of 18F-FDG. Although musculoskeletal tumors show various uptakes of 18F-FDG on PET/CT, its addition to morphological imaging modalities such as CT and MRI is useful for the characterization and differentiation of musculoskeletal lesions.
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Affiliation(s)
- Mana Ishibashi
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan.
| | - Yoshio Tanabe
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Toshihide Ogawa
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, 683-8504, Japan
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Abstract
PURPOSE To review how PET/MR technology could add value for pediatric cancer patients. RECENT FINDINGS Since many primary tumors in children are evaluated with MRI and metastases are detected with PET/CT, integrated PET/MR can be a time-efficient and convenient solution for pediatric cancer staging. 18F-FDG PET/MR can assess primary tumors and the whole body in one imaging session, avoid repetitive anesthesia and reduce radiation exposure compared to 18F-FDG PET/CT. This article lists 10 action points, which might improve the clinical value of PET/MR for children with cancer. However, even if PET/MR proves valuable, it cannot enter mainstream applications if it is not accessible to the majority of pediatric cancer patients. Therefore, innovations are needed to make PET/MR scanners affordable and increase patient throughput. SUMMARY PET/MR offers opportunities for more efficient, accurate and safe diagnoses of pediatric cancer patients. The impact on patient management and outcomes has to be substantiated by large-scale prospective clinical trials.
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Affiliation(s)
- Heike Daldrup-Link
- Department of Radiology, Lucile Packard Children's Hospital, and Pediatric Molecular Imaging Program (@PedsMIPS) in the Molecular Imaging Program at Stanford (MIPS), Stanford University
- Department of Pediatrics, Stanford University
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Chemotherapy and Multidisciplinary Approaches to Pediatric Sarcomas. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Osteosarcoma, a bone cancer most commonly seen in adolescents and young adults, is usually a high-grade malignancy characterized by a very high risk for the development of pulmonary metastases. High-grade osteosarcomas are usually treated by preoperative and postoperative chemotherapy and surgery, with a very limited number of active agents available. Rarer lower-grade variants such as parosteal and periosteal osteosarcoma or low-grade central osteosarcoma are treated by surgery only. Imaging to search for possible metastases focuses on the lung. Computed tomography is the most sensitive method but cannot reliably distinguish small metastases from benign lesions. Advances of local imaging and surgical reconstruction now allow the use of limb-salvage in an ever-increasing proportion of patients. While still troubled by complications, non-invasive endoprosthesis-lengthening mechanisms have led to an increased uptake of limb-salvage, even for young, skeletally immature patients. Radiotherapy is employed when osteosarcomas cannot be removed with clear margins, but very high doses are required, and both proton and carbon-ion radiotherapy are under investigation. Unfortunately, the past 30 years have witnessed few, if any, survival improvements. Novel agents have not led to universally accepted changes of treatment standards. In patients with operable high-grade osteosarcomas, the extent of histological response to preoperative chemotherapy is a significant predictive factor for both local and systemic control. Attempts to improve prognosis by adapting postoperative treatment to response, recently tested in a randomized, prospective setting by the European and American Osteosarcoma Study Group, have not been proven to be beneficial. Many agree that only increased knowledge about osteosarcoma biology will lead to novel, effective treatment approaches and will be able to move the field forward.
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Affiliation(s)
- Stefan S Bielack
- Klinikum Stuttgart - Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin; Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Kriegsbergstrasse 62, Stuttgart Cancer Center, Germany
| | - Stefanie Hecker-Nolting
- Klinikum Stuttgart - Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin; Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Kriegsbergstrasse 62, Stuttgart Cancer Center, Germany
| | - Claudia Blattmann
- Klinikum Stuttgart - Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin; Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Kriegsbergstrasse 62, Stuttgart Cancer Center, Germany
| | - Leo Kager
- St. Anna Children's Hospital, Department of Paediatrics, Medical University Vienna and Children's Cancer Research Institute CCRI, Vienna, Austria
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Interiano RB, Malkan AD, Loh AHP, Hinkle N, Wahid FN, Bahrami A, Mao S, Wu J, Bishop MW, Neel MD, Gold RE, Rao BN, Davidoff AM, Fernandez-Pineda I. Initial diagnostic management of pediatric bone tumors. J Pediatr Surg 2016; 51:981-5. [PMID: 26995522 PMCID: PMC5154299 DOI: 10.1016/j.jpedsurg.2016.02.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common primary pediatric bone malignancies. We sought to assess the diagnostic accuracy of initial tumor biopsies in patients with OS or ESFT at a pediatric cancer center. METHODS All biopsies performed at initial presentation of patients with OS or ESFT at our institution from 2003 to 2012 were retrospectively reviewed. Diagnostic accuracy and incidence of complications were correlated with study variables using logistic regression analysis. RESULTS One hundred forty-two biopsies were performed in 105 patients (median age 13.4years, range: 1.8-23.0), 104 (73.2%) OS and 38 (27.8%) ESFT. Thirty-one (21.8%) were performed on metastatic sites. Eighty-five (76.6%) of 111 primary site biopsies were open procedures, and 26 were percutaneous (23.4%). Primary site biopsies were successful in 94.1% of open and 73.1% of percutaneous procedures. Odds of obtaining a successful diagnostic specimen were 7.8 times higher with open approach (CI: 1.6-36.8). Metastatic site biopsies were successful in 66.7% of percutaneous and 100% of open and thoracoscopic procedures. CONCLUSION Biopsy of metastatic sites was equal to primary site in obtaining diagnostic material with the added benefit of accurate staging, with few adverse events and high diagnostic yield.
