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Percutaneous treatment of chest wall chondroid hamartomas: the experience of a single center. Pediatr Radiol 2023; 53:249-255. [PMID: 36058941 PMCID: PMC9892089 DOI: 10.1007/s00247-022-05498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/28/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thoracic mesenchymal hamartomas are rare benign lesions. Rarely symptomatic, they may compress pulmonary parenchyma, leading to respiratory distress. Although spontaneous regression has been documented, the more common outcome is progressive growth. The treatment of choice is en bloc excision of the involved portion of the chest wall, frequently leading to significant deformity. OBJECTIVE The aim of our study was to describe percutaneous techniques to treat these lesions. MATERIALS AND METHODS We collected data of children with thoracic mesenchymal hamartomas who were treated at our institution from 2005 to 2020 using various percutaneous techniques. Techniques included radiofrequency thermoablation, microwave thermoablation (microwave thermoablation) and cryoablation. RESULTS Five children were treated for chest wall hamartomas; one child showed bilateral localization of the mass. Two children underwent microwave thermoablation, one radiofrequency thermoablation and two cryoablation; one child treated with cryoablation also had radiofrequency thermoablation because mass volume increased after the cryoablation procedure. The median reduction of tumor volume was 69.6% (24.0-96.5%). One child treated with microwave thermoablation showed volumetric increase of the mass and underwent surgical removal of the tumor. No major complication was reported. CONCLUSION Percutaneous ablation is technically feasible for expert radiologists and might represent a valid and less invasive treatment for chest wall chondroid hamartoma, avoiding skeletal deformities.
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Sulaiman SRK, Al-Zubaidi SAM, Sakrana AA. Radio Frequency Ablation for the Treatment of Appendicular Skeleton Chondroblastoma: Is It an Excellent Alternative? Systematic Review and Meta-Analysis. Indian J Radiol Imaging 2022; 32:523-530. [DOI: 10.1055/s-0042-1755248] [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] Open
Abstract
AbstractRadio frequency ablation (RFA) is a minimally invasive technique that has become recognized in clinical practice for treating chondroblastoma, although curettage with bone graft is the standard treatment. Chondroblastoma is a locally aggressive cartilaginous bone tumor, representing nearly 5% of benign bone tumors. Chondroblastoma shows a preference toward the epiphysis or apophysis of long bones, but it was also reported in vertebrae and flat bones. The management of chondroblastoma could be challenging due to the risk to injure the epiphyseal plate or difficult location. The aim of this study was to determine if RFA is a suitable alternative to curettage with bone graft for the treatment of chondroblastoma. Moreover, there will be an evaluation of RFA's effectiveness in terms of symptoms relief; we also define the proper size of the lesion to be treated with RFA, and discuss the complications after the procedure, including the recurrence rate. Furthermore, we review the best imaging method to evaluate the therapeutic response of RFA and for the detection of residual disease early after the ablation. A comprehensive PubMed and Google Scholar search followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 checklist guidelines. Ninety-seven patients were identified after reviewing the available full texts of nine articles. The results of the current review provide further evidence to support the use of RFA as an alternative option to surgery.
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Affiliation(s)
| | | | - Amal Abdelsattar Sakrana
- Department of Diagnostic and Interventional Radiology, Mansoura University Hospital, Mansoura, Egypt
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Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:jcm11123265. [PMID: 35743336 PMCID: PMC9225477 DOI: 10.3390/jcm11123265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/10/2023] Open
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to -40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.
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Salunke A, Amin P, Pandit J, Menon P, Pathak S. A study of 40 patients of chondroblastoma of extremities treated with curettage and reconstruction with bone graft or bone graft substitute or bone cement: What were the outcomes? JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2022. [DOI: 10.4103/jodp.jodp_39_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abo-Elsoud M, Sadek W, Salah-Eldeen M, Abosenna W. Surgical hip dislocation for treatment of femoral head chondroblastoma: efficacy and safety. INTERNATIONAL ORTHOPAEDICS 2021; 46:653-660. [PMID: 34799777 DOI: 10.1007/s00264-021-05264-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Femoral head chondroblastoma poses a surgical challenge. Anatomical limitations may lead to increased risk of local recurrence, damage to the articular cartilage, growth disturbances, and/or avascular necrosis (AVN). We are presenting our results with surgical hip dislocation approach with the aim to evaluate its efficacy in preventing recurrence and its safety, preserving a functional hip joint and avoiding complications. PATIENTS AND METHODS Ten patients were managed using surgical hip dislocation with direct access to femoral head lesions, extended curettage through a modified trapdoor approach, and cement reconstruction. These were six males and four females, with a mean age of 17 ± 2.7 years (range: 14-20) and a mean follow-up of 34 ± 12 months (range: 17-57). The lesion extended into the neck in 60% of patients with the physis being either closed in seven or closing in three patients. RESULTS We had a single case (10%) of recurrence at the trochanters for which re-curettage was done. However, all patients had their hips preserved with good function at the latest follow-up, and no serious complications recorded. The Musculoskeletal Tumor Society score improved significantly from a pre-operative median of 23.5 (range: 16-28) to a post-operative median of 29 (range: 26-30) (P = 0.005). CONCLUSION This report describes a safe reproducible approach to effectively manage these locally aggressive lesions with good short-term results. This is done while maintaining the integrity of the articular surface, growth plate, as well as preserving the femoral head blood supply.
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Affiliation(s)
- Mohamed Abo-Elsoud
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Wael Sadek
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Mostafa Salah-Eldeen
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - Wesam Abosenna
- Department of Orthopaedics and Traumatology, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
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Ruiz Santiago F, Láinez Ramos-Bossini AJ, Martínez Martínez A, García Espinosa J. Chondroblastoma treatment by radiofrequency thermal ablation: Initial experience and implementation. Eur J Radiol 2021; 144:109950. [PMID: 34560504 DOI: 10.1016/j.ejrad.2021.109950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE To present our experience on the implementation of radiofrequency thermal ablation (RFA) for the treatment of chondroblastoma. MATERIALS AND METHODS This case series includes 12 patients (10 males) with chondroblastoma using RFA under CT guidance. Tumours were located in the humeral head (3), femoral head (2), distal femoral epiphysis (4), tibial epiphysis (2) and calcaneus (1). Tumour size ranged from 12 to 60 mm (median: 33 mm). According to tumour size and location, monopolar electrode's active tip ranged from 1 to 3 cm. Dry and perfused ablation mode was used to treat smaller (6) and larger (6) lesions, respectively. Cementation was also made in 5 cases. Technical success was considered if the tumour was treated according to the protocol and complete ablation was achieved. Clinical success was assessed according to a visual analogue scale. RESULTS Technical success was achieved in 11 of 13 cases (83%) afters the first treatment. After a second treatment in the 2 failed cases, pain control was achieved in all cases eventually (100% of clinical success). Follow-up MRI demonstrated resolution of oedema in all cases, as well as a necrotic area extending beyond the outer edge of the lesion in all cases except one. Radiography or CT showed stability of the lesions, with increased sclerosis and no cortex collapse. In one case, a 4 cm shortening of the humerus was observed at the end of skeletal development (7 years after treatment). In another case, early hip osteoarthritis was developed (15 years after treatment). No other long-term complications were observed. CONCLUSION Successful treatment of chondroblastoma can be achieved by RFA. Cementoplasty adds strength to the ablated bone in weight bearing areas. MRI hallmarks associated with clinical success were resolution of bone marrow edema, and area of necrosis extending beyond the tumour edge. Radiography and CT proved to be useful in demonstrating cortex integrity.
