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Clynch AL, Norrington M, Mustafa MA, Richardson GE, Doherty JA, Humphries TJ, Gillespie CS, Keshwara SM, McMahon CJ, Islim AI, Jenkinson MD, P Millward C, Brodbelt AR. Cranial meningioma with bone involvement: surgical strategies and clinical considerations. Acta Neurochir (Wien) 2023; 165:1355-1363. [PMID: 36877330 PMCID: PMC10140130 DOI: 10.1007/s00701-023-05535-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/11/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients. METHODS A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0. RESULTS Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%). CONCLUSION Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.
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Affiliation(s)
- Abigail L Clynch
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.
| | - Max Norrington
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Mohammad A Mustafa
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - George E Richardson
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - John A Doherty
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Thomas J Humphries
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Conor S Gillespie
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Sumirat M Keshwara
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Catherine J McMahon
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Michael D Jenkinson
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Christopher P Millward
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Andrew R Brodbelt
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.,The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
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2
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Bhatti K, Nazir A, Ostergaard S, Schejbel L, Norgaard P, Gjerdrum LM, Moghaddas M, Nielsen TH, Munksgaard L, Pedersen LM. Bone Involvement as a Primary Rare Manifestation of Waldenstrom Macroglobulinemia: A Case Report and Prevalence in a Nationwide Population-Based Cohort Study. J Hematol 2022; 11:233-239. [PMID: 36632577 PMCID: PMC9822657 DOI: 10.14740/jh1073] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
Bone involvement is a rare extranodal manifestation in patients with malignant lymphoproliferative diseases and has also been noted as a rare event in patients with Waldenstrom macroglobulinemia (WM). However, the actual prevalence has not been previously reported. We describe an unusual case of a patient with WM who presented with lower back pain and focal bone lesions at initial diagnosis. Magnetic resonance imaging (MRI) revealed multiple vertebral fractures. Positron emission tomography (PET) detected only nodal changes without pathological skeletal-related metabolic activity. Lymph node and bone marrow biopsies combined with an immunoglobulin M (IgM) M component revealed the diagnosis of WM. A next-generation sequencing (NGS) analysis using a targeted lymphoma panel of 59 recurrently mutated genes in lymphoid neoplasms showed mutations in the MYD88 and CD79B genes. After treatment with rituximab and bendamustine, the patient achieved a partial remission and pain relief. After 3 years of stable disease, a spontaneous subcapital fracture at the base of the femoral neck and new vertebral compression fractures occurred. Whole-body low-dose computed tomography (WB-LDCT) and bone density (dual energy X-ray absorptiometry (DEXA)) scan revealed marked osteopenia. After insertion of a hip prosthesis, examination of the removed hip showed infiltration of clonal lymphoplasmacytic cells. Our case confirms that one must be aware that bone involvement in patients with WM can occur as a rare manifestation. Interestingly, the MYD88/CD79B-mutated (MCD) genotype in diffuse large B-cell lymphoma is characterized by extranodal involvement and may also be involved in the pathogenesis of skeletal-related disease in the present case. As a follow-up to this unusual case, we have carried out an analysis based on the Danish Lymphoma Registry (LYFO) covering the entire national population in the period 2000 - 2020. The registry study included a cohort of 2,459 patients with WM and lymphoplasmacytic lymphoma. Our data revealed that primary bone involvement at diagnosis occurs in 1.75% of adults with WM. To the best of our knowledge, this is the first report of the prevalence of skeletal-related disease in a large nationwide cohort and defines bone involvement as an exceedingly rare event in WM.
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Affiliation(s)
- Khazra Bhatti
- Institute of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Aqsa Nazir
- Institute of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Simon Ostergaard
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Lone Schejbel
- Department of Pathology, Herlev University Hospital, Herlev, Denmark
| | - Peter Norgaard
- Department of Pathology, Herlev University Hospital, Herlev, Denmark
| | - Lise M.R. Gjerdrum
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mahnaz Moghaddas
- Department of Radiology, Herlev University Hospital, Herlev, Denmark
| | - Torsten H. Nielsen
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Munksgaard
- Department of Hematology, Zealand University Hospital, Roskilde, Denmark
| | - Lars M. Pedersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Hematology, Zealand University Hospital, Roskilde, Denmark,Corresponding Author: Lars M. Pedersen, Department of Hematology, Zealand University Hospital, DK-4000 Roskilde, Denmark.
