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Babaei MR, Gharepapagh E, Alamdari AH, Jalili J, Mohammadi A, Karbasi M, Rezaei S. Radiofrequency ablation of osteoid osteoma at the base of the coracoid process: Report of two cases. Clin Case Rep 2024; 12:e9098. [PMID: 38911920 PMCID: PMC11192642 DOI: 10.1002/ccr3.9098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO.
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Affiliation(s)
- Mohammad Reza Babaei
- Department of Interventional Radiology, Firouzgar HospitalIran University of Medical SciencesTehranIran
| | - Esmaeil Gharepapagh
- Department of Nuclear Medicine, Medical SchoolTabriz University of Medical SciencesTabrizIran
| | | | - Javad Jalili
- Department of Interventional Radiology, Medical SchoolTabriz University of Medical SciencesTabrizIran
| | - Amin Mohammadi
- Department of Radiology, Medical SchoolTabriz University of Medical SciencesTabrizIran
| | - Mahsa Karbasi
- Department of Radiology, Medical SchoolTabriz University of Medical SciencesTabrizIran
| | - Sahar Rezaei
- Department of Nuclear Medicine, Medical SchoolTabriz University of Medical SciencesTabrizIran
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2
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Brandea AI, Afkhami M, Klein MJ, Bell D. Osteoblastoma of the thumb with a novel PRSS44::ALK fusion and literature review of osteoblastoma of hands and feet bones. Genes Chromosomes Cancer 2024; 63:e23241. [PMID: 38738966 DOI: 10.1002/gcc.23241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/14/2024] [Accepted: 04/14/2024] [Indexed: 05/14/2024] Open
Abstract
Osteoblastomas (OBs) are benign neoplasms constituting approximately 1% of primary bone tumors with a predilection for the spine and sacrum. We describe an OB of the proximal phalanx of the left thumb in a 38-year-old female. MRI of left hand demonstrated a 29-mm mildly expansile enhancing lesion involving the entire proximal phalanx of the first digit. Histology displayed a bone-forming tumor consisting of trabeculae of remodeled woven bone framed by plump osteoblasts in a vascularized background. Next-generation sequencing analysis identified a PRSS44::ALK fusion gene.
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Affiliation(s)
| | - Michelle Afkhami
- Division of Anatomic Pathology, City of Hope Cancer Center, Duarte, California, USA
- Division of Molecular Diagnostics and biomarkers, Laboratory Medicine, City of Hope Cancer Center, Duarte, California, USA
| | - Michael J Klein
- Department of Pathology, Hospital for Special Surgery, New York City, New York, USA
| | - Diana Bell
- Division of Anatomic Pathology, City of Hope Cancer Center, Duarte, California, USA
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3
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Shao J, Lin H, Ding L, Li B, Xu D, Sun Y, Guan T, Dai H, Liu R, Deng D, Huang B, Feng S, Diao X, Gao Z. Deep learning for differentiation of osteolytic osteosarcoma and giant cell tumor around the knee joint on radiographs: a multicenter study. Insights Imaging 2024; 15:35. [PMID: 38321327 PMCID: PMC10847082 DOI: 10.1186/s13244-024-01610-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES To develop a deep learning (DL) model for differentiating between osteolytic osteosarcoma (OS) and giant cell tumor (GCT) on radiographs. METHODS Patients with osteolytic OS and GCT proven by postoperative pathology were retrospectively recruited from four centers (center A, training and internal testing; centers B, C, and D, external testing). Sixteen radiologists with different experiences in musculoskeletal imaging diagnosis were divided into three groups and participated with or without the DL model's assistance. DL model was generated using EfficientNet-B6 architecture, and the clinical model was trained using clinical variables. The performance of various models was compared using McNemar's test. RESULTS Three hundred thirty-three patients were included (mean age, 27 years ± 12 [SD]; 186 men). Compared to the clinical model, the DL model achieved a higher area under the curve (AUC) in both the internal (0.97 vs. 0.77, p = 0.008) and external test set (0.97 vs. 0.64, p < 0.001). In the total test set (including the internal and external test sets), the DL model achieved higher accuracy than the junior expert committee (93.1% vs. 72.4%; p < 0.001) and was comparable to the intermediate and senior expert committee (93.1% vs. 88.8%, p = 0.25; 87.1%, p = 0.35). With DL model assistance, the accuracy of the junior expert committee was improved from 72.4% to 91.4% (p = 0.051). CONCLUSION The DL model accurately distinguished osteolytic OS and GCT with better performance than the junior radiologists, whose own diagnostic performances were significantly improved with the aid of the model, indicating the potential for the differential diagnosis of the two bone tumors on radiographs. CRITICAL RELEVANCE STATEMENT The deep learning model can accurately distinguish osteolytic osteosarcoma and giant cell tumor on radiographs, which may help radiologists improve the diagnostic accuracy of two types of tumors. KEY POINTS • The DL model shows robust performance in distinguishing osteolytic osteosarcoma and giant cell tumor. • The diagnosis performance of the DL model is better than junior radiologists'. • The DL model shows potential for differentiating osteolytic osteosarcoma and giant cell tumor.
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Affiliation(s)
- Jingjing Shao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hongxin Lin
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Lei Ding
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bing Li
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Danyang Xu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yang Sun
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Tianming Guan
- Department of Radiology, Hui Ya Hospital of The First Affiliated Hospital, Sun Yat-Sen University, Huizhou, Guangdong, China
| | - Haiyang Dai
- Department of Radiology, People's Hospital of Huizhou City Center, Huizhou, Guangdong, China
| | - Ruihao Liu
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Demao Deng
- Department of Radiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Guanxi Academy of Medical Science, Nanning, Guangxi, China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Centre, Shenzhen University, Shenzhen, Guangdong, China
| | - Shiting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Xianfen Diao
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Medicine, Shenzhen University, Shenzhen, Guangdong, China.
| | - Zhenhua Gao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
- Department of Radiology, Hui Ya Hospital of The First Affiliated Hospital, Sun Yat-Sen University, Huizhou, Guangdong, China.