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Affiliation(s)
- Rodrigo B Interiano
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alpin D Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amos H P Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Nathan Hinkle
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fazal N Wahid
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael D Neel
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robert E Gold
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bhaskar N Rao
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Israel Fernandez-Pineda
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Haveman LM, Breunis WB, Cohen JF, van Dalen EC, Owers EC, Dirksen U, Kremer LCM, Jürgens H, van den Berg H, Merks JHM. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) for detecting metastases of Ewing sarcoma. Hippokratia 2016. [DOI: 10.1002/14651858.cd012133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lianne M Haveman
- Emma Children's Hospital/Academic Medical Center; Department of Paediatric Oncology; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Willemijn B Breunis
- Emma Children's Hospital/Academic Medical Center; Department of Paediatric Oncology; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Jérémie F Cohen
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS), Inserm UMR1153, Paris Descartes University; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé); Paris France
- Academic Medical Center; Department of Clinical Epidemiology, Biostatistics and Bioinformatics; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Elvira C van Dalen
- Emma Children's Hospital/Academic Medical Center; Department of Paediatric Oncology; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Emilia C Owers
- Academic Medical Center; Department of Nuclear Medicine; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Uta Dirksen
- Universitätsklinikum Münster; Paediatric Haematology and Oncology; Universitätsklinikum Münster Münster Germany 48149
| | - Leontien CM Kremer
- Emma Children's Hospital/Academic Medical Center; Department of Paediatric Oncology; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Heribert Jürgens
- Universitätsklinikum Münster; Paediatric Haematology and Oncology; Universitätsklinikum Münster Münster Germany 48149
| | - Henk van den Berg
- Emma Children's Hospital/Academic Medical Center; Department of Paediatric Oncology; PO Box 22660 Amsterdam Netherlands 1100 DD
| | - Johannes HM Merks
- Emma Children's Hospital/Academic Medical Center; Department of Paediatric Oncology; PO Box 22660 Amsterdam Netherlands 1100 DD
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Taupin T, Decouvelaere AV, Vaz G, Thiesse P. Accuracy of core needle biopsy for the diagnosis of osteosarcoma: A retrospective analysis of 73 patients. Diagn Interv Imaging 2015; 97:327-31. [PMID: 26616843 DOI: 10.1016/j.diii.2015.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE The goals of this retrospective study were to evaluate the accuracy of core needle biopsy (CNB) for the diagnosis of osteosarcoma and to identify criteria that may predict failed CNB. MATERIALS AND METHODS From 2002 to 2012, 73patients with a total of 73osteosarcomas underwent CNB. Patients demographics and procedure details were recorded, including tumor size, tumor characteristics (hemorrhagic or not, lytic, sclerotic [>50% bone condensation], or mixed), the type of anesthesia, the number of tissue samples, the size of the biopsy needle and pathology report. Procedures were analyzed in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS A diagnosis was not made in 5/73patients (6.8%) with an overall sensitivity of 93.1%, a specificity of 100%, a PPV of 100% and a NPV of 99.9%. No complications due to CNB were observed. No criteria were identified as predictors of CNB failure. CONCLUSION Even in the presence of sclerotic tumors, CNB should be the first line diagnostic test for suspected osteosarcomas, pending performance by a well-trained radiologist and reading by a specialized pathologist. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T Taupin
- Centre de lutte contre le cancer Léon-Bérard, service de radiologie, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France.
| | - A-V Decouvelaere
- Centre de lutte contre le cancer Léon-Bérard, service d'anatomie et de cytologie pathologiques, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - G Vaz
- Hôpital Édouard-Herriot, service de chirurgie orthopédique, place d'Arsonval, 69008 Lyon, France
| | - P Thiesse
- Centre de lutte contre le cancer Léon-Bérard, service de radiologie, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
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Case 2: a 10-year-old girl with hip pain. Pediatr Radiol 2015; 45:640-5. [PMID: 25896334 DOI: 10.1007/s00247-014-3213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 07/03/2014] [Accepted: 10/16/2014] [Indexed: 10/23/2022]
Abstract
In this continuing series designed for pediatric radiology trainees, the imaging management of hip pain and a discovered bony mass are dissected through a specific case of a preadolescent.
