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Castelo F, Faria A, Miranda H, Oliveira V, Cardoso P. Curettage or Resection? A Review on the Surgical Treatment of Low-Grade Chondrosarcomas. Cureus 2023; 15:e39637. [PMID: 37388578 PMCID: PMC10305787 DOI: 10.7759/cureus.39637] [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: 05/29/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Low-grade chondrosarcomas (LG-CS), including atypical cartilaginous tumors (ACT), are locally aggressive lesions. The focus of the discussion sits on the differential diagnosis between benign lesions or aggressive cartilaginous tumors and on their treatment: intralesional curettage or wide resection. This study presents the results obtained in the surgical treatment of 21 cases of LG-CS. Methods This retrospective study includes 21 consecutive patients from a single center with LG-CS who underwent surgery from 2013 to 2021. Fourteen were located in the appendicular skeleton, and seven in the axial (shoulder blade, spine, or pelvis). Mortality rate, recurrence, metastatic disease, overall survival, recurrence-free survival, and metastatic disease-free survival were analyzed for each type of procedure and each disease location. Operative complications and residual tumors were also recorded in cases where resection was performed. Survival was calculated using the Kaplan-Meier method. Results Thirteen patients underwent intralesional curettage (11 appendicular and 2 axial lesions), and eight underwent wide resection (5 axial and 3 appendicular). There were six recurrences during the follow-up, 43% of the axial lesions recurred, rising to 100% in axial curetted ones. Appendicular LG-CS recurred in 21% of cases, and only 18% of curetted appendicular lesions were not eradicated. The overall survival for the entire follow-up is 90.5%, and the 5-year survival rate is 83% (12 patients have adequate follow-up). Recurrence-free and metastasis-free survival were higher in resection cases, with 75% and 87.5%, vs. curettage 69.2% and 76.9%, respectively. In 9% of cases, the preoperative biopsy was inconsistent with the pathology of the surgical specimen. Discussion LG-CS and ACT are described as having high survival and low potential for metastatic disease. For this reason, these lesions are subject to a change in treatment philosophy to reflect these characteristics. Intra-lesional curettage is advocated as a less invasive technique for eradicating atypical cartilage tumors and has fewer and less severe complications, which was in accordance with our findings. Diagnosis, however, is challenging; misgrading is frequent and should be considered. Because of this risk of under-treating higher-grade lesions, some authors still defend wide-resection as the treatment of choice. We observed a trend towards longer survival, less recurrence, and metastatic disease with wide resection. Metastatic disease was higher than expected, present in 19% of cases, and always associated with local recurrence. Conclusion LG-CS is still a diagnostic and treatment challenge; patient selection is fundamental. Overall survival is high, independent of treatment choice or lesion location. We found a higher rate of metastatic disease than described in the literature; this, coupled with a misgrading rate of 9%, reflects the difficulty of preoperative diagnosis and the risk of treating high-grade chondrosarcomas as a low-grade lesion. More studies should be carried out with larger samples to obtain statistically robust results.
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Affiliation(s)
- Filipe Castelo
- Orthopaedics and Trauma, Centro Hospitalar Universitário de Santo António, Porto, PRT
- Orthopaedics and Trauma, Centro Hospitalar Universitário Cova da Beira, Covilhã, PRT
| | - Afonso Faria
- Orthopaedics and Trauma, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Hugo Miranda
- Oncology, Centro Hospitalar Universitário de Santo António, Porto, PRT
- Oncology, Unit for Multidisciplinary Research in Biomedicine, ICBAS-UP, Porto, PRT
| | - Vânia Oliveira
- Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Pedro Cardoso
- Orthopaedics, Centro Hospitalar Universitário de Santo António, Porto, PRT
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Bone and soft tissue tumors at the borderlands of malignancy. Skeletal Radiol 2023; 52:379-392. [PMID: 35767018 DOI: 10.1007/s00256-022-04099-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 02/02/2023]
Abstract
This review examines findings of musculoskeletal neoplasms whose equivocal imaging and/or histopathologic features make it difficult to determine if they will show aggressive behavior. We include both intermediate tumors as defined by the World Health Organization (WHO), and a single low-grade malignancy, low-grade central osteosarcoma, which mimics a benign lesion on imaging and histology. Intermediate tumors are a broad category and are subdivided into tumors that have risk of local recurrence only, and ones that have a risk of distant limb and pulmonary metastases. Difficult intermediate musculoskeletal lesions include atypical cartilaginous tumor/grade 1 chondrosarcoma, atypical lipomatous tumor/grade 1 liposarcoma, and solitary fibrous tumor. We review diagnostic criteria, differential diagnosis, and recommendations for surveillance.