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3
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Brance ML, Cóccaro NM, Roitman P, Castiglioni A, Agostinis F, Spense M, Scheitlin B, Rene N, Brun LR. Pseudomyogenic hemangioendothelioma with bone and soft tissue involvement with favorable response to pamidronate: a case report and systematic review of the literature. Arch Osteoporos 2022; 17:28. [PMID: 35106633 DOI: 10.1007/s11657-022-01062-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/07/2022] [Indexed: 02/03/2023]
Abstract
Pseudomyogenic hemangioendothelioma (PMH) can be a challenge for diagnosis and might be confused with other tumors, such as epithelioid sarcoma. Here we present a case and a systematic review of the literature to identify and discuss PMH treatment in primary bone involvement. A 25-year-old woman was referred for bone pain (10/10) in the left lower limb. Magnetic resonance imaging (MRI) showed multiple bone lesions (left femur, tibia, patella, ankle, and foot) with well-defined borders without signs of local aggressiveness. Positron Emission Tomography-Computed Tomography (PET-CT) showed multiple metabolic musculoskeletal lesions in the left lower limb. A CT scan-guided biopsy was performed. Histological and immunohistochemical findings confirmed the diagnosis of PMH. After treatment with intravenous pamidronate (90 mg/monthly), the patient had clinical improvement, mild pain 2/10 without the use of non-steroidal anti-inflammatory drugs or opiates. Follow-up was assessed by MRI and PET-CT. PET-CT showed metabolic resolution of most of the bone and muscular lesions and a significant improvement of the femoral lesion. MRI showed that the lesions in the left femur, tibia, and foot had a marked decrease in size without intravenous post-contrast enhancement and smaller lesions had disappeared. After a 3-year follow-up, PET-CT showed no metabolically active images. Literature review identified 31 records including 58 clinical cases of PMH with primary bone involvement and treatment description for qualitative analysis. Most lesions (69%) were treated by local excision or curettage. In addition, amputations were performed in a significant percentage of cases (20.7%). In the last years, mTOR inhibitors (n = 7) and anti-resorptive treatments (n = 4) were considered as alternative treatment options, especially in multifocal lesions.
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Affiliation(s)
- María Lorena Brance
- Bone Biology Laboratory, School of Medicine, Rosario National University, Santa Fe, Argentina. .,Reumatología Y Enfermedades Óseas Rosario, Santa Fe, Argentina. .,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina.
