An Epidemiological Study of Primary Bone Tumors of the Fibula

Background

Relatively low incidence has led to an under-rating of fibula tumors. This study aimed to evaluate fibula tumors as a whole and to give detailed information based on histological types according to the anatomic location of the tumors in the fibula.

Methods

Evaluation was made of all the primary bone tumors of the fibula recorded in our bone tumor registry and institute of pathology from 2007 to 2018. Of these, 62 cases were identified. Analysis included assessment of age, gender, tumor localization, the presenting symptoms, the duration of symptoms, and treatment methods.

Results

There were 48 (77.4%%) benign and 14 (22.6%) malignant tumors. The most commonly found benign tumors were non-ossifying fibroma (12/48; 25%) and aneurysmal bone cyst (12/48; 25%), and the malignant tumors were chondrosarcoma (3/14; 21.4%) and chondroblastic osteosarcoma (3/14; 21.4%). The most common location for both benign and malignant tumors (58.3%, 71.4%) are the proximal fibula, followed by the distal fibula (27.1%, 28.6%) and the diaphysis (14.6%, 0%). Six (9.7%) patients presented with pathological fibula fractures.

Conclusion

Fibular tumors are rarely encountered in clinical practice but are mostly benign, with malignancy determined in approximately a quarter of patients. However, as most benign tumors are asymptomatic, and therefore remain undetected, the actual proportion of malignant tumors will be much lower.

Glomus tumors of the upper extremity

BACKGROUND

Glomus tumors are uncommon and painful benign perivascular neoplasms. They usually occur in the subungual region of phalanx, and present with a classic clinical triad of localized tenderness, cold hypersensitivity, and excruciating paroxysmal pain. The aim of this study was to review 45 cases of glomus tumor according to the clinical, radiological and therapeutic characteristics, and the clinical and functional outcomes of surgical treatment.

MATERIALS AND METHODS

A retrospective review was made of 45 glomus tumors of the upper extremity operated on between June 2005 and January 2019. Data were collected of demographic characteristics and the diagnostic, immunohistochemical, therapeutic and postoperative clinical findings.

RESULTS

The patients comprised 69 % females and 31 % males with a median age of 41 years at the time of surgery. The most commonly affected anatomic location was the digits (87 %). Of the 39 cases with an affected digit, there was a predominance of the middle finger in 28 % and the peri-subungual area in 51 %. There was no recurrence or need for secondary surgical intervention in any patient in this study. The mean QuickDASH score was 1.47 at mean 66 months follow-up.

CONCLUSIONS

Glomus tumor, which is usually seen in the middle finger of middle-aged women, presents with excruciating paroxysmal pain out of proportion to the tumor size. The long-term outcomes after surgical loupe-assisted surgery with a transungual approach were seen to be good, without local recurrence and an acceptable rate of postoperative nail dystrophy.

Tenosynovial Giant Cell Tumor in the Hand: Experience with 173 Cases

Background: Tenosynovial giant cell tumor (TSGCT) is the second most common benign tumor of the hand. Even though it is a benign lesion there is still a high incidence of local recurrence (range, 7%-44%) according to data in published papers. In this study, the clinical and epidemiological features of 173 patients who underwent excision of localized TSGCT, the recurrence rates and possible reasons for recurrence were examined in the light of current literature. Methods: Medical records of 173 patients with TSGCT were reviewed. Data on demographic characteristics as well as clinical and intraoperative findings were collected. Patients were asked about the recurrence of the TSGCT and the QuickDASH scoring was applied at the final clinical evaluation after mean follow-up of 81 months. Results: Females were predominantly involved (73%). Patients aged mean 44 years at the time of surgery. There were 93 tumors in flexor zones and 80 tumors in extensor zones of the hand. Of the tumors with flexor zone localization, zone II was most predominantly involved with 46 tumors, and 18 of these were on the index finger. The extensor zones III and IV were mostly involved with 9 tumors each on the middle and ring fingers. A total of 12 recurrences (6.9 %) were determined over the mean follow-up period of 81 months. Conclusions: The characteristics of our patients identified were similar to the previous studies. Surgical excision provides good outcomes in the treatment of TSGCT especially when clear margins are obtained.

Tenosynovial giant cell tumor in the foot and ankle

BACKGROUND

Tenosynovial giant cell tumor (TSGCT) originates from the synovial cells of the tendon sheath and is the most common soft tissue tumor of the foot and ankle. Due to the lack of clinical data about TSGCT in the foot and ankle, this study was performed with the aim of investigating the clinical characteristics, and surgical outcomes that might predict the likelihood of recurrence.

