"Penumbra sign" in knee pain: a case of distal femur osteomyelitis

"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery due to osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.

Endolymphatic Sac Tumour: A Case Report and Review of the Literature

Introduction Endolymphatic sac tumor (ELST) is a slow-growing, low-grade, locallyinfiltrative tumor arising from the endolymphatic sac/duct, which is located in the posterior part of the petrous temporal bone. It may be sporadic in origin, or may be associated with Von-Hippel Lindau (VHL) syndrome. Case description A 40-year-old female patient with an ELST without VHL syndrome who was treated successfully by microsurgical extirpation of the tumor. Discussion We discuss the radiological features and the histopathology of this rare tumor and review the relevant literature. Conclusion The case herein reported adds to the previously-reported cases of this rare tumor.

Expression of amphiregulin in enchondromas and central chondrosarcomas

OBJECTIVES: The aim of this study was to evaluate the role of amphiregulin protein, an epidermal growth factor receptor ligand, in cartilaginous tumors. METHODS: Amphiregulin expression was examined in 31 enchondromas and 67 chondrosarcomas using immunohistochemistry analysis. RESULTS: Overall, 15 enchondromas (48.40%) and 24 chondrosarcomas (35.82%) were positive for amphiregulin. According to the receiver operating characteristic curve test, no difference in amphiregulin expression was observed between enchondromas and low-grade chondrosarcomas (p=0.0880). Additionally, 39 lesions (16 in short bones, 13 in long bones, and 10 in flat bones) were positive for amphiregulin, exhibiting a higher percentage of positive cells (p=0.0030) and intensity of immunohistochemical expression (p=0.0055) in short bone lesions than in others. Among 25 enchondromas localized in short bones, 15 expressed amphiregulin; however, all 6 cases localized in long bones were negative for this marker (p=0.0177). CONCLUSIONS: Amphiregulin did not help in distinguishing enchondromas from low-grade chondrosarcomas. The present study is the first to document the expression of this immunohistochemical marker in enchondromas. Furthermore, amphiregulin expression in enchondromas was localized in short bones, indicating a phenotypic distinction from that in long bones. This distinction may contribute to an improved understanding of the pathogenesis of these lesions.

Osteocondroma de patela. Reporte de caso / Patellar osteochondroma. Case report

Los osteocondromas son tumores benignos frecuentes en la niñez, usualmente localizados en la metáfisis de los huesos y se van alejando de la fisis a medida que se da el crecimiento. Los osteocondromas de patela son poco comunes, refiriéndonos a su ubicación. El objetivo es informar un raro caso de un paciente escolar quien presento este tumor en su rótula derecha.

Osteochondromas are frequent benign tumors in childhood, usually located in bone metaphysis from where they recede from the physis as growth occurs. Osteochondromas of the patella are rare as this location is unfrequent. The objective is to report a rare case of a school patient who presented this tumor in his right patella.

Ginger-partitioned moxibustion in prevention of vomiting induced by chemotherapy in advanced malignant bone tumors: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of ginger-partitioned moxibustion on digestive tract reaction, quality of life and white blood cell count after chemotherapy in advanced malignant bone tumors patients.@*METHODS@#A total of 64 patients were randomly divided into an observation group and a control group, 32 cases in each group. Both groups were treated with adriamycin combined with cisplatin (AP) chemotherapy. The patients in the control group were treated by tropisetron hydrochloride intravenous on preventing the vomiting 1 h before receiving chemotherapy. On the basis of the control group, the patients in the observation group were treated with ginger-partitioned moxibustion at Neiguan (PC 6), Zusanli (ST 36), Shenque (CV 8), and Zhongwan (CV 12) 2 h after chemotherapy, once a day, 30 min each time. The course of chemotherapy, ginger-partitioned moxibustion and tropisetron hydrochloride intravenous was 5 days. The digestive tract reaction rating, quality of life score and white blood cell count were compared 1 d before chemotherapy, 2 d after chemotherapy and 7 d after chemotherapy between the two groups.@*RESULTS@#The number of 0 grade in digestive tract reaction 2 d and 7 d after chemotherapy in the observation group was significantly higher than that in the control group (@*CONCLUSION@#Ginger-partitioned moxibustion can prevent and treat vomiting after chemotherapy in advanced malignant bone tumors, and improve the quality of life and white blood cell count of patients.