| | | | - Pablo Roitman
- Pathology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Mariel Spense
- Orthopaedic Oncology, Sanatorio Británico, Rosario, Argentina
| | | | - Nicholas Rene
- Department of Radiation Oncology, Centro de Radioterapia, Rosario, Argentina
| | - Lucas R Brun
- Bone Biology Laboratory, School of Medicine, Rosario National University, Santa Fe, Argentina.,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
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Gruber I, Koelbl O. Dramatic radiotherapy response of a giant T4 cutaneous squamous cell carcinoma of the scalp with extensive bone destruction: a case report. J Med Case Rep 2021; 15:610. [PMID: 34952636 PMCID: PMC8709952 DOI: 10.1186/s13256-021-03213-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients with large cutaneous squamous cell carcinoma of the scalp are a treatment challenge. We report a case of dramatic radiotherapy response of a patient with a giant cutaneous squamous cell carcinoma of the scalp with extensive skull destruction and suspected infiltration of the dura mater and superior sagittal sinus. This case is the first report of this kind in the literature that shows that large bone defects can heal with the resolution of tumor and inflammation by secondary intention without surgical reconstruction. We want to put an end to concerns about radiocurability of tumors with extensive bone involvement, and show sustained complete response after definitive radiotherapy and programmed cell death protein-1 inhibiting antibody therapy. Case presentation A 74-year-old White man presented with a 7.2 × 6.8 × 5.5 cm painless tumor on the right parietal region of the scalp. Medical imaging revealed widespread destruction of the skull and suspected infiltration of the dura mater and superior sagittal sinus. Biopsies showed cutaneous squamous cell carcinoma (cT4a cN0 cM0, stage IVA). The patient was treated with a total dose of 60 Gy, at 2 Gy per daily fraction with volumetric modulated arc therapy using 6 megavoltage photons. The biologically effective dose (alpha/beta 10 Gy) was 72 Gy. The tumor response correlated with dose received. The patient had a massive tumor necrosis secondary to tumor shrinkage after 18 fractions (36 Gy, biologically effective dose 43.2 Gy). Leakage of cerebrospinal fluid did not occur. Radiotherapy did not hamper the patient’s quality of life. The patient had a clear regression of the initial tumor on the final day of radiotherapy. The bone defect healed by secondary intention without surgical interventions. The patient achieved a complete response with a good cosmetic result after 82 days follow-up. He started a programmed cell death protein-1 inhibiting antibody therapy with cemiplimab 2 months after radiotherapy, and is now at 10 months follow-up without evidence of recurrence. Conclusion Definitive radiotherapy is a safe and highly effective therapy for giant tumors of the scalp with extensive bone destruction. We report a sustained complete response with a good cosmetic result after secondary wound healing.
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Affiliation(s)
- Isabella Gruber
- Department of Radiation Oncology, University Hospital of University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Oliver Koelbl
- Department of Radiation Oncology, University Hospital of University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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5
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Sudo Y, Inagaki H. High-output heart failure associated with primary plasma cell leukaemia due to arteriovenous shunting: a case report. Eur Heart J Case Rep 2021; 5:ytab353. [PMID: 34557641 PMCID: PMC8453388 DOI: 10.1093/ehjcr/ytab353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022]
Abstract
Background Primary plasma cell leukaemia is rarely associated with high-output heart failure, and the underlying mechanism is not well understood. We encountered a rare case of high-output heart failure caused by primary plasma cell leukaemia. Its underlying mechanism was clarified through imaging studies. Case summary A 49-year-old man with no specific medical history was admitted to our hospital because of heart failure that did not improve with diuretic therapy. His condition was diagnosed as high-output heart failure and primary plasma cell leukaemia after admission. Extensive bone involvement in primary plasma cell leukaemia and arteriovenous shunts in the same lesion were suspected after various imaging studies. The first cycle of chemotherapy with bortezomib, adriamycin, and dexamethasone led to remission of primary plasma cell leukaemia and improved heart failure symptoms. The patient received further chemotherapy in addition to autologous peripheral blood stem cell transplantation and maintenance therapy and had no recurrence of pPCL or heart failure for 1 year to date. Discussion Primary plasma cell leukaemia can be associated with high-output heart failure, which is caused by arteriovenous shunting at the lesion site with diffuse bone involvement. Imaging studies may lead to the early diagnosis of aetiology and treatment of patients with high-output heart failure associated with primary plasma cell leukaemia.
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Affiliation(s)
- Yuta Sudo
- Department of Cardiology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama-ken 340-0043, Japan
| | - Hiroshi Inagaki
- Department of Cardiology, Soka Municipal Hospital, 2-21-1, Soka, Soka-shi, Saitama-ken 340-0043, Japan
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6
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Zheng W, Yin QQ, Hui TC, Wu WH, Wu QQ, Huang HJ, Chen MJ, Yan R, Huang YC, Pan HY. Primary bone anaplastic lymphoma kinase positive anaplastic large-cell lymphoma: A case report and review of the literature. World J Clin Cases 2021; 9:3403-3410. [PMID: 34002151 PMCID: PMC8107900 DOI: 10.12998/wjcc.v9.i14.3403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary bone lymphoma (PBL) is an uncommon extranodal disease that represents approximately 1%-3% of lymphomas. Anaplastic lymphoma kinase (ALK) positive anaplastic large-cell lymphoma (ALCL) is an extremely rare type of PBL. The aim of this report is describe the symptoms, diagnosis, and treatment of primary bone ALK-positive ALCL.
