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Tabarestani TQ, Levine N, Sachs E, Scholl A, Colglazier R, French R, Al-Rohil R, Brigman B, Eward W, Visgauss J. Giant cell tumor of bone in the pediatric population: a retrospective study highlighting cases of metaphyseal only location and increased local recurrence rates in skeletally immature patients. Skeletal Radiol 2023; 52:2399-2408. [PMID: 37154873 DOI: 10.1007/s00256-023-04359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To describe the presentation of giant cell tumors (GCT) of the bone in the pediatric population to (1) improve the differential diagnosis of pediatric bone tumors and (2) identify the origin of GCT. Understanding the origin of bone tumors assists in establishing appropriate diagnoses and recommending treatment options. This is particularly important in children, where evaluating the need for invasive procedures is balanced with the desire to avoid overtreatment. GCT have historically been considered epiphyseal lesions with potential metaphyseal extension. Therefore, GCT may be inappropriately excluded from the differential diagnosis of metaphyseal lesions in the skeletally immature. MATERIALS AND METHODS We identified 14 patients from 1981 to 2021 at a single institution who had histologic confirmation of GCT and were less than 18 years old at diagnosis. Patient characteristics, tumor location, surgical treatment, and local recurrence rates were collected. RESULTS AND CONCLUSIONS Ten (71%) patients were female. Eleven (78.6%) were epiphysiometaphyseal (1 epiphyseal, 4 metaphyseal, 6 epiphysiometaphyseal). Five patients had an open adjacent physis, of which three (60%) had tumors confined solely to the metaphysis. Of the five patients with open physis, four (80%) developed local recurrence while only one patient (11%) with a closed physis had local recurrence (p value = 0.0023). Our results illustrate that for the skeletally immature, GCT can (and in our results more commonly did) occur in the metaphyseal location. These findings suggest that GCT should be included in the differential diagnosis of primary metaphyseal-only lesions in the skeletally immature.
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Affiliation(s)
- Troy Q Tabarestani
- Duke University School of Medicine, Duke University Hospital, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
| | - Nicole Levine
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - Elizabeth Sachs
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - Ashley Scholl
- Department of Pathology, Duke University Hospital, Durham, NC, USA
| | - Roy Colglazier
- Department of Radiology, Duke University Hospital, Durham, NC, USA
| | - Robert French
- Department of Radiology, Duke University Hospital, Durham, NC, USA
| | - Rami Al-Rohil
- Department of Pathology, Duke University Hospital, Durham, NC, USA
| | - Brian Brigman
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - William Eward
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
| | - Julia Visgauss
- Department of Orthopedics, Duke University Hospital, Durham, NC, USA
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Biermann JS, Chow W, Reed DR, Lucas D, Adkins DR, Agulnik M, Benjamin RS, Brigman B, Budd GT, Curry WT, Didwania A, Fabbri N, Hornicek FJ, Kuechle JB, Lindskog D, Mayerson J, McGarry SV, Million L, Morris CD, Movva S, O'Donnell RJ, Randall RL, Rose P, Santana VM, Satcher RL, Schwartz H, Siegel HJ, Thornton K, Villalobos V, Bergman MA, Scavone JL. NCCN Guidelines Insights: Bone Cancer, Version 2.2017. J Natl Compr Canc Netw 2017; 15:155-167. [PMID: 28188186 DOI: 10.6004/jnccn.2017.0017] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Bone Cancer provide interdisciplinary recommendations for treating chordoma, chondrosarcoma, giant cell tumor of bone, Ewing sarcoma, and osteosarcoma. These NCCN Guidelines Insights summarize the NCCN Bone Cancer Panel's guideline recommendations for treating Ewing sarcoma. The data underlying these treatment recommendations are also discussed.
