Osteoid Osteoma of the Sacrum: A Case Report / 대한척추외과학회지

STUDY DESIGN: Case report.OBJECTIVES: To report a case of osteoid osteoma arising in the sacrum in a 29-year-old male patient.SUMMARY OF LITERATURE REVIEW: Osteoid osteoma is a benign osteoblastic tumor that usually arises in the long bones. Osteoid osteoma involving the sacrum is extremely rare.MATERIALS AND METHODS: A 29-year-old male patient presented with pain localized in his sacral area for 10 months. His pain was worse at night, relieved by non-steroidal anti-inflammatory drugs, and independent of physical activity. Bone scintigraphy showed increased uptake in the second sacral vertebra (S2). Computed tomography revealed a nidus located in the S2 spinous process. Magnetic resonance imaging showed bone and soft tissue edema around the nidus.RESULTS: En bloc excision including the nidus revealed a diagnosis of osteoid osteoma and provided immediate relief of the patient's long-lasting sacral pain.CONCLUSIONS: When a young patient presents with localized sacral pain that is worse at night, relieved by non-steroidal anti-inflammatory drugs, independent of physical activity, and lasts longer than expected, proper imaging studies should be performed to rule out osteoid osteoma. Although less invasive treatment modalities have been introduced, classical en bloc excision is currently the gold standard for managing osteoid osteoma.

Clear Cell Chondrosarcoma Mimicking Benign Bone Tumors / 대한정형외과학회잡지

PURPOSE: Clear cell chondrosarcoma may have a benign appearance even on a magnetic resonance imaging (MRI). Hence, it can be confused with benign bone tumors, such as a giant cell tumor or chondroblastoma. The aim of our study was to document the doctorassociated diagnostic errors in patients with clear cell chondrosarcoma and oncologic outcomes of these lesions, which were misdiagnosed as benign bone tumors. MATERIALS AND METHODS: We identified 10 patients who were diagnosed with and treated for clear cell chondrosarcoma between January 1996 and December 2014. One patient was excluded due to insufficient clinical data. We then reviewed their data regarding age, gender, symptom onset, tumor location, initial imaging diagnosis, and associated previous treatment. We examined the errors of surgeons and pathologists with respect to patient and tumor characteristics. We also analyzed treatment delay, time to local recurrence, metastasis, follow-up duration, and the oncologic outcome. RESULTS: The initial presumptive diagnosis based on MRIs for all 9 patients was benign bone tumor. Among 8 patients who underwent inappropriate procedure, half of them were diagnosed as clear cell chondrosarcoma immediately after the curettage. As for the remaining 4 patients, the surgeon did not send any tissue samples to a pathologist for a definite diagnosis in three patients and a pathologist made an incorrect diagnosis in one patient. We performed an appropriate surgery on all patients with a wide surgical margin. The average treatment delay was 27 months (range, 0–127 months), and the average follow-up duration was 65 months (range, 13–164 months). One patient had local recurrence after 12 months. Metastatic disease developed in 2 patients with a median time to definitive treatment of 24 months (12–37 months). Ten-year overall survival of patients with clear cell chondrosarcoma was 78%, and two patients died due to disease progression. CONCLUSION: Misdiagnosis of clear cell chondrosacroma as a benign bone tumor is not uncommon, even for experienced orthopaedic oncologists, resulting in definite curative surgery without biopsy. An inappropriate primary treatment may increase the risk of local recurrence and metastasis. Therefore, a proper subsequent surgery is mandatory for patients with clear cell chondrosarcoma who received inadvertent curettage.

Treatment of benign bone lesions of proximal femur using dynamic hip screw and intralesional curettage via Watson-Jones approach / 中国修复重建外科杂志

Objective: To explore the effectiveness of dynamic hip screw (DHS) and intralesional curettage via Watson-Jones approach in treatment of benign bone lesions of the proximal femur.

