[Translated article] Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors

BACKGROUND AND OBJECTIVES

The diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject.

MATERIAL AND METHOD

Observational, longitudinal and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis.

RESULTS

Older age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0mm was used as a predictor of malignancy.

CONCLUSIONS

Advanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.

Comparative study of deep lipomas and atypical lipomatous tumours: Malignancy risk factors

BACKGROUND AND OBJECTIVES

The diagnostic suspicion of an atypical lipomatous tumour (ALT) is difficult. The aim of this study is to delve into the most controversial diagnostic aspects of the subject.

MATERIAL AND METHOD

Observational, longitudinal, and retrospective study of a series of 96 deep adipose tumours (75 lipomas and 21 TLA) from 2006 to 2016: demographic, clinical, imaging and pathological variables were analysed and compared, as well as other variables related to treatment and oncological outcomes of the patients. A descriptive analysis of the collected variables was performed for the statistical study. To evaluate the potential predictor variables of malignancy, a multivariate logistic regression analysis was performed, including those that were statistically significant in the univariate analysis.

RESULTS

Older age at diagnosis, lower limb location and larger size were significantly more frequent in ALTs. MRI findings showed no statistically significant differences between the two groups. In multivariate analysis, the same clinical variables were confirmed as predictors of malignancy. In the ROC curve, an optimal cut-off point of 134.0 mm was used as a predictor of malignancy.

CONCLUSIONS

Advanced age, location in the lower limbs and larger size are risk factors for malignancy in the differential diagnosis of deep lipomas and atypical lipomatous tumours. No radiological variable on MRI reached significance as a predictor of malignancy in our series.

Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management

OBJECTIVE

1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment.

METHODS

Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months.

RESULTS

Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients.

DISCUSSION

Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series.

CONCLUSIONS

Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.

[Health care circuit for patients with soft tissue sarcomas of the extremities. A tortuous and slow road to referral units]

OBJECTIVE

To analyse the waiting periods elapsed since soft tissue sarcomas become symptomatic until their specific treatment in our unit, and to determine new strategies for the improvement of referral circuits.

MATERIAL AND METHODS

This is an ambispective observational study of a cohort of 61 patients, with previously untreated soft tissue sarcomas, obtained from our Musculoskeletal Tumors Database. Several variables related to the patient, tumour, and health care circuit were analysed, as well as the different periods between the initial symptoms of the disease and the first consultation in our unit. The significance level was α=0.05.

RESULTS

The mean size of the sarcomas was 11.3 cm. Thirty-six patients (59%) followed the usual circuit of the National Health System in Spain. The time elapsed since the disease became symptomatic until the first medical consultation was greater than 9.5 months, and nearly another 8.5 months to the consultation in our specific unit. Statistically significant relationships were found between the independent and dependent variables.

DISCUSSION

The study shows that the care of patients with soft tissue sarcomas in our environment is far away from the times of care in our neighbouring countries.

CONCLUSIONS

It is essential to make the population and health professionals aware of this disease, as well as to remember that there is a referral circuit that must be used.