Bone cement type artificial bipolar femoral head replacement for the treatment of bone metastases in the proximal femur / 中国肿瘤临床

Objective: To investigate the clinical efficacy of bone cement type artificial bipolar femoral head replacement for the treatment of bone metastases in the proximal femur. Methods: Medical records of 54 patients who underwent bone cement type artificial bipolar femoral head replacement at the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2012 to June 2019 were retrospectively analyzed. Scoring for pain by visual analogue scale (VAS), musculoskeletal tumor society (MSTS) function score, international society of limb salvage (ISOLS) score, Harris function score, Karnofsky performance status (KPS) scale, and Nottingham health profile (NHP) score were used to evaluate patients' pain, limb function and the overall quality of life after surgery, and the Kaplan-Meier estimate was used for computing the survival over time. Results: Patients were followed up for (10-99) months, with an average of 42.17 months. The average operative time and the intraoperative blood loss were (79.68±6.17) min and (524±39.25) mL, respectively. The VAS score and the NHP score decreased significantly whereas the MSTS score, ISOLS score, Harris score, and KPS score improved significantly at 3, 6 and 12 months after surgery than the pre-surgery scores (P0.05). Six cases of complications were reported during the follow-up period. The mean survival time of the patients was 19.46 months, and the 6-month, 1-year and 3-year survival rates were found to be 88.89%, 70.37% and 11.11%, respectively. Conclusions: Bone cement type artificial bipolar femoral head replacement used in patients with bone metastases in the proximal femurcan effectively relieve pain, improve limb function and quality of life, and prolong survival.

Correlation between imagenological and histological diagnosis of bone tumors. A retrospective study / Correlación entre el diagnóstico imagenológico e histológico de tumores óseos. Un estudio retrospectivo

Abstract: Introduction: The objective of this study was to retrospectively compare imaging techniques with histopathological findings from bone biopsy. Material and methods: Imaging techniques such as X-Ray, CT scan and MRI where compared with the histopathological findings from bone biopsy, in a population of 64 patients with bone tumors, with 64.1% of males and an age range of 5 to 79 years. Results: Histologically, 39.1% were malignant bone tumors, while 60.9% were benign. The X-ray showed 90% of diagnostic accuracy, with sensitivity of 92.9%, specificity of 87.5%, positive predictive value of 86.7% and negative predictive value of 93.3%. CT scan presented 75.9% of diagnostic accuracy, with 84.6, 68.8, and 84.6% of sensitivity, specificity, positive predictive value and negative predictive value, respectively. The MRI documented a diagnostic accuracy of 95.1%, with 94.4% os sensitivity, 95.7% of specificity, 94.4% of positive predictive value and 95.7% for negative predictive value. This showed a great agreement between the histology findings and those within the X-Ray and MRI (K = 0.8 and 0.9, respectively), but doesn't depreciate the value of bone biopsy in diagnosis of bone tumors. Conclusion: This data showed good correlation between imagenological and histopatologic techniques.

Resumen: Introducción: El objetivo de este estudio fue comparar retrospectivamente las técnicas de imagen con los hallazgos histopatológicos de la biopsia ósea. Material y métodos: Las técnicas de diagnóstico por imágenes como rayos X, tomografía computarizada y resonancia magnética fueron comparadas con los hallazgos histopatológicos de la biopsia ósea, en una población de 64 pacientes con tumores óseos, con 64.1% de los varones y un rango de edad de cinco a 79 años. Resultados: Histológicamente, 39.1% eran tumores óseos malignos, mientras que 60.9% eran benignos. Los rayos X mostraron un 90% de precisión diagnóstica, con una sensibilidad de 92.9%, especificidad de 87.5%, valor predictivo positivo de 86.7% y un valor predictivo negativo de 93.3%. La tomografía computarizada presentó 75.9% de la precisión diagnóstica, con 84.6, 68.8, y 84.6% de sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo, respectivamente. La resonancia magnética documentó una precisión diagnóstica de 95.1%, con 94.4% de sensibilidad, 95.7% de especificidad, 94.4% de valor predictivo positivo y 95.7% para valor predictivo negativo. Esto mostró un gran acuerdo entre los hallazgos de histología y los que están dentro de la radiografía y la RMN (K=0.8 y 0.9, respectivamente), pero no deprecia el valor de la biopsia ósea en el diagnóstico de tumores óseos. Conclusiones: Estos datos mostraron una buena correlación entre técnicas imagenológicas e histopatológicas.

