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Kantiwal P, Yadav SK, Nalwa A, Rajnish RK. Primary Ewing's sarcoma of the talus. BMJ Case Rep 2023; 16:e258243. [PMID: 38061850 PMCID: PMC10711897 DOI: 10.1136/bcr-2023-258243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Ewing's sarcoma is a malignant round cell tumour of bones and soft tissues that usually arises from the diaphyseal or meta-diaphyseal parts of long bones and less commonly from flat bones. It occurs rarely in the foot and if occurs, the calcaneus and the metatarsals are commonly involved. We present a case of a young woman diagnosed with primary Ewing's sarcoma of the talus with local spread to adjacent tarsals and the ankle joint. Ewing's sarcoma of feet, if present with even a trivial suspicion of spread either locally or distant, makes limb salvage surgery difficult. So, the treatment with radical surgery or by combined chemotherapy and radiotherapy should be considered-keeping in mind the complex anatomy of the foot and the difficulty in achieving tumour-free margins. Based on this experience, she underwent below-knee amputation. The patient received adjuvant chemotherapy and survived with a disease-free survival at the latest follow-up of 1 year.
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Affiliation(s)
- Prabodh Kantiwal
- Department of Orthopedics, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan, India
| | - Sandeep Kumar Yadav
- Department of Orthopedics, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan, India
| | - Aasma Nalwa
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rajesh Kumar Rajnish
- Department of Orthopedics, All India Institute of Medical Sciences-Jodhpur, Jodhpur, Rajasthan, India
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Jalan D, Sreenivasan R, Prasad R, Singh DK, Jha AK. Ewing's Sarcoma of the Talus in an Adolescent Female: An Unusual Case Presentation With Review of Literature. Cureus 2022; 14:e30946. [DOI: 10.7759/cureus.30946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
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Abstract
BACKGROUND Surgical treatment is usually required for malignant foot and ankle tumors. In this study, we sought to review factors in treatment that may be associated with morbidity and mortality. METHODS All malignant foot and ankle tumors at our institution between April 1988 and April 2018 were retrospectively reviewed. The surgical modalities used and clinical outcomes of patients according to the anatomic location (Kirby zone) and clinical stage (Enneking system) of each tumor were described. Extent of surgical resection required, recurrence, and death rates were assessed. RESULTS Between April 1988 and April 2018, 80 patients with malignant tumors of the foot and ankle were treated at out institution. Mean age of patients was 42.6 (range, 3-89) years. Mean follow-up was 30.2 months (range, 24-120). Tumors were primary in 75 patients (94%) and metastatic from another organ in 5 patients (6%). Tumors originated from bone in 18 patients (22%) and from soft tissue in 63 patients (78%). Synovial sarcoma was the most common soft tissue tumor, and osteosarcoma was the most common osseous tumor.All patients had surgery to resect their tumor. Twenty-one (26%) had unplanned surgical procedures without initial biopsy at an outside institution prior to referral. Those patients were more likely to be treated with amputation or wide excison and free flap surgery (P < .01). The recurrence rate was 50% for the unplanned surgery group and 22% for the planned surgery group. Mortality rate was 10% for the unplanned group and 6% for the planned group. The recurrence and mortality rate was higher in the unplanned group (P = .03). CONCLUSION Our study suggests that unplanned initial surgeries are associated with higher recurrence and mortality rates and reinforces the notion that these patients should be referred for treatment at a center with specialized expertise in tumor management. LEVEL OF EVIDENCE Level, IV, retrospective case series.
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Affiliation(s)
- Mustafa Onur Karaca
- Department of Orthopedics and
Traumatology, Ankara University, Ankara, Turkey
| | - Kerem Başarır
- Department of Orthopedics and
Traumatology, Ankara University, Ankara, Turkey
| | - Abdullah Merter
- Department of Orthopedics and
Traumatology, Ankara University, Ankara, Turkey
| | - Erdinç Acar
- Department of Orthopaedics and
Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Emre Anıl Özbek
- Department of Orthopedics and
Traumatology, Ankara University, Ankara, Turkey
| | - Mustafa Özyıldıran
- Department of Orthopedics and
Traumatology, Ankara University, Ankara, Turkey,Mustafa Özyıldıran, MD, Ankara University,
School of Medicine, Department of Orthopedics and Traumatology, Ibn-i Sina
Hastanesi Talatpaşa Blvd No. 82 TR06230 Altındağ, Ankara, 06100, Turkey.
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Wirth T, Manfrini M, Mascard E. Lower limb reconstruction for malignant bone tumours in children. J Child Orthop 2021; 15:346-357. [PMID: 34476024 PMCID: PMC8381393 DOI: 10.1302/1863-2548.15.210126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023] Open
Abstract
Malignant bone tumours of the lower limb represent the majority of cases in both osteosarcoma and Ewing sarcoma in the growth period. Surgical treatment represents a key element of treatment. Different localizations and age groups require a differentiated surgical approach. Life and limb salvage are first on the list of treatment goals, followed by functional and cosmetic considerations. This review article delivers and discusses current surgical treatment strategies and outcomes for lower limb malignant bone tumours in children.
