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Woltsche JN, Smolle M, Szolar D, Bergovec M, Leithner A. Prevalence and characteristics of benign cartilaginous tumours of the shoulder joint. An MRI-based study. Skeletal Radiol 2024; 53:59-66. [PMID: 37269383 PMCID: PMC10661778 DOI: 10.1007/s00256-023-04375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/28/2023] [Accepted: 05/28/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Enchondromas (EC) of the shoulder joint are benign intraosseous cartilage neoplasms, with atypical cartilaginous tumours (ACT) representing their intermediate counterpart. They are usually found incidentally on clinical imaging performed for other reasons. Thus far the prevalence of ECs of the shoulder has been analysed in only one study reaching a figure of 2.1%. MATERIALS AND METHODS The aim of the current study was to validate this number via retrospective analysis of a 45 times larger, uniform cohort consisting of 21.550 patients who had received an MRI of the shoulder at a single radiologic centre over a time span of 13.2 years. RESULTS Ninety-three of 21.550 patients presented with at least one cartilaginous tumour. Four patients showed two lesions at the same time resulting in a total number of 97 cartilage tumours (89 ECs [91.8%], 8 ACTs [8.2%]). Based on the 93 patients, the overall prevalence was 0.39% for ECs and 0.04% for ACTs. Mean size of the 97 ECs/ACTs was 2.3 ± 1.5 cm; most neoplasms were located in the proximal humerus (96.9%), in the metaphysis (60.8%) and peripherally (56.7%). Of all lesions, 94 tumours (96.9%) were located in the humerus and 3 (3.1%) in the scapula. CONCLUSION Frequency of EC/ACT of the shoulder joint appears to have been overestimated, with the current study revealing a prevalence of 0.43%.
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Affiliation(s)
- Johannes Nikolaus Woltsche
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | | | - Marko Bergovec
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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LaPrade CM, Andryk LM, Christensen JL, Neilson JC, Wooldridge AN, Hackbarth DA, Bedi M, King DM. Natural history of intraosseous low-grade chondroid lesions of the proximal humerus. Front Oncol 2023; 13:1200286. [PMID: 37637054 PMCID: PMC10457155 DOI: 10.3389/fonc.2023.1200286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/21/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Enchondromas and grade 1 chondrosarcomas are commonly encountered low-grade chondroid tumors in the proximal humerus. While there is a concern for malignant transformation, few studies have evaluated the natural history of these lesions. The purpose of this study is to evaluate the natural history of proximal humerus low-grade chondroid lesions managed both conservatively and surgically, and to define management criteria using clinical and radiographic findings for these low-grade chondroid lesions. Methods The patient population included 90 patients intended for conservative treatment and 22 patients proceeding directly to surgery. Data collection was based on a combination of chart review and patient imaging and descriptive statistics were calculated for each group. Results No malignant transformations were noted amongst any group. In the conservative treatment group, 7 of 64 (11%) progressed to surgery after an average of 20.3 months of conservative treatment due to persistent pain unexplained by other shoulder pathology. Importantly, 71% experienced continued pain at a mean of 53.1 months post-operatively. The group that went directly to surgery also demonstrated pain in 41% at an average follow-up of 57.3 months. Discussion Low-grade cartilaginous lesions of the proximal humerus without concerning imaging findings can be managed with conservative treatment and the risk of malignant transformation is very low. Patients with a clear source of their shoulder pain unrelated to their tumor and without concerning characteristics on imaging can be managed with serial annual radiographic imaging. Patients undergoing surgery for these indolent tumors are likely to experience persistent pain even after surgery.