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil / Atrasos no sistema de saúde para crianças, adolescentes e adultos jovens com tumores ósseos no Brasil

ABSTRACT Objective: To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0-29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. Methods: Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. Results: There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. Conclusion: Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

RESUMO Objetivo: Identificar atrasos no sistema de saúde em crianças e adolescentes e adultos jovens (AAJ; até 29 anos) com osteossarcoma e sarcoma de Ewing com informações dos registros de câncer de base hospitalar do Brasil. Métodos: Os dados dos pacientes foram extraídos de 161 registros de câncer de base hospitalar brasileiros entre 2007 e 2011. Os atrasos no hospital, no diagnóstico e no tratamento foram analisados em pacientes sem um diagnóstico histopatológico anterior. Os atrasos no encaminhamento, no hospital e no sistema de saúde foram calculados para pacientes com diagnóstico histopatológico anterior. O intervalo de tempo foi medido em dias. Resultados: Não houve diferença entre os sexos nos atrasos em geral. Todos os atrasos aumentaram na faixa etária mais velha. Os pacientes sem um diagnóstico histopatológico anterior apresentaram o atraso hospitalar mais longo em comparação com os pacientes com diagnóstico histopatológico anterior antes do primeiro contato com o centro de câncer. Os pacientes com sarcoma de Ewing apresentaram atrasos no encaminhamento e no sistema de saúde mais longos do que os com osteossarcoma, que apresentaram diagnóstico histopatológico anterior antes do primeiro contato com o centro oncológico. As regiões Norte e Nordeste apresentaram o atraso mais longo no diagnóstico, ao passo que as regiões Nordeste e Sul apresentaram o atraso mais longo no tratamento. Conclusão: O atraso no sistema de saúde entre os pacientes com diagnóstico anterior foi maior e provavelmente associado ao tempo de encaminhamento para os centros oncológicos. Os pacientes sem um diagnóstico histopatológico anterior apresentaram atrasos mais longos no hospital, o que pode ser associado a possíveis dificuldades com relação à demanda e aos procedimentos de alto custo. Apesar das limitações, nosso estudo ajuda a fornecer um conhecimento inicial sobre os atrasos no sistema de saúde para tratamento de pacientes com câncer em vários hospitais brasileiros.

A novel approach to decalcification in histopathology laboratory: An adaptation from the Hammersmith protocol

Aim: Utility of modified Hammersmith protocol in the deacalcification and/or softening of tissues and samples in a histopathology laboratory were studied. The object of the study was to prepare a novel method for softening/decalcifying tissue for histopathology. Materials and Methods: All the hard tissues received in the histopathology section were received in 10% neutral buffered formalin and then placed in freshly prepared combination of 10 mL of concentrated formaldehyde and 5 mL of 10% formic acid in 85 mL distilled water was used for decalcification. The tissue was checked for evidence of adequate decalcification/softening every 6 hours. Those which were decalcified/softened were sent for routine tissue processing and staining, while those which were not, were again placed in formalin. The process was repeated until the tissue was ready for further processing. The routine sections of these slides were reviewed for morphology and stain quality along with special stains and immunohistochemistry performed. The time taken for decalcification, the variables most likely to affect decalcification, the morphology and staining characteristics were documented. Statistical analysis was done to determine the effect of softening/decalcification process on each variable. Results: A total of 201 blocks in 119 specimens from humans including 61 males and 58 females were studied. Time taken was found to have a significant correlation only with the nature of the tissue (bone vs nonbone) and not with any other parameter viz. age, gender, specimen size, type of bone, and nature of pathology. Conclusion: This novel and modified method has circumvented the common problems of overdecalcification, preserved morphology, and produced consistent results without interfering with special stains and immunohistochemistry.

