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Jalan D, Sreenivasan R, Prasad R, Singh DK, Jha AK. Ewing's Sarcoma of the Talus in an Adolescent Female: An Unusual Case Presentation With Review of Literature. Cureus 2022; 14:e30946. [DOI: 10.7759/cureus.30946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
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2
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The Prognostic Role of the C-Reactive Protein and Serum Lactate Dehydrogenase in a Pediatric Series of Bone Ewing Sarcoma. Cancers (Basel) 2022; 14:cancers14133064. [PMID: 35804835 PMCID: PMC9264769 DOI: 10.3390/cancers14133064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Ewing sarcoma is a rare and aggressive tumor of childhood and adolescence. Over the years, different prognostic factors have been explored to stratify high-risk patients. The roles of C-reactive protein (CRP) and serum lactate dehydrogenase (LDH) as potential new prognostic factors would be a useful and simple for risk stratification, but they have rarely been investigated. In our work, we analyze the role of LDH and CRP as prognostic factors in a population of pediatric and adolescent patients affected by Ewing sarcoma. Our study confirms the potential prognostic role of LDH at diagnosis as an independent prognostic factor. LDH evaluation is not expensive, and it can be beneficial for developing countries where diagnostic and staging resources in the pediatric oncology field are poor. Abstract Background: Ewing sarcoma (ES) is a rare and aggressive pediatric cancer. Numerous studies have attempted to identify new prognostic biomarkers. The predictive value of serum LDH and CRP has not been clearly described, to date. Methods: The objective of our retrospective study was to investigate the prognostic value of LDH and CRP levels and their association with overall survival in a series of ES patients. Results: Between 2004 and 2019, 89 ES patients were included. In a univariable analysis, high levels of LDH and CRP were associated with the worst prognosis. In a multivariable analysis, only higher LDH values remained associated with a lower survival. The high-LDH-level group experienced all 21 deaths registered in our population (24%) and about 90% of disease progressions. The 5-year overall survival was 66.4% in the high-LDH-level group, while no deaths were observed in the low-LDH-level group. The 5-year progression-free survival was 57.9% in the high-LDH-level group versus 80.4% in the low-LDH-level group. Conclusions: In our study, LDH levels at diagnosis were strongly correlated with the prognosis, and they might be considered a prognostic factor in Ewing sarcoma. The LDH value, along with its very low cost and its reproducibility in almost all centers, make it suitable as a potential prognostic biomarker in clinical practice.
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Torner F, Nuñez JH, Inarejos Clemente EJ, Garraus M, Suñol M, Martínez AD, Moreno D. Total calcaneal allograft reconstruction of an Ewing's sarcoma in a child: Outcome and review of the literature. Cancer Rep (Hoboken) 2022; 5:e1626. [PMID: 35583247 PMCID: PMC9458496 DOI: 10.1002/cnr2.1626] [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: 11/06/2021] [Revised: 04/24/2022] [Accepted: 04/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ewing's sarcoma rarely presents in bones of the feet. Surgical management usually includes amputation. Limb sparing surgery is anecdotal. CASE We report the case of a 13-year-old boy with an Ewing sarcoma in his calcaneus who had a calcaneal reconstruction with total calcaneus allograft after induction chemotherapy. CONCLUSIONS At 42 months of follow-up our patient remains disease free and functionally intact. A review of the exceptional limb salvage procedure options for malignant calcaneus tumor was performed.