METHODS

Clinical data, obtained from the pathology records and the clinic files, along with the tumor subtype, local recurrence, and patient functional status among 26 cases of TSGCT were evaluated with the mean 73 months follow-up period.

RESULTS

There were 26 patients including 16 males and 10 females with a mean age of 40 years, who underwent surgery. There were 15 localised TSGCT and 11 diffuse TSGCT. The diffuse TSGCT was more likely to be in the hindfoot dorsum (54,5%, 6/11). The localised TSGCT was mostly located in the forefoot (80%, 12/15). The recurrence rate in the diffuse TSGCT was 27,3% (3/11). In the localised TSGCT, recurrence was seen in 6,6% of patients (1/15). The mean AOFAS score was 79.

CONCLUSION

Diffuse TSGCT is more likely to occur in the hindfoot and localised TSGCT is more common in the forefoot. Excision with clear margins is an effective treatment for TSGCT, with good oncological and clinical outcomes. But the orthopaedic surgeons should consider the equilibrium between surgical margins and the functional status of the patient.

Management of Osteoid Osteoma in Unusual Locations

PURPOSE OF THE STUDY Osteoid osteoma is a benign tumor that forms in bone, which accounts for 3% of all primary bone tumors. The classical clinical finding is substantial nocturnal pain and imaging findings. The management of osteoid osteomas include open surgical excision or minimally invasive percutaneous interventions. Why and which treatment modality should be considered between CT-guided radiofrequency ablation and open surgical excision for osteoid osteomas in unusual locations? MATERIAL AND METHODS We retrospectively reviewed 17 patients with osteoid osteomas in unusual locations included cuboid, triquetrum, coronoid process, and proximal phalanx. We evaluated the duration from symptoms to diagnosis, activity related pain, clinical findings, and possible recurrence or complications. The minimum clinical follow-up was 51 ± 34.8 months. RESULTS CT-guided radiofrequency ablation was applied to 3 patients and open surgical excision procedures to 14. All the complaints of patients gone after treatment. No major complications were observed following CT-guided radiofrequency ablation or surgical excision. Transient weakness/paresthesia was determined in 1 patient in the treated shoulder after CT-guided radiofrequency ablation, which resolved spontaneously in the 6th week. There was only recurrence seen in 1 patient, who had 2nd proximal phalangeal osteoid osteoma. Proximal interphalangeal joint arthrodesis was performed after recurred lesion. DISCUSSION The main challenge in management of the osteoid osteomas of the unusual locations are the diagnosis. When we examined the literature, the interval from the beginning of the symptoms to accurate diagnosis did not change over the past decades. Techniques for management of these lesions should be chosen with consideration of the location of the lesion. CONCLUSIONS If there is long-term complaint of undiagnosed limb pain, the physician should suspect osteoid osteoma. However, the selection of treatment modality should be considered according to the location of the lesion. Which management modality is superior may change depending on the location of the lesion between CT-guided radiofrequency ablation and surgical excision. Key words: osteoid osteoma, unusual locations, CT guided, radiofrequency ablation, benign bone tumor.

A rare case of jejunal gastrointestinal stromal tumor

Gastrointestinal stromal tumors(GISTs) are rare neoplasms of the gastrointestinal(GI) system originating from the mesenchyme. GISTs mostly develop in the stomach and small intestine. We present here a case of jejunal GIST which is the rarest subtype. A 54-year-old man presented with lower right side abdominal pain. On workup, images showed a 7cm solid-cycstic lesion adjacent to ascending colon. On surgical exploration, a large jejunal tumor en bloc resected and jejuno-jejunal primary anastomosis was performed. Pathologic results showed a 9cm jejunal GIST with 5% proliferation index. Immunohistochemistry results demonstrated high expressions of CD117, whereas CD34 negative. The patient was discharged uneventfully. GISTs should be considered in patients with abdominal pain. The mainstay treatment of the jejunal GIST is complete surgical resection. The definitive diagnosis of GISTs is by immunohistochemical stains. KEY WORDS: GIST, Stromal tumor, Jejunum.

