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Van der Woude HJ, Flipsen M, Welsink C, Van der Zwan AL, Ham SJ. Is total-body MRI useful as a screening tool to rule out malignant progression in patients with multiple osteochondromas? Results in a single-center cohort of 319 adult patients. Skeletal Radiol 2024; 53:141-150. [PMID: 37338590 DOI: 10.1007/s00256-023-04389-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/11/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To evaluate the results of total-body (TB) MRI used as a screening tool for assessment or exclusion of malignant transformation in patients with hereditary multiple osteochondromas (HMO). PATIENTS AND METHODS In a single-institute cohort of MO patients, 366 TB-MRI examinations, including T1-weighted and STIR images, were performed for screening and follow-up purposes to rule out the malignant transformation, and retrospectively analyzed. In each patient, the presence and location of osteochondromas in the axial and appendicular bones were recorded. Forty-seven patients underwent a second TB surveillance in this period. STIR sequences were used to identify sites of increased signal intensity that could represent suspicious thickened cartilage caps or indeterminate reactive changes related to osteochondromas. RESULTS In 82% of patients, one or more OC locations were determined in one or more flat bones. In 366 exams, nine OC (2,5 %) with suspicious imaging features were identified. These proved to be peripheral chondrosarcomas after targeted MRI and resection were performed. All nine malignant lesions were in flat bones (pelvis 5, ribs 3, scapula 1). Three of these patients were 19 years of age. In 12 patients who had peripheral or intraosseous low-grade chondrosarcoma in their history, before their first TB-MRI, no new lesions were identified. Twenty-three additional TB-MRI exams, demonstrating focal high T2 signal intensity, also gave rise to performing additional targeted MRI. One OC of the distal femur was excised and appeared benign. No suspicious cartilage caps were depicted on the remaining 22 targeted MRI exams but instead increased T2 signal was clarified by reactive changes (frictional bursitis, soft tissue edema) in close relation with benign osteochondromas. No malignant lesions were found in 47 patients who had a second TB surveillance (mean interval between exams 3.2 years, range 2-5 years). CONCLUSION TB-MRI can identify malignant transformation of osteochondromas in HMO patients. All peripheral chondrosarcomas occurred in flat bones (ribs, scapula, pelvis) in our study. TB-MRI might assist in triage between higher risk patients with a high burden of OC, including the location of OC in main flat bones vs lower risk patients without OC of the flat bones.
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Affiliation(s)
- Henk-Jan Van der Woude
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Mark Flipsen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Chantal Welsink
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Arnard L Van der Zwan
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - S John Ham
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Silva JE, Monteiro GDA, Silva STE, Bezerra GMDS, Cavalcante-Neto JF, Bezerra DDA, Vasconcelos JLM, Leal PRL. Chondrosarcoma secondary to hereditary multiple osteochondromas with spinal cord compression: A case report and systematic review. Surg Neurol Int 2023; 14:387. [PMID: 38053698 PMCID: PMC10695461 DOI: 10.25259/sni_797_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/05/2023] [Indexed: 12/07/2023] Open
Abstract
Background Hereditary multiple osteochondromas (HMOs) are a rare genetic disorder characterized by the formation of multiple benign osteochondromas that can undergo malignant transformation into chondrosarcoma. Case Description A 24-year-old male with a history of HMO and osteochondroma surgery 4 years ago, presented with back pain and paresthesias. The magnetic resonance showed a right paravertebral infiltrating mass at the T12-L1 level causing spinal cord compression. Following en bloc resection of the tumor, the patient's symptoms/ signs resolved. The final pathological diagnosis was consistent with a chondrosarcoma. Conclusion Chondrosarcomas secondary to HMO with spinal cord compression are rare. These patients often presenting with significant myelopathy/cord compression should undergo gross total resection where feasible to achieve the best outcomes.
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Affiliation(s)
- José Elmano Silva
- Department of Neurosurgery, Federal University of Ceará, Sobral, Ceará, Brazil
| | | | | | | | | | - Diego de Aragão Bezerra
- Department of Surgical Oncology, Federal University of Ceará, Sobral, Ceará, Brazil
- Department of Surgical Oncology, Santa Casa de Misericórdia’s Hospital, Sobral, Ceará, Brazil
| | | | - Paulo Roberto Lacerda Leal
- Department of Neurosurgery, Federal University of Ceará, Sobral, Ceará, Brazil
- Department of Neurosurgery, Santa Casa de Misericórdia’s Hospital, Sobral, Ceará, Brazil
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Habeeb A, Roszpopa J, Arnaout A, Grant I, Latimer M. Multiple Distal Femoral Osteochondromas Encasing Popliteal Neurovascular Bundle. Cureus 2023; 15:e46396. [PMID: 37927696 PMCID: PMC10620753 DOI: 10.7759/cureus.46396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Multiple hereditary exostosis syndrome is a rare diagnosis with approximately 1:50000 incidence prevailing in males. The exostoses or osteochondromas are benign but have the potential for malignant transformation in 1-5%. There is a strong genetic component, with exostosis (EXT) signaling pathways being an underlying cause. They can be symptomatic, with pain and functional deficit as the main complaints. We present a case of a 17-year-old male who presented with pain and anatomical deformity in his left lower femur. Magnetic resonance imaging revealed multiple osteochondromas compressing the popliteal neurovascular bundle. Excision of the osteochondromas was performed to decompress the neurovascular bundle in a multidisciplinary approach. Histological examination demonstrated no evidence of malignancy. Currently, there is no consensus for patients diagnosed with multiple osteochondromas regarding further investigation and/or screening for malignant transformation.
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Affiliation(s)
- Amir Habeeb
- Otolaryngology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Jaroszlav Roszpopa
- Plastic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Ali Arnaout
- Plastic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Ian Grant
- Plastic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Mark Latimer
- Orthopedics, University of Leicester Medical School, Leicester, GBR
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4
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Van der Woude HJ, Van der Zwan AL, Flipsen M, Welsink C, Ham SJ. Concurrent intraosseous cartilaginous lesions in patients with multiple osteochondromas identified on total-body MR imaging. Skeletal Radiol 2023; 52:1369-1375. [PMID: 36648521 DOI: 10.1007/s00256-023-04277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the prevalence of intraosseous cartilaginous lesions in patients with multiple osteochondromas based on total-body (TB) MRI examinations, used for screening purposes. SUBJECTS AND METHODS Between 2013 and 2020, TB-MRI examinations were performed in 366 patients with proven multiple osteochondromas syndrome, to rule out malignant progression. For this study, presence, or absence of intraosseous central or eccentrical chondroid lesions, defined as lobulated lesions with low signal intensity on T1-weighted images, replacing bone marrow and high signal intensity equal to fluid on T2-weighted images in the bone marrow of the meta-diaphysis of (one of) the long bones, were recorded in the long bones as part of a TB-MRI protocol. RESULTS In 62 patients out of the 366 MO patients (17%), one or more intraosseous chondroid lesions (either enchondroma or atypical cartilaginous tumor) were detected. The age of the patients at time of diagnosis ranged from 17 to 61 years (mean, 36). Size of the lesions varied from 4 to 69 mm (mean, 16.3 mm). The most common location was the proximal femur (n = 29), followed by the distal femur and proximal humerus (n = 18 and n = 10, respectively). In nine of the patients with an intraosseous chondroid lesion, a second and/or third TB-MRI were available during the period of evaluation (mean interval, 2.7 years between the exams). In none of these patients increase of these intraosseous lesions was noticed. CONCLUSION Intraosseous chondroid lesions (enchondroma and ACT) appear to occur more frequently in MO patients than in the general population. TB-MRI allows to detect these, besides the identification of OC with suspicious features.