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Affiliation(s)
- Ferran Torner
- Tumor Unit, Department of Traumatology and Orthopedic Surgery, Hospital Sant Joan de Deu, Universitat De Barcelona, Barcelona, Spain
| | - Jorge H Nuñez
- Pediatric Department of Traumatology and Orthopedic Surgery, Hospital Sant Joan de Deu, Universitat De Barcelona, Barcelona, Spain.,Department of Traumatology and Orthopedic Surgery, University Hospital of Mutua Terrassa, Barcelona, Spain
| | | | - Moira Garraus
- Department of Oncology and Hematology, Hospital Sant Joan de Deu, Universitat De Barcelona, Barcelona, Spain
| | - Mariona Suñol
- Department of Pathology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Aníbal D Martínez
- Pediatric Department of Traumatology and Orthopedic Surgery, Hospital Sant Joan de Deu, Universitat De Barcelona, Barcelona, Spain
| | - David Moreno
- Pediatric Department of Traumatology and Orthopedic Surgery, Hospital Sant Joan de Deu, Universitat De Barcelona, Barcelona, Spain
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A unique case of adamantinoma-like Ewing sarcoma in the calcaneus, exhibiting prominent squamous differentiation and displaying EWSR1 gene rearrangement. Skeletal Radiol 2022; 51:209-217. [PMID: 34110448 DOI: 10.1007/s00256-021-03831-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/14/2021] [Accepted: 05/23/2021] [Indexed: 02/02/2023]
Abstract
Adamantinoma-like Ewing sarcoma is uncommonly reported in the skeletal sites, including small bones of the feet.A 15-year-old girl presented with pain and swelling in her left foot, leading to difficulty in walking for 8 months. Plain radiograph revealed an ill-defined, lytic-sclerotic lesion without significant periosteal reaction in her left calcaneus. Magnetic resonance imaging (MRI) revealed an expansile lesion involving the anterior calcaneus, which was hypointense on T1 and heterogeneously hyperintense on T2-weighted sequences, infiltrating the adjacent bones and soft tissues. On imaging, the differential diagnoses considered were a giant cell tumor and other primary bone tumors.Histopathological examination revealed a tumor composed of small round cells, with interspersed keratin pearls. Immunohistochemically, the tumor cells were positive for CD99/MIC2, pan-cytokeratin (AE1/AE3), p40, p63, NKX2.2, and synaptophysin. Diagnosis of adamantinoma-like Ewing sarcoma was offered on the initial biopsy. Furthermore, the tumor cells revealed EWSR1 gene rearrangement by fluorescence in situ hybridization, confirming this diagnosis. The patient underwent neoadjuvant chemotherapy, had a poor response, and finally underwent below-knee amputation.This constitutes a rare case of adamantinoma-like Ewing sarcoma in the calcaneus. Ewing sarcoma may be considered as a differential diagnosis for intraosseous lytic-sclerotic lesions, even without significant periosteal reaction, at unusual sites, such as the bones of the foot. Awareness of this entity and application of ancillary techniques is recommended for its exact diagnosis and in differentiating this rare variant from its diagnostic mimics. This case also indicates a poor chemotherapy response in this unusual variant of Ewing sarcoma, occurring in the calcaneus.
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5
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Campanacci DA, Scoccianti G. Benign and Malignant Tumors in Child Foot. Foot Ankle Clin 2021; 26:851-871. [PMID: 34752241 DOI: 10.1016/j.fcl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone tumors affecting pediatric foot are a rare occurrence. Most lesions are benign, but a thorough diagnostic evaluation must always be performed to rule out malignant tumors. Approach to benign lesions is conservative, from observation follow-up to curettage or mininvasive techniques. In malignant lesions, a wide resection must be performed and same protocols applied as in tumors affecting other skeletal sites. Reconstructive procedures should aim to mechanical stability and long-lasting results; joint motion restoring can be attempted when not negatively affecting stability. Amputation procedures should be considered as a still viable choice because of their good functional result in the foot.
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Affiliation(s)
- Domenico Andrea Campanacci
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Brambilla 3, Firenze 50134, Italy.