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Affiliation(s)
- Fernando Ruiz Santiago
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Spain.
| | | | - Alberto Martínez Martínez
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Spain
| | - Jade García Espinosa
- Department of Radiology and Physical Medicine, Hospital Virgen de las Nieves, University of Granada, Spain
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Verma T, Mishra A, Agarwal G, Maini L. Three dimensional surgical planning for mosaicplasty in chondroblastoma of femoral head with articular disruption. J Orthop Sci 2021; 26:719-724. [PMID: 30391136 DOI: 10.1016/j.jos.2018.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/25/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tarun Verma
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Abhishek Mishra
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Gaurang Agarwal
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
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Shi J, Zhao Z, Yan T, Guo W, Yang R, Tang X, Qu H, Dong S. Surgical treatment of benign osteolytic lesions in the femoral head and neck: a systematic review. BMC Musculoskelet Disord 2021; 22:549. [PMID: 34134687 PMCID: PMC8210383 DOI: 10.1186/s12891-021-04442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/02/2021] [Indexed: 12/29/2022] Open
Abstract
Background and objectives Treatment of benign osteolytic lesions in the femoral head and neck can be extremely challenging, particularly in children with open physis or for aggressive tumors with pathological fracture. There remains the difficult management decision as to whether to perform complete excision of the involved area or only curettage. Moreover, there is no agreed consensus on the optimal approach to lesion access when performing curettage, which included the transcervical, open and direct approach. The current systematic review aims to provide guidance for selection of surgical methods in clinical practice by comparing the advantages and drawbacks of different procedures. Methods A comprehensive literature search of PubMed, Embase and Web of Science databases were executed for human studies restricted to the English language. The search was filtered to include studies published from January 1980 to January 2020. Results A total of 33 articles including 274 patients were enrolled in the final analysis. The most common diagnosis was chondroblastoma (CBT) (104, 38.0%), followed by giant cell tumor (GCT) (56, 20.4%). There were 57 (20.8%) patients with pathological fracture. Intralesional curettage was performed in 257 (93.8%) patients with the local recurrence of 12.5% at the mean follow-up of 51.5 months. The patients who were presented with open physis or curetted via transcervical approach developed higher local recurrence in patients with CBT (P < 0.001). The local recurrence rate of GCT is 33.3% after curettage, while 8 of 9 (88.9%) patients with fracture were treated successfully with joint preservation. Two of 45 (4.4%) patients developed avascular necrosis (AVN) of femoral head after surgical hip dislocation. The reported Musculoskeletal Tumor Society (MSTS) Score was comparable among patients with different approaches to curettage. Conclusion The majority of benign osteolytic lesions in the femoral head and neck can be treated with intralesional curettage with acceptable local tumor control and satisfactory function. The incidence of local recurrence might be decreased dramatically for lesion access under direct visualization. The native joint maintenance could be achieved even in patients with aggressive lesions presenting pathological fracture. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04442-y.
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Affiliation(s)
- Jingtian Shi
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Huayi Qu
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Sen Dong
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
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9
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Almenieir N, Hickeson M, Novales-Diaz J, Derbekyan V, Abikhzer G. Incidental Skeletal Findings on Sodium-fluoride Positron Emission Tomography: A Collection of Benign Tumors. Mol Imaging Radionucl Ther 2021; 30:113-116. [PMID: 34082514 PMCID: PMC8185481 DOI: 10.4274/mirt.galenos.2020.89266] [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: 12/01/2022] Open
Abstract
Sodium-fluoride (NaF) positron emission tomography (PET) is a sensitive method to detect altered bone mineralization. Its increasing use in routine clinical practice for metastatic bone disease has also resulted in the detection or characterization of incidental benign bone lesions. A spectrum of NaF PET scan cases with benign bone tumors are presented in this article, including whole body PET bone scan and selected PET/computed tomography (CT), CT, or magnetic resonance imaging (MRI) of the region of interest. The reader will be able to improve their knowledge related to the clinical presentation of these entities, some are rare and recognize based on NaF PET and CT/MRI patterns by reviewing these cases.
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Affiliation(s)
- Nada Almenieir
- McGill University Health Center, Department of Nuclear Medicine, Montreal, Canada,King Saud University, Department of Radiology and Medical Imaging, Riyadh, Saudi Arabia
| | - Marc Hickeson
- McGill University Health Center, Department of Nuclear Medicine, Montreal, Canada
| | - Javier Novales-Diaz
- McGill University Health Center, Department of Nuclear Medicine, Montreal, Canada
| | - Vilma Derbekyan
- McGill University Health Center, Department of Nuclear Medicine, Montreal, Canada
| | - Gad Abikhzer
- Jewish General Hospital, Departement of Nuclear Medicine, Montreal, Canada
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10
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Al-Qassab S, Lalam R, Botchu R, Bazzocchi A. Imaging of Pediatric Bone Tumors and Tumor-like Lesions. Semin Musculoskelet Radiol 2021; 25:57-67. [PMID: 34020468 DOI: 10.1055/s-0041-1723965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bone lesions are commonly seen when reporting pediatric skeletal imaging. Distinguishing aggressive from nonaggressive lesions is essential in making the diagnosis. Not all aggressive lesions are neoplastic; indeed, osteomyelitis frequently presents with aggressive appearances and is far more commonly seen in the pediatric population than neoplastic lesions. In this article, we discuss an approach for the diagnosis of pediatric bone tumors and tumor-like conditions. The most common pediatric benign and malignant bone tumors are discussed in more detail.
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Affiliation(s)
- Sinan Al-Qassab
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Radhesh Lalam
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom
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11
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Zekry KM, Yamamoto N, Hayashi K, Takeuchi A, Araki Y, Alkhooly AZA, Abd-Elfattah AS, Fouly EH, Elsaid ANS, Tsuchiya H. Surgical treatment of chondroblastoma using extended intralesional curettage with phenol as a local adjuvant. J Orthop Surg (Hong Kong) 2020; 27:2309499019861031. [PMID: 31315494 DOI: 10.1177/2309499019861031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study is to report the clinical and radiological outcomes following surgical treatment of chondroblastoma by means of an extended intralesional curettage using high-speed burr, with phenol as a local adjuvant which is followed by the implantation of synthetic bone graft, aiming to lower the recurrence rate of this tumor. PATIENTS AND METHODS This retrospective study included 20 patients with chondroblastoma lesions during the period between 2000 and 2015. RESULTS Fifteen males and five females were followed up for a mean of 63.35 (26-144) months with average age at the time of presentation was 20.8 (range: 12-32) years. Nineteen patients (95%) were complaining of pain at the time of presentation, and the lesion was discovered accidently in one patient. The mean operative time was 138.5 min (75-250). At the most recent follow-up, all patients had regained full physical function without pain at the operation site. CONCLUSION The aggressive treatment of chondroblastoma by an extended intralesional curettage using high-speed burr with phenol as a local adjuvant seems effective in lowering the incidence of local recurrence and secondary more aggressive surgeries. Implantation of the bone defects that result from curettage with the synthetic bone substitutes is a good alternative due to rapid restoration of the mechanical strength with good remodeling.