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Affiliation(s)
- Henk-Jan Van der Woude
- Department of Radiology, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Arnard L Van der Zwan
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - Mark Flipsen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - Chantal Welsink
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - S John Ham
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, P.O Box 95500, 1090 HM, Amsterdam, The Netherlands
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5
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Khalil R, Boels MGS, van den Berg BM, Bruijn JA, Rabelink TJ, Hogendoorn PCW, Baelde HJ. Mutations in the heparan sulfate backbone elongating enzymes EXT1 and EXT2 have no major effect on endothelial glycocalyx and the glomerular filtration barrier. Mol Genet Genomics 2022; 297:397-405. [PMID: 35103870 PMCID: PMC8960589 DOI: 10.1007/s00438-022-01854-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Abstract
In this study, the effect of heterozygous germline mutations in the heparan sulfate (HS) glycosaminoglycan chain co-polymerases EXT1 and EXT2 on glomerular barrier function and the endothelial glycocalyx in humans is investigated. Heparan sulfate (HS) glycosaminoglycans are deemed essential to the glomerular filtration barrier, including the glomerular endothelial glycocalyx. Animal studies have shown that loss of HS results in a thinner glycocalyx. Also, decreased glomerular HS expression is observed in various proteinuric renal diseases in humans. A case report of a patient with an EXT1 mutation indicated that this could result in a specific renal phenotype. This patient suffered from multiple osteochondromas, an autosomal dominant disease caused by mono-allelic germline mutations in the EXT1 or EXT2 gene. These studies imply that HS is indeed essential to the glomerular filtration barrier. However, loss of HS did not lead to proteinuria in various animal models. We demonstrate that multiple osteochondroma patients do not have more microalbuminuria or altered glycocalyx properties compared to age-matched controls (n = 19). A search for all Dutch patients registered with both osteochondroma and kidney biopsy (n = 39) showed that an EXT1 or EXT2 mutation does not necessarily lead to specific glomerular morphological phenotypic changes. In conclusion, this study shows that a heterozygous mutation in the HS backbone elongating enzymes EXT1 and EXT2 in humans does not result in (micro)albuminuria, a specific renal phenotype or changes to the endothelial glycocalyx, adding to the growing knowledge on the role of EXT1 and EXT2 genes in pathophysiology.
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Affiliation(s)
- Ramzi Khalil
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Margien G S Boels
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernard M van den Berg
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan A Bruijn
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Ton J Rabelink
- The Einthoven Laboratory for Vascular and Regenerative Medicine, Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pancras C W Hogendoorn
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Hans J Baelde
- Department of Pathology, Leiden University Medical Center, L1Q, Room P0-107, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Polak KZ, Green ML, Cowan CR, Watson AM, Moore AR. What is your diagnosis? Inguinal mass in a dog. Vet Clin Pathol 2022; 51:279-282. [PMID: 35122281 DOI: 10.1111/vcp.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Klaudia Z Polak
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Michael L Green
- VCA Veterinary Specialists of Northern Colorado, Loveland, Colorado, USA
| | - Catharine R Cowan
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Allison M Watson
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - A Russell Moore
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
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Persistent Atraumatic Knee Pain in a Teenage Female with Bony Protuberance Secondary to Hook-Shaped Osteochrondroma. Case Rep Pediatr 2021; 2021:3088992. [PMID: 34961834 PMCID: PMC8710169 DOI: 10.1155/2021/3088992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022] Open
Abstract
A 13-year-old female presented at her pediatrician's office with a complaint of sharp, intermittent, right-sided knee pain that had been present for the previous three days without any known trauma and no association with activity. Her medical history was significant for fractures, and on physical exam, there was a hard mass palpated on the medial aspect of her distal thigh that was nontender, nonmobile, and without overlying skin changes. The plain radiograph findings were consistent with a hook-shaped osteochondroma of the right medial distal metaphysis. Orthopedics recommended conservative management with continued ibuprofen for pain and six-week follow-up with repeat radiograph to evaluate for progression. The follow-up radiograph showed no interval growth. However, due to continued pain, the patient had surgical excision of the osteochondroma six months after initial presentation, allowing her to finish her current soccer season. The surgery was successful, and the patient did well after operation with no residual pain.
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8
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Garcia SA, Ng VY, Iwamoto M, Enomoto-Iwamoto M. Osteochondroma Pathogenesis: Mouse Models and Mechanistic Insights into Interactions with Retinoid Signaling. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:2042-2051. [PMID: 34809786 PMCID: PMC8647428 DOI: 10.1016/j.ajpath.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 05/02/2023]
Abstract
Osteochondromas are cartilage-capped tumors that arise near growing physes and are the most common benign bone tumor in children. Osteochondromas can lead to skeletal deformity, pain, loss of motion, and neurovascular compression. Currently, surgery is the only available treatment for symptomatic osteochondromas. Osteochondroma mouse models have been developed to understand the pathology and the origin of osteochondromas and develop therapeutic drugs. Several cartilage regulatory pathways have been implicated in the development of osteochondromas, such as bone morphogenetic protein, hedgehog, and WNT/β-catenin signaling. Retinoic acid receptor-γ is an important regulator of endochondral bone formation. Selective agonists for retinoic acid receptor-γ, such as palovarotene, have been investigated as drugs for inhibition of ectopic endochondral ossification, including osteochondromas. This review discusses the signaling pathways involved in osteochondroma pathogenesis and their possible interactions with the retinoid pathway.
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Affiliation(s)
- Sonia Arely Garcia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vincent Y Ng
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Masahiro Iwamoto
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Motomi Enomoto-Iwamoto
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
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9
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Hameed M. Malignant Cartilage-Forming Tumors. Surg Pathol Clin 2021; 14:605-617. [PMID: 34742483 DOI: 10.1016/j.path.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chondrosarcomas are heterogeneous matrix-producing cartilaginous neoplasms with variable clinical behavior. Subtypes include conventional (75%), dedifferentiated (10%), clear cell (2%), mesenchymal (2%), and periosteal chondrosarcoma (<1%). Tumor location and primary vs secondary also play a role. In conventional chondrosarcoma, histologic grading (I, II, and III) remains the gold standard for predicting recurrence and metastases. Due to the locally aggressive but overall nonmetastatic behavior, grade I chondrosarcomas (primary and secondary) of long and short tubular bones have been reclassified as atypical cartilaginous tumor. In this review, the pathologic features of malignant cartilage tumors are discussed with updates on recent genetic findings.
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Affiliation(s)
- Meera Hameed
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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10
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Baugher EC, Batarseh TR, Becker AK, Cantu AJ, Carr EW, Sakthi Velavan S. Multiple Osteochondromas Comorbid With Enlarged Parietal Foramina, Elongated Styloid Processes, and Tibiofibular Synostosis. Am J Clin Pathol 2021; 156:513-520. [PMID: 33769443 DOI: 10.1093/ajcp/aqaa282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigates a unique case of multiple osteochondromas (MO) comorbid with enlarged parietal foramina and correlates the findings with the existing literature. The aim of this study is to provide a deeper understanding of anatomic variation for physicians. METHODS A 66-year-old White male donor was examined during a routine cadaveric dissection performed by medical students in an anatomy laboratory. Detailed exploration of the skeleton and organs was performed, and photographs were taken. Tissue samples were obtained from multiple outgrowths, and histopathologic examination was done. RESULTS Bilateral bony growths were noted rising from the long bones of the upper and lower extremities (femur, tibia, fibula, and radius). An accessory muscle was found to be associated with the left radial bony growth. Histopathologic examination was positive for osteochondroma. Inspection of the skull revealed enlarged parietal foramina. Other findings included tibiofibular synostosis, abnormally shaped vertebral bodies and ribs, and elongated styloid processes of the skull. CONCLUSIONS In combination with the histopathologic examination, the case report and literature review elucidate a more precise clinical picture for those affected with MO or similar disorders. This report also emphasizes the necessity of further investigation of the pathogenesis of MO and Potocki-Shaffer syndrome.
