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Khal AA, Aiba H, Righi A, Gambarotti M, Atherley O'Meally AO, Manfrini M, Donati DM, Errani C. Diagnostic challenges in low-grade central osteosarcoma. Bone Joint J 2024; 106-B:99-106. [PMID: 38160683 DOI: 10.1302/0301-620x.106b1.bjj-2023-0531.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims Low-grade central osteosarcoma (LGCOS), a rare type of osteosarcoma, often has misleading radiological and pathological features that overlap with those of other bone tumours, thereby complicating diagnosis and treatment. We aimed to analyze the clinical, radiological, and pathological features of patients with LGCOS, with a focus on diagnosis, treatment, and outcomes. Methods We retrospectively analyzed the medical records of 49 patients with LGCOS (Broder's grade 1 to 2) treated between January 1985 and December 2017 in a single institute. We examined the presence of malignant features on imaging (periosteal reaction, cortical destruction, soft-tissue invasion), the diagnostic accuracy of biopsy, surgical treatment, and oncological outcome. Results Based on imaging, 35 of 49 patients (71.4%) exhibited malignant features. Overall, 40 of 49 patients (81.6%) had undergone a biopsy before en-bloc resection: 27 of 40 patients (67.5%) were diagnosed on the first biopsy, which was more accurate when carried out by open rather than needle biopsy (91.3% vs 35.3% diagnostic accuracy, respectively; p < 0.001). Of the 40 patients treated by en-bloc resection, surgical margins were wide in 38 (95.0%) and marginal in two (5.0%). Furthermore, nine of 49 patients (18.4%) underwent curettage (intralesional margin) without previous biopsy. All patients with a positive margin developed local recurrence. Distant metastases occurred in five of 49 patients (10.2%). The mean five-year overall survival (OS) and distant relapse-free survival (D-RFS) were 89.3% (SD 5.1%) and 85.7% (SD 5.5%), respectively. Univariate analysis showed that the occurrence of distant metastasis was a poor prognostic factor for OS (hazard ratio 11.54, 95% confidence interval (CI) 1.92 to 69.17; p < 0.001). Local recurrence was a poor prognostic factor for D-RFS (HR 8.72, 95% CI 1.69 to 45.0; p = 0.002). Conclusion The diagnosis of LGCOS can be challenging because it may present with non-malignant features and has a low diagnostic accuracy on biopsy. If precisely diagnosed, LGCOS can be successfully treated by surgical excision with wide margins.
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Affiliation(s)
- Adyb A Khal
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Paediatric Orthopaedics, AP-HM Timone Enfants, Marseille, France
- Department of Orthopedics and Traumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Hisaki Aiba
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedics Surgery, Nagoya City University, Nagoya, Japan
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Gambarotti
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ahmed O Atherley O'Meally
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide M Donati
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- III Clinica di Ortopedia e Traumatologia a prevalente indirizzo oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Answer To Test Yourself Question: A 19-year-old male presents with progressive distal lower limb pain. Skeletal Radiol 2022; 51:225-226. [PMID: 34250552 DOI: 10.1007/s00256-021-03855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/12/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
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Primary osteosarcoma of the parietal bone. Skeletal Radiol 2021; 50:1729-1733. [PMID: 33604706 DOI: 10.1007/s00256-021-03726-7] [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: 10/01/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023]
Abstract
Osteosarcoma is the most common primary bone tumor and usually involves the long bones. Osteosarcoma of the skull, on the other hand, is relatively rare. Here, we present a 29-year-old man with a growing mass in the skull he first noticed after a fall while skateboarding. The initial clinical diagnosis was hematoma. While undergoing an evacuation surgery for a hematoma, a suspicious mass was detected which was biopsied. Histopathological evaluation showed high-grade osteosarcoma. The patient was referred to our hospital where he underwent definitive resection followed by adjuvant chemotherapy. His course was complicated by wound infection. Even though osteosarcoma of the skull is a rare finding, it should be suspected in a patient with a skull mass, and the history of prior head trauma does not exclude the diagnosis.