CASE SUMMARY A 66-year-old man presented to our hospital with neck and shoulder pain and intermittent fever that lasted for 1 mo. After extensive evaluation, positron emission tomography-computed tomography (CT) examination showed multiple osteolytic bone lesions without other sites lesions. CT-guided biopsy of the T10 vertebral body was performed, and the pathology results showed that neoplastic cells were positive for ALK-1, CD30, and CD3. A diagnosis of primary bone ALK positive ALCL was ultimately made. The patient was in partial response after four cycle soft cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy, and we planned to repeat the biopsy and radiological examination after completion of the fifth cycle of therapy.
CONCLUSION Primary bone ALK positive ALCL is a rare disease and physicians should keep in mind that ALCL can present with isolated osseous involvement without nodal involvement, and lymphoma should be considered in the differential diagnosis of primary bone lesions.
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Affiliation(s)
- Wei Zheng
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Qiao-Qiao Yin
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Tian-Chen Hui
- The Graduate School, Bengbu Medical College, Bengbu 233030, Anhui Province, China
| | - Wen-Hao Wu
- The Graduate School, Qingdao University, Qingdao 266071, Shandong Province, China
| | - Qing-Qing Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medicinal University, Hangzhou 310053, Zhejiang Province, China
| | - Hai-Jun Huang
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Mei-Juan Chen
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Rong Yan
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yi-Cheng Huang
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Hong-Ying Pan
- Department of Infectious Diseases, Zhejiang Provincial People’s Hospital People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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Lapietra G, Moleti ML, Giona F, Turchetti A, Celli M, Corsi A, Zambrano A, D'Avanzo M, Celli L, Testi AM. Polyostotic Fibrous Dysplasia Mimicking Bone Involvement in Hodgkin Lymphoma: A Pediatric Case and Literature Review. Acta Haematol 2020; 144:212-217. [PMID: 32712604 DOI: 10.1159/000508261] [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] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/28/2020] [Indexed: 11/19/2022]
Abstract
Bone involvement in Hodgkin lymphoma (HL) is rare. The differential diagnosis between HL bone localization and other malignant or benign skeletal diseases is challenging. We report the case of a girl affected by classic HL, initially staged IVA because of supradiaphragmatic lymph nodes and skeletal involvement. After 6 ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) cycles, positron emission tomography (PET) showed a complete metabolic response of the nodal localizations and a persistent, high metabolic activity of bone lesions. Salvage treatment followed by autologous stem cell transplant was carried out. After the transplant, the bone lesions maintained a high metabolic activity at PET. A targeted bone biopsy led to the diagnosis of a fibrous dysplasia excluding the presence of HL. To our knowledge, the concomitant presence of HL and fibrous dysplasia has not been previously reported. An in-depth evaluation of disease response to frontline treatment with a biopsy of the PET-hypercaptant bone lesions could have avoided overtreatment in this patient.