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Affiliation(s)
- Elizabeth C Baugher
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Tamara R Batarseh
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Ashley K Becker
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Austin J Cantu
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
| | - Evan W Carr
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
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Mordenti M, Gnoli M, Boarini M, Trisolino G, Evangelista A, Pedrini E, Corsini S, Tremosini M, Staals EL, Antonioli D, Stilli S, Donati DM, Sangiorgi L. The Rizzoli Multiple Osteochondromas Classification revised: describing the phenotype to improve clinical practice. Am J Med Genet A 2021; 185:3466-3475. [PMID: 34477285 PMCID: PMC9293117 DOI: 10.1002/ajmg.a.62470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 11/07/2022]
Abstract
Multiple osteochondromas (MO) is a rare disorder, characterized by benign osteocartilaginous tumors (osteochondromas), arising from the perichondrium of bones. The osteochondromas increase during growth, frequently causing deformities and limitations. Our study aims to analyze the data captured by the Registry of Multiple Osteochondromas, to refine Istituto Ortopedico Rizzoli (IOR) Classification, providing a representative picture of the phenotypic manifestations throughout the lifespan. We conducted a single‐institution cross‐sectional study. Patients were categorized according to IOR Classification, which identifies three patients' classes on the presence/absence of deformities and/or limitations. The present dataset was compared with our previously published data, to refine the classification. Nine hundred sixty‐eight patients were included: 243 children (<10 years), 136 adolescents (10–15 years), and 589 adults. Of the entire population, half patients presented at least one deformity, and one quarter reported at least one limitation. Compared with our previous study, the amount of children was more than doubled and the percentage of mild/moderate cases was notably increased, giving a better disease overview throughout the lifespan and suggesting a different cut‐off for dividing Class II in subclasses. We confirmed that MO is characterized by phenotypic heterogeneity, suggesting that an early classification of the disease may offer a useful tool to follow disease pattern and evolution, to support clinical practice, and to propose timely interventions.
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Affiliation(s)
- Marina Mordenti
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Maria Gnoli
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Manila Boarini
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Andrea Evangelista
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Elena Pedrini
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Serena Corsini
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Morena Tremosini
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Eric L. Staals
- Department of Third Orthopedic and Traumatologic Clinic prevalently Oncologic, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Diego Antonioli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Stefano Stilli
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Davide M. Donati
- Department of Third Orthopedic and Traumatologic Clinic prevalently Oncologic, IRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Luca Sangiorgi
- Department of Rare Skeletal DisordersIRCCS Istituto Ortopedico RizzoliBolognaItaly
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12
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Tepelenis K, Papathanakos G, Kitsouli A, Troupis T, Barbouti A, Vlachos K, Kanavaros P, Kitsoulis P. Osteochondromas: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features and Treatment Options. In Vivo 2021; 35:681-691. [PMID: 33622860 DOI: 10.21873/invivo.12308] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
Osteochondroma, the most common benign bone tumor, is a projection on the external surface of the bone, which can be sessile or pedunculated. 85% of osteochondromas present as solitary lesions, while 15% occur in the context of hereditary multiple exostoses (HME), a genetic disorder that is inherited in an autosomal dominant manner. Although often asymptomatic, symptoms may eventuate from compression of adjacent vessels or nerves, fractures, osseous deformities, bursa formation, or malignant transformation. Cartilage cap thickness >2 cm in adults or >3 cm in children as well as new onset of pain or growth, or rapid growth of the lesion, especially after the closure of the growth plate, might reflect cancerous transformation. Surgical resection is indicated for symptomatic lesions, complications, cosmetic reasons or malignant transformation. Excision of the tumor with free margin is the treatment of choice. Local recurrence is less than 2% if complete resection is achieved.
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Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece;
| | | | | | - Theodoros Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Barbouti
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece
| | | | | | - Panagiotis Kitsoulis
- Anatomy - Histology - Embryology, University of Ioannina, Ioannina, Greece.,Orthopaedics, University of Ioannina, Ioannina, Greece
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13
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Żylińska B, Sobczyńska-Rak A, Lisiecka U, Stodolak-Zych E, Jarosz Ł, Szponder T. Structure and Pathologies of Articular Cartilage. In Vivo 2021; 35:1355-1363. [PMID: 33910813 DOI: 10.21873/invivo.12388] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
The aim of the review was to describe a complex microstructure and biomechanical properties of the articular cartilage as well as a current review of its pathologies encountered in veterinary practice. The articular cartilage with its unique features: complex microarchitecture, significant mechanical durability and elasticity, lacking blood, lymphatic vessels, and innervation, seems to stand in contradiction to the laws of biology. It can be involved in a vast majority of diseases, from osteoarthrosis as a result of natural aging process to more complex in nature like osteochondromatosis. The primary role of articular cartilage is to provide the surface for movement in any single joint in the body. Therefore, its diseases lead to physical impairment and deterioration of the quality of life. Treatment of articular cartilage poses a formidable challenge in both modern human and animal medicine.
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Affiliation(s)
- Beata Żylińska
- Department and Clinic of Animal Surgery, University of Life Sciences in Lublin, Lublin, Poland
| | | | - Urszula Lisiecka
- Department of Epizootiology and Clinic of Infectious Diseases, University of Life Sciences in Lublin, Lublin, Poland
| | - Ewa Stodolak-Zych
- Department of Biomaterials, AGH University of Science and Technology, Cracow, Poland
| | - Łukasz Jarosz
- Department of Epizootiology and Clinic of Infectious Diseases, University of Life Sciences in Lublin, Lublin, Poland
| | - Tomasz Szponder
- Department and Clinic of Animal Surgery, University of Life Sciences in Lublin, Lublin, Poland
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Wininger AE, Chhabra BN, Haigler RE, Hanson DS, Scott AC. The Incidence of Vertebral Exostoses in Multiple Hereditary Exostoses and Recommendations for Spinal Screening. J Pediatr Orthop 2021; 41:e226-e231. [PMID: 33417389 DOI: 10.1097/bpo.0000000000001749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple hereditary exostoses (MHE) lead to the development of pedunculated or sessile osteocartilaginous lesions. Vertebral involvement occurs in MHE and encroaching intracanal exostoses can result in devastating consequences. Magnetic resonance imaging (MRI) of the entire spine has been used to screen for vertebral exostoses to detect high-risk patients. The primary purpose of this investigation is to determine the incidence of vertebral and encroaching intracanal exostoses in patients with MHE. A secondary purpose is to determine if pelvis and rib exostoses serve as "harbinger" lesions of vertebral involvement in MHE. METHODS A retrospective chart review was performed on 39 patients (21 male and 18 female individuals) with MHE who underwent routine spinal screening with noncontrast entire spine MRI. The average age at screening was 12.3 years (range, 3 to 17 y). Screening was ordered consecutively on patients seen during the study period who were between ages 8 and 18 years or had complaints that could be related to encroaching intracanal exostoses. RESULTS The incidence of vertebral exostoses in this cohort of 39 patients with MHE was 28% (11 total). An encroaching intracanal exostosis was seen in 3 patients (2 cervical, 1 thoracic). Nonencroaching vertebral exostoses were discovered in 8 patients. Sufficient pelvis and rib imaging to determine the presence of pelvis and rib exostoses was available in 8 of those with vertebral exostoses and 19 of those with no vertebral exostoses on screening MRI. In this cohort, the sensitivity and specificity of the presence of both pelvis and rib exostoses for determining the presence of spinal involvement in MHE are 88% and 5%, respectively. CONCLUSIONS Based on the results of this cohort, vertebral exostoses are common in MHE, and screening MRI of the entire spine can be used to determine which patients need close observation. If a more selective screening protocol is utilized, an entire spine MRI could be obtained for patients who desire increased physical activity levels or for patients with both pelvis and rib exostoses. At a minimum, treating physicians should monitor patients with MHE closely for neurological symptoms and have a low threshold to obtain advanced spinal imaging. LEVEL OF EVIDENCE Level III-diagnostic.