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Affiliation(s)
- Karem M Zekry
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.,2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | - Norio Yamamoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Katsuhiro Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiko Takeuchi
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshihiro Araki
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Ali Zein Aa Alkhooly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Ezzat H Fouly
- 2 Department of Orthopaedic Surgery, Faculty of Medicine, Minia University, Minya, Egypt
| | | | - Hiroyuki Tsuchiya
- 1 Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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12
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Lang Y, Yu Q, Liu Y, Yang L. Chondroblastoma of the patella with pathological fracture in an adolescent: a case report. World J Surg Oncol 2019; 17:218. [PMID: 31831014 PMCID: PMC6909653 DOI: 10.1186/s12957-019-1760-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chondroblastoma is a rare primary bone tumor of young people that generally occurs in the epiphyseal plate of long bones. To date, only 13 cases of patella with pathological fracture in chondroblastoma have been previously published. CASE PRESENTATION A 15-year-old male patient presented with acute pain in the left knee after an injury occurred while playing basketball. Plain radiographs and computed tomography showed a pathological fracture of the left patella with an osteolytic lesion (1.5 × 2 × 3 cm). Magnetic resonance imaging revealed an expansile lesion within the patella with a slightly high signal on the T1-weighted image, a high signal on the T2-weighted image and soft tissue swelling in front of the patella. A m99Tc bone scintigraphy revealed moderate uptake. The preoperative diagnosis was chondroblastoma. This patient underwent intralesional meticulous extended curettage, adjuvant high-speed burr, 95% alcohol and electrotome treatment, autogenous iliac crest bone grafting, and internal fixation. A postoperative pathological diagnosis was chondroblastoma. The patient's function was satisfactory, and there was no sign of tumor recurrence. The internal fixator was good, with no loosening or migration observed at the last follow-up at 20 months after surgery. CONCLUSIONS Rarely, chondroblastoma of the patella can present with acute pain due to pathological fracture. We present the 14th such case in the literature to associate patellar chondroblastoma with pathological fracture. The patient was treated with curettage, inactivation, autogenous bone grafting, and internal fixation. A satisfactory therapeutic effect was obtained. This case may be beneficial to the diagnosis and treatment of chondroblastoma patella.
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Affiliation(s)
- Yun Lang
- Department of Orthopedics, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Qing Yu
- Department of Pathology, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Yuehong Liu
- Department of Orthopedics, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China
| | - Lejin Yang
- Department of Orthopedics, People's Hospital of Deyang City, Taishan North Road 173#, Deyang, 618000, Sichuan Province, People's Republic of China.
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O'Dell MC, Vatsky S. Percutaneous Treatment of Musculoskeletal Disease in Children. Semin Roentgenol 2019; 54:384-394. [PMID: 31706371 DOI: 10.1053/j.ro.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Cody O'Dell
- Department of Radiology, AdventHealth Orlando, Orlando, FL.
| | - Seth Vatsky
- Perelman School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
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14
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Kiefer RM, Wojcik J, Cooper K, Weber KL, Sebro R. Clear Cell Chondrosarcoma With Chondroblastoma-Like Features: A Case for Team Diagnosis. Int J Surg Pathol 2018; 26:766-771. [PMID: 29774790 DOI: 10.1177/1066896918776092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Clear cell chondrosarcoma (CCCS) is a rare variant of conventional chondrosarcoma with low-grade malignant features that may be confused radiographically and histologically with chondroblastoma. We report a case of a 50-year-old female who presented with 6 months of left hip pain. Initial radiographs demonstrated an osteolytic lesion with adjacent area of sclerosis in the proximal left femur. Magnetic resonance imaging demonstrated a marrow-infiltrative lesion with periosteal reaction and thickened enhancing periosteum. Biopsy of the sclerotic area demonstrated chondroblastoma-like findings, whereas biopsy of the lytic area showed features suggestive of CCCS. The patient eventually underwent en bloc resection and reconstruction with a proximal femoral megaprosthesis. The final diagnosis was CCCS. We present this unusual case with review of the radiographic and histologic features of CCCS with attention to its ability to mimic chondroblastomas. This case highlights the importance of sampling radiographically heterogeneous areas within a bone lesion to facilitate accurate diagnosis and appropriate management.
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Affiliation(s)
| | - John Wojcik
- 1 University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Ronnie Sebro
- 1 University of Pennsylvania, Philadelphia, PA, USA
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15
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Berenstein-Weyel T, Lebel E, Katz D, Applbaum Y, Peyser A. Chondromyxoid fibroma of the distal fibula treated by percutaneous radiofrequency ablation. J Orthop Surg (Hong Kong) 2018; 25:2309499017720830. [PMID: 28731366 DOI: 10.1177/2309499017720830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) has been shown to be an effective treatment for soft tissue lesions and also benign bone tumors, especially osteoid osteoma. There are limited data regarding this technique in other bone tumors, specifically larger and more aggressive ones. PURPOSES To describe the use of RFA as a definitive treatment and an alternative to traditional open surgery for the treatment of chondromyxoid fibroma (CMF), a benign but locally aggressive bone tumor. CASE PRESENTATION An 11.5-year-old girl was diagnosed with a 4-cm lytic bone lesion of the distal fibula. Evaluation, including biopsy, revealed CMF. It was managed by fluoroscopy-guided RFA only. Six-year follow-up demonstrated complete healing without damage to the adjacent distal fibular growth plate. DISCUSSION AND CONCLUSIONS RFA induces local heat in the ablation field and causes tissue necrosis. The depth of heat penetration and the size of heated sphere are accurately controlled by modern types of ablation probes and accurate positioning. The current report demonstrates the ability to use this percutaneous technique for larger and more aggressive bone tumors than has been indicated previously.
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Affiliation(s)
- Tamar Berenstein-Weyel
- 1 Pediatric Orthopedic Unit, Department of Orthopedic Surgery, Hadassah-Hebrew University School of Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ehud Lebel
- 1 Pediatric Orthopedic Unit, Department of Orthopedic Surgery, Hadassah-Hebrew University School of Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Daniela Katz
- 2 Department of Oncology, Oncology institute, Assaf Harofeh Medical Center, Zrifin
| | - Yaakov Applbaum
- 3 Department of Radiology, Hadassah-Hebrew University School of Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amos Peyser
- 4 Department of Orthopedic Surgery, Hadassah-Hebrew University School of Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Kwee TC, de Klerk JMH, Nix M, Heggelman BGF, Dubois SV, Adams HJA. Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy. Semin Nucl Med 2017; 47:322-351. [PMID: 28583274 DOI: 10.1053/j.semnuclmed.2017.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Positron emission tomography with the radiotracer 18F-fluoro-2-deoxy-d-glucose (FDG) plays an important role in the evaluation of bone pathology. However, FDG is not a cancer-specific agent, and knowledge of the differential diagnosis of benign FDG-avid bone alterations that may resemble malignancy is important for correct patient management, including the avoidance of unnecessary additional invasive tests such as bone biopsy. This review summarizes and illustrates the spectrum of benign bone conditions that may be FDG-avid and mimic malignancy, including osteomyelitis, bone lesions due to benign systemic diseases (Brown tumor, Erdheim-Chester disease, Gaucher disease, gout and other types of arthritis, Langerhans cell histiocytosis, and sarcoidosis), benign primary bone lesions (bone cysts, chondroblastoma, chondromyxoid fibroma, desmoplastic fibroma, enchondroma, giant cell tumor and granuloma, hemangioma, nonossifying fibroma, and osteoid osteoma and osteoblastoma), and a group of miscellaneous benign bone conditions (post bone marrow biopsy or harvest status, bone marrow hyperplasia, fibrous dysplasia, fractures, osteonecrosis, Paget disease of bone, particle disease, and Schmorl nodes). Several ancillary clinical and imaging findings may be helpful in discriminating benign from malignant FDG-avid bone lesions. However, this distinction is sometimes difficult or even impossible, and tissue acquisition will be required to establish the final diagnosis.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Maarten Nix
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben G F Heggelman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
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17
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Smith MO, Nicosia CE. A rare probable chondroblastoma of the calcaneus in a pre-Columbian subadult from Illinois. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 16:14-21. [PMID: 28290305 DOI: 10.1016/j.ijpp.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/11/2017] [Accepted: 01/14/2017] [Indexed: 06/06/2023]
Abstract
Discrete cystic or tumorous intraosseous lesions can arise from a variety of benign and malignant conditions as well as trauma and infection. They are clinically rarely observed in the calcaneus. A fourteen-to-seventeen-year-old subadult recovered from a Late Woodland (∼AD 800-1100) period mortuary context in the Mississippi River Valley of central Illinois presents with a single lytic intraosseous lesion on the posterior right calcaneus that bilaterally perforates the cortex. The lesion, although primarily anterior to the epiphyseal plate, does breach it. There is also a small perforation of the outer cortex of the epiphysis above the insertion of the Achilles' tendon. The lesion is well-defined with a primarily spongy cancellous interior margin. On the body of the calcaneus, there is periostosis and a slightly expansive endosteal reaction. Comparative radiographic assessments undertaken to differentially diagnose the lesion indicate that it was likely not malignant. Based on the posterior location, the radiographic signature, the bilateral cortical perforation and the breach of the epiphysis, the lesion is best interpreted as a chondroblastoma.