| | - Guido Scoccianti
- Department of Orthopaedic Oncology and Reconstructive Surgery, Careggi University Hospital, Largo Brambilla 3, Firenze 50134, Italy
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6
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Newman ET, van Rein EAJ, Theyskens N, Ferrone ML, Ready JE, Raskin KA, Lozano Calderon SA. Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis. J Surg Oncol 2020; 122:1731-1746. [PMID: 32974945 DOI: 10.1002/jso.26205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/26/2020] [Accepted: 08/24/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Malignant tumors of the calcaneus are rare but pose a treatment challenge. AIMS (1) describe the demographics of calcaneal malignancies in a large cohort; (2) describe survival after amputation versus limb-salvage surgery for high-grade tumors. METHODS Study group: a "pooled" cohort of patients with primary calcaneal malignancies treated at two cancer centers (1984-2015) and systematic literature review. Kaplan-Meier analyses described survival across treatment and diagnostic groups; proportional hazards modeling assessed mortality after amputation versus limb salvage. RESULTS A total of 131 patients (11 treated at our centers and 120 patients from 53 published studies) with a median 36-month follow-up were included. Diagnoses included Ewing sarcoma (41%), osteosarcoma (30%), and chondrosarcoma (17%); 5-year survival rates were 43%, 73% (70%, high grade only), and 84% (60%, high grade only), respectively. Treatment involved amputation in 52%, limb salvage in 27%, and no surgery in 21%. There was no difference in mortality following limb salvage surgery (vs. amputation) for high-grade tumors (HR 0.38; 95% CI 0.14-1.05), after adjusting for Ewing sarcoma diagnosis (HR 5.15; 95% CI 1.55-17.14), metastatic disease at diagnosis (HR 3.88; 95% CI 1.29-11.64), and age (per-year HR 1.04; 95% CI 1.02-1.07). CONCLUSIONS Limb salvage is oncologically-feasible for calcaneal malignancies.
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Affiliation(s)
- Erik T Newman
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eveline A J van Rein
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina Theyskens
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marco L Ferrone
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John E Ready
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin A Raskin
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Nasr L, Naffaa L, El Alayli A, Abboud MR, Khoury NJ. Isolated delayed metastasis to the talus from Ewing's sarcoma. J Radiol Case Rep 2018; 12:17-24. [PMID: 30651917 DOI: 10.3941/jrcr.v12i8.3164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Bone metastasis to the hands and feet, known as acrometastasis, is a very rare finding and tends to be associated with extensive metastasis. We herein report the case of a 14-year-old girl known to have a history of successfully treated Ewing's sarcoma arising from the ribs, who presented with a pathologically proven isolated metastatic lesion to the talus 7 years after achieving clinical and radiologic remission. We describe the imaging findings on MRI, CT scan and PET-CT. To our knowledge, talar metastasis from Ewing's sarcoma has been previously reported only twice in the English literature. Noteworthy is the fact that one of the previously reported lesions was considered a skip metastasis, and the other was under-described in terms of primary and secondary tumor location and time to metastasis. In addition, the overall imaging findings were rather suggestive of a benign lesion, particularly on CT scan.
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Affiliation(s)
- Layla Nasr
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
| | - Lena Naffaa
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
| | - Alaeddine El Alayli
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil J Khoury
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
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8
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Yan L, Zong J, Chu J, Wang W, Li M, Wang X, Song M, Wang S. Primary tumours of the calcaneus. Oncol Lett 2018; 15:8901-8914. [PMID: 29928329 PMCID: PMC6004727 DOI: 10.3892/ol.2018.8487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 03/02/2018] [Indexed: 12/14/2022] Open
Abstract
The calcaneus is a rare location for the occurrence and development of primary tumour types. Clinicians are unfamiliar with calcaneal tumour types, which may result in a delay in diagnosis or a missed diagnosis, resulting in unnecessary morbidity and amputation. Heel pain and localized swelling of the ankle are the most common symptoms. X-ray is the first choice for a tentative diagnosis of a calcaneal tumour. The final diagnosis depends on a histological examination. The treatment of calcaneal tumour types varies depending on the Enneking system. The majority of patients with benign tumours heal, except for a few with a palindromia. For malignant tumours, the prognosis is comparatively poor, resulting in disability and a high rate of metastasis. This review describes the spectrum of calcaneal tumour types and specifically illustrates the epidemiology, symptomatology, imagology, histopathology and treatment options that may facilitate diagnosis and improve prognosis.