Treatment of proximal femoral benign lesions by proximal femoral nail anti-rotation combined with curettage and bone graft through the Watson-Jones approach / 中国修复重建外科杂志

Objective: To evaluate the feasibility and effectiveness of proximal femoral nail anti-rotation (PFNA) combined with curettage and bone graft through Watson-Jones approach in the treatment of proximal femur benign tumors and tumor like lesions. Methods: The clinical data of 38 patients with benign tumors and tumor like lesions in the proximal femur who were treated through the Watson-Jones approach with PFNA combined with curettage and bone graft between January 2008 and January 2015 were retrospective analysed. There were 24 males and 14 females with an average age of 28 years (range, 15-57 years). Pathological types included 20 cases of fibrous dysplasia, 7 cases of bone cyst, 5 cases of aneurysmal bone cyst, 3 cases of giant cell tumor of bone, 2 cases of enchondroma, and 1 case of non-ossifying fibroma. Before operation, hip pain occurred in 19 patients, pathological fracture occurred in 12 patients, limb shortening and coxa varus deformity was found in 4 patients, and 3 patients received surgery for the local recurrence. The operation time, intraoperative blood loss, and full-weight bearing time after operation were recorded. Patients were followed up to observe union of bone graft and the position of internal fixator on X-ray films and CT images. Visual analogue scale (VAS) score was used to evaluate the level of pain. The Musculoskeletal Tumor Society (MSTS93) score was used to evaluate lower limb function. Harris hip score was used to evaluate hip joint function. Results: The operation time was 130-280 minutes (mean, 182 minutes) and the intraoperative blood loss was 300-1 500 mL (mean, 764 mL). After operation, 3 cases of fat liquefaction of incision healed successfully by carefully dressing, and the rest incisions healed by first intention. All patients started partially weight-bearing exercise at 2-4 weeks after operation. The total weight-bearing time was 3-6 months (mean, 4.2 months). All the patients were followed up 24-108 months (median, 60 months). Imaging examination showed that the bone graft fused and the fusion time was 8-18 months (mean, 11.4 months). During the follow-up period, there was no complication such as pathological fracture, femoral head ischemic necrosis, hip joint dislocation, internal fixation loosening and fracture, and no tumor recurrence or distant metastasis occurred. At last follow-up, the VAS score, MSTS93 score, and Harris score were significantly improved when compared with preoperative ones ( P<0.05). Conclusion: The treatment of proximal femoral benign lesions by PFNA combined with curettage and bone graft through the Watson-Jones approach is safe and effective, with advantages of better mechanical stability, less residual tumor, and less postoperative complications.

Therapeutic Approach to Humeral Pathologic Fracture Caused by Benign Bone Tumor / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to suggest an appropriate therapeutic approach by making a comparison between conservative therapy and surgical therapy for a pathologic fractures of the humerus caused by benign bone tumor. MATERIALS AND METHODS: We selected 15 cases with a pathologic fracture of the humerus caused by benign bone tumor from January 2000 to April 2014 to evaluate the fracture union period and remission of primary bone tumor. Eight cases were treated with conservative therapy, and 7 cases by surgical therapy. The mean age was 13.1 years, and the age range was between 1 year and 19 years; there were 8 male cases and 7 female cases. The mean follow-up period was 24.9 months, with a range from 4 months to 72 months. We evaluated the remission of primary benign tumor in accordance with the ‘Modified Neer classification’ system. RESULTS: There was no statistically significant difference in age, sex, and mean follow-up period between the two groups. The pathologic fracture was united in all cases without secondary displacement. There was no statistically significant difference in the fracture union period (p=0.164) and remission of primary benign tumor (p=0.931) between the two groups. CONCLUSION: We suggest that both conservative and surgical therapies can be a treatment for pathologic fracture of the humerus caused by benign bone tumor.