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Li SQ, Tu C, Wan L, Chen RQ, Duan ZX, Ren XL, Li ZH. FGF-induced LHX9 regulates the progression and metastasis of osteosarcoma via FRS2/TGF-β/β-catenin pathway. Cell Div 2019; 14:13. [PMID: 31788020 PMCID: PMC6876112 DOI: 10.1186/s13008-019-0056-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/09/2019] [Indexed: 01/21/2023] Open
Abstract
Background Fibroblast growth factor (FGF) and tumor growth factor-β (TGFβ) have emerged as pivotal regulators during the progression of osteosarcoma (OS). LHX9 is one crucial transcription factor controlled by FGF, however, its function in OS has not been investigated yet. Methods The expression of LHX9, FRS2, BMP4, TGF-beta R1, SMAD2, beta-catenin and metastasis-related proteins was measured by real-time quantitative PCR (RT-qPCR) and Western blot. CCK-8 assay and colony formation assay were employed to determine the proliferation of OS cells, while scratch wound healing assay and transwell assay were used to evaluate their migration and invasion, respectively. In vivo tumor growth and metastasis were determined by subcutaneous or intravenous injection of OS cells into nude mice. Results LHX9 expression was evidently up-regulated in OS tumor tissues and cell lines. Knockdown of LHX9 impaired the proliferation, migration, invasion and metastasis of OS cells. Mechanistically, LHX9 silencing led to the down-regulation of BMP-4, β-catenin and metastasis-related proteins, which was also observed in beta-catenin knockdown OS cells. By contrast, FRS2 knockdown conduced to the up-regulation of LHX9, BMP4, β-catenin and TGF-βR1, while TGF-beta inhibition repressed the expression of LHX9 and metastasis-related proteins. Additionally, let-7c modulates LHX9 and metastasis-related proteins by suppressing TGF-beta R1 expression on transcriptional level. Conclusions This study revealed LHX9 was essential for the proliferation, migration, invasion, and metastasis of OS cells via FGF and TGF-β/β-catenin signaling pathways.
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Affiliation(s)
- Shuang-Qing Li
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
| | - Chao Tu
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
| | - Lu Wan
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
| | - Rui-Qi Chen
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
| | - Zhi-Xi Duan
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
| | - Xiao-Lei Ren
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
| | - Zhi-Hong Li
- Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, No. 139 Renming Road, Changsha, 410010 Hunan People's Republic of China
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Wagner VP, Carlos R, Romañach MJ, Lopes MA, Speight PM, Vargas PA. Malignant transformation of craniomaxillofacial fibro‐osseous lesions: A systematic review. J Oral Pathol Med 2019; 48:441-450. [DOI: 10.1111/jop.12867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/08/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Vivian P. Wagner
- Department of Oral Diagnosis, Piracicaba Dental School University of Campinas Piracicaba São Paulo Brazil
| | - Roman Carlos
- Pathology Department Centro Clinico de Cabeza y Cuello Guatemala City Guatemala
| | - Mário J. Romañach
- Oral Pathology, Department of Oral Diagnosis and Pathology, School of Dentistry Federal University of Rio de Janeiro Rio de Janeiro Brazil
| | - Marcio A. Lopes
- Department of Oral Diagnosis, Piracicaba Dental School University of Campinas Piracicaba São Paulo Brazil
| | - Paul M. Speight
- Department of Oral Pathology, School of Clinical Dentistry University of Sheffield Sheffield UK
| | - Pablo A. Vargas
- Department of Oral Diagnosis, Piracicaba Dental School University of Campinas Piracicaba São Paulo Brazil
- Department of Oral Pathology and Oral Biology, School of Dentistry, Faculty of Health Sciences University of Pretoria Pretoria South Africa
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Zoccali C, Attala D, Rossi B, Zoccali G, Ferraresi V. Fibrous dysplasia: an unusual case of a very aggressive form with costo-vertebral joint destruction and invasion of the contralateral D7 vertebral body. Skeletal Radiol 2018; 47:1571-1576. [PMID: 29789859 DOI: 10.1007/s00256-018-2961-1] [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: 01/13/2018] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
Fibrous dysplasia (FD) is a benign fibro-osseous disease of the bone that may be solitary or multicentric. It is important to distinguish this type of lesion from low-grade osteosarcomas (LGOS) and from secondary sarcomas, because malignant transformation has rarely been reported. It is classically described as having a ground-glass appearance, endosteal scalloping, and thinning of the cortex. Cortical disruption is considered evidence of malignancy, but it can also be present in benign FD with aggressive behavior. We present an unusual case of aggressive FD of the 7th left rib, already diagnosed more than 22 years ago, where cortical and costo-vertebral joint disruption and 7th thoracic vertebral body involvement were not evidence of malignant behavior. From a histological perspective, FD and LGOS are similar; even if histology is of fundamental importance, the diagnosis has to be made based on the clinical and radiological aspects as well, although at imaging, differentiation between FD and LGOS can be difficult. In the present case, even though the histological examination suggested a benign lesion, the radiological examination instead consistently suggests malignancy. It is for this reason that there should be a high index of suspicion during follow-up and a new biopsy should be scheduled in case any changes occur during follow-up.
