Melorheostosis: A Review of the Literature and a Case Report

The contribution of the novel CLTC-VMP1 fusion gene to autophagy regulation and energy metabolism in cisplatin-resistant osteosarcoma

Osteosarcoma (OS) is a highly malignant tumor, and chemotherapy resistance is a major challenge in the treatment of this disease. This study aims to explore the role of the CLTC-VMP1 gene fusion in the mechanism of chemotherapy resistance in OS and investigate its molecular mechanisms in mediating energy metabolism reprogramming by regulating autophagy and apoptosis balance. Using single-cell transcriptome analysis, the heterogeneity of OS cells and their correlation with resistance to platinum drugs were revealed. Cisplatin-resistant cell lines were established in human OS cell lines for subsequent experiments. Based on transcriptomic analysis, the importance of VMP1 in chemotherapy resistance was confirmed. Lentiviral vectors overexpressing or interfering with VMP1 were used, and it was observed that inhibiting VMP1 could reverse cisplatin resistance, promote cell apoptosis, and inhibit autophagy, and mitochondrial respiration and glycolysis. Furthermore, the presence of CLTC-VMP1 gene fusion was validated, and its ability to regulate autophagy and apoptosis balance, promote mitochondrial respiration, and glycolysis was demonstrated. Mouse model experiments further confirmed the promoting effect of CLTC-VMP1 on tumor growth and chemotherapy resistance. In summary, the CLTC-VMP1 gene fusion mediates energy metabolism reprogramming by regulating autophagy and apoptosis balance, which promotes chemotherapy resistance in OS.NEW & NOTEWORTHY This study identifies the CLTC-VMP1 gene fusion as a key driver of chemotherapy resistance in osteosarcoma by regulating autophagy and reprogramming cellular energy metabolism. Through single-cell transcriptomics, the research reveals the heterogeneity of tumor cells and the role of VMP1 in promoting resistance to cisplatin. The findings suggest that targeting the CLTC-VMP1 fusion gene may offer new therapeutic strategies to overcome chemotherapy resistance in osteosarcoma.

Surgical treatment of progressive melorheostosis worsening over 19 years: A case report

BACKGROUND

Melorheostosis is a relatively rare disease, which may cause chronic pain, soft tissue mass and restricted range of motion. Diagnosis and treatment of melorheostosis remains challenging.

CASE REPORT

We describe a patient with sclerotic bone involving the left acetabulum, femur, tibia, and talus. Over 19 years this patient showed slow progression of disease. The bone mass in the right popliteal region resulted in limitation of knee motion. Comprehensive management including physical therapy, medications and surgeries were adopted to obtain a full range of motion and no recurrence for 2 years.

DISCUSSION

Accurate diagnosis and adequate treatments are critical to melorheostosis patients. Resection of redundant calcified mass is an effective method to treat severe limitation of range of motion associated with knee melorheostosis.

Predictive Factors for Cut-Out Risks of Unstable Trochanteric Fractures

Fractures of the trochanteric mass represent a significant proportion of hip fractures. These fractures often occur in the elderly due to compromised bone quality, leading to a high predisposition for instability at the fracture site. The study was conducted through a retrospective analysis of 1,259 hospitalizations in the Department of Orthopedics and Traumatology of the Bucharest University Emergency Hospital between 2022 and 2023, including patients with various types of trochanteric mass fractures: basicervical, per trochanteric, intertrochanteric, subtrochanteric, and trochanter-diaphyseal fractures. In the selection process, 59 patients who met the specific inclusion criteria for the study were chosen. The study population included 59 patients selected based on the afore-mentioned inclusion and exclusion criteria. For these patients, the demographic and clinical data revealed the following: the age of the patients varied between 26 and 91 years, with a mean of 74.69 years, a median of 80 years, and a standard deviation of 14.94 years. The first quartile was at 71 years, and the third quartile was at 84.5 years, resulting in an interquartile range of 13.5 years. The article aims to study prognostic factors for the risk of cut-out in the surgical treatment of unstable trochanteric fractures. A systematic evaluation of patient characteristics, fracture types, and surgical treatment options could establish the relevant factors in predicting the occurrence of cut-out. The results of this research have the potential to facilitate clinical decision-making, optimize treatment strategies, and improve outcomes for patients with unstable trochanteric fractures undergoing surgery.

Arthroscopic Management of Melorheostosis-Induced Ankle Deformity: A Case Report

Melorheostosis is a rare congenital sclerosing bone dysplasia characterized by a distinctive "candle-like flowing wax" radiological appearance. This study presents a case of an 80-year-old male who presented with a decade-long history of left ankle pain and rigid equinus deformity, which substantially impaired his mobility and activities of daily living. Conservative interventions, including physical therapy and custom orthotics, failed to alleviate his symptoms. Subsequent arthroscopic osteotectomy and Achilles tendon lengthening engendered substantial postoperative improvements in pain relief, range of motion, and gait stability, enabling him to resume previous activities such as cycling. This study highlights the potential of minimally invasive surgical techniques in managing melorheostosis-related deformities to optimize patient outcomes and quality of life. Nevertheless, long-term follow-up is essential for assessing the risk of recurrent ankle deformity and the potential requirement for revision surgery.