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Affiliation(s)
- Maria Ostendorf Smith
- Department of Sociology and Anthropology, Illinois State University, Normal, IL, United States.
| | - Christopher E Nicosia
- Department of Sociology and Anthropology, Illinois State University, Normal, IL, United States.
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Barile A, Arrigoni F, Zugaro L, Zappia M, Cazzato RL, Garnon J, Ramamurthy N, Brunese L, Gangi A, Masciocchi C. Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol 2017; 34:53. [PMID: 28236103 DOI: 10.1007/s12032-017-0909-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 12/31/2022]
Abstract
The role of the interventional radiology (IR) in the musculoskeletal system, and in particular in the bone, is a field of knowledge that is growing significantly in the last years with indications for treatment of both benign and malign lesions. In this paper, we review the state of the art of this application of the IR in the bone (bone metastasis and benign bone lesions) with discussion about all the techniques today used.
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Affiliation(s)
- Antonio Barile
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Arrigoni
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marcello Zappia
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Luca Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Carlo Masciocchi
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Cho HS, Park YK, Oh JH, Lee JH, Han I, Kim HS. Proximal Tibia Chondroblastoma Treated With Curettage and Bone Graft and Cement Use. Orthopedics 2016; 39:e80-5. [PMID: 26726978 DOI: 10.3928/01477447-20151222-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 05/27/2015] [Indexed: 02/03/2023]
Abstract
Chondroblastoma has a predilection for the epiphyses or apophyses of long tubular bones. Management of lesions in the proximal tibia is challenging because it is difficult to gain access to intraepiphyseal lesions for completion of curettage. From October 2007 to December 2011, 9 patients with de novo chondroblastoma of the proximal tibia underwent surgery at the authors' institution. All patients initially presented with pain, and 5 patients had limitation of range of motion of the ipsilateral knee. Four lesions abutted the tibial attachment sites of the cruciate ligaments. Surgical procedures included intralesional tumor curettage, additional burring, and packing of the defect with bone graft and/or bone cement. The extra-articular approach was used according to tumor location. The medial or lateral parapatellar approach was used when the tumor was located in the anterior two-thirds of the horizontal plane. When a lesion was located in the posterior third, the posteromedial or posterolateral approach was used as the lesion was cornered. Mean duration of follow-up was 47.2 months (range, 27-80 months). No local recurrence or pulmonary metastasis was noted at latest follow-up. Mean functional score was 29.3 points (range, 28-30 points). All patients fully recovered range of motion in the affected knee. No avulsion fracture or anteroposterior instability of the knee joint was detected. Results of the current study suggest that intralesion curettage followed by additional burring with an extra-articular approach is a successful treatment option for chondroblastoma of the proximal tibia.
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Gerrie BJ, McCulloch PC, Labis JS, Lintner DM, Harris JD. Dorsal Defect of the Patella in a Teenage Male Football Player: A Case Report and Differential Diagnosis of Lytic Patellar Lesion. Orthop J Sports Med 2016; 4:2325967116665580. [PMID: 27652286 PMCID: PMC5019194 DOI: 10.1177/2325967116665580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brayden J Gerrie
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - John S Labis
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - David M Lintner
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Joshua D Harris
- Department of Radiology, Houston Methodist Hospital, Houston, Texas, USA
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Oba M, Inaba Y, Machida J, Saito T. Giant cell tumour of the femur in a 9-year-old girl, resulting in severe leg length discrepancy. BMJ Case Rep 2016; 2016:bcr-2015-214265. [PMID: 27001598 DOI: 10.1136/bcr-2015-214265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Giant cell tumour of bone (GCTB) is a rare benign tumour noted before physeal closure. GCTB cases in patients younger than 10 years are especially uncommon. The authors report the case of a 9-year-old girl with a GCTB of the distal femur. After initial intralesional excision and curettage of the tumour, local recurrence occurred, which needed two more additional surgeries to treat. The primary tumour and the local relapse invaded the growth plate of the right distal femur, leading to growth disturbance of the femur and requiring leg lengthening using Ilizarov apparatus. Surgeons should note the possibility of this rare condition while treating radiographic lytic lesions even in skeletally immature patients. The occurrence of late limb length discrepancy would be more likely in younger patients.
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Affiliation(s)
- Masatoshi Oba
- Department of Orthopedics, Yokohama City University, Yokohama, Japan Department of Pediatric Orthopedics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopedics, Yokohama City University, Yokohama, Japan
| | - Jiro Machida
- Department of Pediatric Orthopedics, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Tomoyuki Saito
- Department of Orthopedics, Yokohama City University, Yokohama, Japan
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Nogueira Drumond JM. BENIGN BONE TUMORS AND TUMOR-LIKE BONE LESIONS: TREATMENT UPDATE AND NEW TRENDS. Rev Bras Ortop 2015; 44:386-90. [PMID: 27004184 PMCID: PMC4783675 DOI: 10.1016/s2255-4971(15)30267-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of benign bone tumors (BBT) and tumor-like bone lesions (TBL) has observed the introduction of new drugs, such as intravenous bisphosphonates, which have ossified bone lesions caused by fibrous dysplasia. Aneurismal bone cyst has been treated with sclerosing agents by percutaneous injection, yielding good results. Adjuvants allow joint salvage, maintenance of movements and function, with low rates of recurrence. Among them, the most used ones are bone cement (PMMA), phenol, nitrogen-based cryotherapy, hydrogen peroxide, ethanol and radiotherapy. New methods of treatment include thermal ablation with radiofrequency and laser, mainly utilized for treating osteoid osteoma. Arthroscopy allows resection of benign intra-joint lesions and assists the surgery of subchondral tumors. A great advance is the utilization of synthetic bone substitutes, which are a mixture of osteoinductive growth factors and osteoconductive ceramics, and have presented comparable results to autogenous bone grafts. There is a recent trend for closed treatments, with percutaneous injection of demineralized bone matrix (DBM) and calcium sulfate. Autogenous cancellous bone graft remains as the gold standard. Vascularized fibula graft, on the other hand, incorporates faster in the treatment of large destructive lesions. Also, allogenic cortical support allows structural augmentation for aggressive tumors. Freeze-dried allografts are used to fill contained defects and as expanders of autografts. Joint endoprosthesis may be used in large destructive lesions of the distal femur, hip and shoulder.
