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Braz. j. med. biol. res ; 54(2): e9161, 2021. graf
Article in English | LILACS | ID: biblio-1153511


Patients with osteosarcoma (OS) usually have poor overall survival because of frequent metastasis. Long non-coding RNAs (lncRNAs) have been reported to be associated with tumorigenesis and metastasis. In this study, we investigated the expression and roles of lncRNA human histocompatibility leukocyte antigen (HLA) complex P5 (HCP5) in OS, aiming to provide a novel molecular mechanism for OS. HCP5 was up-regulated both in OS tissues and cell lines and high expression of HCP5 was associated to low survival in OS patients. Down-regulation of HCP5 inhibited cell proliferation, migration, and invasion, suggesting its carcinogenic role in OS. miR-101 was targeted by HCP5 and its expression was decreased in OS. The inhibitor of miR-101 reversed the impact of HCP5 down-regulation on cell proliferation, apoptosis, and metastasis in OS. Ephrin receptor 7 (EPHA7) was proved to be a target of miR-101 and had ability to recover the effects of miR-101 inhibitor in OS. In conclusion, lncRNA HCP5 knockdown suppressed cell proliferation, migration, and invasion, and induced apoptosis through depleting the expression of EPHA7 by binding to miR-101, providing a potential therapeutic strategy of HCP5 in OS.

Humans , Bone Neoplasms/genetics , Bone Neoplasms/pathology , Osteosarcoma/genetics , Osteosarcoma/pathology , MicroRNAs/metabolism , RNA, Long Noncoding/genetics , Down-Regulation , Gene Expression Regulation, Neoplastic , Cell Movement , Receptor, EphA7/metabolism , Cell Line, Tumor , Cell Proliferation , Neoplasm Invasiveness
Autops. Case Rep ; 11: e2021298, 2021. graf
Article in English | LILACS | ID: biblio-1285412


Plasmacytoma is a neoplastic proliferation of monoclonal plasma cells, which can present clinically as solitary bone neoplasm, extramedullary plasmacytoma, and multiple myeloma. The biological behavior of these tumors is variable from periods of clinical latency to rapid growth and progression from localized forms to more disseminated multiple myeloma. We present the case of solitary plasmacytoma of the mandible with rare bilateral involvement in a 65-year-old female patient. This paper highlights the importance of understanding the maxillofacial manifestations of the disease by the dentist for early diagnosis and thus better prognosis.

Humans , Female , Aged , Plasmacytoma/pathology , Bone Neoplasms/pathology , Mandible/abnormalities , Plasma Cells/pathology , Early Diagnosis , Multiple Myeloma
Autops. Case Rep ; 11: e2021281, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249030


Primary malignant giant cell tumor (PMGCT) is a diagnosis based on the presence of a high-grade sarcomatous component along with a typical benign giant cell tumor (GCT). We report the first case of PMGCT of the sternum in a 28-year-old male with painless swelling over the manubrium sterni. The differential diagnoses of PMGCT and giant cell-rich osteosarcoma were considered. Surgical resection was performed, and the reconstruction was done with a neosternum using polymethyl methacrylate and prolene mesh. At 30 months follow-up, the patient is disease-free.

Humans , Male , Adult , Sternum/pathology , Bone Neoplasms/pathology , Giant Cell Tumor of Bone/pathology , Osteosarcoma , Diagnosis, Differential
Autops. Case Rep ; 10(3): e2020199, 2020. tab, graf
Article in English | LILACS | ID: biblio-1131830


We present the autopsy findings and differential diagnosis in a 42year old male who presented with fever and rapidly progressive respiratory symptoms like breathlessness, nonproductive cough and right sided chest pain. Initial imaging workup done at our hospital revealed a large unilateral tumor with tracheal shift. While being evaluated patient developed facial puffiness, tachypnea suggestive of superior vena cava obstruction. Antemortem biopsy of lung mass was attempted twice and that suggested malignant lesion. Unfortunately, the individual had a rapid downhill course following admission. Post mortem examination was conducted that on opening the thoracic cavity revealed total replacement of right lung tissue by a necrotic growth which was deeply adherent to the rib cage. The contralateral lung as well as all other visceral organs were unremarkable grossly. Histopathology confirmed primary Ewing sarcoma of the lung. We hereby, report a rare case of primary lung Ewing sarcoma diagnosed at autopsy.

Humans , Male , Adult , Sarcoma, Ewing/pathology , Bone Neoplasms/pathology , Neuroectodermal Tumors/pathology , Lung Neoplasms/pathology , Autopsy , Fatal Outcome , Diagnosis, Differential
Autops. Case Rep ; 9(4): e2019091, Oct.-Dec. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1024295


Desmoplastic fibroma (DF) is a rare bone tumor, which is known to involve mostly the gnathic bones. In this setting, the clinical presentation is usually represented by a bulging tumor of the face. Radiologically, the tumor is usually characterized by an expansile lytic bone lesion. The histopathology of the tumor shows a poorly circumscribed hypocellular lesion rich in collagen fibers with interspersed spindle cells having bland nuclear chromatin. Despite the lack of mitoses and nuclear pleomorphism, DF has an aggressive nature, presenting as a destructive growth causing entrapment of neuro-vascular bundles, sinusitis, or trismus. Some cases of DF show mutations in the adenomatous polyposis coli pathway shown by nuclear localization of the ß-catenin protein. Few reports showed an association with tuberous sclerosis, though most of these cases were sporadic. We discuss a rare case of desmoplastic fibroma involving the mandible, and a review of the literature of the DF cases involving the gnathic bones.