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Affiliation(s)
- Litao Yan
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Junwei Zong
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Jin Chu
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Wendong Wang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Mingshu Li
- Department of Ophthalmology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Xianfeng Wang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
- Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116200, P.R. China
| | - Shouyu Wang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
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9
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Abstract
Ewing's sarcoma of the calcaneum is rare. Radiological features of this tumor can be misinterpreted as other benign bone tumors due to its rarity. The overall prognosis of Ewing's sarcoma of calcaneum is inferior compared to other sites of this tumor. Hence, these tumors should have extensive radiological evaluation and histological confirmation as misdiagnosis and treatment delays will have detrimental outcomes.
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Affiliation(s)
- P Ajmal Sherif
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - A Santa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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10
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Li S, Yang Q, Wang H, Wang Z, Zuo D, Cai Z, Hua Y. Prognostic significance of serum lactate dehydrogenase levels in Ewing's sarcoma: A meta-analysis. Mol Clin Oncol 2016; 5:832-838. [PMID: 28105365 DOI: 10.3892/mco.2016.1066] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/12/2016] [Indexed: 11/05/2022] Open
Abstract
A number of studies have investigated the role of serum lactate dehydrogenase (LDH) levels in patients with Ewing's sarcoma, although these have yielded inconsistent and inconclusive results. Therefore, the present study aimed to systematically review the published studies and conduct a meta-analysis to assess its prognostic value more precisely. Cohort studies assessing the prognostic role of LDH levels in patients with Ewing's sarcoma were included. A pooled hazard ratio (HR) with 95% confidence intervals (CIs) of overall survival (OS) or 5-year disease-free survival (DFS) was used to assess the prognostic role of the levels of serum LDH. Nine studies published between 1980 and 2014, with a total of 1,412 patients with Ewing's sarcoma, were included. Six studies, with a total of 644 patients, used OS as the primary endpoint and four studies, with 795 patients, used 5-year DFS. Overall, the pooled HR evaluating high LDH levels was 2.90 (95% CI: 2.09-4.04) for OS and 2.40 (95% CI: 1.93-2.98) for 5-year DFS. This meta-analysis demonstrates that high levels of serum LDH are associated with lower OS and 5-year DFS rates in patients with Ewing's sarcoma. Therefore, serum LDH levels are an effective biomarker of Ewing's sarcoma prognosis.
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Affiliation(s)
- Suoyuan Li
- Department of Orthopedics, Shanghai General Hospital, Nanjing Medical University, Shanghai, P.R. China
| | - Qing Yang
- Department of Orthopedics, Fudan University-Affiliated Zhongshan Hospital, Qingpu Branch, Shanghai, P.R. China
| | - Hongsheng Wang
- Department of Orthopedics, Shanghai 10th People's Hospital, School of Medicine Tongji University, Shanghai, P.R. China
| | - Zhuoying Wang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Dongqing Zuo
- Department of Orthopedics, Shanghai 10th People's Hospital, School of Medicine Tongji University, Shanghai, P.R. China
| | - Zhengdong Cai
- Department of Orthopedics, Shanghai General Hospital, Nanjing Medical University, Shanghai, P.R. China
| | - Yingqi Hua
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
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11
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Binesh F, Sobhanardekani M, Zare S, Behniafard N. Subungual Ewing sarcoma/PNET tumor family of the great toe: a case report. Electron Physician 2016; 8:2238-42. [PMID: 27279998 PMCID: PMC4886564 DOI: 10.19082/2238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/31/2016] [Indexed: 11/20/2022] Open
Abstract
Ewing’s sarcoma is seen mainly in patients less than 18. This aggressive tumor generally affects the axial skeleton and only rarely involves the acral regions. Ewing’s sarcoma in the foot is inordinately scarce. Clinical features are uncertain and can imitate other common diseases. This paper presents a case of 62-year-old malewith complaints of pain and swelling of the subungual area of his right great toe. The lesion was excised, and histopathological diagnosis of Ewing’s sarcoma was made. Histopathological examination, supported by immunochemical methods, remains the mainstay of diagnosis. Surgical ablation along with chemotherapy is the therapy of choice. To our knowledge, this is the first report of Ewing’s sarcoma involving the nail bed of the great toe without bone erosion. The key messages of this case report is “Subungual Ewing sarcoma is a rare case, and Ewing’s sarcoma must be kept in mind for acral lesions, especially in the adult population.”