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4
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Lixa J, Pinho A, Vieira P, Vieira da Silva N, Silva MR, Marques A, Veludo V. Medullary Compression by a Cervical Osteochondroma in a Patient with Multiple Hereditary Exostoses: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00006. [PMID: 38207085 DOI: 10.2106/jbjs.cc.23.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
CASE A 19-year-old man with Multiple Hereditary Exostoses presented with cervical pain without neurological symptoms and/or signs. Magnetic resonance revealed a large C2 osteochondroma, occupying a part of the medullary canal. He was submitted to an en bloc resection with hemilaminectomy without fusion. At the 1-year follow-up, he presented resolution of pain and no neurological symptoms or signs, without cervical instability or radiological signs of disease recurrence. CONCLUSION Cervical osteochondroma is usually asymptomatic. Neurological compression and differentiation to chondrosarcoma are the main concerns. Surgical excision allows the local cure of the disease and is usually performed without fusion.
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Affiliation(s)
- João Lixa
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - André Pinho
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Paula Vieira
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Nuno Vieira da Silva
- Department of Orthopedics and Traumatology, Tâmega e Sousa Hospital Centre, Penafiel, Portugal
| | - Miguel Relvas Silva
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
| | - Ana Marques
- Department of Anatomical Pathology, São João University Hospital Centre, Porto, Portugal
| | - Vitorino Veludo
- Department of Orthopedics and Traumatology, São João University Hospital Centre, Porto, Portugal
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Sood A, Naseri S, Parihar P, Mishra GV. Solitary ulnar diaphyseal osteochondroma in an early adolescent female. BMJ Case Rep 2023; 16:e258681. [PMID: 38081748 PMCID: PMC10728946 DOI: 10.1136/bcr-2023-258681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, India
| | - Suhit Naseri
- Pathology, Datta Meghe Institute of Medical Sciences-Wardha Campus, Wardha, India
| | - Pratapsingh Parihar
- Radiodiagnosis, Datta Meghe Institute of Higher Education & Research, Wardha, Maharashtra, India
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Alghamdi FA, Aljabri NK, Jafar HM, Almatari AH, Bajuifer SA. Solitary Osteochondroma at Unusual Sites: A Case Report and Literature Review. Cureus 2023; 15:e49582. [PMID: 38156180 PMCID: PMC10754374 DOI: 10.7759/cureus.49582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
Osteochondromas (OCs) are bone lesions composed of cartilaginous and medullary bone capped with hyaline cartilage. OCs result from the separation of epiphyseal growth plate cartilage, pushing through the periosteal bone cuff. They commonly appear as pedunculated or sessile masses in the metaphysis of long bones and are the most common benign bone tumors. While rare in the scapula, OCs can occur there. Symptoms may arise from fractures, osseous abnormalities, or potential malignant transformation, especially in the presence of hereditary multiple exostoses (HME). The estimated rate of malignant transformation in solitary lesions is 1%, whereas in hereditary multiple OCs, it can reach up to 3-5%. We report a case of a 10-year-old female who presented with a gradually progressive swelling on the back of her right scapula. This progressive growth has been observed over the course of the past two years accompanied by mild pain. The pain was intermittent and did not affect her daily activities. On examination, a hard, tender, non-mobile swelling of approximately 2 × 2 cm was found over the right scapula. The patient had a normal range of motion in the shoulder and scapulothoracic regions. In conclusion, since solitary scapular OCs are extremely rare, they are quite common when associated with HME. This study aimed to increase awareness of the unusual site of OCs. Furthermore, we have included a full account of the surgical therapy we administered to this patient in order to assist future surgeons who may come across similar conditions.
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Affiliation(s)
| | | | - Hasan M Jafar
- Orthopedic Surgery, Al-Noor Specialist Hospital, Makkah, SAU
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7
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Farrell ND, Dooley JH, Sheffer BW, Sawyer JR, Kelly DM. Radiation exposure in multiple hereditary exostoses: A retrospective review. J Orthop 2023; 40:87-90. [PMID: 37234093 PMCID: PMC10206377 DOI: 10.1016/j.jor.2023.05.004] [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: 04/03/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Background Exposure to ionizing radiation in patients with Multiple Hereditary Exostoses (MHE) is inevitable and necessary for the diagnosis and treatment of MHE. Radiation exposure has many potentially dangerous consequences, including the increased risk of developing cancer. This is especially concerning in the pediatric patient population since children are more likely to develop adverse effects from radiation than adults. This study aimed to quantify radiation exposure over a five-year period among patients diagnosed with MHE since such information is not currently available in the literature. Methods Diagnostic radiographs, computed tomography (CT) scans, nuclear medicine studies, and intraoperative fluoroscopy exposures were analyzed for radiation exposure in 37 patients diagnosed with MHE between 2015 and 2020. Results Thirty-seven patients with MHE underwent 1200 imaging studies, 976 of which were related to MHE and 224 unrelated to MHE. The mean estimated MHE cumulative radiation dose per patient was 5.23 mSv. Radiographs related to MHE contributed the most radiation. Patients from the ages of 10- to 24-years-old received the most imaging studies and exposure to ionizing radiation, especially compared to those under age 10 (P = 0.016). The 37 patients also received a total of 53 surgical-excision procedures, with a mean of 1.4 procedures per person. Conclusions MHE patients are exposed to increased levels of ionizing radiation secondary to serial diagnostic imaging, with those ages 10-24 years old being exposed to significantly higher doses of radiation. Because pediatric patients are more sensitive to radiation exposure and are at an overall higher risk, the use of radiographs should always be justified in those patients.
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Affiliation(s)
- Nolan D. Farrell
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Jennings H. Dooley
- Northwestern University Feinberg School of Medicine, Department of Orthopaedic Surgery, Chicago, IL, USA
| | - Benjamin W. Sheffer
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Jeffrey R. Sawyer
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
| | - Derek M. Kelly
- The University of Tennessee Health Science Center — Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Memphis, TN, USA
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8
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Chalamgari A, Valle D, Palau Villarreal X, Foreman M, Liu A, Patel A, Dave A, Lucke-Wold B. Vertebral Primary Bone Lesions: Review of Management Options. Curr Oncol 2023; 30:3064-3078. [PMID: 36975445 PMCID: PMC10047554 DOI: 10.3390/curroncol30030232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
The assessment and treatment of vertebral primary bone lesions continue to pose a unique yet significant challenge. Indeed, there exists little in the literature in the way of compiling and overviewing the various types of vertebral lesions, which can often have complicated intervention strategies. Given the severe consequences of mismanaged vertebral bone tumors-including the extreme loss of motor function-it is clear that such an overview of spinal lesion care is needed. Thus, in the following paper, we aim to address the assessment of various vertebral primary bone lesions, outlining the relevant nonsurgical and surgical interventional methods. We describe examples of primary benign and malignant tumors, comparing and contrasting their differences. We also highlight emerging treatments and approaches for these tumors, like cryoablation and stereotactic body radiation therapy. Ultimately, we aim to emphasize the need for further guidelines in regard to correlating lesion type with proper therapy, underscoring the innate diversity of vertebral primary bone lesions in the literature.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL 32601, USA
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9
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Muacevic A, Adler JR. Osteochondroma of the Scapula: A Case Report and Literature Review. Cureus 2022; 14:e30558. [PMID: 36311482 PMCID: PMC9595258 DOI: 10.7759/cureus.30558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Osteochondromas are bone lesions composed of medullary and cartilaginous bone covered by a cap of hyaline cartilage. The presence of medullary and cortical bone with the continuity of the tumor is pathognomonic for osteochondroma and aid in establishing the diagnosis. We report a case of a two-year-old girl who presented to our clinic following her mother noticing a palpable, growing, and painful mass on her left scapula. There was no limitation in the range of motion. A clear-cut mass was seen on the dorsal aspect and palpated measuring around 2.5x3 cm. Surgical excision of the mass followed by histologic examination confirmed osteochondroma. Upon follow-up, the patient had no pain and had a full range of left shoulder motion without discomfort or pain. In conclusion, scapular exostoses are very rare and more so when they present dorsally. Symptomatic lesions can be managed effectively with surgical excision of exostosis.