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Affiliation(s)
- Gianfranco Lapietra
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Luisa Moleti
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Fiorina Giona
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Arianna Turchetti
- Expertise for Bone Metabolic Rare Disease Center, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Mauro Celli
- Expertise for Bone Metabolic Rare Disease Center, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Anna Zambrano
- Expertise for Bone Metabolic Rare Disease Center, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Miriam D'Avanzo
- Diagnostic Radiology Center, Department of Pediatrics, Sapienza University of Rome, Rome, Italy
| | - Luca Celli
- Expertise for Bone Metabolic Rare Disease Center, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Testi
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy,
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8
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Zwirner K, Paulsen F, Schittenhelm J, Gepfner-Tuma I, Tabatabai G, Behling F, Skardelly M, Bender B, Zips D, Eckert F. Integrative assessment of brain and bone invasion in meningioma patients. Radiat Oncol 2019; 14:132. [PMID: 31358024 PMCID: PMC6664715 DOI: 10.1186/s13014-019-1341-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. However, assessability of brain or bone involvement is often limited or varies between histopathologic, operative and imaging reports. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches. METHODS A cohort of 111 patients was treated with primary, adjuvant or salvage irradiation between 2008 and 2017 using intensity-modulated radiotherapy. Positron-emission tomography (PET) was available for treatment planning in 81% of patients. Clinical data were extracted from the medical reports. Brain and bone involvement were stratified separately according to histopathologic, operative and imaging reports as well as judged in synopsis. RESULTS WHO grade I tumours, lower estimated proliferation index, primary versus recurrence treatment and localization (i.e. skull base, optic nerve sheath) were beneficial prognostic factors for local control. Judgement of brain and bone invasion partly differed between diagnostic modalities. In synopsis, brain or bone invasion did not show a significant influence on local control rates. CONCLUSIONS Several previously described prognostic factors could be reproduced. However, partly divergent histopathological, surgical and image-based judgements could be found in regard to brain and bone invasion and all methods imply limitations. Therefore, we suggest a particular, complemental synopsis judgement. In synopsis, brain or bone involvement did not coherently impair local control in our irradiated patients. This might be explained by elaborate radiation techniques and PET-based treatment planning.
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Affiliation(s)
- Kerstin Zwirner
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital Tuebingen, Calwerstr. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Irina Gepfner-Tuma
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neuro-Oncology, Departments of Neurology and Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Felix Behling
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) partner site Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany
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9
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Oliveri B, González D, Quiroga F, Silva C, Rozenfeld P. A Comprehensive Study of Bone Manifestations in Adult Gaucher Disease Type 1 Patients in Argentina. Calcif Tissue Int 2019; 104:650-657. [PMID: 30790003 DOI: 10.1007/s00223-019-00536-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/25/2018] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
Gaucher disease (GD) is the most prevalent lysosomal storage disease, and bone involvement is the most disabling condition. The aim of the present study was to evaluate bone involvement in adult patients with GD, using an observational cross-sectional study. Patients were evaluated using X-rays, bone densitometry (BMD), trabecular bone score (TBS), magnetic resonance imaging (MRI), and biochemical bone markers. Thirty-two type 1GD patients were included (mean age: 40 ± 16 years). Patients had received velaglucerase for 2.7 ± 1.4 years; 19/32 had been treated previously with imiglucerase. Ninety-four percent of subjects met therapeutic goals for hematological parameters, and eight were splenectomized (SPX). Nineteen patients had irreversible bone lesions (IL), i.e., avascular necrosis, bone infarction, and/or vertebral fractures. MRI showed marrow infiltration in 71% of patients. Patients with IL had higher bone marrow burden than those without (p = 0.001). All SPX patients had IL, a higher prevalence of bone marrow edema (p = 0.02), and lower TBS (p = 0.03) than non-SPX patients. Only 18.7% of patients had abnormal BMD, with no correlation with fractures (FX). TBS values were < 1350 in 53% of patients and tended to be lower in those with FX (p = 0.06). Patients with P1NP in the lower quartile had lower TBS (p = 0.03) than those with P1NP in the higher quartiles. TBS correlated moderately but not significantly with P1NP (r = 0.32) and BMB (r = - 0.44). A high prevalence of IL was documented. Bone quality was more affected than BMD in fracture patients. Low bone formation, active bone marrow infiltration, and splenectomy might be implicated in IL.