A skin tumor from an orthopedic oncology perspective: Pilomatrixoma in extremities (11 years experience with 108 cases)

Pilomatrixoma, also known as calcifying epithelioma of Malherbe, is a benign skin neoplasm originating from hair follicle matrix cells. Pilomatrixoma is a common skin neoplasm that is often misdiagnosed as another type of skin condition. The aim of our study is to review 11 years' worth of experience in examining clinical and histopathological presentations, imaging findings, management approaches, and treatment outcomes of pilomatrixoma at a tertiary hospital. A review of the pathology database revealed that 108 extremity pilomatrixomas were excised between 2007 and 2018. Hospital charts, and pathology and orthopedic clinic records, were reviewed for patient data such as age, gender, clinical and histopathological presentations, preoperative diagnosis and imaging results, management approach, recurrence, and treatment outcomes. The main presenting symptom was a hard, subcutaneous, slowly growing mass. The preoperative diagnosis was accurate and consistent with the pathological diagnosis of pilomatrixoma in only 35 cases (32%). The optimal diagnostic tool for pilomatrixoma seems to be ultrasound imaging of superficial tissue, and the optimal first-line treatment might be surgical excision with clear margins. However, pilomatrixoma is a benign tumor, with atypical forms, and there no tumor-specific diagnostic tool is available other than careful histopathological examination.

Pancreatic extragastrointestinal stromal tumor invading the duodenum

Extragastrointestinal stromal tumors that arise in the pancreas are extremely rare and managing them can be difficult, particularly if located in the head of pancreas. This case report aims to contribute to the existing data in the literature regarding extragastrointestinal stromal tumors with rare and unusual locations. We present a 56-year-old man who presented with recurrent mild right upper quadrant abdominal pain. Abdominal computed tomography and magnetic resonance imaging revealed a mass lesion with a diameter of 10 cm localized in the head of pancreas. Pancreaticoduodenectomy with complete tumor excision was performed. He was discharged on the postoperative day 14. Only 15 extragastrointestinal stromal tumors cases have been reported. Of these 15 cases, tumors were located in the head of pancreas in six cases. Here we report the seventh case of pancreatic extragastrointestinal stromal tumor arising in the head of pancreas and also the largest of these seven tumors.

Prognostic importance of RASSF2 expression in patients with gastric cancer who had undergone radical gastrectomy

BACKGROUND

Although Ras-association domain family of gene 2 (RASSF2) has been shown to undergo promoter methylation at high frequency in some cancer types and in brain metastases, its clinical utility as a useful prognostic molecular marker remains unclear in gastric cancer.

METHODS

Prognostic significance of RASSF2 expression was retrospectively analysed by immunohistochemically in 105 patients with gastric cancer who underwent curative gastrectomy.

RESULTS

Low RASSF2 expression was detected in 58 (55 %) patients, whereas 47 patients (45 %) had high RASSF2 expression. Lymph node involvement, pT stage, TNM stage, vascular invasion, perineural invasion and the presence of recurrence were found to be significantly related to RASSF2 expression levels. Low PRL-3 expression was closely correlated with lymph node metastasis (p = 0.001), advanced pT stage (p = 0.021), advanced TNM stage (p < 0.001), the presence of vascular invasion (p < 0.001), perineural invasion (p = 0.018) and high prevalence of recurrence (p = 0.003) compared with high RASSF2 expression. The median disease-free survival (DFS) time for patients with low RASSF2 expression was significantly worse than that of patients with high RASSF2 expression (10.2 vs. 50.6 months, p < 0.001). In addition, patients with high RASSF2 expression had the higher overall survival (OS) interval compared to patients with low RASSF2 expression (NR vs. 14.9 months, p < 0.001). In the multivariate analysis, the rate of RASSF2 expression levels was an independent prognostic factor, for DFS [p < 0.001, HR 0.12 (0.10-0.88)] and OS [p < 0.001, HR 0.10 (0.04-0.46)], as were pT stage and TNM stage, respectively.

CONCLUSIONS

RASSF2 may be an important molecular marker for carcinogenesis, prognosis and progression in gastric cancer, but the potential value of RASSF2 expression as a useful molecular marker in gastric cancer progression should be evaluated, comprehensively. It would be possible to develop treatments targeting RASSF2 and advance new treatment strategies for gastric cancer.

A case report of osteoblastoma on the distal phalanx of the ring finger successfully treated with curettage and polymethylmethacrylate filling

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This is the first report of osteoblastoma on the distal phalanx. The finger was monitored closely for two years; sequential films showed a radiopaque interface and no evidence of local recurrence.

