Ewing's sarcoma of rib presenting as pleural effusion in a young child

Ewing's sarcoma of rib is a rare primary malignant bone tumour which poses diagnostic dilemma and has complex treatment. The diagnosis is based on the combination of clinical, imaging, pathology and immunohistochemistry findings. We here present a case of 3.5 years old male child who presented acutely with the complaints of fever, cough and breathlessness mimicking the diagnosis of pneumonia. Massive right-side pleural effusion was seen on chest radiograph. Further radiological investigation of high-resolution contrast computed tomography (HRCT) and Positron emission tomography (PET) scan along with biopsy and immunohistochemistry lead to the diagnosis of Ewing's sarcoma arising from right rib. Patient was treated with chemotherapy, and there was significant reduction in lesion, along with clinical improvement in symptoms.

Assessing the relative benefits of imaging with plain radiographs and microCT scanning to diagnose cancer in past populations

OBJECTIVE

To determine the degree to which plain radiographs (x-rays) and microCT scans can improve accuracy in the diagnosis of cancer in human remains from past populations.

MATERIALS

The skeletal remains of 143 individuals from medieval Cambridgeshire, dating from 6th-16th century CE.

METHODS

Visual inspection of the skeletons for lesions compatible with malignancy, coupled with plain radiographs and microCT scans of the pelvis, femora and vertebra.

RESULTS

Three individuals had visually apparent metastases on their skeletons. Plain radiographs did not identify further individuals with cancer, but did show further lesions in bones with normal external appearance. MicroCT scans identified cancer in two further individuals with normal visual appearance and normal plain radiographs.

CONCLUSIONS

Imaging human skeletal remains increases the detection rate of cancer in human skeletal remains. We found microCT scanning to be a much more sensitive imaging modality than plain radiography. It improved our diagnostic accuracy and enabled us to more reliably distinguish between malignant lesions and taphonomic change.

SIGNIFICANCE

Future studies investigating the prevalence and nature of malignancy in past populations would benefit from systematic microCT scanning of pelvis, femora and vertebrae of skeletons to optimise their diagnostic accuracy.

LIMITATIONS

MicroCT scanning is more expensive than plain radiographs, and may not be easily accessible to biological anthropologists.

SUGGESTIONS FOR FURTHER RESEARCH

To apply this approach to skeletal series from different time periods and geographical regions, where the types of cancer existing in the local population may differ from those we studied in medieval Britain.

Targeting Wnt/β-catenin signaling by microRNAs as a therapeutic approach in chemoresistant osteosarcoma

Osteosarcoma (OS) is an adolescent and young adult malignancy that mostly occurs in long bones. The treatment of OS is still a big challenge for clinicians due to increasing chemoresistance, and many efforts are being made today to find more beneficial treatments. In this regard, the use of microRNAs has shown a high capacity to develop promising therapies. By targeting cancer-involved signaling pathways, microRNAs reduce the cellular level of these protein pathways; thereby reducing the growth and invasion of tumors, and even leading cancer cells to apoptosis. One of these oncogenic pathways that play an important role in OS development and can be targeted by microRNAs is the Wnt/β-catenin signaling pathway. Hence, the first goal of this review article is to explain the cross-talk of microRNAs and the Wnt/β-catenin signaling in OS and then discussing recent findings of the use of microRNAs as a therapeutic approach in OS.

Surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors

Background

The aim of this study is to present and evaluate surgical resection and reconstructive techniques using autologous femoral head bone-grafting in treating partial acetabular defects arising from primary pelvic malignant tumors.

Methods

From January 2009 until January 2015, a total of 20 primary pelvic malignancy cases involving the acetabulum were retrospectively investigated. Surgical resections and reconstructions were conducted based on the type of the tumor with custom osteotomy guides and autologous femoral head bone-grafting. In all cases, prosthesis survival period, complication occurrence, and clinical outcomes data were collected and analyzed.

Results

Thirteen male and 7 female patients with an average age of 48 years old (range 23-69 years old) were followed for a median of 69 months (range 48-112 months). Of these cases, 17 included chondrosarcomas and 3 additional patients with a malignant giant cell tumor of bone (MBGCT) as proven by pathology. During follow-up, 3 cases of chondrosarcoma recurred (15%), of which two cases received hemi-pelvic amputation, 1 case of MBGCT relapsed and developed pulmonary metastases. Two cases of acetabular prosthesis with an impending dislocation received closed reduction followed by 6 weeks of hip abduction brace fixation. One case of prosthesis loosening was revised. In another case a deep infection occurred with debridement and prosthesis removal. Musculoskeletal Tumor Society 1993 (MSTS-93) score was utilized to conduct functional evaluation: 13 cases were good, 6 were average and one was poor.

Conclusion

The precision of the osteotomies performed is likely crucial for this type of reconstructive strategy to be successful. The use of custom guides for acetabular osteotomies and femoral head reconstruction can improve functional outcomes with relatively low complications at the intermediate length of follow-up.