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Affiliation(s)
- Carmine Zoccali
- Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Dario Attala
- Oncological Orthopaedics Department, Muscular-skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Barbara Rossi
- Orthopaedics Department, Gubbio General Hospital, Largo Unità d'Italia, Loc. Branca, 06024, Gubbio, PG, Italy
| | - Giovanni Zoccali
- Department of Plastic Surgery, Guy's and St. Thomas' Hospital, NHS Foundation Trust, London, UK. .,IFO-Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome, Italy.
| | - Virginia Ferraresi
- Medical Oncology "A", IFO-Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Low-Grade Central Osteosarcoma: Report of Two Unusual Morphologic Variants. Indian J Surg Oncol 2018; 9:74-78. [PMID: 29563741 DOI: 10.1007/s13193-017-0713-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022] Open
Abstract
Low-grade central osteosarcoma (LGCO) is a rare subtype of osteosarcoma, constituting < 2% of all osteosarcomas. If not treated appropriately, the tumor can recur with higher-grade disease. We report two cases of low-grade central osteosarcoma with unusual morphologic features and belonging to different age groups. Both presented with pain and swelling in the lower end of femur. Radiologically, both the lesions revealed a large mass with irregular borders and soft tissue invasion. One patient underwent above-knee amputation and wide local excision of tumor was done in the other patient. Histologically, both the tumors showed spindle cell proliferation displaying mild atypia. In synopsis with radiology, diagnosis of low-grade central osteosarcoma was made in both cases. These cases highlight the varied morphological spectrum of low-grade central osteosarcoma and underscore the diagnostic difficulties faced. Recognition of the variants of low-grade central osteosarcoma is based on aggressive radiological appearance and on adequate tumor sampling for histologic examination.
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Muthusamy S, Subhawong T, Conway SA, Temple HT. Locally aggressive fibrous dysplasia mimicking malignancy: a report of four cases and review of the literature. Clin Orthop Relat Res 2015; 473:742-50. [PMID: 25212962 PMCID: PMC4294916 DOI: 10.1007/s11999-014-3926-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 08/27/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fibrous dysplasia is a benign fibroosseous bone tumor that accounts for 5% to 10% of benign bone tumors. It can present as monostotic fibrous dysplasia (70% to 80%), polyostotic fibrous dysplasia (20% to 30%), McCune-Albright syndrome (2% to 3%), or Mazabraud's syndrome in rare cases. Bone lesions in fibrous dysplasia arise in the medullary canal and usually are confined to the bone. Cortical destruction and extension into soft tissue usually indicates malignant transformation or secondary aneurysmal bone cyst formation. Locally aggressive fibrous dysplasia with cortical destruction and extension into soft tissue in the absence of these two possibilities is extremely rare. It is important for the treating physician to distinguish this entity from more aggressive or malignant tumors to avoid overtreating the patient for a benign condition or inattention to a malignant tumor. CASE DESCRIPTIONS We report four unusual cases of fibrous dysplasia with an aggressive radiographic appearance. They occurred in the rib (1), ilium (2), and distal femur (1). Two patients had pain and two had swelling. Radiologically, all were associated with cortical destruction and an associated soft tissue mass, and initially they were interpreted as potentially malignant. Three patients underwent biopsy and one patient did not have a biopsy. Histopathologic analysis by an experienced bone pathologist confirmed fibrous dysplasia in all patients. Two patients were treated surgically; one patient with zoledronic acid and one patient currently is being followed by observation alone. LITERATURE REVIEW There are only a few reports in the literature that describe the locally aggressive variant of fibrous dysplasia that presents with pain and progressive swelling clinically and with cortical destruction and soft tissue extension on imaging which suggest malignancy. We could not find any article that describes the use of bisphosphonates in such lesions or the response to bisphosphonates clinically, on laboratory parameters or imaging. To our knowledge, this is the largest case report published regarding locally aggressive fibrous dysplasia arising outside the craniofacial skeleton. CLINICAL RELEVANCE The locally aggressive variant of fibrous dysplasia may be confused with a malignant tumor or malignant degeneration of fibrous dysplasia. It is important to properly evaluate these lesions to ensure that a proper diagnosis is made, especially with respect to a malignant versus benign mass.
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Affiliation(s)
- Saravanaraja Muthusamy
- />Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL USA
| | - Ty Subhawong
- />Department of Radiology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Sheila A. Conway
- />Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL USA
| | - H. Thomas Temple
- />Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, 1400 NW 12th Avenue, Miami, FL USA
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