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Affiliation(s)
| | | | | | - David Lucas
- _University of Michigan Comprehensive Cancer Center
| | - Douglas R Adkins
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Mark Agulnik
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - G Thomas Budd
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Aarati Didwania
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Joel Mayerson
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Carol D Morris
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Victor M Santana
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
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Whitley MJ, Cardona DM, Blazer DG, Hwang S, Greenup RA, Mosca PJ, Cahill J, Mito JK, Cuneo KC, Larrier N, O'Reilly E, Spasojevic I, Riedel RF, Eward WC, Griffith LG, Bawendi MG, Ferrer J, Strasfeld DB, Lee WD, Brigman B, Kirsch DG. Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-sy36-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Intra-operative detection of residual cancer in the tumor bed can be used to decrease the risk of a positive surgical margin, reduce the rate of re-excision, and tailor adjuvant therapy. LUM015 is a pegylated protease-activated imaging agent containing a near infrared fluorophore and quencher attached by a polypeptide linker. Using mouse models of soft tissue sarcoma (STS), we showed that LUM015 selectively localizes to the tumor and upon cleavage of the linker by proteases in the tissue, the quencher is released, allowing fluorescence to be detected.
We recently completed a phase I clinical trial to test the safety of LUM015 in human patients with cancer. This open-label nonrandomized trial compared 3 dose cohorts (0.5, 1.0, and 1.5 mg/kg) of LUM015 in order to determine a safe dose of LUM015 that labels tumors in humans. A total of 15 subjects, 12 with STS and 3 with breast cancer, received IV LUM015 prior to surgical resection without any adverse pharmacological activity (APA). Quantitative fluorescence imaging of the resected tissues revealed that tumor fluorescence was significantly higher than corresponding normal tissue from the same patient (p<0.0001) with a mean tumor to normal fluorescence ratio of 5.4. Furthermore, within the study population, the distribution of tumor fluorescence values was significantly higher than those recorded for fat or muscle (p<0.009).
We conducted comparative analyses of LUM015 pharmacodynamics in mouse and human subjects showing that biodistribution into tumors and activation by proteases is conserved across species. These studies revealed the presence of a novel, small molecule metabolite that correlates strongly with tissue fluorescence. Additional in vivo studies in mice and in vitro studies with mouse and human tissues showed that LUM015 is selectively distributed to and accumulates in tumors to result in increased fluorescence when compared to normal tissues.
Citation Format: Melodi J. Whitley, Diana M. Cardona, Dan G. Blazer, Shelley Hwang, Rachel A. Greenup, Paul J. Mosca, Joan Cahill, Jeffrey K. Mito, Kyle C. Cuneo, Nicole Larrier, Erin O'Reilly, Ivan Spasojevic, Richard F. Riedel, William C. Eward, Linda G. Griffith, Moungi G. Bawendi, Jorge Ferrer, David B. Strasfeld, W. David Lee, Brian Brigman, David G. Kirsch. Intraoperative molecular imaging with protease-activated fluorescent imaging agents. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr SY36-03. doi:10.1158/1538-7445.AM2015-SY36-03
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Biermann JS, Adkins DR, Agulnik M, Benjamin RS, Brigman B, Butrynski JE, Cheong D, Chow W, Curry WT, Frassica DA, Frassica FJ, Hande KR, Hornicek FJ, Jones RL, Mayerson J, McGarry SV, McGrath B, Morris CD, O'Donnell RJ, Randall RL, Santana VM, Satcher RL, Siegel HJ, von Mehren M, Bergman MA, Sundar H. Bone cancer. J Natl Compr Canc Netw 2014; 11:688-723. [PMID: 23744868 DOI: 10.6004/jnccn.2013.0088] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary bone cancers are extremely rare neoplasms, accounting for fewer than 0.2% of all cancers. The evaluation and treatment of patients with bone cancers requires a multidisciplinary team of physicians, including musculoskeletal, medical, and radiation oncologists, and surgeons and radiologists with demonstrated expertise in the management of these tumors. Long-term surveillance and follow-up are necessary for the management of treatment late effects related to surgery, radiation therapy, and chemotherapy. These guidelines discuss the management of chordoma, giant cell tumor of the bone, and osteosarcoma.