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Affiliation(s)
| | - Logan M. Andryk
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joshua L. Christensen
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - John C. Neilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Adam N. Wooldridge
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Donald A. Hackbarth
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Manpreet Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - David M. King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
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Schumacher KM, Damron TA. Evaluation of triage tool for low-grade cartilage tumors: Four-quadrant approach. J Surg Oncol 2021; 125:273-281. [PMID: 34586629 DOI: 10.1002/jso.26699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES The "four-quadrant approach" (FQA) for triage of benign enchondromas (E) and low-grade malignant chondrosarcomas (LGC) divides patients into treatment categories based on the presence or absence of pain and observation of aggressive or benign radiographic features. This article evaluates the usefulness of the FQA in predicting E versus LGC and operative versus nonoperative outcome. METHODS Patients had working diagnosis of E or LGC, 1-year minimum follow-up, imaging, clinical data, outcomes, and no radiographic evidence of high-grade chondrosarcoma. Statistical analysis determined whether quadrant distribution correlated to E versus LGC and operative versus nonoperative intervention. RESULTS Of 56 lesions (49 patients), 9 were LGC and 47 E. Twenty-five lesions (all 9 LGC, 16 E) were treated operatively and 31 (all E) nonoperatively. There were statistically significant correlations between quadrant distribution and both tumor type (p = 1.9 × 10-6 ) and operative intervention (p = 6.28 × 10-6 ). CONCLUSIONS The FQA is a promising diagnostic tool to distinguish between E and LGC hyaline cartilage tumors, along with determining operative versus nonoperative intervention. Prospective evaluation is warranted.
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Affiliation(s)
- Katherine M Schumacher
- Department of Orthopedic Surgery, Upstate Bone and Joint Center, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Timothy A Damron
- Department of Orthopedic Surgery, Upstate Bone and Joint Center, SUNY Upstate Medical University, Syracuse, New York, USA
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Abstract
Chondrosarcoma is the second most common primary bone tumor, with >90% of cases representing the primary conventional subtype. In addition to arising de novo, conventional chondrosarcoma can arise secondary to a benign underlying lesion, such as enchondroma or osteochondroma. Symptoms are often characterized by focal, dull, aching pain to the affected region. Grade is a well-recognized prognostic factor in these tumors. Grade I lesions/atypical cartilaginous tumors rarely metastasize, rarely recur, and have a 10-year survival rate of >80%. By contrast, grade III lesions are associated with a poor prognosis with the highest local recurrence rates, a lung metastasis rate of >50%, and a 10-year survival rate of <30%. The standard treatment of high-grade conventional chondrosarcoma is complete surgical resection with wide margin. However, low-grade lesions may be amenable to curettage plus or minus adjuvant local treatment. Conventional chondrosarcoma does not respond to chemotherapy or standard radiation doses. Adjuvant treatment can be beneficial for some subtypes such as chemotherapy for dedifferentiated and mesenchymal chondrosarcoma and radiation additionally for mesenchymal chondrosarcoma. Emerging radiation technologies may also play a useful role in treating tumors in anatomically complex areas such as the spine or pelvis.
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Sullivan CW, Kazley JM, Murtaza H, Cooley M, Jones D, DiCaprio MR. Team Approach: Evaluation and Management of Low-Grade Cartilaginous Lesions. JBJS Rev 2021; 8:e0054. [PMID: 32105237 DOI: 10.2106/jbjs.rvw.19.00054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
» Assessment of chondral lesions begins with a clinical evaluation and radiographs.
» Longitudinal follow-up with serial radiographs is appropriate in cases without evidence of aggressive radiographic features.
» Concerning radiographic features include periosteal reaction, soft-tissue extension, cortical destruction, endosteal scalloping of greater than two-thirds of the native cortex, larger lesion size (≥5 cm), and location in the axial skeleton.
» Biomarkers such as IMP3, SOX4, microRNA, and periostin may be used as an adjunct in histologic assessment to help differentiate benign enchondroma from a low-grade chondrosarcoma.
» Advanced-imaging studies, such as computed tomography (CT), bone scans, magnetic resonance imaging (MRI), dynamic contrast-enhanced MRI, and fluorodeoxyglucose positron emission tomography (FDG-PET), may be considered for borderline cases.
» Aggressive or concerning radiographic features should prompt evaluation with advanced imaging or referral to an orthopaedic oncologist.