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Ma Z, Yang Q, Liu X, Li Z. Application of allograft and absorbable screws in the reconstruction of a massive bone defect following resection of giant osteochondroma: A retrospective study. Front Surg 2022; 9:938750. [PMID: 36211287 PMCID: PMC9535078 DOI: 10.3389/fsurg.2022.938750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
Background This study aims to introduce a reconstruction method of applying allografts and absorbable screws to repair large bone defects caused by the resection of giant osteochondroma. Methods A retrospective study of a series of patients who underwent the resection of giant osteochondroma reconstructed by allografts and absorbable screws was conducted from February 2020 to September 2021. Their demographic data, location site, area of bone defect, and pertinent operative details were recorded. The reconstruction modality of allografts was elaborated on. In the follow-up, radiographic images were utilized to determine bone union, and the Musculoskeletal Tumor Society score was used to evaluate postoperative limb function. Results A total of seven patients were included, including three males and four females with an average age of 16.6 ± 6.5 years. Among them, three cases of tumors occurred in the humerus and four cases occurred in the femur. The average follow-up time was 11.3 ± 3.0 months. The average area of bone defect was 25.9 ± 8.3 cm2. No complications such as infection, nonunion, and allograft bone fracture were found during the follow-up period. Six months after the operation, the average Musculoskeletal Tumor Society score was 26.4 ± 1.6, with acceptable postoperative function. Conclusions The cooperative application of absorbable screw fixation and allografts including mixed cortical bone and cancellous bone, which yielded satisfactory functional outcomes and acceptable postoperative complications, is an effective reconstruction method for a massive bone defect after the resection of giant osteochondroma.
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Affiliation(s)
| | | | - Xinyu Liu
- Correspondence: Zhenfeng Li Xinyu Liu
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11
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Ha TH, Ha TMT, Nguyen Van M, Le TB, Le NTN, Nguyen Thanh T, Ngo DHA. Hereditary multiple exostoses: A case report and literature review. SAGE Open Med Case Rep 2022; 10:2050313X221103732. [PMID: 35693925 PMCID: PMC9178996 DOI: 10.1177/2050313x221103732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Osteochondroma is the most common bone tumor representing 20%–50% of all benign bone tumors and 10%–15% of all bone tumors. Osteochondroma has similar radiological appearance in both solitary and multiple forms; the latter is an autosomal dominant disorder termed hereditary multiple exostoses. Associated complications of osteochondroma include deformity, fracture, neurovascular compromise, bursa formation, and malignant transformation. Measurement of the cartilage cap thickness is an important index suggesting secondary malignancy of osteochondroma. The upper limit of cap thickness after skeletal maturation is 1.5 cm which can be reliably measured on ultrasound or magnetic resonance imaging. Hereditary multiple exostoses are linked to the mutations of different exostoses genes located on chromosome 8, 11, and 19. We reported cases of two siblings presented with multiple osteochondromas managed by surgical excision. We evaluated their clinical and radiological presentation, genetic correlations and compared with the literature.
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Affiliation(s)
- Thi Hien Ha
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thi Minh Thi Ha
- Department of Medical Genetics, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Mao Nguyen Van
- Department of Histology, Embryology, Pathology and Forensic Medicine, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Trong Binh Le
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Nghi Thanh Nhan Le
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thao Nguyen Thanh
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Dac Hong An Ngo
- Department of Radiology, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Proximal clavicular osteochondroma: A report of an unusual site. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102152] [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] Open
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13
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Obanife HO, Kingsley A, Ashindointiang J, Asuquo J, Ogunleye O, Joshua IE. Unusual location of osteochondroma in the temporal region in a patient with functional pituitary adenoma. J Int Med Res 2021; 49:3000605211058860. [PMID: 34861124 PMCID: PMC8649454 DOI: 10.1177/03000605211058860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Osteochondromas are common in the long bones and relatively rare in the head and
neck regions. We herein report a case of a solitary temporal bone osteochondroma
associated with a functional pituitary adenoma hypersecreting prolactin. The
patient was a 48-year-old man with progressive, painless temporal swelling
associated with gradual visual loss, gynaecomastia, erectile dysfunction, and
loss of libido. A brain computed tomography scan with bone windows showed right
temporal sessile bony expansion and a pituitary tumour. A pituitary function
test revealed hyperprolactinaemia. His symptoms resolved with medical
management, and excisional biopsy of the temporal tumour confirmed an
osteochondroma. To the best of our knowledge, this is the first reported case of
a solitary temporal bone osteochondroma with a functional pituitary adenoma
hypersecreting prolactin.