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Kinoshita H, Kamoda H, Hagiwara Y, Kinoshita S, Ohtori S, Yonemoto T. Prognostic Factors for Survival in Patients With High-grade Chondrosarcoma. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:681-685. [PMID: 36340450 PMCID: PMC9628161 DOI: 10.21873/cdp.10159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND/AIM Chondrosarcoma (CS) is a rare primary malignant bone tumor, which is the second most common tumor after osteosarcoma. Since chemotherapy and radiotherapy have poor efficacy for CS, amputation or surgical wide resection is the main strategy for localized high-grade CS, making CS therapy difficult. As studies on high-grade CS are limited owing to its rare nature, there are many unknown prognostic factors for survival. PATIENTS AND METHODS This retrospective cohort study included 44 patients with high-grade CS who underwent surgery at a single institution. Overall survival (OS), distant failure-free survival (DFFS), and local failure-free survival (LFFS) were evaluated using the Kaplan-Meier method. Furthermore, we evaluated prognostic factors for survival in patients with high-grade CS using univariate and multivariate analyses. RESULTS The 5-year OS, LFFS, and DFFS rates of high-grade CS were 75.9%, 90.8%, and 66.5%, respectively. Univariate analysis revealed that tumor size, tumor grade, and surgical margin were significant prognostic factors for OS and DFFS, and distant metastasis was significantly associated with OS. Furthermore, the multivariate analysis indicated that the presence of local recurrence and distant metastasis was significantly associated with OS. CONCLUSION Local recurrence and distant metastasis were significant prognostic factors for high-grade CS.
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Affiliation(s)
| | - Hiroto Kamoda
- Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Yoko Hagiwara
- Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Seiko Kinoshita
- Laboratory of Oncogenomics, Chiba Cancer Center Research Institute, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsukasa Yonemoto
- Department of Orthopedic Surgery, Chiba Cancer Center, Chiba, Japan
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Görgün B, Kürşat Özşahin M, Tok O, Deniz Davulcu C, Karaismailoğlu B, Hız M, Hiz M. Intralesional curettage and cementation of low-grade chondrosarcomas of the appendicular skeleton: Long-term results from a single center. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2022; 56:402-407. [PMID: 36567544 PMCID: PMC9885716 DOI: 10.5152/j.aott.2022.22091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the results and complications in patients who had low-grade chondrosarcomas in the appendicular skeleton and were treated by intralesional curettage and cementation within the scope of 25 years of experience in a single center. METHODS Ninety-one patients (72 female and 19 male) were retrospectively analyzed. The median at the time of surgery was 43 (17-78) years, and the median follow-up was 102 (26-288) months. All patients were treated by intralesional curettage followed by cementation with high-viscosity bone cement (polymethylmethacrylate). Complications and local recurrence rates, as well as clinical outcome scores were recorded. RESULTS Five patients (5.49%) developed local recurrence at an average of 6.6 (6-9) months postoperatively. Four were treated with local wide excision and reconstruction with tumor prosthesis. One patient received recurettage and cementation. Two recurred patients were dedifferentiated into grade II chondrosarcomas in the last intervention. No major postoperative complication was identified in the series. Patients achieved an average Musculoskeletal Tumor Society scoring system of 92.4% (standard deviation 5.2; range 80-100) in the sixth postoperative month. Musculoskeletal Tumor Society scores in the recurrent patients decreased from an average of 90% to 75.3% after the final intervention. CONCLUSION Intralesional curettage and cementation seem safe and reliable techniques with low recurrence and complication rates in treating low-grade chondrosarcomas of the appendicular skeleton. Clinical, radiological, and pathological evaluations are mandatory before surgical intervention, and a multidisciplinary approach is crucial. A strict follow-up regimen in the early postoperative period is needed and strongly recommended to detect local recurrence. LEVEL OF EVIDENCE Level IV, Therapeutic Study.