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Affiliation(s)
- Connor W Sullivan
- Division of Orthopaedic Surgery (C.W.S., J.M.K., H.M., and M.R.D.), Department of Radiology (M.C.), and Department of Pathology (D.J.), Albany Medical Center, Albany, New York
| | - Jillian M Kazley
- Division of Orthopaedic Surgery (C.W.S., J.M.K., H.M., and M.R.D.), Department of Radiology (M.C.), and Department of Pathology (D.J.), Albany Medical Center, Albany, New York
| | - Hamza Murtaza
- Division of Orthopaedic Surgery (C.W.S., J.M.K., H.M., and M.R.D.), Department of Radiology (M.C.), and Department of Pathology (D.J.), Albany Medical Center, Albany, New York
| | - Michael Cooley
- Division of Orthopaedic Surgery (C.W.S., J.M.K., H.M., and M.R.D.), Department of Radiology (M.C.), and Department of Pathology (D.J.), Albany Medical Center, Albany, New York
| | - David Jones
- Division of Orthopaedic Surgery (C.W.S., J.M.K., H.M., and M.R.D.), Department of Radiology (M.C.), and Department of Pathology (D.J.), Albany Medical Center, Albany, New York
| | - Matthew R DiCaprio
- Division of Orthopaedic Surgery (C.W.S., J.M.K., H.M., and M.R.D.), Department of Radiology (M.C.), and Department of Pathology (D.J.), Albany Medical Center, Albany, New York
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Samuel AM, Munger AM, Lee FY, Friedlaender GE, Ibe IK, Lindskog DM. Bone Scans Have Little Utility in the Evaluation of Well-Differentiated Cartilaginous Lesions of the Humerus. Orthopedics 2020; 43:e498-e502. [PMID: 32882054 DOI: 10.3928/01477447-20200827-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
In the humerus, pain is a poor guide for differentiating between benign enchondromas and malignant well-differentiated chondrosarcomas. Radionuclide bone scans often are used, and chondrosarcomas reliably show increased uptake. However, it remains to be seen whether enchondromas consistently have negative findings on bone scans, which would provide reliable differentiation from malignant lesions. Imaging and medical records were reviewed for patients who underwent radionuclide bone scans for enchondroma of the humerus at one academic medical center over a period of 7 years. Bivariate logistic regression was used to determine the association of bone scan results with the finding of endosteal scalloping on radiographs and magnetic resonance imaging (MRI) scans. During initial evaluation, 25 patients who had enchondroma of the humerus underwent radionuclide bone scans. No patients showed progression of lesions during an average follow-up of 69 weeks. On bone scan, 18 (72%) had significantly positive findings, 5 (20%) had mildly positive findings, and 2 (8%) had negative findings. Of the 22 patients who underwent MRI scans, 4 showed endosteal scalloping and none showed aggressive features. No statistically significant association was seen between significantly positive (P=.299) or mildly positive findings on bone scans (P=.810) and the finding of endosteal scalloping on radiographs or MRI scans. Enchondromas rarely showed negative findings on bone scans, and bone scan findings did not correlate with the findings on radiographs or MRI scans. The diagnosis of enchondroma can be made based on clinical and radiographic findings, and the added utility of bone scans does not justify their regular use. [Orthopedics. 2020;43(6):e498-e502.].
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Lichtl AJ, Lee CS. Primary total shoulder arthroplasty in the setting of a benign enchondroma. J Shoulder Elbow Surg 2020; 29:e345-e349. [PMID: 32815810 DOI: 10.1016/j.jse.2020.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
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Davies AM, Patel A, James SL, Azzopardi C, Botchu R. An imaging protocol for the management of central cartilage tumours of the proximal fibula. Clin Radiol 2020; 75:714.e1-714.e6. [PMID: 32665062 DOI: 10.1016/j.crad.2020.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/19/2020] [Indexed: 10/23/2022]
Abstract
AIM To retrospectively review a series of solitary central cartilage tumours (CCTs) of the proximal fibula and propose an imaging protocol for their management. MATERIALS AND METHODS Over 11 years, 48 patients were identified with a CCT of the proximal fibula. The initial magnetic resonance imaging (MRI) and follow-up imaging were assessed for tumour length, endosteal scalloping, or aggressive/malignant features. Each case was categorised according to the Birmingham Atypical Cartilage Tumour Imaging Protocol (BACTIP). The final diagnosis and outcome were reviewed to establish an appropriate imaging protocol for the management of similar cases in the future. RESULTS The final diagnosis based on imaging alone or imaging and histopathology was enchondroma in 46 cases (96%) and atypical cartilage tumour (ACT)/low-grade chondrosarcoma in two (4%). Using the BACTIP classification, the majority were type IC (48%) with type IA the second commonest (24%). Of 19 that underwent follow-up MRI, only two revealed any increase in length, neither of which was shown to be malignant. No cases re-presented later with evidence of malignant transformation. CONCLUSION There has been a significant increase in the number of CCTs of the proximal fibula referred to Royal Orthopaedic Hospital, Birmingham, over the past decade. This can largely be attributed to the increased use of MRI. The majority were benign with only 4% classified as an ACT. A modified BACTIP, the Fibular Atypical Cartilage Tumour Imaging Protocol (FACTIP) is presented, indicating which cases would benefit from follow-up imaging and which require referral to a specialist orthopaedic oncology service.