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Affiliation(s)
| | - Akaba Kingsley
- Department of Haematology, 108337University of Calabar Teaching Hospital, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - John Ashindointiang
- Department of Surgery, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Joseph Asuquo
- Department of Orthopaedic Surgery, 108337University of Calabar Teaching Hospital, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Olabisi Ogunleye
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Iwasam E Joshua
- Department of Orthopaedic Surgery, 108337University of Calabar Teaching Hospital, University of Calabar Teaching Hospital, Calabar, Nigeria
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Bailescu I, Popescu M, Sarafoleanu L, Bondari S, Sabetay C, Mitroi M, Tuculina MJ, Albulescu DM. Diagnosis and evolution of the benign tumor osteochondroma. Exp Ther Med 2021; 23:103. [DOI: 10.3892/etm.2021.11026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Iulia Bailescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihai Popescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Lavinia Sarafoleanu
- Department of Histopathology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Simona Bondari
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Corneliu Sabetay
- Department of Pediatric Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela Mitroi
- Department of Otorhinolaryngology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Mihaela-Jana Tuculina
- Department of Restorative Dentistry, Craiova University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Dana-Maria Albulescu
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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15
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Chang YC, Stoyanova R, Danilova S, Pretell-Mazzini JA, Kerr DA, Wilky BA, Subhawong T. Radiomics on radiography predicts giant cell tumor histologic response to denosumab. Skeletal Radiol 2021; 50:1881-1887. [PMID: 33733693 DOI: 10.1007/s00256-021-03752-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Denosumab is an established targeted systemic therapy for treatment of giant cell tumor of bone (GCTB). We sought to determine whether treatment response could be quantified from radiomics analysis of radiographs taken longitudinally during treatment. MATERIALS AND METHODS Pre- and post-treatment radiographs of 10 GCTB tumors from 10 patients demonstrating histologic response after treatment with denosumab were analyzed. Intensity- and texture-based radiomics features for each manually segmented tumor were calculated. Radiomics features were compared pre- and post-treatment in tumors. RESULTS Mean intensity (p = 0.033) significantly increased while skewness (p = 0.028) significantly decreased after treatment. Post-treatment increases in fractal dimensions (p = 0.057) and abundance (p = 0.065) approached significance. A potential linear correlation in mean (p = 0.005; ΔMean = 0.022 * duration - 0.026) with treatment duration was observed. CONCLUSION Radiomics analysis of plain radiographs quantifies time-dependent matrix mineralization and trabecular reconstitution that mark positive response of giant cell tumors of bone to denosumab.
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Affiliation(s)
- Yu-Cherng Chang
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.,Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Sofia Danilova
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan A Pretell-Mazzini
- Sylvester Comprehensive Cancer Center, Miami, FL, USA.,Department of Orthopedics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Breelyn A Wilky
- Department of Medicine-Medical Oncology, University of Colorado Hospital, Aurora, CO, USA
| | - Ty Subhawong
- Sylvester Comprehensive Cancer Center, Miami, FL, USA. .,Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA.
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16
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Copy number alteration profiling facilitates differential diagnosis between ossifying fibroma and fibrous dysplasia of the jaws. Int J Oral Sci 2021; 13:21. [PMID: 34188021 PMCID: PMC8242074 DOI: 10.1038/s41368-021-00127-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
Ossifying fibroma (OF) and fibrous dysplasia (FD) are two fibro-osseous lesions with overlapping clinicopathological features, making diagnosis challenging. In this study, we applied a whole-genome shallow sequencing approach to facilitate differential diagnosis via precise profiling of copy number alterations (CNAs) using minute amounts of DNA extracted from morphologically correlated microdissected tissue samples. Freshly frozen tissue specimens from OF (n = 29) and FD (n = 28) patients were obtained for analysis. Lesion fibrous tissues and surrounding normal tissues were obtained by laser capture microdissection (LCM), with ~30–50 cells (5 000–10 000 µm2) per sample. We found that the rate of recurrent CNAs in OF cases was much higher (44.8%, 13 of 29) than that in FD cases (3.6%, 1 of 28). Sixty-nine percent (9 of 13) of the CNA-containing OF cases involved segmental amplifications and deletions on Chrs 7 and 12. We also identified eight CNA-associated genes (HILPDA, CALD1, C1GALT1, MICALL2, PHF14, AIMP2, MDM2, and CDK4) with amplified expression, which was consistent with the copy number changes. We further confirmed a jaw lesion with a previous uncertain diagnosis due to its ambiguous morphological features and the absence of GNAS mutation as OF based on the typical Chr 12 amplification pattern in its CNA profile. Moreover, analysis of a set of longitudinal samples collected from an individual with a cellular lesion in suspicion of OF at the first surgery, recurrence and the latest malignant transformation revealed identical CNA patterns at the three time points, suggesting that copy number profiling can be used as an important tool to identify borderline lesions or lesions with malignant potential. Overall, CNA profiling of fibro-osseous lesions can greatly improve differential diagnosis between OF and FD and help predict disease progression.
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17
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Tepelenis K, Papathanakos G, Kitsouli A, Troupis T, Barbouti A, Vlachos K, Kanavaros P, Kitsoulis P. Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options. In Vivo 2021; 35:681-691. [PMID: 33622860 DOI: 10.21873/invivo.12308] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often asymptomatic, symptoms may eventuate from compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation. Cartilage cap thickness >2 cm in adults or >3 cm in children as well as new onset of pain or growth, or rapid growth of the lesion, especially after the closure of the growth plate, might reflect cancerous transformation. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2% if complete resection is achieved.