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Fowler J, Takayanagi A, Fiani B, Cathel A, Sarhadi KJ, Arshad M, Lau S, Siddiqi I, Ghanchi H, Wolberg A, Hariri O. Diagnosis, Management, and Treatment Options: A Cervical Spine Osteochondroma Meta-Analysis. World Neurosurg 2021; 149:215-225.e6. [PMID: 33561553 DOI: 10.1016/j.wneu.2021.01.148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
Osteochondroma is described as a capped benign bony neoplasm that forms on the outer surface of bone. These tumors affect nearly 6 million people per year. Although osteochondromas most often involve the appendicular skeleton, many involve the spine, with many cases located in the cervical spine. When osteochondromas involve the spine, they can present with a variety of symptoms, including pain, radiculopathy, and myelopathy, which may necessitate surgical treatment. Spinal osteochondromas can be classified into 2 types: multiple osteochondromas in the context of patients with multiple hereditary exostosis (MHE) and solitary osteochondroma or solitary exostosis (SE). Previous reviews have captured only some of the available literature on cervical osteochondromas and have generally focused on either SE or those associated with MHE. The purpose of our review was to provide an extensive review of all previously reported cervical osteochondromas and to compare osteochondroma characteristics, clinical presentation, and outcomes in the context of MHE and SE.
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Affiliation(s)
- James Fowler
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | - Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA.
| | - Alessandra Cathel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | | | - Mohammad Arshad
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, California, USA
| | - Sean Lau
- Department of Pathology, Kaiser Permanente, Anaheim, California, USA
| | - Imran Siddiqi
- Western University of Health Sciences College of Osteopathic Medicine, Pomona, California, USA
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health System, Riverside, California, USA
| | - Adam Wolberg
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Omid Hariri
- Department of Neurosurgery, Kaiser Permanente Orange County, Anaheim, California, USA
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Jurik AG, Jørgensen PH, Mortensen MM. Whole-body MRI in assessing malignant transformation in multiple hereditary exostoses and enchondromatosis: audit results and literature review. Skeletal Radiol 2020; 49:115-124. [PMID: 31273432 DOI: 10.1007/s00256-019-03268-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the results of annual screening using whole-body magnetic resonance imaging (WBMRI) in patients with multiple hereditary exostoses (MHE) and enchondromatosis (EC), and estimate the risk for transformation to chondrosarcoma (CS) in these disorders. MATERIALS AND METHODS A total of 62 patients (57 with MHE and five with EC) screened during a mean follow-up period of 4.6 years (range, 1-10 years) using 253 WBMRIs (median four WBMRIs per patient, range, 1-10) were analyzed retrospectively. The time of WBMRIs was compared with dates for diagnosed CSs. A supplementary literature review was performed focusing on the risk of malignant transformation. RESULTS Ten patients had CS before being enrolled in the screening program, nine with MHE and one with EC. Three asymptomatic CSs were detected by screening; one in a patient with EC and two in patients with MHE, one of whom had CS previously. During the screening period, there was no occurrence of CS not detected by WBMRI in the study group. Histopathologically, the CSs were predominantly grade 1 and were, except for in two patients, located at the truncus, proximal femur, and shoulder girdle. Based on the current material and literature review, the risk of CS seems to be in the range of 2-3.7% for MHE and up to 50% for EC patients. CONCLUSIONS MRI may be used as a screening method detecting malignant transformation in MHE and EC patients, but the efficacy has to be confirmed in long-term follow-up studies including cost analysis.
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Affiliation(s)
- Anne Grethe Jurik
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd 99, 8200, Aarhus N, Denmark. .,Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Aarhus N, Denmark.
| | - Peter Holmberg Jørgensen
- Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd 99, 8200, Aarhus N, Denmark
| | - Mikkel Meng Mortensen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd 99, 8200, Aarhus N, Denmark
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Heparanase: A Potential Therapeutic Target in Sarcomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1221:405-431. [PMID: 32274719 DOI: 10.1007/978-3-030-34521-1_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcomas comprise a heterogeneous group of rare malignancies of mesenchymal origin including more than 70 subtypes. They may arise in muscle, bone, cartilage and other connective tissues. Their high histological and genetic heterogeneity makes diagnosis and treatment very challenging. Deregulation of heparanase has been found in several sarcoma subtypes and high expression levels have been correlated with poor prognosis in Ewing's sarcoma and osteosarcoma. Altered expression of specific heparan sulfate proteoglycans and heparan sulfate biosynthetic enzymes has also been observed. Advances in molecular pathogenesis of sarcomas have evidenced the critical role of several heparan sulfate binding growth factors and receptor tyrosine kinases, highly interconnected with the microenvironment, in sustaining tumor growth and progression. Interference with heparanase/heparan sulfate functions represents a potential therapeutic approach in sarcoma. In this chapter, we summarize the current knowledge about the biological significance of heparanase expression and its potential as a therapeutic target in subtypes of both soft tissue and bone sarcomas. Particular emphasis is given to the involvement of heparan sulfate proteoglycans and their synthesizing and modifying enzymes in bone physiology and disorders leading up to the pathobiology of bone sarcomas. The chapter also describes the cooperation between exostin loss-of-function and heparanase upregulation in hereditary Multiple Osteochondroma syndrome as a paradigmatic example of constitutive alteration of the heparanase/heparan sulfate proteoglycan system which may contribute to progression to malignant secondary chondrosarcoma. Preclinical evidence of the role of heparanase as a promising therapeutic target in various sarcoma subtypes is finally resumed.
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Yu J, Yang T, Dai J, Wang X. Histopathological features of condylar hyperplasia and condylar Osteochondroma: a comparison study. Orphanet J Rare Dis 2019; 14:293. [PMID: 31842965 PMCID: PMC6916444 DOI: 10.1186/s13023-019-1272-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Both mandibular condylar hyperplasia and condylar osteochondroma can lead to maxillofacial skeletal asymmetry and malocclusion, although they exhibit different biological behavior. This study attempted to compare the histological features of mandibular condylar hyperplasia and condylar osteochondroma using hematoxylin-and-eosin (H&E) staining, and immunohistochemistry staining of PCNA and EXT1 with quantitative analysis method. Results The H&E staining showed that condylar hyperplasia and condylar osteochondroma could be divided into four histological types and exhibited features of different endochondral ossification stages. There was evidence of a thicker cartilage cap in condylar osteochondroma as compared condylar hyperplasia (P = 0.018). The percentage of bone formation in condylar osteochondroma was larger than was found in condylar hyperplasia (P = 0.04). Immunohistochemical staining showed that PCNA was mainly located in the undifferentiated mesenchymal layer and the hypertrophic cartilage layer, and there were more PCNA positive cells in the condylar osteochondroma (P = 0.007). EXT1 was mainly expressed in the cartilage layer, and there was also a higher positive rate of EXT1 in condylar osteochondroma (P = 0.0366). The thicker cartilage cap, higher bone formation rate and higher PCNA positive rate indicated a higher rate of proliferative activity in condylar osteochondroma. The more significant positive rate of EXT1 in condylar osteochondroma implied differential biological characteristic as compared to condylar hyperplasia. Conclusions These features might be useful in histopathologically distinguishing condylar hyperplasia and osteochondroma.
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Affiliation(s)
- Jingshuang Yu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 20011, People's Republic of China
| | - Tong Yang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 20011, People's Republic of China.,Shanghai LinkedCare Information Technology Co., Ltd, Shanghai, People's Republic of China
| | - Jiewen Dai
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 20011, People's Republic of China.
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 20011, People's Republic of China.
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Baig MN, O'Malley S, Fenelon C, Kaar K. Osteochondroma of acromioclavicular joint. BMJ Case Rep 2019; 12:12/8/e230246. [PMID: 31444263 DOI: 10.1136/bcr-2019-230246] [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: 11/03/2022] Open
Abstract
Osteochondroma is the most common type of benign bone tumour. It is a benign chondrogenic lesion derived from aberrant cartilage from the perichondral ring, and it commonly presents in the proximal humerus, proximal femur and knee. Osteochondroma is usually solitary but can be multiple with patients with hereditary multiple exostoses. Malignant changes happen in approximately 1% of cases. Osteochondroma usually causes local pain or swelling. We discuss a unique case of an osteochondroma that highlights the fact that osteochondroma can occur in the most unlikely places, and they should be properly visualised via radiography to evaluate any extensions and compromised surrounding structures before surgical intervention.