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Biermann JS, Adkins DR, Benjamin RS, Brigman B, Chow W, Conrad EU, Frassica DA, Frassica FJ, George S, Hande KR, Hornicek FJ, Letson GD, Mayerson J, McGarry SV, McGrath B, Morris CD, O'Donnell RJ, Randall RL, Santana VM, Satcher RL, Siegel HJ, Somaiah N, Yasko AW. Bone cancer. J Natl Compr Canc Netw 2010; 8:688-712. [PMID: 20581300 DOI: 10.6004/jnccn.2010.0051] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Trevor Gaskill
- Division of Orthopaedic Surgery, Duke Medical Center, DUMC Box 3000, Durham, NC 27710, USA.
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Kontogeorgakos VA, Xenakis T, Papachristou D, Korompilias A, Kanellopoulos A, Beris A, Brigman B. Cortical desmoid and the four clinical scenarios. Arch Orthop Trauma Surg 2009; 129:779-85. [PMID: 18612646 DOI: 10.1007/s00402-008-0687-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 06/17/2008] [Indexed: 11/25/2022]
Abstract
We reviewed four patients diagnosed with a cortical desmoid lesion at the distal posterior medial femur. Each case reflects a clinical scenario that can be present. Cortical desmoid is a benign, self-limited entity which occasionally can exhibit aggressive radiologic features. Here, we present the specific imaging features in association with patients history and clinical findings facilitating establishment of correct diagnosis. Exact diagnosis is important in order to avoid unnecessary biopsy and complicated therapeutic strategies.
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Biermann JS, Adkins D, Benjamin R, Brigman B, Chow W, Conrad EU, Frassica D, Frassica FJ, George S, Healey JH, Heck R, Letson GD, Mayerson J, McGarry SV, O'Donnell RJ, Patt J, Randall RL, Santana V, Satcher RL, Schmidt RG, Siegel HJ, Wong MK, Yasko AW. Bone cancer. J Natl Compr Canc Netw 2007; 5:420-37. [PMID: 17442233 DOI: 10.6004/jnccn.2007.0037] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary bone cancers are extremely rare neoplasms, accounting for less than 0.2% of all cancers. Primary bone cancers show wide clinical heterogeneity and, perhaps most importantly, are often curable. With current multimodality treatment, including multi-agent chemotherapy, approximately three quarters of all patients diagnosed with osteosarcoma are cured. Updates for 2007 include changes in recommendations for treating chondrosarcoma, Ewing's sarcoma, and osteosarcoma.
For the most recent version of the guidelines, please visit NCCN.org
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Biermann JS, Baker LH, Benjamin R, Brigman B, Chow W, Conrad EU, Frassica D, Frassica FJ, George S, Healey JH, Heck R, Letson GD, Mayerson J, Neff J, O'Donnell RJ, Randall RL, Santana V, Satcher RL, Schmidt RG, Siegel HJ, Wong MK, Yasko AW. Bone cancer clinical practice guidelines. J Natl Compr Canc Netw 2005; 3:124-40. [PMID: 19817025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
Giant cell tumor of soft parts (GCTSP) is an extremely rare lesion with an unpredictable behavior. Some patients are cured with a simple surgical excision whereas others will develop metastatic disease within a relatively short interval. To date, there are no consistently reliable criteria, either clinical or histologic, to separate the benign from more aggressive lesions. We describe the clinical, histologic and radiologic features of a case with malignant behavior. The patient presented with a fungating skin and soft tissue mass and concurrent pulmonary nodules. The lesion recurred rapidly despite wide resection with negative surgical margins. Biopsy of the pulmonary lesions demonstrated metastatic disease.
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Affiliation(s)
- Leslie G Dodd
- Department of Pathology, Duke University Hospital, Durham, North Carolina, USA.