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Affiliation(s)
- A M Davies
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - A Patel
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
| | - S L James
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - C Azzopardi
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
| | - R Botchu
- Department of Diagnostic Imaging, The Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK
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9
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Jassim SS, Hilton T, Saifuddin A, Pollock R. The incidence and outcome of chondral tumours as incidental findings on investigation of shoulder pathology. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:97-102. [DOI: 10.1007/s00590-019-02532-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
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10
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Patel A, Davies A, Botchu R, James S. A pragmatic approach to the imaging and follow-up of solitary central cartilage tumours of the proximal humerus and knee. Clin Radiol 2019; 74:517-526. [DOI: 10.1016/j.crad.2019.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/30/2019] [Indexed: 02/08/2023]
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McLaughlin RJ, Watts CD, Rock MG, Sperling JW. Reverse total shoulder arthroplasty in a patient with osteogenesis imperfecta type I complicated by a proximal humeral enchondroma: a case report and review of the literature. JSES OPEN ACCESS 2017; 1:119-123. [PMID: 30675552 PMCID: PMC6340830 DOI: 10.1016/j.jses.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Chad D Watts
- OrthoCarolina Hip & Knee Center, Charlotte, NC, USA
| | - Michael G Rock
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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12
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Rosario MS, Yamamoto N, Hayashi K, Takeuchi A, Kimura H, Miwa S, Higuchi T, Inatani H, Abe K, Taniguchi Y, Aiba H, Tsuchiya H. An unusual case of proximal humeral simple bone cyst in an adult from secondary cystic change. World J Surg Oncol 2017; 15:102. [PMID: 28506249 PMCID: PMC5433014 DOI: 10.1186/s12957-017-1166-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/23/2017] [Indexed: 01/30/2023] Open
Abstract
Background Simple bone cysts (SBC) have been documented to occur in adults with closed physeal plates, most commonly affecting the calcaneus in this patient subset. Although most authors theorize an association to trauma, etiology of simple bone cysts remains an enigma up to now. Case presentation A 26-year-old kickboxing coach sought consult for a painful right shoulder which on radiographs and magnetic resonance (MR) imaging showed a proximal humeral lesion with signs of ossification. The patient was lost to follow-up but again sought consult after 3 years for the recurring complaint. On repeat radiographs, computed tomography (CT) scan, and MR images, tumor enlargement with cystic findings typical of simple bone cyst were documented. Diagnostic aspiration of the lesion was firstly done, revealing straw-colored fluid. The patient then underwent intralesional curettage with alpha-tricalcium phosphate cement reconstruction of the lytic defect. No perioperative complications were incurred, and on latest follow-up at 3 years postoperatively, Musculoskeletal Tumor Society (MSTS) and visual analog scale (VAS) pain scores were 30/30 and 0/10, respectively. Conclusions The authors believe their report provides support to a possible association to trauma of simple bone cysts occurring in the adult population with closed physes and suggest this subset of patients may require a different treatment approach from that for juvenile simple bone cysts.
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Affiliation(s)
- Mamer S Rosario
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan.,Department of Orthopaedics, East Avenue Medical Center, East Avenue, Diliman, 1101, Quezon City, Metro Manila, Philippines
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan.