Bone tumors in pre-modern skulls from human skeletal series of Joseon Dynasty / 대한해부학회지

To date, there are still very few reports on benign-tumor cases based on East Asian skeletal series, even though other regions and continents have been well represented. In our study on the Joseon Human Skeletal Series, we identified benign bone tumors in two skeletons (cases Nos. 75 and 96). Our radiological analyses showed both cases to be homogeneous sclerotic bone masses aligned with the cranial vault suture. In a subsequent series of differential diagnoses, we determined both cases to be osteoma, the most common bone-tumor type reported for archaeological samples. Our study is the osteoarchaeological basis for this, the first-ever report on benign bone neoplasm in a pre-modern East Asian population.

Large desmoplastic fibroma: case report using microvascularized fibula graft for reconstruction / Fibroma desmoplásico de grandes proporções: relato de caso usando enxerto microvascularizado de fibula para reconstrução

The Desmoplastic Fibroma is a benign rare tumor of fibroblastic origin, representing only 0.03% of benign bone tumors. Displays aggressive behavior and high rates of recurrence, which makes the treatment more aggressive. The authors present a case of an 11 years-old female, complaining of increased volume in the jaw. The patient had an extensive swelling of the left mandibular body with invasion of the border of the tongue and floor of the mouth at the same side. She had a history of 4 recurrences at the same site. Image exams revealed expansive lesion in body and ramus of the mandible with involvement of soft tissue on the lingual side of the lesion. The treatment was excision of the lesion with extra oral access and reconstruction with microvascularized fibula graft. The patient has been followed for 2 years with no clinical or radiographic signs and without recurrence

O Fibroma Desmoplásico é um tumor benigno raro de origem fibroblástica que representa apenas 0,03% dos tumores ósseos benignos. Apresenta comportamento agressivo e elevadas taxas de recorrência, o que torna o seu tratamento mais agressivo. Os autores apresentam um relato de caso de uma paciente do sexo feminino de 11 anos de idade com queixa de aumento de volume em mandíbula. A mesma apresentou extensa expansão do corpo mandibular esquerdo, com invasão da borda da língua e assoalho da boca do mesmo lado, com histórico de quatro recorrências na mesma localização. Os exames de imagem revelaram lesão expansiva no corpo e ramo da mandíbula com envolvimento dos tecidos moles do lado lingual da lesão. O tratamento foi a excisão da lesão com acesso extra-oral e reconstrução com enxerto microvascularizado de fíbula. A paciente apresenta seguimento de 2 anos sem sinais clínicos ou radiográficos de recidiva.

Tumor Treated by Endoscopy

BACKGROUND: This study was conducted to examine the clinical usefulness and efficacy of endoscopic curettage on benign bone tumor. METHODS: Thirty-two patients (20 men and 12 women) with benign bone tumor were included in the study. The patients were aged between five and 76 years; the mean follow-up period was 27.05 months (range, 9.6 to 39.9 months). The primary sites include simple bone cyst (9 cases), fibrous dysplasia (6 cases), enchondroma (5 cases), non-ossifying fibroma (4 cases), bone infarct (3 cases), aneurysmal bone cyst (1 case), chondroblastoma (1 case), osteoblastoma (1 case), intraosseous lipoma (1 case), and Brodie abscess (1 case). A plain radiography was performed to assess the radiological recovery. Radiological outcomes, including local recurrence and bone union, were evaluated as excellent, good, poor, and recurred. RESULTS: In our series, there were 27 cases (84.4%) of good or better outcomes, six cases (18.8%) of complications (4 local recurrence, 1 wound infection, and 1 pathologic fracture). CONCLUSIONS: Our results showed that endoscopic curettage and bone graft had a lower rate of recurrence and a higher cure rate in cases of benign bone tumor. It can, therefore, be concluded that endoscopic curettage and bone graft might be good treatment modalities for benign bone tumors.

