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Majd N, Theriault RV, Darrow MA, Thorpe SW, Chen DC. Osteochondroma-like parosteal osteosarcoma: A case highlighting diagnostic challenge and surgical advances. Radiol Case Rep 2024; 19:4091-4099. [PMID: 39104452 PMCID: PMC11298835 DOI: 10.1016/j.radcr.2024.06.045] [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] [Received: 12/18/2023] [Revised: 06/11/2024] [Accepted: 06/15/2024] [Indexed: 08/07/2024] Open
Abstract
Parosteal osteosarcomas are uncommon malignant bone tumors that arise from the bone surface. Their heterogenous components can present challenges in diagnosis. We present a case of a rare variant of this tumor known as an osteochondroma-like parosteal osteosarcoma, which was initially misdiagnosed as a cartilaginous tumor on core needle biopsy. Surgical resection of the tumor ultimately allowed for definitive diagnosis. Our case demonstrates the limitations of needle biopsy in diagnosing variants of parosteal osteosarcoma and the vital role of multidisciplinary discussions in guiding diagnosis and treatment. Furthermore, our case utilizes 3-dimensional printing technology in the surgical treatment, and illustrates the recent advances in patient-specific surgical techniques.
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Affiliation(s)
- Naveed Majd
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Raminta V. Theriault
- Department of Orthopedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
- Department of Orthopedic Surgery, Ochsner Medical Center, 1515 River Road, Jefferson, LA 70121, USA
| | - Morgan A. Darrow
- Department of Pathology, University of California Davis Medical Center, 4400 V Street, Sacramento, CA 95817, USA
| | - Steven W. Thorpe
- Department of Orthopedic Surgery, University of California Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA
| | - Dillon C. Chen
- Department of Radiology, University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
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Sampath K, Rajagopal S, Chintanpalli A. A comparative analysis of CNN-based deep learning architectures for early diagnosis of bone cancer using CT images. Sci Rep 2024; 14:2144. [PMID: 38273131 PMCID: PMC10811327 DOI: 10.1038/s41598-024-52719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024] Open
Abstract
Bone cancer is a rare in which cells in the bone grow out of control, resulting in destroying the normal bone tissue. A benign type of bone cancer is harmless and does not spread to other body parts, whereas a malignant type can spread to other body parts and might be harmful. According to Cancer Research UK (2021), the survival rate for patients with bone cancer is 40% and early detection can increase the chances of survival by providing treatment at the initial stages. Prior detection of these lumps or masses can reduce the risk of death and treat bone cancer early. The goal of this current study is to utilize image processing techniques and deep learning-based Convolution neural network (CNN) to classify normal and cancerous bone images. Medical image processing techniques, like pre-processing (e.g., median filter), K-means clustering segmentation, and, canny edge detection were used to detect the cancer region in Computer Tomography (CT) images for parosteal osteosarcoma, enchondroma and osteochondroma types of bone cancer. After segmentation, the normal and cancerous affected images were classified using various existing CNN-based models. The results revealed that AlexNet model showed a better performance with a training accuracy of 98%, validation accuracy of 98%, and testing accuracy of 100%.
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Affiliation(s)
- Kanimozhi Sampath
- Department of Sensor and Biomedical Technology, School of Electronics Engineering, Vellore Institute of Technology, Vellore, 632014, India
| | - Sivakumar Rajagopal
- Department of Sensor and Biomedical Technology, School of Electronics Engineering, Vellore Institute of Technology, Vellore, 632014, India.
| | - Ananthakrishna Chintanpalli
- Department of Communication Engineering, School of Electronics Engineering, Vellore Institute of Technology, Vellore, 632014, India
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An update on the imaging of diaphyseal aclasis. Skeletal Radiol 2021; 50:1941-1962. [PMID: 33791832 DOI: 10.1007/s00256-021-03770-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
Solitary osteochondromas are common, benign hyaline cartilage-capped exostoses that primarily arise from the metaphyses of long and flat bones. Diaphyseal aclasis is an autosomal dominant condition resulting from EXT1 or EXT2 gene mutations and is characterized by multifocal osteochondromas. These can result in a wide spectrum of complications, such as skeletal deformity, neurological and vascular complications, adventitial bursa formation, fracture, and rarely malignant transformation to peripheral chondrosarcoma. In this review, we outline in detail the multimodality imaging features of DA and its associated complications.
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Motififard M, Hatami S, Jamalipour Soufi G. Periosteal chondroma of pelvis - an unusual location. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2020; 10:174-180. [PMID: 32934873 PMCID: PMC7486565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Periosteal chondroma is a slow growing benign tumor with prevalence rate of less than 2% of all chondromas. This tumor is mostly observed in clavicle, ribs and humerus and only one previous case has been reported in pelvis. Here we present an unusual case of periosteal chondroma due to uncommon presentation, location and age range. Our case is a 39 year-old male diagnosed with periosteal chondroma in pelvis. He had unspecific signs and symptoms overlapping with low back pain and disk herniation. By the time of admission he had gluteal muscle atrophy and also claudication. Differentiation of periosteal chondroma from other malignant tumors are pivotal in order to prevent aggressive and inappropriate therapies. He underwent surgical procedures and periosteal chondroma was ascertained by both radiological and Histopathological evidence. 6 months after surgery, he declared no pain, he was able to walk freely. He claimed partial paresthesia but he also declared that his paresthesia has ameliorated.