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Takashi Higuchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Hiroyuki Inatani
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Kensaku Abe
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Yuta Taniguchi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8640, Ishikawa, Japan
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Sampath Kumar V, Tyrrell PNM, Singh J, Gregory J, Cribb GL, Cool P. Surveillance of intramedullary cartilage tumours in long bones. Bone Joint J 2017; 98-B:1542-1547. [PMID: 27803232 DOI: 10.1302/0301-620x.98b11.37864] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 07/12/2016] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this study was to determine if clinical and radiological surveillance of cartilage tumours with low biological activity is appropriate. PATIENTS AND METHODS A total of 98 patients with an intramedullary cartilage neoplasm in a long bone met our inclusion criteria and were included in the study. These patients had undergone a total of 384 scans. Patients with radiological follow-up of more than three years (46 patients) were divided into two groups: an active group (11 patients) and a latent group (35 patients). RESULTS Active lesions had a total growth in all three planes that was > 6 mm, whilst latent lesions had < 6 mm of growth. Most latent lesions were heavily calcified: active lesions were calcified less than 50% (p = 0.025). CONCLUSION Clinico-radiological surveillance can identify growing cartilage lesions: MRI is the surveillance modality of choice. A CT scan is recommended, in addition, at presentation to assess the amount of calcification within the lesion. A first follow-up MRI is suggested one year from diagnosis. If the total growth in the cartilage lesion is > 6 mm, surgical treatment should be considered. Otherwise, a second surveillance scan can be performed at three years to determine further management. Cite this article: Bone Joint J 2016;98-B:1542-7.
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Affiliation(s)
- V Sampath Kumar
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P N M Tyrrell
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - J Gregory
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - G L Cribb
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
| | - P Cool
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry SY10 7AG, UK
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Abstract
Patients with potential bone and soft tissue tumors can be challenging for orthopedic surgeons. Lesions that appear benign can still create anxiety for the clinician and patient. However, attention to a few key imaging and clinical findings is enough to correctly diagnose five of the most common bone and soft tissue lesions: lipoma, enchondroma, osteochondroma, nonossifying fibroma, and Paget disease. Accurate identification of these lesions should be within the scope of most orthopedic surgeons and, because most of these patients will not need surgical treatment, referral to orthopedic oncology will not typically be required.
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Affiliation(s)
- Felasfa M Wodajo
- Musculoskeletal Tumor Surgery, Virginia Hospital Center, 1625 North George Mason, Suite 464, Arlington, VA 22205-3698, USA; Orthopedic Surgery, Georgetown University, Washington, DC, USA; Orthopedic Surgery, VCU School of Medicine, Inova Campus, VA 22205, USA.
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15
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Potter BK, Forsberg JA, Conway S, Morris CD, Temple HT. Pitfalls, Errors, and Unintended Consequences in Musculoskeletal Oncology: How They Occur and How They Can Be Avoided. JBJS Rev 2013; 1:01874474-201311000-00004. [PMID: 27490398 DOI: 10.2106/jbjs.rvw.m.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Benjamin K Potter
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, America Building, 2nd Floor - Ortho, Bethesda, MD 20889
| | - Jonathan A Forsberg
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Rockville Pike, America Building, 2nd Floor - Ortho, Bethesda, MD 20889
| | - Sheila Conway
- Division of Musculoskeletal Oncology, Department of Orthopaedics, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136
| | - Carol D Morris
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - H Thomas Temple
- Division of Musculoskeletal Oncology, Department of Orthopaedics, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL 33136
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16
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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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17
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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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18
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Duckworth LV, Reith JD. Well-Differentiated Central Cartilage Tumors of Bone: An Overview. Surg Pathol Clin 2012; 5:147-61. [PMID: 26837919 DOI: 10.1016/j.path.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Well-differentiated hyaline cartilage tumors are among the most common tumors encountered in the skeleton; their radiographic and pathologic classification and clinical management can be challenging. Pathologists find cartilage tumors difficult because their precise classification is as dependent on the clinical and radiographic findings as the histologic features; the distinction between benign and malignant cartilage neoplasms demands good communication and teamwork between pathologists, orthopedic surgeons, and radiologists. This review focuses on the necessary clinical, radiographic, and pathologic features that allow distinction between enchondroma and low-grade central chondrosarcoma and interpretation of lesions encountered in the enchondromatosis syndromes.