Early Result of Demineralized Bone Matrix (DBM, Genesis(R)) in Bone Defect after Operative Treatment of Benign Bone Tumor / 대한골관절종양학회지

PURPOSE: This study was performed to evaluate the efficiency of demineralized bone matrix (DBM, Genesis(R)) used for bone defect after operative traetment of benign bone tumors by clinical and radiological methods. MATERIALS AND METHODS: DBM was used to treat bone defect after operative treatment of benign tumor from February 2012 to May 2013. Total 25 benign bone tumor cases (15 males, and 10 females) with mean age of 30.3 were studied. The diagnoses were solitary bone cyst in 9 cases, non ossifying fibroma in 5, fibrous dysplasia in 5, aneurysmal bone cyst in 3 and enchondroma in 3. In categorization by location of tumor, there were 5 cases of distal femur, 4 of proximal tibia, 3 of proximal femur, 3 of proximal humerus, 3 of phalanx, 2 of distal radius, 2 of hip bone, 2 of calcaneus, and 1 of scapula. Autogenous bone was used with DBM in 6 cases, and only DBM used in 19 cases. Mean periods of follow up were 8.7 months (range: 6 to 14 months). Amount of graft resorption and bone formation was observed with compare of post operation radiograph and the difference was shown by percentage. Resorption level was measured by DBM level which could be observed from simple x-ray, and bone formation level by bone trabecular formation level at impaired site. RESULTS: Twenty three cases of total 25 cases showed bone union. In the 23 cases, more than 98% DBM resorption was observed after mean 4.3 months, and more than 98% bone formation was observed after mean 6.9 months. Lesser bone defect sizes showed faster bone formation and it was statistically significant (p=0.036). But other comparative studies on other factors such as, sex, age of patients and combination of autogenous bone were no statistically significant differences in graft resorption and bone formation. And there was no significant complication in periods of follow-up. CONCLUSION: Demineralized Bone Matrix (Genesis(R)) is thought to be useful treatment for bone defect after operative treatment of benign bone tumor, however longer follow-up periods appears to be needed.

The Effect of Platelet-Rich Plasma on Allograft Transplantation after Curettage in Benign Bone Tumor / 대한골관절종양학회지

PURPOSE: This study was performed to evaluate the efficiency of Platelet-rich plasma (PRP) for acceleration of bone healing process on allograft transplantation after curettage in benign bone tumor. MATERIALS AND METHODS: From December 2007 to February 2009, twenty-one patients who had benign bone tumor and underwent allograft transplantation after curettage were evaluated. Mean follow-up period was 14.6 months (range, 12-26 months). We compared with 13 cases of PRP group and 8 cases of non-PRP group in terms of size of lesion, bone resorption, amount of applied PRP and complications. The mean age at surgery was 23.6 years (range, 4-73 years). The most common diagnosis was simple bone cyst (7) followed by enchondroma (4), giant cell tumor (3), undifferentiated benign bone tumor (3) and so on. RESULTS: The mean size of lesion was 33.5 cm3 (range, 2.3-181.9 cm3) (29.4 cm3 in PRP group and 40.2 cm3 in non-PRP group). The mean volume of injected PRP was 7.4 cc (range, 3-12 cc). Bone union started at 3.0 months (range, 1.5-5.8 months) in PRP group and 5.3 months (range, 4-8 months) in non-PRP group. Three cases for each group were excluded due to recurrence and pathologic fracture. One patient had febrile episode 3 weeks later after surgery which subsided with antibiotics. CONCLUSION: The PRP could accelerate bone union in allograft transplantation after curettage of benign bone tumor. Furthermore, we expect that PRP can accelerate bone union in fracture or non-union.