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Affiliation(s)
| | - Sandra O'Malley
- Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland
| | | | - Ken Kaar
- Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland
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Andrews K, Rowland A, Tank J. Knee locked in flexion: incarcerated semitendinosus tendon around a proximal tibial osteochondroma. J Surg Case Rep 2019; 2019:rjy346. [PMID: 30788088 PMCID: PMC6368137 DOI: 10.1093/jscr/rjy346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022] Open
Abstract
This case reports on a knee locked in flexion due to incarceration of the semitendinosus tendon around an osteochondroma in a patient with a history of multiple hereditary exostoses (MHE). An 18-year-old female with history of MHE presented with acute right medial knee pain and inability to extend her knee. Radiographs confirmed multiple lower extremity osteochondromas, notably a large, 3-cm pedunculated osteochondroma about her right medial proximal tibia. This was assessed as a locked knee secondary to incarcerated hamstring tendons around an osteochondroma. Excision of the osteochondroma restored normal flexion and extension of her knee. At the 3-month follow-up visit, she had returned to all activities with no recurrent medial knee pain or locking. The differential diagnosis for a locked knee joint can be broad, but tendon incarceration should be considered in appropriate patients with significant symptoms. In patients with a history of MHE, osteochondromas may be the cause of tendon entrapment.
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Affiliation(s)
- Kyle Andrews
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Andrea Rowland
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Jason Tank
- Department of Orthopaedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA.,Department of Orthopaedic Surgery, ProMedica Toledo Hospital, Toledo, OH 43606, USA
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Osteochondromas of the proximal humerus. Diagnostic and therapeutic management. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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22
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Ramos-Pascua LR, Sánchez-Herraéz S, Casas-Ramos P, Mora-Fernández M, Izquierdo-García FM. Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:168-177. [PMID: 29572078 DOI: 10.1016/j.recot.2017.12.003] [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] [Received: 10/14/2016] [Revised: 02/04/2017] [Accepted: 12/12/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. METHODS Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months. RESULTS Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. DISCUSSION Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. CONCLUSIONS Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.
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Affiliation(s)
- L R Ramos-Pascua
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España.
| | - S Sánchez-Herraéz
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España
| | - P Casas-Ramos
- Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, León, España
| | - M Mora-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Burgos, Burgos, España
| | - F M Izquierdo-García
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de León, León, España
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Mărginean CO, Meliţ LE, Mărginean MO. Daughter and mother diagnosed with hereditary multiple exostoses: A case report and a review of the literature. Medicine (Baltimore) 2017; 96:e5824. [PMID: 28072741 PMCID: PMC5228701 DOI: 10.1097/md.0000000000005824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hereditary multiple exostoses (HME) or osteochondromatosis is a rare autosomal dominant disease characterized by multiple osteochondromas and skeletal deformities. PATIENT CONCERNS & DIAGNOSES We present the case of a 5 years and 9 month-old patient who presented with inferior limb pain for approximately 6 months, associating also deformity of the right index finger for a month. Hand X-ray revealed a radiologic abnormality of the right radius, therefore the child was referred to our clinic for further investigations. The X-rays revealed multiple osteochondromas of the radius, metacarpal bones, hand phalangeal bones, femur, tibia, fibula, metatarsal bones, and foot phalangeal bones. We mention that the same radiological aspect was identified in the case of the patient's mother, undiagnosed until that moment. OUTCOMES The particularity of this case consists in identification of a rare genetic pathology, HME in a 5-year-old patient, without any known familial history, after the occurrence of a nontraumatic joint dislocation of the right index finger. CONCLUSION HME is a rare genetic condition, without a curative treatment, burdened by multiple complications, and whose diagnosis is usually established during childhood.
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Veeravagu A, Li A, Shuer LM, Desai AM. Cervical Osteochondroma Causing Myelopathy in Adults: Management Considerations and Literature Review. World Neurosurg 2017; 97:752.e5-752.e13. [DOI: 10.1016/j.wneu.2016.10.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
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Kulkarni U, Kulkarni A. Response to the comment to: "Kulkarni U and Kulkarni A: Posterior talus osteochondroma a rare location, treated by posterior ankle arthroscopy. Foot Ankle Surg. 2015 Sep;21(3):e51-4″. Foot Ankle Surg 2016; 22:288. [PMID: 27810031 DOI: 10.1016/j.fas.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Umesh Kulkarni
- Consultant Orthopaedic Surgeon, Sanjivan Hospital, Off Gangapur Road, Nashik 422013, Maharashtra, India.
| | - Ameya Kulkarni
- Dept. of Orthopaedics, VP Medical College Adgaon, Nashik, Maharashtra, India
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Eka Wiratnaya IG, Aditya Gitapradita B NG, Yudhi Setiawan IGN, Suyasa IK, Siki Kawiyana IK, Astawa P. Case Report of the positive exostosin-1 without B-cell lymphoma-2 gene expression of giant cell tumor lesion in hereditary multiple exostosis. Int J Surg Case Rep 2016; 29:141-145. [PMID: 27846455 PMCID: PMC5109267 DOI: 10.1016/j.ijscr.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/04/2016] [Accepted: 11/04/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The giant cell tumor, in which BCL-2 gene was expressed only in its malignant transformation, is a benign, primary skeletal neoplasm with variable biologic aggressiveness. The is of the giant cell tumor. A coexistence with hereditary multiple exostosis with expression of EXT-1 is very rare. The correlation between giant cell tumor in hereditary multiple exostosis is still not clearly determined. PRESENTATION OF CASE A 31-years-old female presented with pain and lump on her left wrist and a coexistence of non tender multiple lump in the right and left knee. A wide excision of the tumor and reconstruction using non vascularized fibular graft was performed, followed by histopathology and immunohistochemistry of EXT-1 and BCL-2. DISCUSSION In this case, the tumor showed negative BCL-2 and positive EXT-1 gene expression. Giant cell tumor and hereditary multiple exostosis also demonstrated associations of chromosomes 11 with a different pathological process. CONCLUSION Giant cell tumor in hereditary multiple exostosis revealed positive EXT-1 without BCL-2 expression. It still need more investigation to confirm the relationship between these tumors.
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Affiliation(s)
- I Gede Eka Wiratnaya
- Orthopaedic Surgeon at Department of Orthopaedic and Traumatology, Medical Faculty, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia.
| | - Nyoman Gede Aditya Gitapradita B
- Orthopaedic Resident at Department of Orthopaedic and Traumatology, Medical Faculty, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I G N Yudhi Setiawan
- Orthopaedic Resident at Department of Orthopaedic and Traumatology, Medical Faculty, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
| | - I Ketut Suyasa
- Chief of Orthopaedic and Traumatology Department at Sanglah General Hospital, Medical Faculty, Udayana University, Denpasar, Bali, Indonesia
| | - I Ketut Siki Kawiyana
- Professor at Orthopaedic and Traumatology Department at Sanglah General Hospital, Medical Faculty, Udayana University, Denpasar, Bali, Indonesia
| | - Putu Astawa
- Professor at Orthopaedic and Traumatology Department at Sanglah General Hospital, Medical Faculty, Udayana University, Denpasar, Bali, Indonesia
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Fouasson-Chailloux A, Menu P, Dubois C, Dauty M. Severe chronic compression of the spinal cord by a C2 laminar osteochondroma in a 71-year-old woman: A case report. Ann Phys Rehabil Med 2016; 60:410-413. [PMID: 27751750 DOI: 10.1016/j.rehab.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/18/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Alban Fouasson-Chailloux
- MPR Locomotrice et Respiratoire, PHU 10, Médecine Physique et Réadaptation, Hôpital, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France.