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Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece;
| | | | | | - Theodoros Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Barbouti
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece
| | | | | | - Panagiotis Kitsoulis
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece.,Orthopaedics, University of Ioannina, Ioannina, Greece
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18
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Pan J, Zhang K, Le H, Jiang Y, Li W, Geng Y, Li S, Hong G. Radiomics Nomograms Based on Non-enhanced MRI and Clinical Risk Factors for the Differentiation of Chondrosarcoma from Enchondroma. J Magn Reson Imaging 2021; 54:1314-1323. [PMID: 33949727 DOI: 10.1002/jmri.27690] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Differentiating chondrosarcoma from enchondroma using conventional MRI remains challenging. An effective method for accurate preoperative diagnosis could affect the management and prognosis of patients. PURPOSE To validate and evaluate radiomics nomograms based on non-enhanced MRI and clinical risk factors for the differentiation of chondrosarcoma from enchondroma. STUDY TYPE Retrospective. POPULATION A total of 103 patients with pathologically confirmed chondrosarcoma (n = 53) and enchondroma (n = 50) were randomly divided into training (n = 68) and validation (n = 35) groups. FIELD STRENGTH/SEQUENCE Axial non-contrast-enhanced T1-weighted images (T1WI) and fat-suppressed T2-weighted images (T2WI-FS) were acquired at 3.0 T. ASSESSMENT Clinical risk factors (sex, age, and tumor location) and diagnosis assessment based on morphologic MRI by three radiologists were recorded. Three radiomics signatures were established based on the T1WI, T2WI-FS, and T1WI + T2WI-FS sequences. Three clinical radiomics nomograms were developed based on the clinical risk factors and three radiomics signatures. STATISTICAL TESTS The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of radiomics signatures and clinical radiomics nomograms. RESULTS Tumor location was an important clinical risk factor (P < 0.05). The radiomics signature based on T1WI and T1WI + T2WI-FS features performed better than that based on T2WI-FS in the validation group (AUC in the validation group: 0.961, 0.938, and 0.833, respectively; P < 0.05). In the validation group, the three clinical radiomics nomograms (T1WI, T2WI-FS, and T1WI + T2WI-FS) achieved AUCs of 0.938, 0.935, and 0.954, respectively. In all patients, the clinical radiomics nomogram based on T2WI-FS (AUC = 0.967) performed better than that based on T2WI-FS (AUC = 0.901, P < 0.05). DATA CONCLUSION The proposed clinical radiomics nomogram showed promising performance in differentiating chondrosarcoma from enchondroma. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jielin Pan
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China.,Department of Radiology, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Ke Zhang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Hongbo Le
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Yunping Jiang
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Wenjuan Li
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Yayuan Geng
- Scientific Research Department, HY Medical Technology, Beijing, China
| | - Shaolin Li
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Guobin Hong
- Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
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Abstract
PURPOSE OF REVIEW To highlight the new developments in the management of advanced giant cell tumor of bone, a rare locally aggressive benign tumor, which was traditionally managed with surgery alone by either curettage and local adjuvant therapy, wide resection, or marginal excision. Here, we review the current role of systemic therapy for management of locally advanced or metastatic giant cell tumor of bone (GCTB). RECENT FINDINGS The elucidation of the pathophysiology of giant cell tumor of bone, especially with regards to the role of nuclear factor kappa B ligand (RANKL), has led to the Food and Drug Administration (FDA) approval of denosumab in the management of locally advanced or metastatic GCTB. For advanced giant cell tumor where surgical resection alone can cause severe morbidity, the paradigm has shifted from local treatment alone to multidisciplinary management with the consideration of use of denosumab.
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Affiliation(s)
- Atrayee Basu Mallick
- Department of Medical Oncology, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 700, Philadelphia, PA, 19107, USA.
| | - Sant P Chawla
- Sarcoma Oncology Center, 2811 Wilshire Blvd, Santa Monica, CA, 90403, USA
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20
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Subungual Osteochondroma in a Pediatric Patient. Dermatol Surg 2020; 47:886-887. [PMID: 34029259 DOI: 10.1097/dss.0000000000002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Recent Insights into Long Bone Development: Central Role of Hedgehog Signaling Pathway in Regulating Growth Plate. Int J Mol Sci 2019; 20:ijms20235840. [PMID: 31757091 PMCID: PMC6928971 DOI: 10.3390/ijms20235840] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022] Open
Abstract
The longitudinal growth of long bone, regulated by an epiphyseal cartilaginous component known as the “growth plate”, is generated by epiphyseal chondrocytes. The growth plate provides a continuous supply of chondrocytes for endochondral ossification, a sequential bone replacement of cartilaginous tissue, and any failure in this process causes a wide range of skeletal disorders. Therefore, the cellular and molecular characteristics of the growth plate are of interest to many researchers. Hedgehog (Hh), well known as a mitogen and morphogen during development, is one of the best known regulatory signals in the developmental regulation of the growth plate. Numerous animal studies have revealed that signaling through the Hh pathway plays multiple roles in regulating the proliferation, differentiation, and maintenance of growth plate chondrocytes throughout the skeletal growth period. Furthermore, over the past few years, a growing body of evidence has emerged demonstrating that a limited number of growth plate chondrocytes transdifferentiate directly into the full osteogenic and multiple mesenchymal lineages during postnatal bone development and reside in the bone marrow until late adulthood. Current studies with the genetic fate mapping approach have shown that the commitment of growth plate chondrocytes into the skeletal lineage occurs under the influence of epiphyseal chondrocyte-derived Hh signals during endochondral bone formation. Here, we discuss the valuable observations on the role of the Hh signaling pathway in the growth plate based on mouse genetic studies, with some emphasis on recent advances.
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22
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Test yourself answer: painful knee swelling. Skeletal Radiol 2019; 48:1829-1830. [PMID: 31312868 DOI: 10.1007/s00256-019-03274-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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23
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Abstract
BACKGROUND Osteomas are infrequent benign bone tumors of uncertain etiology. They are usually situated at extremities and their occurrence in the jaws is relatively rare. There are 3 types of osteoma: central, peripheral, and extraskeletal. Preoperative presumptive diagnosis is performed by means of radiography using orthopantomographs, computerized tomographs, or cone beam scans. Treatment is surgical and consists of careful exeresis and curettage of the adjacent tissue. In recent years, piezoelectric surgery has been used to treat bone pathologies in the maxillofacial area, orthopedic surgery, and neurosurgery. When used for the exeresis of a bone lesion, the device minimizes risks and eliminates possible complications arising from affectation of the vascular and nerve structures close to the lesion. OBJECTIVE This clinical report describes a peripheral mandibular osteoma situated in the left mandibular basilar which recurred 45 years after surgical treatment at another center. METHODS For resection, the surgical approach followed the scar remaining from the earlier surgery and was performed using piezoelectric surgery. Surgery did not cause hemorrhagic complications, affect the sensitivity of the left labial menton, or cause paralysis of the lower lip. CONCLUSIONS Based on the present patient, it may be concluded that mandibular osteoma treatment by means of piezoelectric surgery makes precise exeresis possible with less affectation of the important surrounding structures such as the inferior alveolar nerve and the marginal mandibular branch of the facial nerve.
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24
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Abstract
Bone-forming tumors are defined by neoplastic cells that differentiate along the lines of osteoblasts that deposit neoplastic bone. The morphology and biological spectrum of bone-forming tumors is broad, and their accurate diagnosis requires the careful correlation of their clinical, morphologic, and radiologic characteristics. Immunohistochemical and molecular analyses have an important role in select instances. At present, the identification of neoplastic bone largely depends on histologic analysis, which can be subjective. The major types of osteosarcoma are defined according to their morphology, origin within or on the surface of the bone, and their histologic grade.
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Affiliation(s)
- Yaxia Zhang
- Department of Pathology, Lerner College of Medicine, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue L25, Cleveland, OH 44195, USA
| | - Andrew E Rosenberg
- Department of Pathology, Miller School of Medicine, University of Miami, 1400 Northwest 12th Avenue, Miami, FL 33136, USA.