Humans , Female , Child, Preschool , Bone Neoplasms/pathology , Fibroma, Desmoplastic/pathology , Mandible
An. bras. dermatol ; 94(2): 233-235, Mar.-Apr. 2019. graf
Article in English | LILACS | ID: biblio-1001147


Abstract We report the case of an 8-year-old child with subungual exostosis, whose diagnosis was suspected on the basis of dermoscopic findings and subsequently confirmed by X-ray and histopathology.

Humans , Child , Bone Neoplasms/diagnostic imaging , Exostoses/diagnostic imaging , Nail Diseases/diagnostic imaging , Bone Neoplasms/pathology , Radiography , Exostoses/pathology , Dermoscopy , Diagnosis, Differential , Onycholysis/diagnostic imaging , Nail Diseases/pathology
Rev. Col. Bras. Cir ; 46(2): e2094, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1003087


RESUMO Objetivo: determinar a expressão de neurotrofinas e seus receptores tirosina quinases em pacientes com osteossarcoma (OS) e sua correlação com desfechos clínicos. Métodos: biópsias de tumores primários de pacientes com OS tratados em uma única instituição, consecutivamente, entre 2002 e 2015, foram analisados através de imuno-histoquímica para expressão de receptores de tirosina quinase A e B (TrKA e TrKB), fator de crescimento neural (NGF) e fator neurotrófico derivado do cérebro (BDNF). De forma independente, dois patologistas classificaram os marcadores de imuno-histoquímica como negativos (negativos e focais fracos) ou positivos (moderado focal/difuso ou forte focal/difuso). Resultados: foram analisados dados de 19 pacientes (10 do sexo feminino e 9 do masculino) com mediana de idade de 12 anos (5 a 17,3 anos). Dos tumores, 83,3% estavam localizados em membros inferiores e 63,2% dos pacientes eram metastáticos ao diagnóstico. A sobrevida global em cinco anos foi de 55,3%. BDNF foi positivo em 16 pacientes (84%) e NGF em 14 pacientes (73%). TrKA e TrKB apresentaram coloração positiva em quatro (21,1%) e oito (42,1%) pacientes, respectivamente. A análise de sobrevida não demonstrou diferença significativa entre receptores TrK e neurotrofinas. Conclusão: amostras de OS primário expressam neurotrofinas e receptores TrK através de imuno-histoquímica. Estudos futuros podem auxiliar na identificação do papel das mesmas na patogênese do OS e determinar se há possível correlação prognóstica.

ABSTRACT Objective: to determine the expression of neurotrophins and their tyrosine-kinase receptors in patients with osteosarcoma (OS) and their correlation with clinical outcomes. Methods: we applied immunohistochemistry to biopsy specimens of patients consecutively treated for primary OS at a single institution between 2002 and 2015, analyzing them for expression receptors of tyrosine kinase A and B (TrKA and TrKB), neural growth factor (NGF) and brain derived neurotrophic factor (BDNF). Independently, two pathologists classified the immunohistochemical markers as negative (negative or weak focal) or positive (moderate focal/diffuse or strong focal/diffuse). Results: we analyzed data from 19 patients (10 females and 9 males), with median age of 12 years (5 to 17.3). Tumors' location were 83.3% in the lower limbs, and 63.2% of patients had metastases at diagnosis. Five-year overall survival was 55.3%. BDNF was positive in 16 patients (84%) and NGF in 14 (73%). TrKA and TrKB presented positive staining in four (21,1%) and eight (42,1%) patients, respectively. Survival analysis showed no significant difference between TrK receptors and neurotrophins. Conclusion: primary OS samples express neurotrophins and TrK receptors by immunohistochemistry. Future studies should explore their role in OS pathogenesis and determine their prognostic significance in larger cohorts.

Humans , Male , Female , Child, Preschool , Child , Adolescent , Bone Neoplasms/pathology , Osteosarcoma/pathology , Brain-Derived Neurotrophic Factor/analysis , Receptor, trkA/analysis , Receptor, trkB/analysis , Nerve Growth Factors/analysis , Reference Values , Bone Neoplasms/mortality , Immunohistochemistry , Biomarkers, Tumor , Osteosarcoma/mortality , Risk Factors , Statistics, Nonparametric , Kaplan-Meier Estimate
Clinics ; 74: e701, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001831