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Affiliation(s)
- José Marcos Nogueira Drumond
- Master of Health Sciences, IPSEMG, Belo Horizonte; Orthopedist, IPSEMG, FHEMIG and Orthopedic Hospital, Belo Horizonte, MG, Brazil; Head of the Clinic, FHEMIG, Hospital Foundation of the State of Minas Gerais
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23
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Ultrasonography-guided radiofrequency ablation of malignant musculoskeletal soft-tissue tumors using the "moving-shot" technique at a single-institution experience. Ultrasound Q 2015; 30:295-300. [PMID: 25415868 DOI: 10.1097/ruq.0000000000000062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present study describes the use of the "moving-shot" technique for successful radiofrequency ablation (RFA) of malignant musculoskeletal soft-tissue tumors. Ultrasonography-guided RFA was performed in 6 malignant soft-tissue tumors in 5 patients. Short-term follow-up after RFA (8-27 weeks) showed that complete necrosis was achieved in all lesions, and 5 lesions (83%) decreased in size. Discomfort caused by the tumors decreased subjectively in all patients after ablation. Our results indicate that ultrasonography-guided RFA using the moving-shot technique can be an effective treatment option for locoregional control of malignant soft-tissue tumors. Long-term follow-up studies with a larger number of patients are necessary.
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24
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Dutt L, Schade VL, Manoso MW. Calcaneal chondroblastoma with pathologic fracture and recurrence. J Foot Ankle Surg 2015; 54:258-67. [PMID: 25624038 DOI: 10.1053/j.jfas.2014.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Indexed: 02/03/2023]
Abstract
Chondroblastomas account for <2% of all bone tumors. The calcaneus is the fifth most common location of occurrence. Males in their second decade of life are most often affected, presenting with an insidious onset of localized pain, swelling, and tenderness. The finding of associated pathologic fracture has been rare. Imaging studies can aid in the formulation of the differential diagnosis and surgical plan. The definitive diagnosis requires histologic examination. Curettage and bone grafting is curative in >80% of cases. Local recurrence rates of ≤38% have been reported, most often because of inadequate resection, and have been associated with malignant conversion and metastasis. Adjuvant therapies can help minimize the incidence of local recurrence. Long-term follow-up examinations are recommended, given the protracted interval that can exist between recurrence and the potential for malignant conversion and metastasis. We present the case of a young, healthy, active male with a calcaneal chondroblastoma and associated pathologic fracture whose initial treatment consisted of curettage, hydrogen peroxide lavage, and allogeneic bone grafting. Recurrence developed at 15 months postoperatively and was treated with repeat curettage, high-speed burring, and reconstruction with steel Steinman pins and polymethylmethacrylate, resulting in no pain or recurrence at the 5-month follow-up point.
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Affiliation(s)
- Laksha Dutt
- Postgraduate Year 2 Resident, Podiatric Medicine Surgical Residency, Madigan Army Medical Center, Tacoma, WA
| | - Valerie L Schade
- Chief, Limb Preservation Service, Madigan Army Medical Center, Tacoma, WA.
| | - Mark W Manoso
- Chief, Orthopedic Surgery Service, Madigan Army Medical Center, Tacoma, WA
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25
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Radiofrequency ablation of chondroblastoma: long-term clinical and imaging outcomes. Eur Radiol 2014; 25:1127-34. [DOI: 10.1007/s00330-014-3506-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/01/2014] [Accepted: 11/13/2014] [Indexed: 01/17/2023]
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Xu H, Niu X, Li Y, Binitie OT, Letson GD, Cheong D. What are the results using the modified trapdoor procedure to treat chondroblastoma of the femoral head? Clin Orthop Relat Res 2014; 472:3462-7. [PMID: 25115583 PMCID: PMC4182374 DOI: 10.1007/s11999-014-3771-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of chondroblastoma in the femoral head is challenging owing to the particular location and its aggressive nature. There is little published information to guide the surgeon regarding the appropriate approach to treating a chondroblastoma in this location. We developed a modified trapdoor procedure to address this issue. The primary modification is that the window surface of the femoral head is covered by the ligamentum teres rather than cartilage as in the traditional procedure. QUESTIONS/PURPOSES We assessed (1) the clinical presentation of chondroblastoma of the femoral head and treatment results with the modified trapdoor procedure in terms of (2) the frequency of local recurrence, (3) complications, and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. METHODS Between 1999 and 2010, we treated 14 patients for chondroblastoma of the femoral head. All patients received the modified trapdoor procedure. Of those, 13 were available for followup at a minimum of 36 months (mean, 66 months; range, 36-117 months) and one patient was lost to followup. There were nine males and four females, with a mean age of 18 years (range, 9-29 years). Clinical features were ascertained by chart and radiographic review, and recurrence, complications, and functional outcomes (MSTS score) were recorded from chart review. Patterns of bone destruction were evaluated using the Lodwick classification, which ranges from IA (geographic appearance with sclerotic rim) to III (permeative appearance). RESULTS The symptoms at diagnosis were pain in nine patients and discomfort in four. The mean duration of symptom was 11 months (range, 1-36 months). The physis was open in two patients, closing in one, and closed in 10. The patterns of bone destruction were evaluated as Lodwick Class IA in six patients, Lodwick Class IB in five, and Lodwick Class IC in two. At latest followup, no local recurrence was observed. Two patients had postoperative complications. One had avascular necrosis of the femoral head and was treated with prosthesis replacement. The other had asymptomatic heterotopic ossification in the surgical field. The mean MSTS score was 29.6 (range, 28-30). CONCLUSIONS Based on this small series, we believe our modified trapdoor procedure is a safe, effective means of treating a chondroblastoma in the femoral head, but additional clinical evaluation with more patients is necessary to confirm our findings. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hairong Xu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, China
| | - Yuan Li
- Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Peking University, Beijing, China
| | - Odion T. Binitie
- Department of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - G. Douglas Letson
- Department of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - David Cheong
- Department of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL 33612 USA
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Abstract
Bone and soft tissue tumor ablation has reached widespread acceptance in the locoregional treatment of various benign and malignant musculoskeletal (MSK) lesions. Many principles of ablation learned elsewhere in the body are easily adapted to the MSK system, particularly the various technical aspects of probe/antenna design, tumoricidal effects, selection of image guidance, and methods to reduce complications. Despite the common use of thermal and chemical ablation procedures in bone and soft tissues, there are few large clinical series that show longitudinal benefit and cost-effectiveness compared with conventional methods, namely, surgery, external beam radiation, and chemotherapy. Percutaneous radiofrequency ablation of osteoid osteomas has been evaluated the most and is considered a first-line treatment choice for many lesions. Palliation of painful metastatic bone disease with thermal ablation is considered safe and has been shown to reduce pain and analgesic use while improving quality of life for cancer patients. Procedure-related complications are rare and are typically easily managed. Similar to all interventional procedures, bone and soft tissue lesions require an integrated approach to disease management to determine the optimum type of and timing for ablation techniques within the context of the patient care plan.