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Affiliation(s)
- Lizette Vila Duckworth
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - John D Reith
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA; Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL, USA
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Hong ED, Carrino JA, Weber KL, Fayad LM. Prevalence of shoulder enchondromas on routine MR imaging. Clin Imaging 2011; 35:378-84. [DOI: 10.1016/j.clinimag.2010.10.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 09/02/2010] [Indexed: 11/30/2022]
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Souna BS, Belot N, Duval H, Langlais F, Thomazeau H. No recurrences in selected patients after curettage with cryotherapy for grade I chondrosarcomas. Clin Orthop Relat Res 2010; 468:1956-62. [PMID: 20054673 PMCID: PMC2881994 DOI: 10.1007/s11999-009-1211-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Accepted: 12/15/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND The low aggressiveness of Grade I chondrosarcomas is compatible with conservative surgical treatment. QUESTIONS/PURPOSE We asked whether combined curettage and cryotherapy would yield low rates of recurrence and whether supplemental internal fixation would retain function with low rates of complications in patients with Grade I central chondrosarcomas of the proximal humerus or distal femur. METHODS We retrospectively reviewed 15 patients: nine women and six men with a mean age of 45 years (range, 26-70 years). All patients underwent curettage and cryosurgery through a cortical window; we replaced the window and plated the region with at least three screws beyond the curetted area. None of the patients was lost to followup, and 14 patients (93%) were reexamined by us after a minimum of 5 years (mean, 8 years; range, 5-11 years). RESULTS There were no perioperative anesthetic, neurologic, hardware, or healing complications. None of the patients had local recurrence or metastases develop. At last followup, the Musculoskeletal Tumor Society score was 27.9 (range, 22-30) and all patients had resumed their previous activities. No complications were associated with this simplified cryotherapy technique. CONCLUSIONS The data confirm the appropriateness of conservative surgery for central low-grade chondrosarcomas of the proximal humerus and distal femur based on a combination of intralesional curettage and cryogenic parietal sterilization. Candidates for this approach should be chosen on the basis of the affected bone site, local extension staging, and clinicopathologic grading. We recommend supplementary internal fixation. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Badio S. Souna
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Nicolas Belot
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Hélène Duval
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Frantz Langlais
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
| | - Hervé Thomazeau
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire de Rennes, 16 Bd de Bulgarie, BP 90347, 35203 Rennes Cedex 2, France
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Heck RK, O'Malley AM, Kellum EL, Donovan TB, Ellzey A, Witte DA. Errors in the MRI evaluation of musculoskeletal tumors and tumorlike lesions. Clin Orthop Relat Res 2007; 459:28-33. [PMID: 17545757 DOI: 10.1097/blo.0b013e3180485681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Interpretation of an MRI of a suspected musculoskeletal neoplasm can be extremely difficult. Fifty-six MRIs originally evaluated by outside radiologists were independently evaluated by an expert panel consisting of three specialized musculoskeletal radiologists. The outside reports were then graded based upon accuracy and completeness of the differential diagnosis. We compared the expert opinions with those of the outside radiologists. According to the expert panel, only 30 of the 56 (54%) outside reports listed the most likely diagnosis as such and only 35 (63%) listed it at all. A complete appropriate differential diagnosis was listed in only 22 (39%) of the outside reports. Furthermore, 18 (32%) of the outside reports listed diagnoses judged to be extremely unlikely by the experts. In a subset of 15 patients with images that the expert panel had judged diagnostic of specific entities, only nine of the outside reports listed the correct diagnosis as such and only 10 listed it at all. Furthermore, 11 (73%) of the outside reports listed extremely unlikely possibilities for these diagnostic images. We found a substantial difference between the expert and the outside opinions.
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Affiliation(s)
- Robert K Heck
- University of Tennessee Campbell Clinic, Department of Orthopaedic Surgery, Memphis, TN 38104, USA.
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Thomazeau H, Ropars M, Belot N, Lasbleiz J, Langlais F. Tumeurs bénignes épiphysométaphysaires. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.emcrho.2005.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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