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Banes AJ, Tsuzaki M, Hu P, Brigman B, Brown T, Almekinders L, Lawrence WT, Fischer T. PDGF-BB, IGF-I and mechanical load stimulate DNA synthesis in avian tendon fibroblasts in vitro. J Biomech 1995; 28:1505-13. [PMID: 8666590 DOI: 10.1016/0021-9290(95)00098-4] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Resident cells in the surface epitenon and internal compartment of flexor tendons are subjected to cyclic mechanical load as muscle contracts to move limbs or digits. Tendons are largely tensile load bearing tissues and are highly matrix intensive with nondividing cells providing maintenance functions. However, when an injury occurs, tendon cells are stimulated to divide by activated endogenous growth factors and those from platelets and plasma. We hypothesize that tendon cells detect mechanical load signals but do not interpret such signals as mitogenic unless an active growth factor is present. We have used an in vitro mechanical load model, application of cyclic strain to cells cultured on flexible bottomed culture plates, to test the hypothesis that tendon cells require platelet-derived growth factor (PDGF-BB) and insulin-like growth factor-I (IGF-I) in addition to mechanical load to stimulate DNA synthesis. In addition, we demonstrate that in avian tendon cells, load and growth factors stimulate phosphorylation of tyrosine residues in multiple proteins, including pp60src, a protein kinase that phosphorylates receptor protein tyrosine kinases. A lack of mitogenic responsiveness to mechanical load alone by tendon cells may be a characteristic of a regulatory pathway that modulates cell division.
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Affiliation(s)
- A J Banes
- Department of Surgery, University of North Carolina, Chapel Hill 27599-7050, USA.
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Banes AJ, Tsuzaki M, Yamamoto J, Fischer T, Brigman B, Brown T, Miller L. Mechanoreception at the cellular level: the detection, interpretation, and diversity of responses to mechanical signals. Biochem Cell Biol 1995; 73:349-65. [PMID: 8703408 DOI: 10.1139/o95-043] [Citation(s) in RCA: 274] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Cells from diverse tissues detect mechanical load signals by similar mechanisms but respond differently. The diversity of responses reflects the genotype of the cell and the mechanical demands of the resident tissue. We hypothesize that cells maintain a basal equilibrium stress state that is a function of the number and quality of focal adhesions, the polymerization state of the cytoskeleton, and the amount of extrinsic, applied mechanical deformation. A load stimulus detected by a mechano-electrochemical sensory system, including mechanically sensitive ion channels, integrin-cytoskeleton machinery, and (or) a load-conformation sensitive receptor or nonreceptor tyrosine kinase, may activate G proteins, induce second messengers, and activate an RPTK or JAK/STAT kinase cascade to elicit a response. We propose the terms autobaric to describe a self-loading process, whereby a cell increases its stress state by contracting and applying a mechanical load to itself, and parabaric, whereby a cell applies a load to an adjacent cell by direct contact or through the matrix. We predict that the setpoint for maintaining this basal stress state is affected by continuity of incoming mechanical signals as deformations that activate signalling pathways. A displacement of the cytoskeletal machinery may result in a conformational change in a kinase that results in autophosphorylation and cascade initiation. pp60Src is such a kinase and is part of a mechanosensory protein complex linking integrins with the cytoskeleton. Cyclic mechanical load induces rapid Src phosphorylation. Regulation of the extent of kinase activation in the pathway(s) may be controlled by modulators such as G proteins, kinase phosphorylation and activation, and kinase inhibitors or phosphatases. Intervention at the point of ras-raf interaction may be particularly important as a restriction point.
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Affiliation(s)
- A J Banes
- University of North Carolina, Chapel Hill, NC 27599-7050, USA
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Knox D, Brigman B. Contraception and condom use among two samples of university students: 1982 and 1992. Coll Stud J 1993; 27:133-4. [PMID: 12288436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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