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Affiliation(s)
- Ryan C B Foster
- Department of Radiology, Hospital for Special Surgery, New York, New York
| | - Joseph M Stavas
- Department of Radiology, the University of North Carolina, Chapel Hill, North Carolina
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28
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Kurup AN, Callstrom MR. Ablation of musculoskeletal metastases: pain palliation, fracture risk reduction, and oligometastatic disease. Tech Vasc Interv Radiol 2014; 16:253-61. [PMID: 24238380 DOI: 10.1053/j.tvir.2013.08.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Thermal ablation is an effective, minimally invasive alternative to conventional therapies in the palliation of painful musculoskeletal metastases and an emerging approach to obtain local tumor control in the setting of limited metastatic disease. Various thermal ablation technologies have been applied to bone and soft tissue tumors and may be used in combination with percutaneous cement instillation for skeletal lesions with or at risk for pathologic fracture. This article reviews current practices of percutaneous ablation of musculoskeletal metastases with an emphasis on radiofrequency ablation and cryoablation of painful skeletal metastases.
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29
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Image guided radiofrequency thermo-ablation therapy of chondroblastomas: should it replace surgery? Skeletal Radiol 2014; 43:513-22. [PMID: 24477425 DOI: 10.1007/s00256-014-1820-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the safety and effectiveness of image-guided radiofrequency ablation (RF ablation) in the treatment of chondroblastomas as an alternative to surgery. MATERIALS AND METHODS Twelve patients with histologically proven chondroblastoma at our institution from 2003 to date. We reviewed the indications, recurrences and complications in patients who underwent RF ablation. RESULTS Twelve patients were diagnosed with chondroblastoma. Out of these, 8 patients (6 male, 2 female, mean age 17 years) with chondroblastoma (mean size 2.7 cm) underwent RF ablation. Multitine expandable electrodes were used in all patients. The number of probe positions needed varied from 1 to 4 and lesions were ablated at 90 °C for 5 min at each probe position. The tumours were successfully treated and all patients became asymptomatic. There were no recurrences. There were 2 patients with knee complications, 1 with minor asymptomatic infraction of the subchondral bone and a second patient with osteonecrosis/chondrolysis. CONCLUSION Radiofrequency ablation appears to be a safe and effective alternative to surgical treatment with a low risk of recurrence and complications for most chondroblastomas. RF ablation is probably superior to surgery when chondroblastomas are small (less than 2.5 cm) with an intact bony margin with subchondral bone and in areas of difficult surgical access.
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30
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Mashhour MA, Abdel Rahman M. Lower recurrence rate in chondroblastoma using extended curettage and cryosurgery. INTERNATIONAL ORTHOPAEDICS 2013; 38:1019-24. [PMID: 24248272 DOI: 10.1007/s00264-013-2178-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/31/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE Various methods for the treatment of chondroblastoma of bone have been used including simple curettage, or combined with bone grafting, in addition to the use of adjuvant therapy. However, local recurrence still represents a challenge in the management of this aggressive tumour. This study focuses on evaluating the role of intraregional extended curettage together with the use of adjuvant cryotherapy and autogenous bone grafting in the treatment of benign chondroblastoma of bone aiming to decrease the recurrence rate. METHODS All patients with chondroblastoma included in this study underwent intralesional extended curettage, adjuvant cryotherapy using liquid nitrogen, and autogenous iliac crest bone grafting. Follow up for healing of chondroblastoma lesions and detection of any local recurrence was assessed on clinical and radiological bases. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. RESULTS The mean follow-up period was 49 months. The average time for bone healing was 7.4 months. Our rate of local recurrence is 7.1 %. Two patients (14.3 %) developed physeal growth arrest. One patient had superficial skin sloughing (7.1 %). None of the cases had pathological fracture. The mean Musculoskeletal Tumour Society functional score was 92.7 %. CONCLUSION Chondroblastoma is an aggressive benign bone tumour with a high rate of recurrence. The use of high-speed burr combined with adjuvant intralesional cryotherapy and iliac crest autogenous bone grafting is a reliable method of treatment with a low rate of recurrence.
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Affiliation(s)
- Mohamed Ahmed Mashhour
- Department of Orthopaedic Surgery, Orthopaedic Oncology Unit, Faculty of Medicine, Ain Shams University, Abbasseia Square, Cairo, Egypt,
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31
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Kurup AN, Callstrom MR. Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Intervent Radiol 2012; 27:276-84. [PMID: 22550367 DOI: 10.1055/s-0030-1261786] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Image-guided percutaneous ablation of bone and soft tissue tumors is an effective minimally invasive alternative to conventional therapies, such as surgery and external beam radiotherapy. Proven applications include treatment of benign primary bone tumors, particularly osteoid osteoma, as well as palliation of painful bone metastases. Use of percutaneous ablation in combination with cementoplasty can provide stabilization of metastases at risk for fracture. Local control of oligometastatic disease and treatment of desmoid tumors are emerging applications.
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32
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Abstract
Percutaneous image-guided ablation has become a standard of practice and one of the primary modalities for treatment of benign bone tumors. Ablation is most commonly used to treat osteoid osteomas but may also be used in the treatment of chondroblastomas, osteoblastomas, and giant cell tumors. Percutaneous image-guided ablation of benign bone tumors carries a high success rate (>90% in case series) and results in decreased morbidity, mortality, and expense compared with traditional surgical methods. The ablation technique most often applied to benign bone lesions is radiofrequency ablation. Because the ablation technique has been extensively applied to osteoid osteomas and because of the uncommon nature of other benign bone tumors, we will primarily focus this discussion on the percutaneous ablation of osteoid osteomas.
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33
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Rosenthal D, Callstrom MR. Critical Review and State of the Art in Interventional Oncology: Benign and Metastatic Disease Involving Bone. Radiology 2012; 262:765-80. [DOI: 10.1148/radiol.11101384] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Stilli S, Marchesini Reggiani L, Boriani L, Donzelli O. Osteochondral allograft in a femoral head chondroblastoma: a case report. Hip Int 2010; 20:280-3. [PMID: 20544654 DOI: 10.1177/112070001002000224] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2010] [Indexed: 02/04/2023]
Abstract
Osteoarthritis of the hip joint secondary to femoral head collapse may develop after curettage of lesions in the femoral head. We report the case of a patient with chondroblastoma of the femoral head who was treated with wide curettage of the lesion and implantation of an osteochondral allograft to prevent femoral head collapse.
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Strong DP, Grimer RJ, Carter SR, Tillman RM, Abudu A. Chondroblastoma of the femoral head: management and outcome. INTERNATIONAL ORTHOPAEDICS 2010; 34:413-7. [PMID: 19387641 PMCID: PMC2899288 DOI: 10.1007/s00264-009-0779-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/29/2009] [Accepted: 03/29/2009] [Indexed: 10/20/2022]
Abstract
Chondroblastoma of the femoral head presents particular problems in treatment because the tumour is surrounded by articular cartilage on one side and epiphyseal plate on the other. Ten patients underwent treatment for a chondroblastoma involving the proximal femoral capital epiphysis. The patients were aged between eight and 19 years and in four the epiphysis was not yet fused. Five had curettage via a drill hole created up the femoral neck, of whom two developed local recurrence. Five had a direct approach to the chondroblastoma through the femoral neck, and there were no local recurrences in this group. Both patients with local recurrence were under 14 years of age-one was cured by a direct approach through the neck of the femur and the other by lifting a trap door of articular cartilage. Apart from one patient with a temporary leg length discrepancy, there were no other complications. We conclude that a direct approach is likely to lead to the best outcome for this rare condition.