Small round cell lesions of the bone: Diagnostic approach, differential diagnoses and impact on treatment

Small round cell lesions of the bone encompass a heterogeneous group of tumors and tumor-like lesions, including Ewing sarcoma, small cell osteosarcoma, mesenchymal chondrosarcoma, neuroblastoma, non-Hodgkin's lymphoma (NHL), “Ewing-like” undifferentiated round cell sarcomas, metastasizing small cell carcinoma, along with plasma cell dyscrasia and Langerhan's cell histiocytosis. At the same time, there are tumor mimics, for example, chronic osteomyelitis, which has overlapping radiologic features with Ewing sarcoma and a primary intraosseous NHL. An exact diagnosis necessitates integration of clinical, radiologic, pathologic, and ancillary test results, including immunohistochemical and molecular results. Currently, there are several immunohistochemical markers and specific molecular signatures, driving most of these tumors, available, for an exact diagnosis. This review focuses on a pragmatic approach towards uncovering specific small round cell lesions of the bone, emphasizing upon integration of traditional morphology with ancillary techniques, including immunohistochemical markers and molecular techniques, the latter, especially in cases of Ewing sarcoma, Ewing-like undifferentiated round cell sarcoma, mesenchymal chondrosarcoma, and neuroblastoma. Subsequent to the diagnostic approach, including an impact on treatment, individual intraosseous round cell lesions have been described in detail. The references include updated articles from PUBMED.

Imaging findings of primary peripheral primitive neuroectodermal tumors of bone / 中国医师进修杂志

investigate the clinical and imaging features of primary peripheral primitive neuroectodermal tumors (pPNETs) of bone. Methods Clinical and X-ray, CT and MRI findings of 6 cases of primary bone pPNETs in Wenzhou Hospital of Traditional Chinese Medicine of Zhejiang, Yueqing People′s Hospital of Zhejiang, and Wenzhou People′s Hospital of Zhejiang were retrospectively analyzed. Results There were 4 males and 2 females, aged from 2 to 38 years, with an average age of (18.5 ± 12.0) years old. Local pain was found in all cases, including 4 cases with mass, with an average survival of (22.2 ± 16.9) months. Iliac bone tumor was found in 2 cases, sacrum in 2 cases, scapula in 1 case and femur in 1 case. Digital radiography(DR) examination was performed in 4 cases:4 cases showed osteolytic destruction, including 1 case with mild swelling changes, 1 case with laminar periosteal reaction and radial bone needle, and 3 cases with soft tissue mass. CT examination was done in 4 cases, and there were 4 cases of osteolytic destruction accompanied by soft tissue mass without periosteal reaction. Among them, 1 case had irregular sclerosis at the edge of bone destruction and 2 cases had fine calcification in soft tissue mass. MRI examination in 4 cases:there were 3 cases with equal signal on T1WI and 1 case with moderate to high signal on T1WI, 3 cases with inhomogeneous medium and high signal on T2WI and STIR, and 1 case with homogeneous high signal on T1WI, and 4 cases with soft tissue masses and peritumoral edema. Conclusions Bone pPNETs is characterized by osteolytic destruction with soft tissue masses, periosteal reaction with or w ithout periosteal reaction, and intratumor al calcification. Im aging exam ination is helpful to under stand the extent of lesions, formulation of therapeutic measures and evaluation of therapeutic effect.

Imaging findings of primary peripheral primitive neuroectodermal tumors of bone / 中国医师进修杂志

Objective@#To investigate the clinical and imaging features of primary peripheral primitive neuroectodermal tumors (pPNETs) of bone.@*Methods@#Clinical and X-ray, CT and MRI findings of 6 cases of primary bone pPNETs in Wenzhou Hospital of Traditional Chinese Medicine of Zhejiang, Yueqing People′s Hospital of Zhejiang, and Wenzhou People′s Hospital of Zhejiang were retrospectively analyzed.@*Results@#There were 4 males and 2 females, aged from 2 to 38 years, with an average age of (18.5 ± 12.0) years old. Local pain was found in all cases, including 4 cases with mass, with an average survival of (22.2 ± 16.9) months. Iliac bone tumor was found in 2 cases, sacrum in 2 cases, scapula in 1 case and femur in 1 case. Digital radiography(DR) examination was performed in 4 cases:4 cases showed osteolytic destruction, including 1 case with mild swelling changes, 1 case with laminar periosteal reaction and radial bone needle, and 3 cases with soft tissue mass. CT examination was done in 4 cases, and there were 4 cases of osteolytic destruction accompanied by soft tissue mass without periosteal reaction. Among them, 1 case had irregular sclerosis at the edge of bone destruction and 2 cases had fine calcification in soft tissue mass. MRI examination in 4 cases:there were 3 cases with equal signal on T1WI and 1 case with moderate to high signal on T1WI, 3 cases with inhomogeneous medium and high signal on T2WI and STIR, and 1 case with homogeneous high signal on T1WI, and 4 cases with soft tissue masses and peritumoral edema.@*Conclusions@#Bone pPNETs is characterized by osteolytic destruction with soft tissue masses, periosteal reaction with or without periosteal reaction, and intratumoral calcification. Imaging examination is helpful to understand the extent of lesions, formulation of therapeutic measures and evaluation of therapeutic effect.