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25
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Chakrabarty S, Foderingham N, O’Hara H. Selected Disorders of the Musculoskeletal System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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26
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Rupp M, Hardes J, Raschke MJ, Skwara A. Bilateral Scapulothoracic Osteochondromas in a Patient With Hereditary Multiple Exostosis: A Case Report and Review of the Literature. Orthop Rev (Pavia) 2016; 8:6501. [PMID: 27761218 PMCID: PMC5066108 DOI: 10.4081/or.2016.6501] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/30/2016] [Accepted: 07/31/2016] [Indexed: 12/11/2022] Open
Abstract
Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by two or more benign growing, cartilage capped tumors of long bones called osteochondromas. If abnormal growth and clinical symptoms of osteochondromas newly appear in adults, malignant transformation of the usually benign growing tumors should be suspected and diagnostic testing should be initiated. Against the background of hypothesized higher malignant transformation of osteochondromas into chondrosarcoma in individuals with shoulder exostoses, we report a case of bilateral scapulothoracic osteochondromas in a patient suffering from HME. A 60-year-old female with HME complained of chest pain while being hospitalized for bilateral femoral fractures. A computed tomography scan of the chest was performed to rule out pulmonary embolism. However, bilateral osteochondromas in the scapulothoracic spaces were detected. Due to absence of radiographic evidences for malignant transformation in the patient, invasive diagnostic procedures such as biopsy and histological examination were recommended in order to exclude malignant transformation of both osteochondromas. Physicians should be aware that patients with HME who present with shoulder pain should be examined for osteochondromas in the scapulothoracic space. Due to possible sarcomatous transformation, regular follow-ups are necessary for adolescents and adults.
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Affiliation(s)
- Markus Rupp
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Giessen and Harburg, Campus Giessen
- Department of Trauma-, Hand- and Reconstructive Surgery, Muenster University Hospital
| | - Jendrik Hardes
- Clinic for General Orthopedics and Tumor Orthopedics, Muenster University Hospital
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, Muenster University Hospital
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27
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Woo SB. Central Cemento-Ossifying Fibroma: Primary Odontogenic or Osseous Neoplasm? J Oral Maxillofac Surg 2016; 73:S87-93. [PMID: 26608158 DOI: 10.1016/j.joms.2015.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 01/05/2023]
Abstract
Currently, central cemento-ossifying fibroma is classified by the World Health Organization as a primary bone-forming tumor of the jaws. However, histopathologically, it is often indistinguishable from cemento-osseous dysplasias in that it forms osteoid and cementicles (cementum droplets) in varying proportions. It is believed that pluripotent cells within the periodontal membrane can be stimulated to produce either osteoid or woven bone and cementicles when stimulated. If this is true, cemento-ossifying fibroma would be better classified as a primary odontogenic neoplasm arising from the periodontal ligament. Cemento-ossifying fibromas also do not occur in the long bones. The present report compares several entities that fall within the diagnostic realm of benign fibro-osseous lesions and reviews the evidence for reclassifying central cemento-ossifying fibroma as a primary odontogenic neoplasm.
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Affiliation(s)
- Sook-Bin Woo
- Associate Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA; Chief, Clinical Affairs, Division of Oral Medicine and Dentistry and Consultant Pathologist, Department of Pathology, Brigham and Women's Hospital, Boston, MA.
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28
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Thompson MJ, Domson G, Dragoescu E. Do Osteoblastoma and Osteoid Osteoma Represent the Same Pathologic Entity?: A Case Report and Review of the Recent Literature. JBJS Case Connect 2015; 5:e68. [PMID: 29252855 DOI: 10.2106/jbjs.cc.n.00173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present the case of a fourteen-year-old boy with a benign diaphyseal femoral lesion that initially fulfilled the diagnostic criteria for osteoid osteoma but rapidly progressed and was finally diagnosed as osteoblastoma. CONCLUSION Clinical and radiographic criteria provide imperfect and somewhat arbitrary distinguishing features between osteoid osteoma and osteoblastoma. Although previous work highlighted the importance of histologic interpretation in this regard, recent comparative histologic and immunohistochemical evaluations failed to differentiate the two. We conclude that consideration should be given to the classification of osteoid osteoma and osteoblastoma as the same pathologic entity, with treatment based on presentation along a continuum of aggressiveness, and that future directions for study may include identification of factors predictive of progression and/or recurrence.
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Affiliation(s)
- Matthew J Thompson
- Departments of Orthopaedic Surgery (M.J.T. and G.D.) and Pathology (E.D.), Virginia Commonwealth University Health System, P.O. Box 980153, 1200 East Broad Street, 9th Floor, Richmond, VA 23298.
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29
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Zhou S, Xie Y, Tang J, Huang J, Huang Q, Xu W, Wang Z, Luo F, Wang Q, Chen H, Du X, Shen Y, Chen D, Chen L. FGFR3 Deficiency Causes Multiple Chondroma-like Lesions by Upregulating Hedgehog Signaling. PLoS Genet 2015; 11:e1005214. [PMID: 26091072 PMCID: PMC4474636 DOI: 10.1371/journal.pgen.1005214] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/13/2015] [Indexed: 12/21/2022] Open
Abstract
Most cartilaginous tumors are formed during skeletal development in locations adjacent to growth plates, suggesting that they arise from disordered endochondral bone growth. Fibroblast growth factor receptor (FGFR)3 signaling plays essential roles in this process; however, the role of FGFR3 in cartilaginous tumorigenesis is not known. In this study, we found that postnatal chondrocyte-specific Fgfr3 deletion induced multiple chondroma-like lesions, including enchondromas and osteochondromas, adjacent to disordered growth plates. The lesions showed decreased extracellular signal-regulated kinase (ERK) activity and increased Indian hedgehog (IHH) expression. The same was observed in Fgfr3-deficient primary chondrocytes, in which treatment with a mitogen-activated protein kinase (MEK) inhibitor increased Ihh expression. Importantly, treatment with an inhibitor of IHH signaling reduced the occurrence of chondroma-like lesions in Fgfr3-deficient mice. This is the first study reporting that the loss of Fgfr3 function leads to the formation of chondroma-like lesions via downregulation of MEK/ERK signaling and upregulation of IHH, suggesting that FGFR3 has a tumor suppressor-like function in chondrogenesis.