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Affiliation(s)
- Thomas Wirth
- Department of Orthopaedics, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany,Correspondence should be sent to T. Wirth, MD, PhD, Department of Orthopaedics, Klinikum Stuttgart, Olgahospital, Kriegsbergstraße 62, D-70174 Stuttgart, Germany. E-Mail:
| | - Marco Manfrini
- Department of Musculoskeletal Oncology Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eric Mascard
- Department of Paediatric Orthopaedic Surgery, Necker University Hospital, Paris, France
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Abstract
METHODS A multicentre retrospective study was carried out at two tertiary sarcoma centres. A database search identified all patients with a CS treated between January 1995 and January 2018. There were 810 CSs of which 76 (9.4%) were located in the fingers, toes, metacarpals, and metatarsal bones. RESULTS The median age of the study population was 55 years (36 to 68) with a median follow-up of 52 months (22 to 87) months. Overall, 70% of the tumours were in the hand (n = 54) and 30% in the foot (n = 22). Predictors for LR were margin (p = 0.011), anatomical location (p = 0.017), and method of surgical management (p = 0.003). Anatomical location (p = 0.026), histological grade between 1 and 3 (p = 0.004) or 2 and 3 (p = 0.016), and surgical management (p = 0.001) were significant factors for LR-free survival. Disease-specific survival was affected by histological grade (p < 0.001), but not by LR (p = 0.397). CONCLUSION Intralesional curettage of a low-grade CS is associated with an increased risk of LR, but LR does not affect disease-specific survival. Therefore, for low-grade CSs of the hands and feet, surgical management should aim to preserve function. In grade 2 CS, our study did not show any decreased disease-specific survival after recurrence; however, we suggest a more aggressive surgical approach to these tumours to prevent local recurrence, especially in the metacarpal and metatarsal bones. In high-grade tumours, the incidence of progressive disease is high and, therefore, the treatment of the primary tumour should be aggressive where possible, and patients observed closely for the development of metastatic disease. Cite this article: Bone Joint J 2021;103-B(3):562-568.
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Affiliation(s)
- Gilber Kask
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital, Helsinki, Finland
| | - Minna K Laitinen
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jonathan Stevenson
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
| | | | - Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Science, Aston University, Birmingham, UK
| | - Michael C Parry
- Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Aston University, Birmingham, UK
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Jahan N, Rehman S. Non-osseous soft tissue metastasis in the foot from renal cell carcinoma. BMJ Case Rep 2020; 13:e236051. [PMID: 33093058 PMCID: PMC7583075 DOI: 10.1136/bcr-2020-236051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 11/03/2022] Open
Abstract
Metastatic tumours of the distal extremities, also known as acrometastases, are rare. The majority of the acrometastases involve bones-involvement of the soft tissues of the feet and hands is extremely rare. We report a case of clear cell renal cell carcinoma metastasised to the soft tissues of the foot. The patient presented with pain and swelling in his right foot. Diagnosis of acrometastases frequently gets delayed due to the rarity of this condition and resultant low clinical suspicion. Possibility of metastatic disease should be entertained as an important differential diagnosis when patients with a history of cancer present with musculoskeletal symptoms. A systematic evaluation incorporating thorough clinical assessment, advanced imaging techniques like MRI and pathological examination is critical to establish the diagnosis.