MR imaging of primary malignant bone tumors with surgical and histopathological correlation

Background: A bone tumor is a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous). Aims and objectives: The purpose of this study was to evaluate the role of MRI in cases of primary malignant bone tumors and MRI characteristics of different primary malignant bone tumors, to compare the imaging findings with surgical and gross pathological findings, Staging of tumor on MRI, correlating them with operative and histopathological findings. Materials and methods: This was a prospective study done in Department of Radiodiagnosis of NRIGH comprising of 40 patients 21 male and 19 female who were suspected or proven cases of the malignant bone tumor. Plain radiographs in AP and Lateral views (including the adjacent joint) were taken in all cases. The primary pulse sequences included T1 and T2 WI using spine echo and gradient echo techniques with TR of 600 msec. and TE 30msec. for T1WI and TR of 2740 msec. and TE of 85 msec. for T2 WI . The MR morphology was correlated with surgical and histopathological features. Results: The study “Multiplanar MR Imaging of primary malignant bone tumors with surgical and histopathological correlation” comprised of 40 patients in a two year period starting from august 2010 to September 2012 the age ranged from 8 years to 71 years (mean 40 years). There were 21 males and 19 females. Conclusion: MRI in combination with plain radiography is an excellent modality for evaluation of the musculoskeletal pathologies especially differentiating a malignant from a benign lesion. The multiplanar imaging capabilities place a major role in delineation of tumour extent in to the bone and Karuna V, R Vikash Babu. MR imaging of primary malignant bone tumors with surgical and histopathological correlation. IAIM, 2019; 6(10): 8-21. Page 9 soft tissues with high contrast and resolution with additional information of neurovascular bundle involvement, joint involvement and staging.

Aspectos radiográficos de osteossarcoma em maxila-relato de caso / Radiographic aspects of osteosarcoma in jaw

O osteossarcoma é uma neoplasia maligna, derivada de células ósseas, de etiologia idiopática, mais comum em ossos longos e raramente encontrado nos maxilares. Clinicamente, apresenta-se por meio de aumento de volume local, dor intensa, mobilidade dentária e limitação funcional. Radiograficamente, apresenta imagens osteofíticas de aspecto semelhante a raios de sol. O diagnóstico é estabelecido por achados clínicos, imaginológicos e histopatológicos. O tratamento consiste em ressecção cirúrgica, associada ou não à radioterapia e/ ou quimioterapia. Este presente artigo tem como objetivo apresentar um caso de osteossarcoma na maxila de um paciente de 30 anos, com enfoque em seus aspectos de imagem e radiográficos... (AU)

Ostessarcoma is the malignant neoplasm derived from bone cells, with idiopathic etiology, occurring more frequently in the long bones and rarely in the jaws. Clinically presents through local volume increase, severe pain, tooth mobility and functional limitation. Radiographically presents osteophytics images similar to sunshine. The diagnosis is established by clinical, imaginary and histopathological findings. The treatment consists of surgical resection associated or not with radiotherapy and / or chemotherapy. This article has as objective to present a case of osteosarcoma in the maxillary of a 30-year-old patient, focusing on its radiographic aspects... (AU)

Lesões líticas de alto risco e fraturas patológicas / High-risk lytic lesions and pathologic fractures