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Affiliation(s)
- Mehdi Motififard
- Associate Professor of Orthopaedics, Department of Orthopedic Surgery, School of Medicine, Kashani Hospital, Isfahan University of Medical SciencesIsfahan, Iran
| | - Saeed Hatami
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
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A rare case of juxtacortic chondromyxoid fibroma in proximal humerus. TRANSLATIONAL RESEARCH IN ANATOMY 2020. [DOI: 10.1016/j.tria.2020.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Parosteal Osteosarcoma: A Benign-Looking Tumour, Amenable to a Variety of Surgical Reconstruction. Int J Surg Oncol 2020; 2020:4807612. [PMID: 32550023 PMCID: PMC7275216 DOI: 10.1155/2020/4807612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/27/2020] [Indexed: 12/01/2022] Open
Abstract
Osteosarcoma arising from cortical surface is classified into parosteal, periosteal and high-grade surface osteosarcoma. Along the spectrum, parosteal osteosarcoma occupies the well-differentiated end. It is a relatively rare disease entity, comprised only 4% of all osteosarcomas and barely reported in the literature. The objective of this study is to describe cases of parosteal osteosarcoma as well as a variety of treatment options amenable to such entity. Six cases of parosteal osteosarcoma were identified based on histopathological reports in a tertiary referral hospital in Jakarta, Indonesia between January 2001 and December 2019. The mean age was 29.8 years old; four of them (66.7%) were male. Distal end of femur was the most commonly involved bone (five cases, 83.3%). The patients were treated with wide excision followed by several different reconstruction methods: replacement with endoprosthesis, extracorporeal irradiation, knee arthrodesis, or prophylactic fixation. One of our patients presented with dedifferentiated component, and therefore was treated by limb ablation. While two cases died of pulmonary metastasis, other patients reported fair to excellent functional outcome.
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Hansford BG, Pytel P, Moore DD, Stacy GS. Osteoma of long bone: an expanding spectrum of imaging findings. Skeletal Radiol 2015; 44:755-61. [PMID: 25380570 DOI: 10.1007/s00256-014-2046-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/19/2014] [Accepted: 10/24/2014] [Indexed: 02/02/2023]
Abstract
Osteoma of long bone is an extremely rare, benign bone-forming surface lesion with the largest published case series consisting of only 14 patients. The most important and often most difficult lesion to differentiate from osteoma of long bone radiographically is parosteal osteosarcoma, which is a rare, low-grade surface osteosarcoma with the potential for dedifferentiation. Reports of imaging studies of osteoma of long bone depict a well-defined ossified mass arising from the surface of the diaphysis or metadiaphysis of a long bone. A characteristic feature is the homogeneity of the mass, with uniform density near or equal to that of cortical bone from the base of the lesion to its periphery. The 45-year-old female in this case presented with left hip fullness and was subsequently found to have a proximal femoral osteoma, which was unique in that it contained large fatty marrow spaces that corresponded to bands of relatively low density on plain radiography and computed tomography, giving it a heterogeneous appearance atypical of osteoma of long bone. Furthermore, the osteoma reported here was associated with a small but separate nodular focus of ossification in the adjacent soft tissue. These findings led to a presumptive diagnosis of parosteal osteosarcoma with a local soft tissue metastasis or satellite nodule resulting in radical resection of the tumor. Definitive diagnosis of osteoma was made on histology of both the parent lesion and ossified nodule as no neoplastic spindle cell proliferation was present to establish a diagnosis of low-grade osteosarcoma. This represents, to the best of our knowledge, the first such presentation of osteoma of long bone.
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Affiliation(s)
- Barry Glenn Hansford
- University of Chicago Medicine, 5841 South Maryland Ave, MC 526, Chicago, IL, 60637, USA,
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Sinelnikov A, Kale H. Osteochondromas of the spine. Clin Radiol 2014; 69:e584-90. [PMID: 25282617 DOI: 10.1016/j.crad.2014.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/16/2014] [Accepted: 08/22/2014] [Indexed: 12/30/2022]
Abstract
Osteochondromas are common developmental benign bone lesions, which rarely involve the spine. In a narrow space, such as the spinal canal, they may potentially lead to serious complications. Moreover, because this condition is fairly rare in the spine, it may be confused with other entities. The objective of this review is to describe the typical imaging findings of this rare, but occasionally significant condition of the spine.