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Liao CL, Lin JH, Lien JC, Hsu SC, Chueh FS, Yu CC, Wu PP, Huang YP, Lin JG, Chung JG. The crude extract of Corni Fructus inhibits the migration and invasion of U-2 OS human osteosarcoma cells through the inhibition of matrix metalloproteinase-2/-9 by MAPK signaling. ENVIRONMENTAL TOXICOLOGY 2015; 30:53-63. [PMID: 23955962 DOI: 10.1002/tox.21894] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 07/10/2013] [Accepted: 07/11/2013] [Indexed: 06/02/2023]
Abstract
Osteosarcoma is the most common primary malignancy of the bone cancers. In the Chinese population, the crude extract of Corni Fructus (CECF) has been used as Traditional Chinese medicine to treat several different diseases for hundreds of years. In the present study, effects of CECF on inhibition of migration and invasion in U-2 OS human osteosarcoma cells were examined. CECF significantly inhibited migration and invasion of U-2 OS human osteosarcoma cells. We also found that CECF inhibited activities of matrix metalloproteinases-2 (MMP-2) and matrix metalloproteinases-9 (MMP-9). CECF decreased protein levels of FAK, PKC, SOS1, MKK7, MEKK3, GRB2, NF-κB p65, COX-2, HIF-1α, PI3K, Rho A, ROCK-1, IRE-1α, p-JNK1/2, p-ERK1/2, p-p38, Ras, p-PERK, MMP-2, MMP-9, and VEGF in U-2 OS cells. Results of this study indicate that CECF may have potential as a novel anticancer agent for the treatment of osteosarcoma by inhibiting migration and invasion of cancer cells.
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Affiliation(s)
- Ching-Lung Liao
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, 404, Taiwan
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Quartuccio N, Fox J, Kuk D, Wexler LH, Baldari S, Cistaro A, Schöder H. Pediatric bone sarcoma: diagnostic performance of ¹⁸F-FDG PET/CT versus conventional imaging for initial staging and follow-up. AJR Am J Roentgenol 2015; 204:153-60. [PMID: 25539251 DOI: 10.2214/ajr.14.12932] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the diagnostic performance of (18)F-FDG PET/CT and conventional imaging for staging and follow-up of pediatric osteosarcoma and skeletal Ewing sarcoma. MATERIALS AND METHODS We calculated sensitivity, specificity, and accuracy of PET/CT and conventional imaging (CT, MRI, bone scanning) for sites of disease and number of lesions. Diagnostic benefit, defined as better characterization of lesions, was evaluated on a per-scan basis, comparing PET/CT and conventional imaging. RESULTS A total of 412 lesions were characterized by imaging in 64 patients (20, osteosarcoma; 44, Ewing sarcoma). For osteosarcoma patients PET/CT was available only at follow-up, where it proved more accurate than conventional imaging for the detection of bone lesions (accuracy, 95% vs 67% for CT and 86% for MRI) and complementary to CT in evaluating lung nodules (sensitivity, 84% vs 94%; specificity, 79% vs 71%) with diagnostic benefit in 18% of examinations. In patients with Ewing sarcoma, PET/CT tended to perform better during follow-up than at initial staging (accuracy, 85% vs 69%). For lung findings, PET/CT was more specific than CT but was less sensitive. The diagnostic benefit of PET/CT was greater at staging (28%) than during followup (9%). On a per-patient basis, PET/CT provided diagnostic benefit in 21 of 44 patients with Ewing sarcoma and nine of 20 patients with osteosarcoma at least once during clinical management. CONCLUSION FDG PET/CT provides diagnostic benefit in Ewing sarcoma and osteosarcoma, with the exception of small lung nodules. Prospective studies are needed to define the best imaging algorithm and combination of tests in the staging and follow-up of patients with pediatric bone sarcoma.