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Affiliation(s)
- Beatriz Oliveri
- Laboratorio de Osteoporosis y Enf. Metabólicas Oseas, INIGEM (UBA-CONICET) Hosp.de Clínicas JSM, Cordoba 2351-Piso 8, 1120, Ciudad Autonoma de Buenos Aires, Argentina.
| | - Diana González
- Mautalen Salud e Investigación, Azcuenaga, 1860-Piso 6, 1128, Ciudad Autonoma de Buenos Aires, Argentina
| | - Felisa Quiroga
- Diagnóstico Maipú, Av. Maipú 1660, Vicente López, 1602, Buenos Aires, Argentina
| | - Claudio Silva
- Diagnóstico Maipú, Av. Maipú 1660, Vicente López, 1602, Buenos Aires, Argentina
| | - Paula Rozenfeld
- IIFP, Universidad Nacional de La Plata, CONICET, Facultad de Ciencias Exactas, Departamento de Ciencias Biologicas, Calle 47 y 115-La Plata, 1900, Buenos Aires, Argentina
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Abstract
Giant cell tumour of tendon sheath (GCTTS) is considered benign, but well known for its high recurrence rate. Bone involvement of GCTTS is not uncommon and closely related to local recurrence after surgery. Radiologic findings of bone involvement are pressure erosion, circumscribed cortical destruction and degenerative arthritis. The treatment involves complete resection of tumor including bone lesion. This case presents GCTTS of young male patient with multiple bone destructions of different state, treated by complete excision of the tumor and curettage of bone lesion.
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Affiliation(s)
- Jin Young Kim
- 1 Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jae Hyun Kim
- 1 Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
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Mosheimer BA, Oppl B, Zandieh S, Fillitz M, Keil F, Klaushofer K, Weiss G, Zwerina J. Bone Involvement in Rosai-Dorfman Disease (RDD): a Case Report and Systematic Literature Review. Curr Rheumatol Rep. 2017;19:29. [PMID: 28401384 PMCID: PMC5388731 DOI: 10.1007/s11926-017-0656-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose of Review Rosai-Dorfman disease (RDD) is a rare histiocytic disorder typically presenting as painless cervical lymphadenopathy. Extranodal involvement is common and may also affect bones. Here, we present a patient with typical nodal disease and multifocal bone manifestations. Further, a systematic literature review was performed to better understand the phenotype, clinical course and treatment options of such patients. Recent Findings RDD is a nonmalignant, classically sporadic histiocytosis. Nevertheless, increasing evidence also suggests familial forms of the disease. According to our literature review, bone involvement is exceedingly rare and heterogeneous. Clinical outcome in terms of mortality seems to be favorable in most cases. Currently, therapy strategies include surgical and immunosuppressive treatments, but the optimal treatment of osseous RDD remains to be defined. Summary Patients with osseous RDD may present to rheumatologists with arthralgia or arthritis. Due to the rarity of the disease, diagnosis and treatment remain challenging. Electronic supplementary material The online version of this article (doi:10.1007/s11926-017-0656-6) contains supplementary material, which is available to authorized users.
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Real-Peña L, Talamantes Escribá F, Quilis-Quesada V, González-Darder JM. [Prognostic variability in atypical meningioma with complete resection. Proposed treatment algorithm]. Neurocirugia (Astur) 2015; 27:15-23. [PMID: 26687847 DOI: 10.1016/j.neucir.2015.08.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/21/2015] [Accepted: 08/24/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The authors attempt to show how the current prognostic factors that try to assess the risk of recurrence of atypical meningiomas are insufficient to predict the future of this disease. MATERIALS AND METHOD Using data obtained from hospital databases, a sample of 27 patients was obtained with pathological diagnosis of atypical meningioma, and who had a minimum follow-up time of 6months after diagnosis. Later prognostic factors (age <50years, male gender, bone involvement, peri-lesional swelling, tumour volume, location, Ki67/MIB-1) were evaluated after the stratification of patients undergoing complete resection in recurrencies and non-recurrencies. Univariate analysis was performed using Mann-Whitney test, χ(2) homogeneity test/Fisher exact test. Finally, multivariate analysis was performed using binary logistic regression to obtain the values for R(2) Nagelkerke and the Hosmer-Lemeshow to evaluate the goodness of fit. RESULTS The uni- and multivariate analysis showed no statistically significant differences between recurrent and non-recurrent subgroups of patients undergoing complete resection. It is noted in the results that for each year of age above 50 years, the risk of recurrence is decreased by 5.8%. CONCLUSIONS Although current prognostic factors may show an increased risk of recurrence once patients are stratified by the two most important factors (pathology and extent of resection), those factors are insufficient to predict the ultimate outcome of patients affected by this pathology.