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Affiliation(s)
- Barış Görgün
- Academy of Children Orthopaedics, İstanbul, Turkey,Corresponding author:Barış
| | - Mahmut Kürşat Özşahin
- Department of Orthopaedics and Traumatology, İstanbul University—Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbul, Turkey
| | - Okan Tok
- Private Practice, İstanbul, Turkey
| | - Cumhur Deniz Davulcu
- Department of Orthopaedics and Traumatology, İstanbul University—Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbul, Turkey
| | - Bedri Karaismailoğlu
- Department of Orthopaedics and Traumatology, İstanbul University—Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbul, Turkey
| | - Murat Hız
- Department of Orthopaedics and Traumatology, İstanbul University—Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbul, Turkey
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Haygood TM, Amini B. Chondroid Tumors of Bone. Semin Ultrasound CT MR 2021; 42:123-133. [PMID: 33814100 DOI: 10.1053/j.sult.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent scholarship on enchondroma, chondrosarcoma, and chondroblastoma is presented. The focus of this article is on the imaging appearance of these tumors and the means by which they can be distinguished from one another by both clinical and imaging criteria.
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Affiliation(s)
- Tamara Miner Haygood
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Behrang Amini
- Department of Musculoskeletal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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Cozma GV, Sima LV, Cloşca RM, Baderca F, Horhat ID, Balica NC, Tischer AA, Moţ IC, Maliţa DC, Marin A, Sarău CA. Conventional grade 1 chondrosarcoma: a challenging diagnosis with important implications on therapy and prognosis. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:605-613. [PMID: 35024752 PMCID: PMC8848212 DOI: 10.47162/rjme.62.2.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
Chondrosarcoma (CHS) is a malignant tumor of soft tissue with cartilaginous differentiation that represent one tenth of all malignant proliferations developed from bone tissues. Even if CHS represents the third malignancy with bone localization, after myeloma and osteosarcoma, it is far less diagnosed in the head and neck region. The current paper presented two cases of conventional CHSs, which were diagnosed in Department of Thoracic Surgery and Department of Otorhinolaryngology of Emergency City Hospital, Timişoara, Romania, between February and June 2021. The malignant cases were of peripheral CHSs, one of scapula, and the other one had an extremely rare tracheal location with microscopic features of conventional low-grade tumors (grade 1). In all cases, conservative surgical curative treatment was performed, with a favorable postoperative evolution.
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Affiliation(s)
- Gabriel Veniamin Cozma
- Department of Surgical Semiology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Laurenţiu Vasile Sima
- Department of Surgical Semiology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | | | - Flavia Baderca
- Service of Pathology, Emergency City Hospital, Timişoara, Romania
- Department of Microscopic Morphology, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Ioana Delia Horhat
- Department of ENT, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | | | | | - Ion Cristian Moţ
- Department of ENT, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Daniel Claudiu Maliţa
- Department of Radiology and Medical Imaging, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Aurel Marin
- PhD Student, Department of ENT, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristian Andrei Sarău
- Department of Medical Semiology I, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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The changing face of central chondrosarcoma of bone. One UK-based orthopaedic oncology unit's experience of 33 years referrals. J Clin Orthop Trauma 2021; 17:106-111. [PMID: 33747783 PMCID: PMC7972956 DOI: 10.1016/j.jcot.2021.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022] Open
Abstract
AIM To ascertain the changing incidence over time of the three commonest primary sarcomas of bone. Data obtained with particular reference to central chondrosarcoma from the annual referral rate to a large UK-based specialist orthopaedic oncology unit. To discuss how the "barnyard pen" analogy of cancers previously applied to certain commoner cancers can also be applicable to central chondrosarcoma (CS) of bone. MATERIALS AND METHODS A retrospective review was conducted of a computerised database identifying all central cartilage tumours (CCT) of bone, including enchondroma and CS subtypes, between 1985 and 2018. These were compared with the referrals of the other two commonest primary sarcomas of bone, osteosarcoma and Ewing sarcoma. RESULTS There was a total of 1507 CS showing a 68% overall increase in annual referral rate/incidence over the study period. 68% cases were the borderline malignant lesions now known as atypical cartilaginous tumour (ACT). The annual referral rate/incidence of this entity increased by 194% over the 30 years. Whereas, the annual referral rate/incidence for osteosarcoma and Ewing sarcoma was static for the past 20 years. CONCLUSION The annual incidence of central CS of bone showed a marked increase over the 33-year period as compared with both osteosarcoma and Ewing sarcoma. This is especially in the ACT category and is thought to be due to the increased provision of MRI scanning flagging up a rise in incidental findings. The spectrum of CCTs from benign to highly malignant elegantly fits the "barn yard" pen analogy and could prove useful as an explanatory tool for patients and clinicians unfamiliar with these diseases.