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Affiliation(s)
- Fariba Binesh
- M.D. of Pathology, Professor, Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Sobhanardekani
- M.D. of Radiology, Assistant Professor, Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Saeedeh Zare
- Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Behniafard
- M.D., General Physician, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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12
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Do malignant bone tumors of the foot have a different biological behavior than sarcomas at other skeletal sites? Sarcoma 2013; 2013:767960. [PMID: 23737703 PMCID: PMC3655663 DOI: 10.1155/2013/767960] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/22/2013] [Indexed: 11/17/2022] Open
Abstract
We analyze the delay in diagnosis and tumor size of malignant bone tumors of the foot in a retrospective study. We compared the oncological and surgical long-term results with identical tumor at other anatomical sites in order to analyze the biological behavior of sarcomas that are found in the foot. Thirty-two patients with a histologically proven malignant bone tumor (fifteen chondrosarcomas, nine osteosarcomas, and eight Ewing sarcomas) between the years 1969 and 2008 were included. The median follow-up was 11.9 years. The overall median time gap between the beginning of symptoms and diagnosis in the study group was 10 months. Ewing sarcoma presented with the longest delay in diagnosis (median of 18 months), followed by osteosarcoma (median of 15 months) and chondrosarcoma (median of 7.5 months). The delay in diagnosis of these tumors was significantly longer than that of equivalent tumors at other skeletal sites, but the 5- and 10-year survival rates and the occurrence of distant metastases were comparable. In contrast, the average size of foot tumors was 5- to 30-fold less than that of tumors analyzed at other skeletal sites. This study indicates that sarcomas of the foot demonstrate a distinct biological behavior compared to the same tumor types at other skeletal sites.
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13
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MR imaging of the paediatric foot and ankle. Pediatr Radiol 2013; 43 Suppl 1:S107-19. [PMID: 23478926 DOI: 10.1007/s00247-012-2449-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/09/2012] [Accepted: 06/06/2012] [Indexed: 02/07/2023]
Abstract
Radiography is the mainstay for initial evaluation of paediatric foot and ankle pathology. MRI is the preferred exam for further characterisation of the majority of these conditions. The modality features high sensitivity and specificity for this purpose with few exceptions. Findings on MRI will often dictate patient referral and further management, and are frequently required for surgical planning. This article will provide an overview of a variety of pathologies that afflict the foot and ankle in children. These include tarsal coalition, osteochondral lesions, osteonecrosis, osteochondroses, stress fractures, osteomyelitis, inflammatory arthritis, neoplasms of bone and soft tissue, and foreign bodies. Their respective imaging manifestations on MRI are the focus of the paper. Technical parameters and marrow signal variation are also discussed.
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14
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Brasme JF, Morfouace M, Grill J, Martinot A, Amalberti R, Bons-Letouzey C, Chalumeau M. Delays in diagnosis of paediatric cancers: a systematic review and comparison with expert testimony in lawsuits. Lancet Oncol 2012; 13:e445-59. [PMID: 23026830 DOI: 10.1016/s1470-2045(12)70361-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Delayed diagnosis of paediatric cancers is reported regularly and is a source of remorse for physicians and parents and a leading cause of malpractice claims. We did a systematic review of information about the distribution, determinants, and consequences of time to diagnosis of paediatric malignancies and compared these findings with those of court-appointed expert witnesses in malpractice claims in Canada and France. Time to diagnosis varied widely between tumour types in the 98 relevant studies (medians ranged from 2-260 weeks) without any significant decrease with time. Determinants of a long delay in diagnosis included older age, qualification of the first physician contacted, non-specific symptoms, histological type, and tumour localisation. Delayed diagnosis was associated with poor outcome for retinoblastoma and possibly for leukaemia, nephroblastoma, and rhabdomyosarcoma (data were insufficient for definitive conclusions). It was not associated with an adverse outcome for most CNS tumours, osteosarcoma or Ewing's sarcoma, and, paradoxically, was frequently associated with better outcomes than was short time to diagnosis in these cancers. A third of the court-appointed experts provided testimony concordant with the medical literature. The relations between delay in diagnosis and outcome are complex and probably depend more on tumour biology than on parental or medical factors.