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Affiliation(s)
- A Sinelnikov
- Department of Radiology, Neuroradiology Division, University of Pittsburgh Medical Center, Presby South Tower, Suite 3950, 200 Lothrop St, Pittsburgh, PA 15213, USA
| | - H Kale
- Department of Radiology, Neuroradiology Division, University of Pittsburgh Medical Center, Presby South Tower, Suite 3950, 200 Lothrop St, Pittsburgh, PA 15213, USA.
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Seo SG, Sung KH, Chung CY, Lee KM, Lee SY, Choi Y, Kim TG, Baek JK, Kwon SS, Kwon DG, Choi IH, Cho TJ, Yoo WJ, Park MS. Incidental findings on knee radiographs in children and adolescents. Clin Orthop Surg 2014; 6:305-11. [PMID: 25177456 PMCID: PMC4143518 DOI: 10.4055/cios.2014.6.3.305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022] Open
Abstract
Background Despite the wide use of knee radiography in children and adolescent patients visiting the outpatient clinic, there has been no analysis about the prevalence and type of incidental findings yet. This study was performed to investigate the incidental findings on knee radiographs in children and adolescents according to age. Methods A total of 1,562 consecutive patients younger than 18 years of age were included. They who visited Seoul National University Bundang Hospital's outpatient clinic with a chief complaint of knee pain or malalignment between 2010 and 2011. We reviewed the knee radiographs and analyzed the prevalence and type of incidental findings, such as metaphyseal lucent area, epiphyseal cortical irregularity, osteochondroma and Harris growth arrest line. Results The mean age of the patients was 10.2 years (range, 1 month to 18 years). We identified 355 incidental findings in 335 patients (21.4%) and 98 abnormal findings (6.3%). The most common incidental finding was metaphyseal lucent area (131, 8.4%), followed by epiphyseal cortical irregularity (105, 6.7%), Harris growth arrest line (75, 4.8%), and osteochondroma (44, 2.8%). An epiphyseal cortical irregularity tended to have a higher prevalence at younger age (p < 0.001) and the prevalences of metaphyseal lucent area and Harris growth arrest line were also higher at a younger age (p = 0.001 and p < 0.001, respectively). However, the osteochondroma tended to have a higher prevalence at an older age (p = 0.004). Conclusions This study describes the incidental findings on knee radiographs in children and adolescents and provides effective information from a viewpoint of an orthopedic doctor. The authors recommend considering those incidental findings if unfamiliar findings appear on a knee radiograph in the pediatric outpatient clinic.
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Affiliation(s)
- Sang Gyo Seo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Chin Youb Chung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Yeol Lee
- Department of Orthopaedic Surgery, Myongji Hospital, Goyang, Korea
| | - Young Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Gyun Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Kook Baek
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon-Sun Kwon
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dae Gyu Kwon
- Department of Orthopedic Surgery, Inha University Hospital, Incheon, Korea
| | - In Ho Choi
- Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Tae-Joon Cho
- Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Won Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
Parosteal osteosarcoma is a rare malignant bone tumor arising from the bone cortical surface. It most commonly occurs in young women over the metaphyseal region, especially the long bones near the knee joint. Patients usually report a slow-growing mass for years. The tumor is characterized by its bland microscopic morphology, prone to be misdiagnosed as other benign tumors. In the absence of dedifferentiation, the prognosis is generally better than that of conventional osteosarcoma. Recent studies demonstrated distinctive cytogenetic abnormality resulting in amplification of the CDK4 and MDM2 genes, which may serve as markers for molecular diagnosis. In this article, we review the clinical, radiologic, and pathologic features of parosteal osteosarcoma and identify some diagnostic pitfalls, discuss the prognostic variables, and update recent molecular advances and their application in the diagnosis.
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Affiliation(s)
- Jen-Fan Hang
- From the Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Paul Chih-Hsueh Chen
- From the Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Abstract
Osteosarcoma (OS), the commonest malignancy of osteoarticular origin, is a very aggressive neoplasm. Divergent histologic differentiation is common in OS; hence triple diagnostic approach is essential in all cases. 20% cases are atypical owing to lack of concurrence among clinicoradiologic and pathologic features necessitating resampling. Recognition of specific anatomic and histologic variants is essential in view of better outcome. Traditional prognostic factors of OS do stratify patients for short term outcome, but often fail to predict their long term outcome. Considering the negligible improvement in the patient outcome during the last 20 years, search for novel prognostic factors is in progress like ezrin vascular endothelial growth factor, chemokine receptors, dysregulation of various micro ribonucleic acid are potentially promising. Their utility needs to be validated by long term followup studies before they are incorporated in routine clinical practice.
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Affiliation(s)
- Neelam Wadhwa
- Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, New Delhi, India,Address for correspondence: Dr. Neelam Wadhwa, Department of Pathology, University College of Medical Sciences, University of Delhi, Shahdra, New Delhi - 110 095, India. E-mail:
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The importance of radiographic imaging in the microscopic assessment of bone tumors. Eur J Radiol 2013; 82:2100-14. [DOI: 10.1016/j.ejrad.2011.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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