| | - Pierre Menu
- MPR Locomotrice et Respiratoire, PHU 10, Médecine Physique et Réadaptation, Hôpital, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France
| | - Charles Dubois
- MPR Locomotrice et Respiratoire, PHU 10, Médecine Physique et Réadaptation, Hôpital, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France
| | - Marc Dauty
- MPR Locomotrice et Respiratoire, PHU 10, Médecine Physique et Réadaptation, Hôpital, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex 1, France
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Rupp M, Hardes J, Raschke MJ, Skwara A. Bilateral Scapulothoracic Osteochondromas in a Patient With Hereditary Multiple Exostosis: A Case Report and Review of the Literature. Orthop Rev (Pavia) 2016; 8:6501. [PMID: 27761218 PMCID: PMC5066108 DOI: 10.4081/or.2016.6501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/30/2016] [Accepted: 07/31/2016] [Indexed: 12/11/2022] Open
Abstract
Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by two or more benign growing, cartilage capped tumors of long bones called osteochondromas. If abnormal growth and clinical symptoms of osteochondromas newly appear in adults, malignant transformation of the usually benign growing tumors should be suspected and diagnostic testing should be initiated. Against the background of hypothesized higher malignant transformation of osteochondromas into chondrosarcoma in individuals with shoulder exostoses, we report a case of bilateral scapulothoracic osteochondromas in a patient suffering from HME. A 60-year-old female with HME complained of chest pain while being hospitalized for bilateral femoral fractures. A computed tomography scan of the chest was performed to rule out pulmonary embolism. However, bilateral osteochondromas in the scapulothoracic spaces were detected. Due to absence of radiographic evidences for malignant transformation in the patient, invasive diagnostic procedures such as biopsy and histological examination were recommended in order to exclude malignant transformation of both osteochondromas. Physicians should be aware that patients with HME who present with shoulder pain should be examined for osteochondromas in the scapulothoracic space. Due to possible sarcomatous transformation, regular follow-ups are necessary for adolescents and adults.
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Affiliation(s)
- Markus Rupp
- Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Giessen and Harburg, Campus Giessen
- Department of Trauma-, Hand- and Reconstructive Surgery, Muenster University Hospital
| | - Jendrik Hardes
- Clinic for General Orthopedics and Tumor Orthopedics, Muenster University Hospital
| | - Michael J. Raschke
- Department of Trauma-, Hand- and Reconstructive Surgery, Muenster University Hospital
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Zhou Q, Yang C, Chen MJ, Li LZ. Detection of exostosin glycosyltransferase gene mutations in patients with non-hereditary osteochondromas of the mandibular condyle. Mol Clin Oncol 2016; 5:295-299. [PMID: 27588195 DOI: 10.3892/mco.2016.955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 01/20/2016] [Indexed: 11/05/2022] Open
Abstract
Exostosin glycosyltransferase (EXT) 1 and EXT2 have been identified as causative genes in osteochondroma; however, it is not known whether these genes are also involved in condylar osteochondromas. The aim of this study was to identify EXT1 and EXT2 mutations in patients with non-hereditary osteochondromas of the mandibular condyle. DNA was obtained from resected tissues (cartilage cap) of 12 patients with solitary condylar osteochondromas. The exons, 3',5'-untranslated regions and intron-exon boundaries of EXT1 and EXT2 were amplified by polymerase chain reaction and the products were sequenced directly. Through direct sequencing, four genetic variations of EXT1 in 4 cases and three variations of EXT2 in 5 cases were identified. The intronic alteration of the EXT2 gene, occurring in 2 cases, was novel, whereas the other alterations had been previously reported. Nonsense somatic mutations were detected in tumor DNA. Our study extended the mutational spectrum in EXT1 and EXT2 and may facilitate a better understanding of the pathophysiology of condylar osteochondromas.
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Affiliation(s)
- Qin Zhou
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
| | - Chi Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
| | - Min-Jie Chen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
| | - Ling-Zhi Li
- Department of Stomatology, Huashan Hospital, Fudan University, Shanghai 200438, P.R. China
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Parente B, Fiorucci B, Simonte G, Brambilla DM, Lenti M. Osteochondromas: An Unusual Cause of Vascular Disease in Young Patients: 2 Clinical Cases. Ann Vasc Surg 2016; 32:129.e7-11. [DOI: 10.1016/j.avsg.2015.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
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Domínguez M, Rayo J, Serrano J, Infante J, García L, Moreno M. Gammagrafía ósea de cuerpo completo con 99mTc-MDP de 3 hermanos afectos de osteocondromatosis múltiple familiar. Rev Esp Med Nucl Imagen Mol 2016; 35:61-3. [DOI: 10.1016/j.remn.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 11/29/2022]
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99m Tc-MDP bone scintigraphies of three brothers affected by multiple osteochondromas. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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A painful, hard mass on the ankle. JAAPA 2015; 28:61-2. [PMID: 26501583 DOI: 10.1097/01.jaa.0000472634.91020.0e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhou Q, Yang C, Chen MJ. Osteochondroma of bilateral mandibular condyle: a case report. Int J Clin Exp Med 2015; 8:2989-2992. [PMID: 25932269 PMCID: PMC4402916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
Osteochondroma represents the largest group of benign tumors of bone, which usually develops in long bones and relatively uncommon in the craniofacial region. The condyle and coronoid tip are the most common sites of occurrence in the mandible, but both sides of condyle involved has never been reported. Here, we describe a case of osteochondroma arising from the bilateral mandibular condyle.
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Affiliation(s)
- Qin Zhou
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai 200011
| | - Chi Yang
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai 200011
| | - Min-Jie Chen
- Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai 200011
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Cerrahoğlu L, Ulusoy A, Akgül Ö. Ankle pain in hereditary multiple exostoses: a case report. Rheumatol Int 2014; 35:1107-9. [PMID: 25410013 DOI: 10.1007/s00296-014-3176-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Lale Cerrahoğlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
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R K, K P, B G, Naseer B S, Ds K. Multiple heriditary exostoses in a family for three generation of Indian origin with review of literature. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2014; 8:LD01-3. [PMID: 25478377 DOI: 10.7860/jcdr/2014/8228.4942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/14/2014] [Indexed: 11/24/2022]
Abstract
Multiple hereditary exostoses (MHE) are an autosomal dominant disorder, consisting of multiple cartilage capped bone tumour arising from the metaphysis of long tubular bones. Mutations are seen in Exostosin-1 and Exostosin-2 genes. We present a family of MHE for three generations. The index case was a 10-year-old male presented with multiple exostoses in hand, forearm, leg, right knee and chest. Family history revealed similar complaints in younger brother, father, paternal uncle, paternal aunt & her daughter and grandfather.
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Affiliation(s)
- Kalyani R
- Professor, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Prabhakar K
- Professor, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Gopinath B
- Resident, Deparment of Medicine, Department of Pathology, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Sheik Naseer B
- Professor of Orthopaedics, Department of Orthopaedics, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Krishnamurthy Ds
- Scientific Adviser, Genome Lab, Genome Lab, Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
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A broad spectrum of genomic changes in latinamerican patients with EXT1/EXT2-CDG. Sci Rep 2014; 4:6407. [PMID: 25230886 PMCID: PMC4166712 DOI: 10.1038/srep06407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/22/2014] [Indexed: 02/03/2023] Open
Abstract
Multiple osteochondromatosis (MO), or EXT1/EXT2-CDG, is an autosomal dominant O-linked glycosylation disorder characterized by the formation of multiple cartilage-capped tumors (osteochondromas). In contrast, solitary osteochondroma (SO) is a non-hereditary condition. EXT1 and EXT2, are tumor suppressor genes that encode glycosyltransferases involved in heparan sulfate elongation. We present the clinical and molecular analysis of 33 unrelated Latin American patients (27 MO and 6 SO). Sixty-three percent of all MO cases presented severe phenotype and two malignant transformations to chondrosarcoma (7%). We found the mutant allele in 78% of MO patients. Ten mutations were novel. The disease-causing mutations remained unknown in 22% of the MO patients and in all SO patients. No second mutational hit was detected in the DNA of the secondary chondrosarcoma from a patient who carried a nonsense EXT1 mutation. Neither EXT1 nor EXT2 protein could be detected in this sample. This is the first Latin American research program on EXT1/EXT2-CDG.