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Affiliation(s)
- Jean-François Brasme
- INSERM U953, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Hôpital Saint-Vincent-de-Paul, Paris, France.
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15
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Parida L, Fernandez-Pineda I, Uffman J, Navid F, Davidoff AM, Neel M, Krasin MJ, Rao BN. Clinical management of Ewing sarcoma of the bones of the hands and feet: a retrospective single-institution review. J Pediatr Surg 2012; 47:1806-10. [PMID: 23084188 DOI: 10.1016/j.jpedsurg.2012.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE Bones of the hands and feet are uncommon sites for Ewing sarcoma. In this study, we reviewed our experience in the management of these tumors. METHODS We retrospectively reviewed clinical presentation, management, and outcome of patients with Ewing sarcoma of the bones of hands and feet treated at our institution (1981-2006). RESULTS The cohort included 6 males and 3 females (8 white, 1 African American; median age at diagnosis, 15 years). Primary tumor site was the hand in 6 and the foot in 3 patients. Three patients had distant metastatic disease at diagnosis (lung [n = 2]; ipsilateral axillary lymph node[(n = 1]). All patients had painful swelling at the primary site, and 2 (22%) had pathological fracture. All patients received chemotherapy and local control measures (surgery [n = 6], radiation [n = 2], surgery and radiation [(n = 1]). Three patients received radiotherapy for distant metastases. Three patients had systemic recurrence (lungs [n = 2], lung and brain [n = 1]); none had local tumor recurrence. Median follow-up was 5 years. Five patients (55.6%) are alive at last follow-up. CONCLUSIONS Chemotherapy and surgical excision of primary tumor are the mainstays of treatment. Radiotherapy is recommended for local control of lesions in the hand for patients declining excisional therapy.
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Affiliation(s)
- Lalit Parida
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA
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16
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San-Julian M, Duart J, de Rada PD, Sierrasesumaga L. Limb salvage in Ewing's sarcoma of the distal lower extremity. Foot Ankle Int 2008; 29:22-8. [PMID: 18275732 DOI: 10.3113/fai.2008.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ewing's sarcoma (ES) of the foot and ankle is a rare condition whose treatment is controversial. There are no large series covering this issue. Some authors advise amputation as the "gold standard" treatment. The authors here prsent their experience in limb salvage of fourteen cases of ES in distal lower extremities. METHODS The clinical records of fourteen patients affected by ES in ankle or foot were reviewed. Particular attention was paid to followup, functional status, type of treatment, survivorship and histological response to treatment. RESULTS Straightforward amputation was employed in just 3 cases of toe location, and another case located in the calcaneum was considered unresectable. Limb salvage was achieved in most patients with tumors in tarsal and metatarsal bones, as well as distal tibia and distal fibula locations. There were no local recurrences of the tumor. All but on patient survived after a minimum follow-up of four years (4 to 22). The function at the last follow-up was excellent or good in 80% of cases of limb salvage, mainly in non-irradiated patients. CONCLUSIONS Chemotherapy and resection with reconstruction of the foot yielded excellent results in ES cases. Survivorship of ES in distal locations seems to be better than for proximal ones. High doses of radiotherapy and amputation can be avoided in the treatment of these tumors.
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Affiliation(s)
- Mikel San-Julian
- Department Of Orthopedic Surgery, University of Navarre, Avd. Pio XII 36, 31080 Pamplona, Spain.
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Abstract
Approximately 3% of osseous tumors occur in the foot and ankle. Solitary bone cysts, chondroblastoma, intraosseous lipoma, osteoid osteoma, chondrosarcoma, and Ewing's sarcoma seem to have a predilection for the calcaneus. Biopsy is often a crucial step in management. Tumor-like conditions, such as cysts, reactive lesions, and osteomyelitis, must be considered during evaluation. Treatment is often observation or curettage of benign lesions and resection or amputation for malignancies.
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Affiliation(s)
- William B Kilgore
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USA
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