Intraosseous lipoma: radiological findings / Lipoma intra-ósseo: achados radiológicos

OBJECTIVE: Intraosseous lipomas may be less rare lesions than previously suggested in the literature. They have frequently been misdiagnosed as other benign bone lesions. A combination of computed tomography, magnetic resonance imaging and radiography is essential for decreasing misdiagnosis rates. MATERIALS AND METHODS: This retrospective study presents ten cases of intraosseous lipoma. The patients' ages ranged from 25 to 80 years, and six of them were female. Six patients presented with bone pain, whereas four patients were asymptomatic with incidentally discovered lesions. The involved bones were: femur (four patients), tibia (two patients), calcaneus (one patient), sacrum (one patient), iliac bone (one patient), navicular bone (one patient). All of the patients were assessed by means of conventional radiography, computed tomography and magnetic resonance imaging of the affected region. RESULTS: In all of the cases, plain films revealed well-defined lytic lesions. Both computed tomography and magnetic resonance imaging were quite useful in demonstrating fat within the femur. The histologic pattern of all tumors was that of mature adipose tissue. CONCLUSION: Intraosseous lipoma is a well-defined entity that may develop with varying presentations. Plain radiographs alone cannot establish the diagnosis of this lesion. However, both computed tomography and magnetic resonance imaging are quite useful methods in these cases.

OBJETIVO: Lipomas intra-ósseos podem ser lesões menos raras do que anteriormente sugerido na literatura. Freqüentemente têm sido erroneamente diagnosticados como outras lesões ósseas benignas. A combinação de tomografia computadorizada, ressonância magnética e radiografia é essencial para reduzir as taxas de erro diagnóstico. MATERIAIS E MÉTODOS: Este estudo retrospectivo apresenta dez casos de lipoma intra-ósseo. As idades dos pacientes variavam entre 25 e 80 anos, e seis deles eram do sexo feminino. Seis pacientes apresentavam dor óssea, enquanto quatro eram assintomáticos com lesões descobertas casualmente. Os ossos afetados foram: fêmur (quatro pacientes), tíbia (dois pacientes), calcâneo (um paciente), sacro (um paciente), osso ilíaco (um paciente), osso navicular (um paciente). Todos os pacientes foram avaliados por meio de radiografia convencional, tomografia computadorizada e ressonância magnética das regiões afetadas. RESULTADOS: Em todos os casos, as radiografias revelaram lesões líticas bem delimitadas. Tanto a tomografia computadorizada como a ressonância magnética foram bastante úteis para demonstrar gordura dentro do tumor. O padrão histológico de todos os tumores caracterizou-se por tecido adiposo maduro. CONCLUSÃO: Lipoma intra-ósseo é uma entidade bem definida que pode se desenvolver com variadas apresentações. Radiografias convencionais, isoladamente, não podem diagnosticar essas lesões. Entretanto, a tomografia computadorizada e a ressonância magnética são métodos bastante úteis nesses casos.

Treatment of Bone Loss using Ilizarov Fixation after Resection ofBenign Tumor in the Long Bone / 대한정형외과학회잡지

PURPOSE: This study analyzed the results of treatment of bone loss using Ilizarov fixation after resection of benign tumor in the long bone radiologically and clinically. MATERIALS AND METHODS: Initial diagnoses were 5 osteofibrous dysplasia, 1 aneurysmal bone cyst and 1 giant cell tumor. Three indices were used to evaluate the results; percentage transport, healing index and percentage increase. The function of the affected limb was assessed according to Ennecking rating. And we assessed the radiological and functional results according to A.S.A.M.I.'s classification. RESULTS: Percentage transport averaged 75% (range: 29-144), healing index averaged 64.5 day/cm (range: 34.8-108.6) and the percentage increase averaged 13% (range: 11-20). In Enneking rating, there were 6 cases that were classified as being better than good. In A.S.A.M.I.'s classification, there were 6 good cases, and 1 fair case each in the bone result and functional result, respectively. CONCLUSION: Ilizarov technique is a reconstruction method using living bone. It is safe and effective for the treatment of bone loss after the resection of a benign tumor in the long bone.