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Affiliation(s)
- Nusrat Jahan
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Shabnam Rehman
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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Ebeid WA, Abo-Senna WG, Hasan BZ, Badr IT, Mesregah MK. Functional and oncological outcomes of limb-salvage surgery for foot and ankle tumors. Foot (Edinb) 2019; 41:34-38. [PMID: 31678860 DOI: 10.1016/j.foot.2019.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Limb-salvage surgery has become the backbone treatment for musculoskeletal tumors in the last decades. However, limb-salvage with safe margins for tumors of the foot and ankle is challenging, due to the complex anatomy of this region. This study aimed to evaluate functional and oncological outcomes, complications, and local recurrence of limb-salvage procedures for tumors of the foot and ankle. METHODS This study was a retrospective review of 18 patients with primary tumors of the foot and ankle who underwent limb-salvage surgery between 1996 and 2015, with a minimum follow-up of 2 years. Clinical presentations, radiological and histopathological investigations, surgical procedures, functional and oncological outcomes, complications and local recurrences were analyzed. The Musculoskeletal Tumor Society (MSTS) scoring system was utilized for evaluation of the functional outcome. RESULTS With a mean follow-up period of 44.2 months, 7 males and 11 females with a mean age of 29.2 years were included. Nine patients were presented as recurrent cases. The most common location was forefoot in 7 patients. Synovial sarcoma was the histopathologic diagnosis in 7 patients. The final surgical margins were wide in 15 patients, wide-contaminated in one patient, and marginal in two patients. After resection, soft tissue reconstruction and wound coverage were done by soft tissue flaps in 4 patients. The mean MSTS score was 27.5. Four patients developed local recurrence, all of them were recurrent cases. CONCLUSION Limb-salvage surgery for foot and ankle tumors is an effective treatment option with good functional outcome. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Walid Atef Ebeid
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Bahaa Zakarya Hasan
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ismail Tawfeek Badr
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt; Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Grieser T. [Foot and ankle tumours : Part I: overview of incidence, diagnosis and staging of pedal tumours]. Radiologe 2019; 58:442-458. [PMID: 29487963 DOI: 10.1007/s00117-018-0359-7] [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: 10/17/2022]
Abstract
CLINICAL ISSUE Foot and ankle tumours are rare. Part I of this paper provides a survey about tumour distribution regarding age and location of benign and malignant bone and soft tissue tumours. STANDARD RADIOLOGICAL METHODS All diagnostic radiological procedures are used for the diagnostic work-up of pedal tumours, in particular plain radiography, MRI, and ultrasonography. METHODICAL INNOVATIONS Dual-energy CT proves to be a valuable (differential) diagnostic tool in identifying urate dihydrate crystals. PERFORMANCE There are no reliable numbers available on accuracy of the aforementioned diagnostic procedures regarding tumour detection and identification. This is particularly true for soft tissue tumours which are small and well-defined, thus requiring histological clarification. ACHIEVEMENTS To evaluate pedal tumours correctly and reasonably, a full range of radiological diagnostics should be employed. Neither plain radiography alone nor a stand-alone MRI examination-depending on the tumour site-are sufficient to characterize such tumours including staging. PRACTICAL RECOMMENDATIONS Plain radiography remains the first-choice imaging modality. Ultrasonography is superior to reliably detect and identify ganglion cysts. MRI, however, continues to remain the upmost diagnostic modality of choice for evaluating foot and ankle tumours. CT possesses unchallanged diagnostic power to assess osseous changes. Bone scintigraphy (including SPECT-CT) and FDG-PET imaging are used when multifocal distribution or metastatic disease are suspected or to detect avidity of the pedal lesions, respectively.
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Affiliation(s)
- T Grieser
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
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Wang Z, Li S, Li Y, Lin N, Huang X, Liu M, Pan W, Yan X, Sun L, Li H, Li B, Qu H, Wu Y, Lin P, Ye Z. Prognostic factors for survival among patients with primary bone sarcomas of small bones. Cancer Manag Res 2018; 10:1191-1199. [PMID: 29795990 PMCID: PMC5958943 DOI: 10.2147/cmar.s163229] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Primary bone sarcomas of the hands or feet are rare lesions and poorly documented. Moreover, the prognostic determinants of bone sarcomas of the hands or feet have not been reported. Materials and methods The Surveillance, Epidemiology, and End Results (SEER) program database was used to screen patients with bone sarcomas of the hands or feet from 1973 to 2013, with attention paid to chondrosarcoma, Ewing sarcoma, and osteosarcoma. The prognostic values of overall survival (OS) and cancer-specific survival (CSS) were assessed using Cox proportional hazards regression model with univariate and multivariate analyses. The Kaplan–Meier method was used to obtain OS and CSS curves. Results A total of 457 cases were selected from the SEER database. Chondrosarcoma was the most common form of lesion in hands or feet or both, followed by Ewing sarcoma and osteosarcoma. The 5- and 10-year OS rates of the entire group were 75.7% and 66.1%, respectively. The 5- and 10-year CSS rates were 78.7% and 73.7%, respectively. Multivariate analysis revealed that age under 40 years, localized stage, low grade, surgical treatment, and first primary tumor were associated with improved OS, and decade of diagnosis, stage, grade, and surgery were independent predictors of CSS. However, no significant differences were observed in OS and CSS among patients with different primary tumor locations and tumor subtypes. Additionally, the most significant prognostic factor was whether metastasis had occurred at the time of initial diagnosis. Conclusion Among patients with primary bone sarcomas of the hands or feet, younger age (<40 years), localized stage, low grade, surgical treatment, and first primary tumor are favorable factors for prolonging survival.
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Affiliation(s)
- Zhan Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Shu Li
- Key Laboratory of Cancer Prevention and Intervention, Key Laboratory of Molecular Biology in Medical Sciences, National Ministry of Education, Department of Hematology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Cancer Institute, Hangzhou, China
| | - Yong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Nong Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xin Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Meng Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Weibo Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Xiaobo Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Lingling Sun
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hengyuan Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Binghao Li
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Hao Qu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Peng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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