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Herget GW, Kontny U, Saueressig U, Baumhoer D, Hauschild O, Elger T, Südkamp NP, Uhl M. [Osteochondroma and multiple osteochondromas: recommendations on the diagnostics and follow-up with special consideration to the occurrence of secondary chondrosarcoma]. Radiologe 2014; 53:1125-36. [PMID: 24129968 DOI: 10.1007/s00117-013-2571-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Osteochondroma represents the most common form of benign bone tumor. Clinical manifestations include deformity of bone, compression of surrounding tissue and vascular or neurological compromise. Osteochondromas may be solitary (solitary osteochondroma, SO) or multiple (multiple osteochondromas MO). Recurrence after surgery is a known problem especially in MO and malignant transformation is rare but more common in MO than in solitary cases. Reliable recommendations regarding diagnostics and clinical follow-up are currently lacking. PATIENTS AND METHODS A comprehensive literature review and a review of own patient files with SO/MO treated between 2000 and 2011 in this hospital were performed. The age of patients at diagnosis, tumor localization, clinical aspects, recurrence and the risk of malignant transformation in secondary (i.e. epiexostotic) chondrosarcoma were analyzed. The follow-up including patients who received surgery ranged between 2 and 127 months for patients with SO and between 2 and 84 months for MO. RESULTS A total of 39 patients with SO from this hospital were included in the study. Out of 36 patients who received surgery 3 recurrences were registered after an average time of 62 months. In addition, 11 patients with MO were identified and all received surgery. In 5 out of 11 cases recurrences occurred after an average time of 20.6 months. Secondary chondrosarcomas were not recorded in this series. According to the literature an increased risk of malignant transformation was found for osteochondromas of the axial skeleton, in the proximal aspect of the extremities, as well as for recurrent tumors and for MO. Pain and/or increase in size of lesions after skeletal maturation were the most common clinical signs of transformation. There was a wide time interval between the initial diagnosis and the development of secondary chondrosarcoma. In MO secondary chondrosarcoma has been described before skeletal maturity. CONCLUSIONS The risk of malignant transformation of SO is generally low. Axial lesions as well as recurrent osteochondromas and MO seem to have an increased risk of malignant transformation. The follow-up, requiring sufficient primary diagnostics, includes regular self-control and can usually be clinically carried out in more peripherally located lesions but in certain cases supplementary X-ray imaging is needed. In cases of anatomical regions which are more difficult to access manually, follow-up examination by magnetic resonance imaging (MRI) is the method of choice. Especially MO patients seem to benefit from long-term follow-up: when the tumor is located in the trunk and in (proximal) long bones MRI or whole-body MRI, respectively, should be performed once a year after skeletal maturity because of the higher risk of malignant transformation in these patients.
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Affiliation(s)
- G W Herget
- Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland,
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Fitzgerald CWR, Rowan FE, O'Neill SC, Mulhall KJ. A mountain among molehills: removing an impinging large femoral neck osteochondroma in a man with hereditary multiple exostoses. BMJ Case Rep 2014; 2014:bcr2013202317. [PMID: 24408944 PMCID: PMC3902964 DOI: 10.1136/bcr-2013-202317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 31-year-old man with a history of hereditary multiple exostoses (HME) presented with persistent right groin pain and reduced hip range of movement. Examination demonstrated a positive FADIR (flexion, adduction and internal rotation) test suggesting femoroacetabular impingement (FAI). Investigations showed multiple sessile osteochondromata of the right femur with a dominant anterolateral femoral neck osteochondroma causing flexion block. The patient underwent an uncomplicated proximal femoral exostectomy. Six-week postoperative pain, range of movement and daily activity had greatly improved. This case highlights that even in the setting of multiple osteochondromata, excellent impingement relief can be achieved following selective proximal femoral exostectomy.
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Affiliation(s)
- Conall W R Fitzgerald
- Department of Trauma and Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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40
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Spinal exostosis in a boy with multiple hereditary exostoses. Case Rep Orthop 2013; 2013:758168. [PMID: 24324905 PMCID: PMC3844191 DOI: 10.1155/2013/758168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
We report on a 13-year-old boy who presented with multiple hereditary exostosis and had development of back pain, associated with neurological deficits, and was found to have exostoses in the spinal canal. Spine radiograph showed a cauliflower-like abnormality of multiple exostoses of the posterior arch (pedicle) of the thoracic vertebrae (T3-5). Reformatted CT scanning revealed the simultaneous development of intra- and extraspinal osteochondromatosis of T3-5. The spinal cord was compressed by the intraspinal exostosis. Our patient was surgically treated for intraspinal exostoses and showed cessation of neurological deficits. We report what might be a rare association of spinal cord compression in a patient with multiple hereditary exostoses.
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Zhang F, Liang J, Guo X, Zhang Y, Wen Y, Li Q, Zhang Z, Ma W, Dai L, Liu X, Yang L, Wang J. Exome sequencing and functional analysis identifies a novel mutation in EXT1 gene that causes multiple osteochondromas. PLoS One 2013; 8:e72316. [PMID: 24009674 PMCID: PMC3757002 DOI: 10.1371/journal.pone.0072316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022] Open
Abstract
Multiple osteochondromas (MO) is an inherited skeletal disorder, and the molecular mechanism of MO remains elusive. Exome sequencing has high chromosomal coverage and accuracy, and has recently been successfully used to identify pathogenic gene mutations. In this study, exome sequencing followed by Sanger sequencing validation was first used to screen gene mutations in two representative MO patients from a Chinese family. After filtering the data from the 1000 Genome Project and the dbSNP database (build 132), the detected candidate gene mutations were further validated via Sanger sequencing of four other members of the same MO family and 200 unrelated healthy subjects. Immunohistochemisty and multiple sequence alignment were performed to evaluate the importance of the identified causal mutation. A novel frameshift mutation, c.1457insG at codon 486 of exon 6 of EXT1 gene, was identified, which truncated the glycosyltransferase domain of EXT1 gene. Multiple sequence alignment showed that codon 486 of EXT1 gene was highly conserved across various vertebrates. Immunohistochemisty demonstrated that the chondrocytes with functional EXT1 in MO were less than those in extragenetic solitary chondromas. The novel c.1457insG deleterious mutation of EXT1 gene reported in this study expands the causal mutation spectrum of MO, and may be helpful for prenatal genetic screening and early diagnosis of MO.
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Affiliation(s)
- Feng Zhang
- Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Faculty of Public Health, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | | | - Xiong Guo
- Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Faculty of Public Health, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- * E-mail: (XG); (JW)
| | - Yingang Zhang
- Department of Orthopedics, First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yan Wen
- Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Faculty of Public Health, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Qiang Li
- Department of Orthopedics, First People’s Hospital of Longxi County, Gansu, China
| | - Zengtie Zhang
- Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Faculty of Public Health, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Weijuan Ma
- Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Faculty of Public Health, College of Medicine, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | | | | | | | - Jun Wang
- BGI-Shenzhen, Shenzhen, China
- Department of Biology, University of Copenhagen, Copenhagen, Denmark
- King Abdulaziz University, Jeddah, Saudi Arabia
- * E-mail: (XG); (JW)
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Kelleher FC, Cain JE, Healy JM, Watkins DN, Thomas DM. Prevailing importance of the hedgehog signaling pathway and the potential for treatment advancement in sarcoma. Pharmacol Ther 2012; 136:153-68. [PMID: 22906929 DOI: 10.1016/j.pharmthera.2012.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 12/19/2022]
Abstract
The hedgehog signaling pathway is important in embryogenesis and post natal development. Constitutive activation of the pathway due to mutation of pathway components occurs in ~25% of medulloblastomas and also in basal cell carcinomas. In many other malignancies the therapeutic role for hedgehog inhibition though intriguing, based on preclinical data, is far from assured. Hedgehog inhibition is not an established part of the treatment paradigm of sarcoma but the scientific rationale for a possible benefit is compelling. In chondrosarcoma there is evidence of hedgehog pathway activation and an ontologic comparison between growth plate chondrocyte differentiation and different chondrosarcoma subtypes. Immunostaining epiphyseal growth plate for Indian hedgehog is particularly positive in the zone of pre-hypertrophic chondrocytes which correlates ontologically with conventional chondrosarcoma. In Ewing sarcoma/PNET tumors the Gli1 transcription factor is a direct target of the EWS-FLI1 oncoprotein present in 85% of cases. In many cases of rhabdomyosarcomas there is increased expression of Gli1 (Ragazzini et al., 2004). Additionally, a third of embryonal rhabdomyosarcomas have loss of Chr.9q22 that encompasses the patched locus (Bridge et al., 2000). The potential to treat osteosarcoma by inhibition of Gli2 and the role of the pathway in ovarian fibromas and other connective tissue tumors is also discussed (Nagao et al., 2011; Hirotsu et al., 2010). Emergence of acquired secondary resistance to targeted therapeutics is an important issue that is also relevant to hedgehog inhibition. In this context secondary resistance of medulloblastomas to treatment with a smoothened antagonist in two tumor mouse models is examined.