The Usefulness of Calcium Sulfate in Treatment of Benign Bone Tumor / 대한정형외과학회잡지

PURPOSE: This study evaluated the results of the curettage and grafting of calcium sulfate for the treatment of a benign bone tumor to determine its efficacy as a bone graft substitute. MATERIALS AND METHODS: Thirty six cases of calcium sulfate(Osteoset(R)) grafting for bone defect after curettage of benign bone tumor were evaluated. There were 21 males and 15 females with a mean age of 23 years (6-64). There were 23, 10 and 3 cases grafted with the Osteoset only, the Osteoset with allografts and the Osteoset with autografts, respectively. The average follow up duration was 19 months (12-49). The process of bone formation was observed and the times for graft absorption and complete bone formation were assessed. In addition, the time of bone formation was compared according to the patients' age, size of lesion, and grafting method, and the development of complications was observed. RESULTS: Complete bone formation was observed in 34 (94.4%) out of 36 cases. The groups of younger patients, smaller size of lesion and grafting of Osteoset(R) only showed more rapid bone formation. However, there was no statistical significance. There was one case of soft tissue calcification observed. CONCLUSION: Calcium sulfate is an effective substitute for an autogenous bone graft in the case of the treatment of a benign bone tumor, particularly in the case of an insufficient graft, such as in children and in those with a large bone defect. This method is a safe method that prevents complications in the donor site.

A Clinical Study of Benign Bone Tumors Treated by Partly Deproteinised Xenograft(Kiel Bone) / 대한정형외과학회잡지

The use of lyophilised bone from calves as a heterograft was introduced by Maatz and Bauermeister in 1957 as an alternative to autografts and freeze-dried homografts which were then in general use. The Kiel bone was known to possess no antigenecity and serial radiographs revealed that it is incorporated into the recipient site by a process of creeping substitution from surrounding bone. In patients with benign bone tumors, the surgical dead space was filled with Kiel bone graft in the departments of orthopedic surgery, Pusan national university hospital. The results were followed up for more than 14 months, and were evaluated by the palin film findings. The results were as follows : l. Of the 22 cases, satisfactory result was obtained in 18 cases(81,8%). 2. The mean lesion size(diameter of lesion/diameter of bone)of success cases was 61.6%, and the mean lesion size of failed cases was 82.8%. 3. The duration from the Kiel bone graft to the evidence of new bone formation and remodelling was 10.5 months on an average with a range of 7months to 15months, and the duratin from the Kiel bone graft to the complete resorption of the Kiel bone was 45.7 months on an average with a range of 29 months to 66 months. 4. The causes of the failed cases were thought to be incomplete removal of the lesion, decreased vascularity due to repeated surgery, large size of the lesion, and the potentiality of tumor, 5. It was difficult to evaluate success rate according to underlying disease because the number of the cases was not large enough, but giant cell tumor showed high recurrence rate.

A Case of Large Chondroblastoma Occupying Middle Cranial Fossa

Chondroblastoma is a benign occurrence bone tumor arising most often in the epiphyses of long bone and its occurance in skull is rare. The authors recently encountered a case of large chondroblastoma occupying middle cranial fossa. The clinical presentation, reoentgenographic appearance, gross and microscopic characteristics, surgical treatment, differential diagnosis, and the rapeutic result are presented. A 27 year old male patient was admitted to the Department of Neurosurgery, Keimyung University Hospital because of progressive diffuse swelling in right temporal area of 4 months duration. In physical examination, nontender, firm, nonmovable diffuse mass in right temporal area and bean sized polypoid mass in the anterior and superior wall of the right external auditory canal were noted. Plain skull X-rays showed lytic defect in the right temporal squama, base of middle cranial fossa, sphenoid ridge, a part of petrous bone and anterior fossa with rather sharp, but not sclerotic margin. Brain CT scan showed a lentiform nonhomogeneous slight high density mass with scattered calcification in the entire middle cranial fossa, and the tumor enhanced slightly. Selective external carotid serial angiogram revealed complete obstruction of external carotid artery just behind the origin of lingual artery without tumor staining. Right temporal craniectomy was performed with nearly total curetting of tumor mass grossly. The histological diagnosis was chondroblastoma. The patient was discharged with good result.