Background

Osteoblastoma is an aggressive benign tumor whose presentation varies with location and size. This rare bone tumor is thus difficult to diagnose particularly when it occurs outside its most common location – the vertebral column and long bones.

Case

We report a case of osteoblastoma of the fourth distal phalanx of the left hand in an 18-year-old male, presented with pain and swelling and treated with curettage and polymethylmethacrylate filling followed by immobilization by a cast, which was opened 10 days later to start physical therapy. Patient was pain-free, recovered full function of his finger, and remained without pain at one month post-surgery. The finger was monitored closely for two years; sequential films showed a radiopaque interface and no evidence of local recurrence.

Conclusion

This is the first report of osteoblastoma on the distal phalanx. The possibility of osteoblastoma should be considered in cases of pain and swelling of phalanx, and if diagnosed, curettage and polymethylmethacrylate filling may be the treatment of choice.

Myopericytoma of the tongue: a case report

Myopericytoma is a rare benign tumour composed of pericytic cells that show myoid differentiation and have a tendency for concentric perivascular growth. It belongs to a spectrum ofperivascular myoid cell neoplasms. To date, only a small number of cases of myopericytoma involving the oral cavity have been reported. We describe a case of myopericytoma presenting as a slowly growing tongue nodule in a 61-year-old woman. A diagnosis of myopericytoma was established with the histopathological findings combined with immunohistochemical staining. Myopericytoma should be included in the differential diagnosis of well-circumscribed, slow-growing lesions of the oral cavity.

The relationship between collapsin response mediator protein-1 (CRMP 1) expression and histopathogic parameters and survival in patient with gastric cancer

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Background: Biomarkers which indicate invasion and metastasis in patients with gastric cancer are important. Collapsin response mediator protein (CRMP) family proteins are cytosolic phosphoproteins involved in semaphorin 3A-mediated neuronal cell growth cone collapse and cancer invasion. CRMP1 over expression levels were found to have negative association with invasion and metastasis in lung cancer tissue samples. The aim of the study was to investigate relationship between CRMP1 expression and histopathological parameters and prognostic value of CRMP1 expression in patients with gastric cancer. Methods: We analyzed 52 patients who were diagnosed with gastric cancer. The CRMP1 expression was examined by performing immunohistochemical staining. High CRMP1 expression in gastric tumor samples was defined as being immunoreactive to CRMP1 antibody in more than 50% of the cancer cells. The correlation between CRMP1 expression and age, gender, tumor grade, lenfovascular-perineural invasion, t stage and nodal involvement was investigated. Results: Among the 52 patients (CRMP1 positive/CRMP1 negative= 24/28), median age was 56 years (27-84). Thirty-five patients were male and 17 patients were female. The median follow-up time was 14 (2-60) months. The median disease-free survival time (DFS) was 20 (SE: 4; 95% CI: 13-27) months. In addition, the median overall survival time (OS) was not reached. The significant relationship was found between CRMP1 high expression levels and high grade tumors (p:0.03), and nodal metastasis (p:0.019). In univariate analysis, only high CRMP1 expression was associated with poor disease-free survival (p:0.004). Also, male gender (p:0.023), high grade tumors (p:0.044), nodal involvement (p:0.028) and high CRMP-1 expression were associated shorter overall survival. In multivariate analysis, no independent prognostic factor was found in this group. Conclusions: We found that high expression of CRMP1 was associated with tumor aggressiveness of tumor and poor survival. Larger studies and further clinical trials are warranted to confirm these findings.

Case report: soft tissue metastasis from immature teratoma of the testis: second case report and review of the literature

BACKGROUND

Testicular cancer, like other histopathologic types, commonly metastasizes to the lungs, liver, and brain. Spread to soft tissue, however, is rare with only four cases with seminoma reported. However, one case with metastasis of testicular immature teratoma to soft tissue was documented previously.

CASE DESCRIPTION

We report the case of a 38-year-old man with recurrent immature teratoma of the testis who presented with a painless soft tissue mass in the left thigh previously treated with standard chemotherapy. After removal of the soft tissue mass, his serum alpha-fetoprotein level had returned to the normal range.

LITERATURE REVIEW

To our knowledge, this is the second case of immature teratoma of the testis metastasized to soft tissue.

PURPOSES AND CLINICAL RELEVANCE

We suggest that for a man with testicular cancer who has a soft tissue mass, metastasis of soft tissue from testicular cancer and other solid malignancies should be considered in the differential diagnosis of a soft tissue mass together with primary soft tissue sarcoma.