Introdução: As neoplasias ósseas, sejam primárias ou metastáticas, representam um grande risco à qualidade de vida do paciente; especialmente quando se tratam de lesões dolorosas e com risco de evoluírem a fraturas ósseas, principalmente as do tipo osteolíticas. Lesões osteolíticas podem ocorrer em diversas patologias ósseas não tumorais, como cisto ósseo simples, cisto aneurismático, hiperparatireoidismo, bem como por neoplasias, entre elas destacando-se Mieloma Múltiplo tumores metastáticos, principalmente, Câncer de Mama, Próstata, Pulmão e Rim, cujas principais complicações são as fraturas ósseas patológicas. Métodos: Foram revisados artigos disponíveis em plataformas indexadas online, bem como revisada a literatura disponível em livros textos, guidelines e base de dados nacionais e internacionais. Resultados: Fraturas patológicas podem acometer até 30% dos pacientes com doença metastática óssea, causando dor importante mesmo no período anterior à fratura propriamente dita (Fratura Iminente) ou quando ela já é inevitável. Visando avaliar de forma objetiva a indicação de intervenções profiláticas, Mirels propôs um escore de pontuação avaliando multifatorialmente as lesões ósseas e seus possíveis prognósticos para fraturas. Conclusão: Embora ainda seja considerada o padrão-ouro e relativamente eficiente, o sistema de pontuação de Mirels deve ser aplicado junto com a avaliação clínica e de exames de imagem do médico, como a melhor forma de antever a fratura e, se possível, tratá-la profilaticamente.

Introduction: Bone neoplasms, whether primary or metastatic, represent a great risk to the patient's quality of life; especially when they deal with painful lesions and risk of developing osteolytic fractures. Osteolytic lesions may occur as a result of several non-tumorous bone pathologies, such as simple bone cyst, aneurysmal cyst, hyperparathyroidism, as well as neoplasias, among them Metastatic Multiple Myeloma, Breast Cancer, Prostate, Lung, and Kidney and its main complications are the bone fractures. Methods: Articles available on online indexed platforms were reviewed, as well as the literature available in national and international text books, guidelines and databases. Results: Pathological fractures can affect up to 30% of patients with metastatic bone disease, causing important pain even in the period before the fracture itself (Imminent Fracture), when it is already inevitable. In order to objectively evaluate the functionality of prophylactic interventions, Mirels proposed a scoring score evaluating multifactorially the bone lesions and their possible prognoses. Conclusion: Although the gold standard is still considered to be relatively efficient, the Mirels scoring system should be applied in conjunction with clinical assessment and imaging of the physician in order to better anticipate the fracture and, if possible, treat prophylactically.

A rare case of multifocal pseudomyogenic hemangioendothelioma, involving soft tissues and bone, misdiagnosed as a rhabdomyosarcoma: Diagnostic and treatment implications.

Pseudomyogenic hemangioendothelioma (PHE) is an uncommon, but distinctive soft tissue tumor, characterized by multifocality. A 17‑year‑old male referred to us with progressively increasing multiple subcutaneous nodular lesions over his left leg and foot, reported elsewhere as a spindle cell rhabdomyosarcoma. On review, microscopy showed a cellular tumor comprising plump spindle cells arranged in loose fascicles with interspersed inflammatory cells. Tumor cells exhibited mild nuclear variation. Immunohistochemically, tumor cells expressed AE1/AE3, CD31, Fli‑1, and smooth muscle actin (SMA), confirming diagnosis of PHE. Whole‑body positron emission tomography–computed tomography (PET‑CT) scan revealed multiple, metabolically active, subcutaneous nodular lesions over the left lower leg and in the distal tibia. Subsequently, resection specimens from the various lesions and bone curettage also revealed features of PHE. Three months later, the patient developed multiple lesions over his fourth toe and left foot, for which he underwent tumor resections. At present, he is disease‑free. PHE is a locally aggressive soft tissue tumor characterized by multifocality, rarely bony involvement and can be misdiagnosed as a high‑grade sarcoma.