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Affiliation(s)
- Natale Quartuccio
- 1 Nuclear Medicine Unit, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
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Abstract
Bone scintigraphy is a well-established method to evaluate for metastatic disease in osteosarcoma. We identified a patient who had a negative (cold) bone scan at skeletal relapse and consequently reviewed the frequency of cold scans in osteosarcoma at our institution. No cold scans were identified at diagnosis, and only 1 patient had a cold scan at skeletal recurrence. No correlation was identified between clinical outcomes and bone scan features, other than identification of metastatic disease. Patients with skeletal recurrence were all symptomatic, thus we suggest that bone scintigraphy is not indicated in routine postchemotherapy surveillance for patients with osteosarcoma.
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Deguelin inhibits the migration and invasion of U-2 OS human osteosarcoma cells via the inhibition of matrix metalloproteinase-2/-9 in vitro. Molecules 2014; 19:16588-608. [PMID: 25322282 PMCID: PMC6271177 DOI: 10.3390/molecules191016588] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/16/2014] [Accepted: 09/23/2014] [Indexed: 11/16/2022] Open
Abstract
Osteosarcoma is the most common malignant primary bone tumor in children and young adults and lung metastasis is the main cause of death in those patients. Deguelin, a naturally occurring rotenoid, is known to be an Akt inhibitor and to exhibit cytotoxic effects, including antiproliferative and anticarcinogenic activities, in several cancers. In the present study, we determined if deguelin would inhibit migration and invasion in U-2 OS human osteosarcoma cells. Deguelin significantly inhibited migration and invasion of U-2 OS human osteosarcoma cells which was associated with a reduction of activities of matrix metalloproteinases-2 (MMP-2) and matrix metalloproteinases-9 (MMP-9). Furthermore, results from western blotting indicated that deguelin decreased the cell proliferation and cell growth-associated protein levels, such as SOS1, PKC, Ras, PI3K, p-AKT(Ser473), IRE-1α, MEKK3, iNOS, COX2, p-ERK1/2, p-JNK1/2, p-p38; the cell motility and focal adhesion-associated protein levels, such as Rho A, FAK, ROCK-1; the invasion-associated protein levels, such as TIMP1, uPA, MMP-2. MMP-9, MMP-13, MMP-1 and VEGF in U-2 OS cells. Confocal microscopy revealed that deguelin reduced NF-κB p65, Rho A and ROCK-1 protein levels in cytosol. MMP-7, MMP-9 and Rho A mRNA levels were suppressed by deguelin. These in vitro results provide evidence that deguelin may have potential as a novel anti-cancer agent for the treatment of osteosarcoma and provides the rationale for in vivo studies in animal models.
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Gao S, Zheng Y, Cai Q, Yao W, Wang J. Preliminary clinical research on epiphyseal distraction in osteosarcoma in children. World J Surg Oncol 2014; 12:251. [PMID: 25099460 PMCID: PMC4132209 DOI: 10.1186/1477-7819-12-251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 07/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The feasibility of distal femur epiphysis preservation through epiphyseal distraction by external fixator in childhood osteosarcoma was explored. METHODS Between July 2007 and May 2011, 10 children who were suffering from distal femur osteosarcoma received epiphyseal distraction by external fixator, combined with tumor resection and repair with massive allograft bone to preserve the epiphysis of the distal femur and knee function. There were six male and four female patients, 9- to 14-years old (average 10.5 years old). The tumors were staged clinically according to the Enneking staging method: six cases were classified as stage in IIA and four cases as stage in IIB. All patients were diagnosed by biopsy, then received chemotherapy before and after surgery. All patients received tumor bone resection and the defects of the bone were repaired with massive allograft bone that was fixed by intramedullary nails; the distracted epiphysis and allograft bone were fixed with cancellous screws. RESULTS All cases received follow-up from 15 to 56 months (average 38.5 months). There were no local recurrences. One case died of lung metastasis and one case had poor incision healing for rejection of allograft bone. According to the functional evaluation criteria of the International Society of Limb Salvage (ISOLS) after operation, five cases were rated excellent, four cases good and one case fair. The ratio of excellent or good was 90.0%. There was no statistically significant difference in length between the operated and the normal lower limbs during the last review. CONCLUSIONS Epiphyseal distraction by external fixator can result in satisfactory limb length and joint function for children with a malignant bone tumor.
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Affiliation(s)
- Songtao Gao
- Department of Orthopaedics, The Affiliated Tumor Hospital of Zhengzhou University, Zhengzhou, Henan 450008, China.