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Affiliation(s)
- D. P. Strong
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - R. J. Grimer
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - S. R. Carter
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - R. M. Tillman
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
| | - A. Abudu
- Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham, B31 2AP UK
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Gangi A, Tsoumakidou G, Buy X, Quoix E. Quality improvement guidelines for bone tumour management. Cardiovasc Intervent Radiol 2010; 33:706-13. [PMID: 20151138 PMCID: PMC2908451 DOI: 10.1007/s00270-009-9738-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 10/05/2009] [Indexed: 11/28/2022]
Affiliation(s)
- A Gangi
- Non-Vascular Interventional Radiology Department, Strasbourg University Hospital, 67091 Strasbourg, Cedex, France.
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Martel Villagrán J, Bueno Horcajadas A, Ortiz Cruz E. Tratamiento mediante radiofrecuencia percutánea de los tumores óseos benignos: osteoma osteoide, osteoblastoma y condroblastoma. RADIOLOGIA 2009; 51:549-58. [DOI: 10.1016/j.rx.2009.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 08/04/2009] [Accepted: 08/17/2009] [Indexed: 01/14/2023]
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Abstract
BACKGROUND Chondroblastoma is a rare benign bone lesion that occurs in young patients and has a high rate of recurrence. The purpose of the present study was to report on eighty-seven cases of chondroblastoma in children and to identify the possible factors that increase the risk of recurrence. METHODS We retrospectively reviewed eighty-seven cases of chondroblastoma in patients with open physes at the time of diagnosis and treatment. Historical data, complete imaging data, histological findings, and surgical charts were analyzed. Multiple logistic regression was used to identify predictors of recurrence. RESULTS The series included fifty-three boys and thirty-four girls with a mean age of 12.5 years. Lesions were located in the epiphysis in 68% of the patients, especially in the proximal part of the tibia (twenty-four patients) and the proximal part of the femur (twenty-three patients). Pain was the presenting symptom in 84% of the patients. The treatment consisted of intralesional curettage with autogenous bone-grafting in 63% of the patients. The functional outcome at an average of 62.5 months of follow-up was good for 68.5% of the patients. At a minimum of twenty-four months of follow-up, 32% of the lesions had recurred. Sex, radiographic aggressiveness, an aneurysmal bone-cyst component on histological analysis, and the method of surgical treatment had no significant influence on recurrence. Epiphyseal chondroblastomas were associated with a higher risk of recurrence when compared with metaphyseal, apophyseal, and epiphyseal-metaphyseal lesions (p = 0.004). CONCLUSIONS Chondroblastoma in growing children is most frequently located in the proximal part of the tibia and the proximal femoral epiphysis. The recurrence rate is high, particularly for strictly epiphyseal lesions. Proximal femoral lesions and tarsal lesions are associated with a poorer outcome.
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Affiliation(s)
- Frédéric Sailhan
- Department of Orthopaedic Surgery, Hôpital Cochin, Paris, France.
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Munk PL, Rashid F, Heran MK, Papirny M, Liu DM, Malfair D, Badii M, Clarkson PW. Combined cementoplasty and radiofrequency ablation in the treatment of painful neoplastic lesions of bone. J Vasc Interv Radiol 2009; 20:903-11. [PMID: 19481469 DOI: 10.1016/j.jvir.2009.03.035] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 03/04/2009] [Accepted: 03/30/2009] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the safety and effectiveness of combined radiofrequency (RF) ablation and cementoplasty in the treatment of painful neoplastic lesions of bone. MATERIALS AND METHODS The authors performed a retrospective analysis of 25 combined treatments comprising RF ablation followed by injection of polymethylmethacrylate cement performed in 19 patients during a 22-month period. Patients ranged in age from 42 to 82 years (mean, 58.9 years) and included five women and 14 men. Eleven vertebrae (eight lumbar and three thoracic), nine acetabulae, three sacra, one pubis, and one humerus were treated with a total of 36 RF ablations (in several instances, overlapping ablations were used). The location of the primary neoplasm, lesion size, pain before and after the procedure (as determined with a 10-point visual analog scale [VAS]), number of RF treatments, type of device used for cementoplasty, RF time, cement volume, and extravasation were documented. RESULTS A total of 25 combined RF ablations and cementoplasties were performed. The technical success rate was 100% (25 of 25 treatments). There were seven minor complications: six limited cement extravasations and a transient thermal nerve injury. The mean RF time was 9.1 minutes (range, 6-12 minutes). The mean cement volume injected was 6.1 mL (range, 0.8-16 mL). The mean preprocedure pain (as measured with a VAS) was 7.9 (range, 7.0-9.0) and the mean posttreatment pain was 4.2 (range, 0-6); the difference was statistically significant (mean score, 4.08; 95% confidence interval: 3.92, 4.87; P < .0001) using a paired t test. CONCLUSIONS Combined RF ablation and cementoplasty appears to be safe and effective in the treatment of painful neoplastic lesions of bone.
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Affiliation(s)
- Peter L Munk
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 W 12th Ave, Vancouver, BCV52 1M9 Canada.
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Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors. Semin Ultrasound CT MR 2009; 30:78-90. [PMID: 19358439 DOI: 10.1053/j.sult.2008.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A wide range of thermal and cryoablation methods is currently available for the curative eradication or palliative treatment of a variety of bone and soft-tissue tumors. Radiofrequency ablation has been developed as a multipurpose tool for the skeletal system. Cryoablation has the added advantages of direct computed tomography or magnetic resonance visualization and monitoring of treatment outcome with less peri- and postoperative pain. Use of appropriate thermo-sensors and insulation techniques, like carbon dioxide insufflation, results in enhanced safety and efficacy. Ablation of weight-bearing bones has to be supplemented with cement consolidation. The authors present an overview of the current status of percutaneous image-guided ablation therapy of bone and soft-tissue tumors, analyze the merits and limitations of the various systems available, and discuss possible new applications for the future.
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Affiliation(s)
- Tarun Sabharwal
- Department of Interventional Radiology, Guy's and St. Thomas' Hospital, 1st Floor, Lambeth Wing, Lambeth Palace Road, London SE1 7EH, UK
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Rybak LD, Rosenthal DI, Wittig JC. Chondroblastoma: radiofrequency ablation--alternative to surgical resection in selected cases. Radiology 2009; 251:599-604. [PMID: 19304917 DOI: 10.1148/radiol.2512080500] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To demonstrate that radiofrequency (RF) ablation can be used safely and effectively to treat selected cases of chondroblastoma. MATERIALS AND METHODS Approval was obtained from institutional review boards, research was in compliance with HIPAA protocol. The need to obtain informed consent was waived for retrospective review of patient records. The records of patients with biopsy-proved chondroblastoma who were treated with RF ablation at two academic centers from July 1995 to July 2007 were reviewed. RF ablation was performed with a single-tip electrode by using computed tomography for guidance. Lesion characteristics were determined from imaging studies obtained at the time of the procedure. Symptoms were assessed before and 1 day after the procedure. Longer-term follow-up was obtained from medical records. RESULTS Thirteen male and four female patients were treated (mean age, 17.3 years). The lesions were located in the proximal humerus (n = 7), proximal tibia (n = 4), proximal femur (n = 3), and distal femur (n = 3). The mean volume of the lesions was 2.46 mL. All patients reported relief of symptoms on postprocedure day 1. Three patients were lost to follow-up. Of the 14 patients for whom longer-term (mean, 41.3 months; range, 4-134 months) follow-up was available, 12 had complete relief of symptoms with no need for medications and full return to all activities. The patient who had the largest lesion of the study required surgical intervention because of collapse of the articular surface in the treatment area. Residual viable tumor was found at surgery. Another patient experienced mechanical problems that were thought to be unrelated to the RF ablation and was rendered pain-free after subsequent surgical treatment. CONCLUSION Percutaneous RF ablation is an alternative to surgery for treatment of selected chondroblastomas. Larger lesions beneath weight-bearing surfaces should be approached with caution due to an increased risk of articular collapse and recurrence.