Enchondroma in the Fibular Diaphysis: A Case Report

Chondroma is a benign tumor formation that occurs through the proliferation of cartilaginous tissue. It can be located centrally (enchondroma) or peripherally, often appears between 10-30 years of age, and is commonly discovered incidentally. This case report describes a 46-year-old woman presenting with pain in the left calf and partial functional impotence. The onset of her symptoms was affirmatively marked by a mild skiing-related trauma. Following protocol, X-ray imaging (antero-posterior and lateral views) of the calf was performed, with the only finding being a solitary bony lesion, with internal calcifications, sclerotic margin and radiolucent internal matrix. Facing the uncertainty of diagnosis from a clinical and radiographic standpoint, it was decided to admit the patient for further evaluation and start the standard protocol of imaging investigations - computed tomography, magnetic resonance imaging, and bone scintigraphy - and determine the subsequent therapeutic behavior. Differential diagnosis between enchondroma and low-grade chondrosarcoma can be difficult due to their histopathological similarity. The therapy of choice in enchondroma comprises non-surgical treatment (observation) if the lesion remains unaltered in imaging, or curettage/filling with bone substitutes/allografts, but considering the advanced age and interruption of the bone cortex in our case, we opted for curative surgical treatment.

Melorheostosis (Leri's Disease): A Review

Melorheostosis is a noncancerous bone disease characterized by abnormal bone and soft tissue growth. Despite being identified almost a century ago, there are still many unknown aspects surrounding this condition. It can often be an incidental discovery, with patients experiencing associated pain and deformities. Diagnosis typically relies on X-rays, although not all cases exhibit the classic candle wax appearance. A new imaging sign known as the "dumpling on a plate sign" has been proposed for flat bones for both MRI and CT scans. A biopsy may be necessary in cases of uncertainty, as there is not a definitive histological feature. It is not uncommon for melorheostosis to be linked with other conditions, and a collaborative approach involving a multidisciplinary team should be considered. This condition should be considered in the differential diagnosis of sclerotic bone conditions. Management is generally aimed at symptom relief, either through conservative measures or surgical intervention.

A focus on melorheostosis disease: a literature review and case report of femoral-acetabular impingement due to melorheostosis treated with surgical hip osteoplasty

OBJECTIVE

Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence and progresses gradually over time. This disease represents a true challenge to the physician because of its variability due to location, extension of the affected bone, and involvement of associated soft tissue. Pain management, physical therapy, and surgery may be recommended, depending on the individual case. This review aims to get an overview of the latest evidence relating to epidemiology, clinical and radiographic characteristics, diagnosis, and possible therapeutic strategies for melorheostosis and describe our experience through a clinical case.

METHODS

We designed a comprehensive literature search on melorheostosis in MEDLINE (via Pubmed) up to April 2023 and reviewed reports published in international journals.

RESULTS

The purpose is to highlight the importance of a multidisciplinary approach in the management of a rare disease such as melorheostosis. We discuss the role of different physicians, including genetists, rheumatologists, physiatrists, physical therapists, and orthopedic surgeons, in providing accurate diagnoses and effective treatments. We conducted a comprehensive review of the literature on the treatment of melorheostosis to support these findings. In addition, the article presents a case study of a patient suffering from melorheostosis, focusing on difficulties in reaching a correct diagnosis and attempts towards conservative and surgical interventions. The patient underwent hip arthroplasty, and the final result was an improvement in function and a reduction in pain.

CONCLUSIONS

Managing melorheostosis can be challenging, and there is no standardized treatment for this condition at the moment.

Management of Acetabular Bone Loss in Hip Revision Arthroplasty: Case Series Presentation

Considering the increase in life expectancy in the general population and the need for a more active lifestyle, total hip arthroplasty has become an absolutely necessary surgical intervention to maintain these desired results. Along with the evolution of medicine and the increase in the quality and performance of the materials used to make prostheses, the number of patients who benefit from total hip replacement is constantly increasing, and proportionally, the number of patients who will require revision arthroplasty is increasing. Before discussing the need for hip arthroplasty revision, it is necessary to carry out a rigorous clinical and imaging examination for differential diagnosis with other pathologies such as low back pain, the presence of bone or soft tissue tumors, arterial occlusions and claudication, or other systemic diseases. One of the biggest challenges for the orthopedic surgeon in planning a hip revision is the compensation of the remaining acetabular bone defect, either as a result of the osteolysis process or following the process of removing the acetabular component, which in some cases can lead to severe bone loss that is difficult to anticipate in the preoperative planning. In this paper, we will present the short-term results of the use of reinforcement cages fixed with screws and cemented retentive acetabular cups in the case of hip revisions with extensive bone loss. The discussions that derive from the presented series of cases are related to the use of reinforcement cages, which are based on the principle of primary stability obtained with the help of screw fixation but whose risk of osteolysis and implant fixation damage is greater than in the case of implants that also associate biological integration at bone level. The use of reinforcement cages together with the retentive acetabular cup in the case of elderly patients with associated comorbidities, a moderate level of physical activity, and severe muscle insufficiency at the hip level as a result of not using the affected pelvic limb is still a viable solution that allows the patient to walk immediately after the surgery, avoiding the risk of dislocation (especially in patients who use the posterolateral approach) and avoiding morbidity induced by prolonged bed rest.