Tratamiento quirúrgico de los tumores primarios malignos de pelvis de la zona II de Enneking / Surgical treatment of malignant primary tumors of the pelvis on Enneking's zone II

Resumen: Introducción: El tratamiento quirúrgico de los tumores óseos malignos de pelvis con afectación periacetabular está en continua evolución. Las reconstrucciones acetabulares mejoran la calidad de vida sin perjudicar el control oncológico; sin embargo, no están exentas de complicaciones. Nuestro objetivo es describir los resultados funcionales y las complicaciones quirúrgicas de diferentes técnicas reconstructivas de la zona II de Enneking. Material y métodos: 15 pacientes fueron intervenidos de tumores óseos malignos de pelvis entre 2002 y 2012. Según la clasificación de Enneking y Dunham, hubo siete individuos con afectación periacetabular: tipo II-3, tipo I + II-1, tipo II + III-2, tipo I + II + III-1, que se evaluaron retrospectivamente. Cinco presentaron un condrosarcoma convencional y dos un osteosarcoma. Cuatro eran varones y tres mujeres, con una edad media de 43 años. El seguimiento mínimo fue 12 meses (6.14 años de media). En todos se realizó una resección oncológica con reconstrucción periacetabular: aloinjerto osteocondral masivo en tres sujetos, aloinjerto estructural más artroplastía de cadera en dos personas y dos con prótesis de anclaje ilíaco. Fueron evaluados clínica, radiológica y funcionalmente mediante la escala MSTS (1993). Resultados: La media MSTS a los seis meses de la cirugía fue 20.71 (69%). Complicaciones quirúrgicas aparecieron en cinco casos (71.4%): dos luxaciones de cabeza femoral nativa sobre aloinjerto, una desimplantación protésica aséptica y dos infecciones profundas. Hubo bordes libres intraoperatorios en todos los casos. Conclusiones: Las reconstrucciones acetabulares después de resecciones oncológicas en tumores óseos malignos parecen ofrecer buenos resultados funcionales. Sin embargo, sólo casos seleccionados deberían ser sometidos a intervenciones con alta tasa de complicaciones.

Abstract: Introduction: Surgical treatment of malignant bone tumors of the pelvis with periacetabular involvement is constantly evolving. Even though acetabular reconstructions improve quality of life without impairing cancer control, they are not complication free. Our purpose is to describe the functional outcomes and surgical complications of different reconstructive techniques for Enneking zone II tumors. Material and methods: Fifteen patients underwent surgery for malignant pelvic bone tumors between 2002 and 2012. Seven patients were retrospectively evaluated according to the Enneking and Dunham classification and were found to have periacetabular involvement, as follows: 3 were type II; 1 types I + II; 2 types II + III, and one types I + II + III. Five patients had a standard chondrosarcoma and 2 osteosarcoma. Patients included 4 males and 3 females; mean age was 43 years. The minimum follow-up period was 12 months (mean 6.14 years). All of them underwent cancer resection with periacetabular reconstruction: massive osteochondral allograft in 3 patients, structural allograft and hip arthroplasty in 2 patients, and prosthesis with iliac anchoring in 2. They were clinically, radiologically and functionally evaluated with the MSTS scale (1993). Results: The mean MSTS score 6 months after surgery was 20.71 (69%). Five patients (71.4%) had surgical complications: 2 dislocations of the native femoral head on the allograft; one aseptic prosthetic dislodgement, and 2 deep infections. All patients had free intraoperative borders. Conclusions: Acetabular reconstructions after oncologic resection for malignant bone tumors seem to provide good functional outcomes. However, only selected cases should undergo surgeries associated with a high complication rate.

Angiolipoma intraóseo del calcáneo. Reporte de un caso y revisión de la literatura / Calcaneous intraosseous angiolipoma. A Case Report and literatura review

Los lipomas intraóseos son considerados como los tumores óseos primarios benignos más raros por su muy poca frecuencia. Su incidencia es menor del 1 por 1.000 entre los tumores primarios y para 2002 se habían publicado menos de 100 casos a nivel mundial. El angiolipoma, es una variante histológica del lipoma aún menos frecuente, representando sólo del 5 al 17% de todos los lipomas intraóseos. Generalmente se trata de una lesión asintomática, un hallazgo radiológico en exámenes realizados por otras razones suele ser la forma de su diagnóstico. Sin embargo, algunos lipomas pueden ser sintomáticos. Presentamos el caso de paciente femenino de 36 años quien posterior a presentar dolor del tobillo derecho se diagnostica una lesión en el calcáneo, que posterior a su análisis anatomopatológico resultó ser un angiolipoma intraóseo. Presentamos su tratamiento con médula ósea autóloga y su evolución(AU)