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Affiliation(s)
- Siru Zhou
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yangli Xie
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Junzhou Tang
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Junlan Huang
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qizhao Huang
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei Xu
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zuqiang Wang
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Fengtao Luo
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Quan Wang
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Hangang Chen
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiaolan Du
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yue Shen
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Di Chen
- Department of Biochemistry, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Lin Chen
- Center of Bone Metabolism and Repair, Department of Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
- * E-mail:
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30
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Solitary C1 spinal osteochondroma causing vertebral artery compression and acute cerebellar infarct. Skeletal Radiol 2015; 44:299-302. [PMID: 25109381 DOI: 10.1007/s00256-014-1974-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 02/02/2023]
Abstract
Osteochondroma is a common benign bone lesion, usually involving the long bones. Spinal involvement is rare. The clinical presentation of spinal osteochondroma varies according to the site of the lesion. The most common reported clinical presentation is secondary to encroachment of the lesion on the spinal canal or nerve roots. Less common presentations such as a palpable neck mass, dysphagia, sleep apnea, paralysis of left vocal cord or acute respiratory distress have been reported when the lesions compress the anatomic structures anteriorly. We describe a rare case of a young patient who presented with an emergent critical condition of acute cerebellar infarct as a result of vertebral artery compression caused by a solitary C1 spinal osteochondroma.
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31
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O'Connor W, Quintana M, Smith S, Willis M, Renner J. The hypermetabolic giant: 18F-FDG avid giant cell tumor identified on PET-CT. J Radiol Case Rep 2014; 8:27-38. [PMID: 25426232 DOI: 10.3941/jrcr.v8i6.1328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
An 87 year-old white female presented with a two-year history of intermittent discomfort in her left foot. PET-CT identified intense18F-fluorodeoxyglucose (FDG) uptake corresponding to the lesion. Histology of a fine needle aspiration and open biopsy were consistent with a benign giant cell tumor (GCT) of the bone. GCT of bone is an uncommon primary tumor typically presenting as a benign solitary lesion that arises in the end of the long bones. While GCT can occur throughout the axial and appendicular skeleton, it is exceedingly uncommon in the bone of the foot. While 18F-FDG has been established in detecting several malignant bone tumors, benign disease processes may also be identified. The degree of 18F-FDG activity in a benign GCT may be of an intensity that can be mistakenly interpreted as a malignant lesion. Therefore, GCT of the bone can be included in the differential diagnosis of an intensely 18F-FDG-avid neoplasm located within the tarsal bones.
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Affiliation(s)
- Wendi O'Connor
- Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC, USA ; Department of Pathology & Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Megan Quintana
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Scott Smith
- Department of Pathology & Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Monte Willis
- Department of Surgery, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Jordan Renner
- Department of Radiology, University of North Carolina Hospitals, Chapel Hill, NC, USA
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32
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Selected Disorders of the Musculoskeletal System. Fam Med 2014. [DOI: 10.1007/978-1-4939-0779-3_121-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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33
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Taghipour Zahir S, Sefidrokh Sharahjin N, Kargar S. A rare case of rib osteoblastoma: imaging features and review of literature. IRANIAN JOURNAL OF RADIOLOGY 2013; 10:152-5. [PMID: 24348601 PMCID: PMC3857978 DOI: 10.5812/iranjradiol.7108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 10/28/2012] [Accepted: 12/12/2012] [Indexed: 01/07/2023]
Abstract
Osteoblastoma is a rare benign, but locally aggressive bone tumor with rare malignant transformation. It mostly affects the vertebral column and long bones. Radiographically, it is seen as an expansile, oval, sclerotic or lytic mass-like lesion with well-defined borders, although sometimes it may mimic a malignant tumor such as osteogenic sarcoma by its irregular borders. Herein, we report a case of osteoblastoma in a 22 year-old man with a long history of back and neck pain accompanied with neck stiffness. On the routine chest X-ray, the salient lesion appeared as an expansile, oval, sclerotic mass with well-defined borders and speckled calcification without any internal lucency and periosteal reaction, involving the posterolateral aspect of the first left thoracic rib, a rare anatomical site. Despite the unusual location, osteoblastoma should be considered in the differential diagnosis of a solitary rib lesion.
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Affiliation(s)
- Shokouh Taghipour Zahir
- Department of Pathology,Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Corresponding author: Shokouh Taghipour Zahir, Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel.: +98-3518113615, Fax: +98-3518224100, E-mail:
| | | | - Saeed Kargar
- Department of Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Denosumab chemotherapy for recurrent giant-cell tumor of bone: a case report of neoadjuvant use enabling complete surgical resection. Case Rep Oncol Med 2013; 2013:496351. [PMID: 23984138 PMCID: PMC3745896 DOI: 10.1155/2013/496351] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/10/2013] [Indexed: 01/23/2023] Open
Abstract
Giant-cell tumor of the bone (GCTB) is a rare neoplasm that affects young adults. The tumor is generally benign but sometimes can be locally aggressive. There are no standardized approaches to the treatment of GCTB. Recently, the RANKL inhibitor denosumab has shown activity in this tumor type. We present the case of a young female who presented with locally advanced disease and was successfully managed with the neoadjuvant use of denosumab allowing for surgical resection of the tumor that was previously deemed unresectable. Following surgery, the patient is being managed with continued use of denosumab as ‘maintenance,' and she continues to be free of disease. Our case highlights a novel approach for the management of locally advanced and aggressive giant cell tumor of the bone.