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Is Methylene Diphosphonate Bone Scan Necessary for Initial Staging of Ewing Sarcoma if18F-FDG PET/CT Is Performed? AJR Am J Roentgenol 2014; 202:859-67. [DOI: 10.2214/ajr.13.11239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hsu SC, Lin JH, Weng SW, Chueh FS, Yu CC, Lu KW, Wood WG, Chung JG. Crude extract of Rheum palmatum inhibits migration and invasion of U-2 OS human osteosarcoma cells by suppression of matrix metalloproteinase-2 and -9. Biomedicine (Taipei) 2013. [DOI: 10.1016/j.biomed.2013.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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PET/MRI in cancer patients: first experiences and vision from Copenhagen. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 26:37-47. [DOI: 10.1007/s10334-012-0357-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 01/08/2023]
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Mosier SM, Patel T, Strenge K, Mosier AD. Chondrosarcoma in childhood: the radiologic and clinical conundrum. J Radiol Case Rep 2012; 6:32-42. [PMID: 23365701 DOI: 10.3941/jrcr.v6i12.1241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Less than 10% of chondrosarcomas occur in children. In addition, as little as 0.5% of low-grade chondrosarcomas arise secondarily from benign chondroid lesions. The presence of focal pain is often used to crudely distinguish a chondrosarcoma (which is usually managed with wide surgical excision), from a benign chondroid lesion (which can be followed by clinical exams and imaging surveillance). Given the difficulty of localizing pain in the pediatric population, initial radiology findings and short-interval follow-up, both imaging and clinical, are critical to accurately differentiate a chondrosarcoma from a benign chondroid lesion. To our knowledge, no case in the literature discusses a chondrosarcoma possibly arising secondarily from an enchondroma in a pediatric patient. We present a clinicopathologic and radiology review of conventional chondrosarcomas. We also attempt to further the understanding of how to manage a chondroid lesion in the pediatric patient with only vague or bilateral complaints of pain.
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Affiliation(s)
- Susan M Mosier
- Department of Pediatrics, Ireland Army Community Hospital, Fort Knox, KY, USA
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Abstract
After initial evaluation with radiography, magnetic resonance (MR) imaging is the most common modality used to establish the diagnosis and characterize osseous and soft tissue tumors of the hip. Tumors involving the proximal femur are often benign, and MR imaging can be specific in diagnosing solitary bone cyst, osteochondroma, and chondroblastoma. Benign and malignant soft tissue tumors about the hip are often nonspecific in their MR imaging appearances, but knowledge of the patient's age may direct a more limited differential diagnosis. In the setting of malignancy, MR imaging is commonly used to stage tumors and follow patients postoperatively.
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Correlation of non-mass-like abnormal MR signal intensity with pathological findings surrounding pediatric osteosarcoma and Ewing's sarcoma. Skeletal Radiol 2012; 41:1453-61. [PMID: 22406919 DOI: 10.1007/s00256-012-1383-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/27/2011] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this work was to determine the role of MRI in interpreting abnormal signals within bones and soft tissues adjacent to tumor bulk of osteosarcoma and Ewing's sarcoma in a pediatric population by correlating MR findings with histopathology. MATERIALS AND METHODS Thirty patients met the inclusion criteria, which included (1) osteosarcoma or Ewing's sarcoma, (2) MR studies no more than 2 months prior to surgery, (3) presence of abnormal MR signal surrounding the tumor bulk, (4) pathological material from resected tumor. The patients received standard neoadjuvant chemotherapy. Using grid maps on gross pathology specimens, the abnormal MR areas around the tumor were matched with the corresponding grid sections. Histopathology slides of these sections were then analyzed to determine the nature of the regions of interest. The MR/pathological correlation was evaluated using Mann-Whitney U test and Fisher's exact test. RESULTS Twenty-seven patients had osteosarcoma and three patients had Ewing's sarcoma. Of the studied areas, 17.4% were positive for tumor (viable or necrotic). There was no statistically significant correlation between areas positive for tumor and age, gender, signal extent and intensity on MRI, or tissue type. There was, however, a statistically significant correlation between presence of tumor and the appearance of abnormal soft tissue signals. A feathery appearance correlated with tumor-negative areas whereas a bulky appearance correlated with tumor-positive regions. CONCLUSIONS MR imaging is helpful in identifying the nature of abnormal signal areas surrounding bone sarcomas that are more likely to be tumor-free, particularly when the signal in the soft tissues surrounding the tumor is feathery and edema-like in appearance.
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Farcas N, Arzi B, Verstraete FJM. Oral and maxillofacial osteosarcoma in dogs: a review. Vet Comp Oncol 2012; 12:169-80. [DOI: 10.1111/j.1476-5829.2012.00352.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/31/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Affiliation(s)
- N. Farcas
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine; University of California-Davis; Davis CA USA
| | - B. Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis CA USA
| | - F. J. M. Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California-Davis; Davis CA USA
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