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Affiliation(s)
- Fergal C Kelleher
- Sarcoma Service, Peter MacCallum Cancer Centre, 12 St. Andrew's Place, A'Beckitt Street, Melbourne, Victoria, Australia.
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Franchi A. Epidemiology and classification of bone tumors. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2012; 9:92-95. [PMID: 23087718 PMCID: PMC3476517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Primary bone tumors are uncommon and this has certainly contributed to the scarcity of data about their relative frequency, and to the limited understanding of the risk factors. Overall, bone sarcomas account for 0.2% of all malignancies, and the adjusted incidence rate for all bone and joint malignancies is 0.9 per 100,000 persons per year, while the 5-year overall survival rate is 67.9%. The age specific incidence rates of bone sarcomas show a bimodal distribution, with a first peak occurring in the second decade, and a second peak occurring in patients older than sixty, in relation with the age distribution of the main histological subtypes. Several bone tumor types occur in the setting of inherited syndromes, while some other develop in association with non-neoplastic precursors or in the setting of previous benign tumors. In recent years, significant advances have occurred in the molecular and cytogenetic characterization of benign and malignant bone tumors. The detection of clonal chromosomal aberrations, specific molecular genetic changes, and the identification of growth related tumor cell signaling pathways have resulted in a better understanding of the pathogenesis of several neoplastic entities, and have provided the basis for an improvement in the diagnostic workup and differential diagnosis of several bone tumors presenting with overlapping clinical, radiological and pathological features, as well as for the identification of new prognostic factors and therapeutic targets.
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Affiliation(s)
- Alessandro Franchi
- Address for correspondence: Alessandro Franchi, MD, Division of Anatomic Pathology, Department of Critical Care Medicine and Surgery, University of Florence, Largo Brambilla 3, 50134, Florence, Italy, Phone: +39 055 4478102, Fax: + 39 055 4379868, E-mail:
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Lotfinia I, Vahedi P, Tubbs RS, Ghavame M, Meshkini A. Neurological manifestations, imaging characteristics, and surgical outcome of intraspinal osteochondroma. J Neurosurg Spine 2010; 12:474-89. [PMID: 20433295 DOI: 10.3171/2009.11.spine0980] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECT Spinal osteochondromas (OCs) are rare and can originate as solitary lesions or in the context of hereditary multiple exostoses. Concurrent spinal cord compression is a very rare entity. The purpose of this study was to evaluate the authors' 10-year experience with the imaging characteristics and surgical outcome in patients with symptomatic spinal OC. METHODS Between 1997 and 2007, 8 consecutive cases of symptomatic intraspinal OC with documented spinal cord compression were treated surgically. These patients were analyzed with regard to presentation, imaging, and outcome. The relevant English literature was reviewed using MEDLINE and Google search engines. RESULTS Three patients had cervical, 2 had thoracic, and 3 had lumbar lesions. Classic MR imaging characteristics were rarely found. Multiple hereditary exostoses were equally responsible for cervical, thoracic, and lumbar lesions (33%). The origin of the lesion was from the pedicle (25%), lamina (25%), vertebral body (25%), and superior or inferior facets (25%). A posterior approach to the spine was used in 6 patients, and a combined anterior and posterior approach with fusion was performed for 2 thoracic lesions. Surgical outcome was satisfactory in 75% of patients. The prognosis was poor in the patients with thoracic lesions. CONCLUSIONS In the authors' experience, early detection and surgical removal in cases of symptomatic spinal OC is a key element for the best outcome. Posterior approaches are generally sufficient. The chronicity of symptoms may limit functional recovery postoperatively, especially with cervical and thoracic lesions.
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Affiliation(s)
- Iraj Lotfinia
- Department of Neurosurgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Malignant progression in two children with multiple osteochondromas. Sarcoma 2010; 2010:417105. [PMID: 20467466 PMCID: PMC2866243 DOI: 10.1155/2010/417105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 03/03/2010] [Indexed: 11/17/2022] Open
Abstract
Multiple Osteochondromas (MO) is a disease of benign bony growths with a low incidence of malignant transformation. Secondary chondrosarcoma in children is rare even in children with MO. Making a diagnosis of malignancy in low-grade cartilage tumors is challenging and requires consideration of clinical, radiographic, and histopathological factors. We report two cases of skeletally immature patients with MO who presented with rapidly enlarging and radiographically aggressive lesions consistent with malignant transformation. Both underwent allograft reconstruction of the involved site with no signs of recurrence or metastatic disease at a minimum of four-year follow-up.
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Abstract
Benign cartilaginous tumors of bones, intrinsic to their name, are tumors forming cartilaginous matrix with a clinically benign behavior. In this group, we recognize osteochondromas, (en)chondromas, chondroblastomas, and chondromyxoid fibromas. This group includes common tumors, that is, osteochondroma and (en)chondroma as well as rare tumors such as chondroblastoma and chondromyxoid fibroma. Several benign and malignant tumors may mimic benign cartilaginous tumors of bones. We reviewed the main morphologic features and the differential diagnosis is discussed. The genetics of these tumors is intriguing ranging from single gene event (ie, EXT mutation in multiple osteochondromas) to heterogeneous rearrangements with no recurrent involved chromosomal regions such as in chondroblastoma. The main genetic findings are hereby reviewed.
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49
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Heinritz W, Hüffmeier U, Strenge S, Miterski B, Zweier C, Leinung S, Bohring A, Mitulla B, Peters U, Froster UG. New Mutations ofEXT1andEXT2Genes in German Patients with Multiple Osteochondromas. Ann Hum Genet 2009; 73:283-91. [DOI: 10.1111/j.1469-1809.2009.00508.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Abstract
Multiple osteochondromas (MO) is characterised by development of two or more cartilage capped bony outgrowths (osteochondromas) of the long bones. The prevalence is estimated at 1:50,000, and it seems to be higher in males (male-to-female ratio 1.5:1). Osteochondromas develop and increase in size in the first decade of life, ceasing to grow when the growth plates close at puberty. They are pedunculated or sessile (broad base) and can vary widely in size. The number of osteochondromas may vary significantly within and between families, the mean number of locations is 15-18. The majority are asymptomatic and located in bones that develop from cartilage, especially the long bones of the extremities, predominantly around the knee. The facial bones are not affected. Osteochondromas may cause pain, functional problems and deformities, especially of the forearm, that may be reason for surgical removal. The most important complication is malignant transformation of osteochondroma towards secondary peripheral chondrosarcoma, which is estimated to occur in 0.5-5%. MO is an autosomal dominant disorder and is genetically heterogeneous. In almost 90% of MO patients germline mutations in the tumour suppressor genes EXT1 or EXT2 are found. The EXT genes encode glycosyltransferases, catalyzing heparan sulphate polymerization. The diagnosis is based on radiological and clinical documentation, supplemented with, if available, histological evaluation of osteochondromas. If the exact mutation is known antenatal diagnosis is technically possible. MO should be distinguished from metachondromatosis, dysplasia epiphysealis hemimelica and Ollier disease. Osteochondromas are benign lesions and do not affect life expectancy. Management includes removal of osteochondromas when they give complaints. Removed osteochondromas should be examined for malignant transformation towards secondary peripheral chondrosarcoma. Patients should be well instructed and regular follow-up for early detection of malignancy seems justified. For secondary peripheral chondrosarcoma, en-bloc resection of the lesion and its pseudocapsule with tumour-free margins, preferably in a bone tumour referral centre, should be performed.
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Affiliation(s)
- Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
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