Intraosseous lipomas are considered the rarest and a very infrequently benign primary bone tumors. Its incidence is less than 1 per 1,000 between primary tumors and by 2002 had published fewer than 100 cases worldwide. The angiolipoma, is a histological variant of lipoma even rarer, representing only 5 to 17% of all intraosseous lipomas. This is usually an asymptomatic lesion, radiological finding in tests performed for other reasons is usually the way to diagnosis. However, some may be symptomatic lipomas. We report the case of a female patient aged 36 who after presenting pain in the right calcaneus, which after pathologic analysis proved diagnosed intraosseous angiolipoma. We present treatment with autologous bone marrow and evolution(AU)

Osteosarcoma de fémur en un adulto y manejo con artroplastia no convencional. Reporte de un caso / Femur osteosarcoma in an adult and management with non-conventional arthroplasty. Report of a case

El osteosarcoma es el tumor óseo maligno primario más frecuente. Se caracteriza por la producción de osteoide tumoral (trabéculas óseas inmaduras) por parte de las células neoplásicas. Su mayor incidencia se da en la adolescencia y después de los 65 años. Son más comunes en varones y personas de raza negra. A pesar de su baja incidencia este tipo de lesión requiere una atención multidisciplinaria, diagnostico precoz, y tratamientos oportunos para aumentar la sobrevida y mantener la calidad de vida del paciente. En la actualidad y con los adelantos quirúrgicos-reconstructivos, la resección tumoral con cirugía de preservación del miembro es el tratamiento estándar para esta patología. Presentamos el caso de paciente masculino de 25 años quien presentó un osteosarcoma del fémur distal derecho. Fue tratado con quimioterapia adyuvante y resección en bloque y artroplastia total no convencional de la rodilla. Presentamos los resultados de su tratamiento y su evolución a largo plazo(AU)

Osteosarcoma is the most common primary malignant bone tumor. It's characterized by the production of tumor osteoid (immature bone trabeculae) by the neoplastic cells. His greatest incidence occurs in adolescence and after age 65. They are more common in males and blacks individuals. The low incidence of this type of injury, requires a multidisciplinary care, early diagnosis and appropriate treatments to increase survival and maintain quality of life of patients. Today, with the reconstructive surgical advances, tumor resection with limb-sparing surgery is the standard treatment for this condition. We present a 25 years old male patient who presented an osteosarcoma of the right distal femur. He was treated with adjuvant chemotherapy and en bloc resection and unconventional Total Knee Arthroplasty. We present the results of their treatment and long-term evolution(AU)

Epidemiological data and case load spectrum of patients presenting to bone and soft tissue disease management group at a tertiary cancer center.

INTRODUCTION AND BACKGROUND: This study was conducted to know the spectrum and number of bone and soft tissue (BST) tumors presenting to our institute. We needed to assess the gap between the number of patients seen and infrastructure available, and based on this information, help formulate guidelines for optimum utilization of resources and to provide best possible evidence‑based cancer care. SETTINGS AND DESIGNS: This is a prospective observational study (epidemiological). MATERIALS AND METHODS: This study included all new patients seen in BST‑disease management group (DMG) in the year 2010. An audit form was devised to capture all the relevant information. A comparison of our data with other national and international studies was also done. RESULTS: Out of total 31,951 new patients registered at our institute, 2007 patients availed BST‑DMG services. Sixty percent were bone tumors and 36% were soft tissue tumors. In bone tumor, 66% were malignant, 15% were benign, and 19% were non-neoplastic. Osteosarcoma (43%) was the most common malignant tumor followed by primitive neuroectodermal tumor/Ewing’s (27%) and chondrosarcoma (11%). Giant cell tumor was the most common benign bone tumor. Eighty‑one percent of all soft tissue lesions were malignant, of which 75% were of mesenchymal origin and 25% were of cutaneous origin. CONCLUSION: This is an attempt to document the epidemiology of musculoskeletal tumors presenting to our institution while guiding the institute to frame and implement disease‑specific protocols and generate further research questions. Continued data collection and follow‑up can provide valuable information on long‑term survival and treatment‑related toxicities. This data (within limitations) may be extrapolated to national level to identify the need for infrastructure and human resources.