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Affiliation(s)
- Luis Real-Peña
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia, Valencia, España.
| | | | - Vicent Quilis-Quesada
- Servicio de Neurocirugía, Hospital Clínico Universitario de Valencia, Valencia, España
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Diallo B, Barro-Traoré F, Bamba S, Sanou-Lamien A, Traoré SS, Andonaba JB, Konaté I, Niamba P, Traoré A, Guiguemdé TR. [Multiple sites extrapodal actinomycetoma: Favorable outcome to treatment with a combination of cotrimoxazole and NSAI]. J Mycol Med 2015; 25:297-302. [PMID: 26547231 DOI: 10.1016/j.mycmed.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
Mycetoma is a bacteriological or fungal infectious disease affecting the skin and/or soft tissues, which can be complicated by bone involvement. The most common feature is a tumor of the foot, but extrapodal localizations have been described. We report one case of a 47-year-old man who presented with tumefaction of a leg with multiple skin fistulae. Histopathological examination permitted to confirm the diagnosis of actinomycetoma and TDM showed the degree of bone and soft tissues involvement. Our case was characterized by the very inflammatory aspect of the tumor, its localization to the leg without foot involvement, the modest functional signs compared to the importance of radiological bone involvements, the deep destruction of the fibula while the tibia was apparently intact and the good response to treatment. In spite of its characteristic features, diagnosis of mycetoma is still late in our country, often with bone and/or articular spread. Priority may be given to measures for reduction of mycetoma diagnosis lateness.
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Affiliation(s)
- B Diallo
- Service de dermatologie du centre hospitalier universitaire Sanou Sourô, Bobo-Dioulasso, Burkina Faso
| | - F Barro-Traoré
- Service de dermatologie du centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - S Bamba
- Service de parasitologie-mycologie du centre hospitalier universitaire Sanou Sourô, Bobo-Dioulasso, Burkina Faso; Service d'imagerie médicale du centre hospitalier universitaire Sanou Sourô, Bobo-Dioulasso, Burkina Faso.
| | - A Sanou-Lamien
- Service d'anatomie pathologique du centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - S S Traoré
- Service d'imagerie médicale du centre hospitalier universitaire Sanou Sourô, Bobo-Dioulasso, Burkina Faso
| | - J-B Andonaba
- Service de dermatologie du centre hospitalier universitaire Sanou Sourô, Bobo-Dioulasso, Burkina Faso
| | - I Konaté
- Service de dermatologie du centre hospitalier universitaire Sanou Sourô, Bobo-Dioulasso, Burkina Faso
| | - P Niamba
- Service de dermatologie du centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - A Traoré
- Service de dermatologie du centre hospitalier universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - T R Guiguemdé
- Service de parasitologie-mycologie de l'institut supérieur des sciences de la santé, université polytechnique de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
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Liepe K. False-positive finding in FDG-PET in a patient with seminoma and sarcoidosis. Acta Clin Belg 2015; 70:138-40. [PMID: 25409626 DOI: 10.1179/2295333714y.0000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 33-year-old white man with testicular cancer (seminoma) stage IIIa showed a response in mediastinal lymph node metastases after chemotherapy. However, the tumor markers increase slightly, and therefore an (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography was performed. Multiple FDG avid lesions were found in lymph node, liver and bone. The standardized uptake value (SUV) was discrete increase with a value of 2·8 to 5·7, which is more typical for inflammatory disease than a malignancy. The histological findings in a mediastinal lymph node reported a sarcoidosis, and therefore all lesions were diagnosed as a sarcoidosis. The one-year follow-up showed no further increase in tumor markers and no evidence for metastases.
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