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Chawla S, Henshaw R, Seeger L, Choy E, Blay JY, Ferrari S, Kroep J, Grimer R, Reichardt P, Rutkowski P, Schuetze S, Skubitz K, Staddon A, Thomas D, Qian Y, Jacobs I. Safety and efficacy of denosumab for adults and skeletally mature adolescents with giant cell tumour of bone: interim analysis of an open-label, parallel-group, phase 2 study. Lancet Oncol 2013; 14:901-8. [PMID: 23867211 DOI: 10.1016/s1470-2045(13)70277-8] [Citation(s) in RCA: 400] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Giant cell tumour of bone (GCTB) is a very rare, aggressive, and progressive osteolytic tumour for which no standard medicinal treatment or chemotherapy exists. We report interim safety and efficacy results from a phase 2 study of denosumab in patients with GCTB. METHODS We did an international, open-label, parallel-group, phase 2 trial of patients with histologically confirmed GCTB and radiographically measurable active disease. Eligible patients were adults or skeletally mature adolescents with radiographic evidence of at least one mature long bone who were at least 12 years old and weighed at least 45 kg. We divided patients into three cohorts--those with surgically unsalvageable GCTB (cohort 1), those with salvageable GCTB whose surgery was associated with severe morbidity (cohort 2), and those who transferred from a previous study of denosumab for GCTB (cohort 3). Patients in cohorts 1 and 2 received 120 mg of subcutaneous denosumab every 4 weeks with loading doses on days 8 and 15 of the first cycle; those in cohort 3 continued the regimen from the previous study. Investigator-determined disease status and clinical benefit were assessed every 4 weeks. Our primary endpoint was the safety profile of denosumab in terms of adverse events and laboratory abnormalities. Prespecified secondary endpoints were time to disease progression in cohort 1 and the proportion of patients without any surgery at 6 months in cohort 2. Safety analyses included all patients who received at least one dose of denosumab. Efficacy analyses included all eligible patients who received at least one dose of denosumab. This study is registered with ClinicalTrials.gov, identifier NCT00680992. FINDINGS 282 patients, including ten adolescents, were included between Sept 9, 2008, and March 25, 2011. Of the 281 patients analysable for safety, three (1%) had osteonecrosis of the jaw and 15 (5%) hypocalcaemia. The most common grade 3-4 adverse events were hypophosphataemia, which occurred in nine (3%) patients, and anaemia, back pain, and pain in extremities, each of which occurred in three patients (1%). Serious adverse events were reported in 25 (9%) patients. No treatment-related deaths were reported. On the basis of investigators' assessment of disease status, 163 of 169 (96%) analysable patients in cohort 1 had no disease progression after median follow-up of 13 months (IQR 5·8-21·0). In cohort 2, 74 of 100 (74%) analysable patients had no surgery and 16 of 26 (62%) patients who had surgery underwent a less morbid procedure than planned. Median follow-up in cohort 2 was 9·2 months (IQR 4·2-12·9). INTERPRETATION Adverse events were consistent with the known safety profile of denosumab. Denosumab was associated with tumour responses and reduced the need for morbid surgery in patients with GCTB. Denosumab represents a new treatment option for patients with GCTB. FUNDING Amgen.
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Affiliation(s)
- Sant Chawla
- Sarcoma Oncology Center, Santa Monica, CA 90403, USA.
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O'Brien MS, Donnell A, Miller J, Iven VG, Pascale M. An abnormal bone lesion of the scapula in a collegiate basketball player: a case report. J Athl Train 2013; 48:859-63. [PMID: 23725460 DOI: 10.4085/1062-6050-48.3.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To present the case of a bone lesion of the scapula in a collegiate basketball player. BACKGROUND A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion. DIFFERENTIAL DIAGNOSIS Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture. TREATMENT The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken. UNIQUENESS Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex. CONCLUSIONS Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma.
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The imaging of cartilaginous bone tumours. I. Benign lesions. Skeletal Radiol 2012; 41:1195-212. [PMID: 22707094 DOI: 10.1007/s00256-012-1427-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/18/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
Benign cartilage tumours of bone are the most common benign primary bone tumours and include osteochondroma, (en)chondroma, periosteal chondroma, chondroblastoma and chondromyxoid fibroma. These neoplasms often demonstrate typical imaging features, which in conjunction with lesion location and clinical history, often allow an accurate diagnosis. The aim of this article is to review the clinical and imaging features of benign cartilage neoplasms of bone, as well as the complications of these lesions.
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Abstract
PURPOSE OF REVIEW Fibrous dysplasia is a rare condition characterized by replacement of normal bone by fibro-osseous connective tissue exhibiting varying degrees of osseous metaplasia, which can affect the craniofacial complex. This article reviews the recent literature with the intent to highlight the innovative information that has contributed to elucidate the pathophysiology, diagnostic criteria, and treatment principles of the disease. RECENT FINDINGS A mutation in the GNAS1 gene on chromosome 20 has been identified as the molecular hallmark of fibrous dysplasia. This finding is not present in ossifying fibroma, which has been traditionally included in differential diagnosis. The concept that asymptomatic patients do not require surgical treatment has been reinforced by a meta-analysis specifically addressing the issue of optic nerve decompression. SUMMARY A diagnosis of fibrous dysplasia can be achieved by combined assessment of clinical, radiologic, and pathologic findings. There is general agreement that, when the disease is not associated with symptoms, partial or radical resection is not indicated, but patients do require periodic radiologic evaluations. There is, however, an absolute need for prospective studies to identify factors predicting the possible late growth of the disease and to investigate the efficacy and side-effects of pharmacological treatment with biphosphonates.
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Branstetter DG, Nelson SD, Manivel JC, Blay JY, Chawla S, Thomas DM, Jun S, Jacobs I. Denosumab induces tumor reduction and bone formation in patients with giant-cell tumor of bone. Clin Cancer Res 2012; 18:4415-24. [PMID: 22711702 DOI: 10.1158/1078-0432.ccr-12-0578] [Citation(s) in RCA: 298] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Giant-cell tumor of bone (GCTB) is a locally aggressive, benign osteolytic tumor in which bone destruction is mediated by RANK ligand (RANKL). The RANKL inhibitor denosumab is being investigated for treatment of GCTB. We describe histologic analyses of GCTB tumor samples from a phase II study of denosumab in GCTB. EXPERIMENTAL DESIGN Adult patients with recurrent or unresectable GCTB received subcutaneous denosumab 120 mg every 4 weeks (with additional doses on days 8 and 15). The primary histologic efficacy endpoint was the proportion of patients who had a 90% or more elimination of giant cells from their tumor. Baseline and on-study specimens were also evaluated for overall tumor morphology and expression of RANK and RANKL. RESULTS Baseline tumor samples were typically composed of densely cellular proliferative RANKL-positive tumor stromal cells, RANK-positive rounded mononuclear cells, abundant RANK-positive tumor giant cells, and areas of scant de novo osteoid matrix and woven bone. In on-study samples from 20 of 20 patients (100%), a decrease of 90% or more in tumor giant cells and a reduction in tumor stromal cells were observed. In these analyses, thirteen patients (65%) had an increased proportion of dense fibro-osseous tissue and/or new woven bone, replacing areas of proliferative RANKL-positive stromal cells. CONCLUSIONS Denosumab treatment of patients with GCTB significantly reduced or eliminated RANK-positive tumor giant cells. Denosumab also reduced the relative content of proliferative, densely cellular tumor stromal cells, replacing them with nonproliferative, differentiated, densely woven new bone. Denosumab continues to be studied as a potential treatment for GCTB.
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Un enchondrome huméral vieux de 1700ans. Ann Pathol 2012; 32:239-41. [DOI: 10.1016/j.annpat.2012.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/17/2011] [Accepted: 01/07/2012] [Indexed: 12/21/2022]
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