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The value of chest and skeletal staging studies in conventional chondrosarcoma. Skeletal Radiol 2021; 50:125-135. [PMID: 32666323 DOI: 10.1007/s00256-020-03539-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of chest and skeletal staging in patients presenting with conventional chondrosarcoma (CS). MATERIALS AND METHODS Retrospective review of patients with CS diagnosed between January 2007 and December 2019. Data collected included age, sex, skeletal location and results of chest CT and whole-body bone scintigraphy (WB-BSc) obtained at initial diagnosis. The histological tumour grade based on surgical resection or needle biopsy was classified as low-grade (LGCT), high-grade (HGCT) and dedifferentiated (DD-CS). Findings of chest CT and WB-BSc were correlated with tumour grade. RESULTS Four hundred twenty patients were included (234 males and 186 females with mean age 54.5 years, range 9-91 years). The major long bones were involved in 205 cases, the flat bones in 166 cases, the mobile spine in 14 cases and the small bones of the hands and feet in 35 cases. Three hundred fifty tumours were central in location, 39 peripheral and 31 on the surface of the bone. There were 151 LGCTs, 196 HGCTs and 73 DD-CSs. Of patients with LGCT, 41.7% underwent chest CT and 25.2% WB-BSc. Of patients with HGCT, 95.4% underwent chest CT and 76.5% WB-BSc. Of patients with DD-CS, 98.6% underwent chest CT and 86.3% WB-BSc. Metastases were diagnosed in 2 (3.3%) chest CT studies and 0 WB-BSc in LGCT, in 8 (4.3%) chest CT studies and 0 WB-BSc in HGCT and in 21 (30%) chest CT studies and 6 (21%) WB-BSc in DD-CS. DISCUSSION Staging chest CT and WB-BSc is of little or no value except in DD-CS.
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Parafioriti A, Cifola I, Gissi C, Pinatel E, Vilardo L, Armiraglio E, Di Bernardo A, Daolio PA, Felsani A, D’Agnano I, Berardi AC. Expression profiling of microRNAs and isomiRs in conventional central chondrosarcoma. Cell Death Discov 2020; 6:46. [PMID: 32566253 PMCID: PMC7287106 DOI: 10.1038/s41420-020-0282-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Conventional central chondrosarcoma (CCC) is a malignant bone tumor that is characterized by the production of chondroid tissue. Since radiation therapy and chemotherapy have limited effects on CCC, treatment of most patients depends on surgical resection. This study aimed to identify the expression profiles of microRNAs (miRNAs) and isomiRs in CCC tissues to highlight their possible participation to the regulation of pathways critical for the formation and growth of this type of tumor. Our study analyzed miRNAs and isomiRs from Grade I (GI), Grade II (GII), and Grade III (GIII) histologically validated CCC tissue samples. While the different histological grades shared a similar expression profile for the top abundant miRNAs, we found several microRNAs and isomiRs showing a strong different modulation in GII + GIII vs GI grade samples and their involvement in tumor biology could be consistently hypothesized. We then in silico validated these differently expressed miRNAs in a larger chondrosarcoma public dataset and confirmed the expression trend for 17 out of 34 miRNAs. Our results clearly suggests that the contribution of miRNA deregulation, and their targeted pathways, to the progression of CCC could be relevant and strongly indicates that when studying miRNA deregulation in tumors, not only the canonical miRNAs, but the whole set of corresponding isomiRs should be taken in account. Improving understanding of the precise roles of miRNAs and isomiRs over the course of central chondrosarcoma progression could help identifying possible targets for precision medicine therapeutic intervention.
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Affiliation(s)
- Antonina Parafioriti
- Pathology Department, Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Ingrid Cifola
- Institute for Biomedical Technologies (ITB), CNR, Segrate, Italy
| | - Clarissa Gissi
- U.O.C. of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Eva Pinatel
- Institute for Biomedical Technologies (ITB), CNR, Segrate, Italy
| | - Laura Vilardo
- Institute for Biomedical Technologies (ITB), CNR, Segrate, Italy
| | - Elisabetta Armiraglio
- Pathology Department, Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | - Andrea Di Bernardo
- Pathology Department, Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| | | | - Armando Felsani
- Institute of Biochemistry and Cell Biology (IBBC), CNR, Monterotondo, Italy
- Genomnia Srl, Bresso, Italy
| | - Igea D’Agnano
- Institute for Biomedical Technologies (ITB), CNR, Segrate, Italy
| | - Anna Concetta Berardi
- U.O.C. of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
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