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Affiliation(s)
- Leon D Rybak
- Department of Radiology, New York University Hospital for Joint Diseases, 301 E 17th St, 6th Floor, New York, NY 10003-3899, USA.
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Santiago FR, Del Mar Castellano García M, Montes JLM, García MR, Fernández JMT. Treatment of bone tumours by radiofrequency thermal ablation. Curr Rev Musculoskelet Med 2009; 2:43-50. [PMID: 19468917 PMCID: PMC2684952 DOI: 10.1007/s12178-008-9042-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Accepted: 12/10/2008] [Indexed: 01/10/2023]
Abstract
Radiofrequency thermal ablation (RFTA) is considered the treatment of choice for osteoid osteomas, in which it has long been safely used. Other benign conditions (chondroblastoma, osteoblastoma, giant cell tumour, etc.) can also be treated by this technique, which is less invasive than traditional surgical procedures. RFTA ablation is also an option for the palliation of localized, painful osteolytic metastatic and myeloma lesions. The reduction in pain improves the quality of life of patients with cancer, who often have multiple morbidities and a limited life expectancy. In some cases, these patients are treated with RFTA because conventional therapies (surgery, radiotherapy, chemotherapy, etc.) have been exhausted. In other cases, it is combined with conventional therapies or other percutaneous treatments, e.g., cementoplasty, offering faster pain relief and bone strengthening. A multidisciplinary approach to the management of these patients is recommended to select the optimal treatment, including orthopaedic surgeons, neurosurgeons, medical and radiation oncologists and interventional radiologists.
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Affiliation(s)
- Fernando Ruiz Santiago
- Traumatology Hospital (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18013 Granada, Spain.
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Radiofrequency ablation of chondroblastoma: procedure technique, clinical and MR imaging follow up of four cases. Skeletal Radiol 2008; 37:1011-7. [PMID: 18641981 DOI: 10.1007/s00256-008-0526-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 05/15/2008] [Accepted: 05/16/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study is to describe the procedure technique, clinical and imaging outcomes of patients treated with radiofrequency ablation for chondroblastoma. MATERIALS AND METHODS Four patients (female/male, 3:1; mean age, 13 years; age range; 9-16 years) underwent the procedure. All had pre-operative magnetic resonance imaging (MRI) and symptomatic, biopsy-proven chondroblastomas (two proximal femur, two proximal tibia). The lesion size ranged from 1.5 to 2.5 cm in maximal dimension (mean size, 1.8 cm). Bone access was gained with a Bonopty biopsy needle system (mean number of radiofrequency needle placements, 5; mean ablation time, 31 min). RESULTS Clinical and MRI follow-up was available in all cases (mean, 12.25 months; range, 5-18 months). All patients reported resolution of symptoms at 2-6 weeks post ablation. At their most recent clinical follow-up, three patients remained completely asymptomatic with full return to normal activities and one patient had minor local discomfort (different pain pattern) that was not limiting activity. All four patients' follow-up MRI studies demonstrated resolution of the oedema pattern around the lesion and temporal evolution of the internal signal characteristics with fatty replacement. CONCLUSION Radiofrequency ablation for chondroblastoma provides an alternative to surgical curettage, and we have demonstrated both a clinical improvement in symptoms and the follow-up MRI appearances.
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Moser T, Buy X, Goyault G, Tok CH, Irani F, Gangi A. [Image-guided ablation of bone tumors: review of current techniques]. ACTA ACUST UNITED AC 2008; 89:461-71. [PMID: 18477952 DOI: 10.1016/s0221-0363(08)71449-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple interventional radiology techniques are available for percutaneous ablation of bone tumors: alcohol, laser, radiofrequency, microwave, ultrasound, and cryogenic ablation. Several indications have already been validated, including radiofrequency ablation of osteoid osteoma and bone metastases, with results superior to conventional treatment. More indications should be added over the coming years. The purpose of this article is to review the principles of the different ablation techniques, summarize their respective indications and results and discuss their implementation and the eventual combination with cementoplasty techniques.
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Affiliation(s)
- T Moser
- Service de Radiologie B, CHU Strasbourg, Hôpital Civil, Strasbourg Cedex, France.
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Keil S, Bruners P, Brehmer B, Mahnken AH. Percutaneous radiofrequency ablation for treatment of recurrent retroperitoneal liposarcoma. Cardiovasc Intervent Radiol 2008; 31 Suppl 2:S213-6. [PMID: 18175176 DOI: 10.1007/s00270-007-9263-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Revised: 11/20/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
Abstract
Percutaneous CT-guided radiofrequency ablation (RFA) is becoming more and more established in the treatment of various neoplasms, including retroperitoneal tumors of the kidneys and the adrenal glands. We report the case of RFA in a patient suffering from the third relapse of a retroperitoneal liposarcoma in the left psoas muscle. After repeated surgical resection and supportive radiation therapy of a primary retroperitoneal liposarcoma and two surgically treated recurrences, including replacement of the ureter by a fraction of the ileum, there was no option for further surgery. Thus, we considered RFA as the most suitable treatment option. Monopolar RFA was performed in a single session with a 2-cm umbrella-shaped LeVeen probe. During a 27-month follow-up period the patient remained free of tumor.
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Affiliation(s)
- Sebastian Keil
- Department of Diagnostic Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
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Bertocchini A, Falappa P, Accinni A, Devito R, Inserra A. Radiofrequency thermoablation in chest wall mesenchymal hamartoma of an infant. Ann Thorac Surg 2007; 84:2091-3. [PMID: 18036945 DOI: 10.1016/j.athoracsur.2007.06.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 06/11/2007] [Accepted: 06/13/2007] [Indexed: 11/16/2022]
Abstract
We report on an infant presenting with a chondroid hamartoma managed with a combined conservative surgical treatment and radiofrequency thermoablation.
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Brown SD, vanSonnenberg E. Issues in Imaging-Guided Tumor Ablation in Children Versus Adults. AJR Am J Roentgenol 2007; 189:626-32. [PMID: 17715110 DOI: 10.2214/ajr.07.2444] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Despite the growing use of percutaneous imaging-guided tumor ablation in adults, few reports describe its use in children except for osteoid osteoma. Our objective is to describe how tumor ablation in children and adults may differ, both to facilitate dialogue on pediatric tumor ablation and to increase awareness and use of this valuable technique. CONCLUSION There are numerous indications for which various ablative techniques may be safe and effective for treatment of pediatric tumors. Nonetheless, important differences between the pediatric and adult populations warrant consideration.
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Affiliation(s)
- Stephen D Brown
- Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
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Affiliation(s)
- Sanket R Diwanji
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Jeonnam, Korea
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