OBJECTIVES: Osteosarcoma of the jaw (OSAJ) is fundamentally different in clinical practice from its peripheral counterparts. Studies are difficult to conduct due to low incidence rates. The primary aim of this study was to provide for the first time a comprehensive retrospective analysis of the treatment concepts and outcome data of OSAJ patients treated at the University Hospital Vienna and to compare these with two recently published studies on OSAJ. The clinical study was accompanied by a biomarker study investigating the prognostic relevance of melanoma-associated antigen-A (MAGE-A) in OSAJ specimens. METHOD: Eighteen patients were included, and their outcomes were compared to published data. Immunohistochemistry was performed with mouse monoclonal antibodies against MAGE-A. Survival rates were estimated by the Kaplan-Meyer method. The log-rank test was used to analyze potential prognostic parameters. Fisher's exact test was performed to define the significant differences between the survival rates of the current study and the DOESAK registry. RESULTS: Disease-specific survival was 93.8% after five and 56.3% after ten years. The development of metastases (p=0.033) or relapse (p=0.037) was associated with worsened outcomes in our group as well as in the comparative group. Despite the different treatment concepts of the study groups, survival rates were comparable. MAGE-A failed to show prognostic relevance for OSAJ patients. CONCLUSIONS: Uncertainties about the optimal treatment strategies of OSAJ patients will currently remain. Thus, prospective studies of OSAJ are needed but are only feasible in a multicenter study setting, conducted over a prolonged time period.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Bone Neoplasms/therapy , Osteosarcoma/therapy , Prognosis , Austria/epidemiology , Bone Neoplasms/mortality , Bone Neoplasms/pathology , Immunohistochemistry , Biomarkers/analysis , Osteosarcoma/mortality , Osteosarcoma/pathology , Survival Rate , Retrospective Studies , Antibodies, Monoclonal/analysis , Antigens, Neoplasm/analysis
Braz. j. med. biol. res ; 51(12): e7665, 2018. graf
Article in English | LILACS | ID: biblio-974250


Osteosarcoma (OS) has a high incidence, malignity, and frequency of recurrence and metastasis. In this study, we aimed to explore the potential anti-cancer effects of Astragalus polysaccharides (APS) on human OS MG63 cells as well as underlying mechanisms. Viability of MG63 cells was assessed by CCK-8 assay to determine the adequate concentration of APS. Then, effects of APS on MG63 cell proliferation, cell cycle distribution, apoptosis, and migration and invasion were analyzed by BrdU incorporation, PI staining, flow cytometry, and transwell assays, respectively. The expression levels of proteins involved in these physiological processes were assessed by western blot analysis. Afterwards, miR-133a level in APS-treated cells was determined by qRT-PCR, and whether APS affected MG63 cells through regulation of miR-133a was determined. Finally, the activation of c-Jun N-terminal protein kinase (JNK) pathway was detected. We found that APS treatment suppressed the viability, proliferation, migration, and invasion of MG63 cells, as well as induced cell apoptosis. Moreover, APS enhanced the expression of miR-133a in MG63 cells. Knockdown of miR-133a reversed the APS treatment-induced MG63 cell proliferation, migration and invasion inhibition, as well as cell apoptosis. Furthermore, APS inactivated JNK pathway in MG63 cells. Knockdown of miR-133a reversed the APS treatment-induced inactivation of JNK pathway in MG63 cells. To conclude, APS repressed proliferation, migration, and invasion while induced apoptosis of OS MG63 cells by up-regulating miR-133a and then inactivating JNK pathway.

Humans , Bone Neoplasms/pathology , Cell Movement/drug effects , Apoptosis/drug effects , Astragalus Plant/chemistry , Cell Proliferation/drug effects , Bone Neoplasms/drug therapy , Cell Cycle/drug effects , Up-Regulation/drug effects , Cell Survival/drug effects , Blotting, Western , Reproducibility of Results , Analysis of Variance , MicroRNAs/analysis , Cell Line, Tumor , JNK Mitogen-Activated Protein Kinases/analysis , Antineoplastic Agents/pharmacology
Rev. Col. Bras. Cir ; 45(3): e1129, 2018. tab
Article in Portuguese | LILACS | ID: biblio-956556


RESUMO Objetivo: determinar, em pacientes pediátricos portadores de neoplasias malignas, as características de nódulos pulmonares identificados à tomografia computadorizada, capazes de diferenciar nódulos benignos de metástases. Métodos: estudo retrospectivo de pacientes submetidos a ressecções pulmonares de nódulos diagnosticados como metástases em um período de sete anos. Achados de tomografia e da cirurgia, assim como resultados dos exames anatomopatológicos foram comparados. Resultados: nove pacientes, submetidos a 11 intervenções cirúrgicas, foram estudados. Entre as variáveis estudadas, apenas o tamanho do nódulo, maior do que 12,5mm provou ser estatisticamente significante para predizer malignidade. Conclusão: esse estudo sugere que, entre as características tomográficas de nódulos pulmonares de crianças portadoras de neoplasias malignas, apenas o tamanho da lesão foi preditor de malignidade.

ABSTRACT Objective: to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. Methods: we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. Results: we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. Conclusion: among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.

Humans , Child, Preschool , Child , Unnecessary Procedures , Lung Neoplasms/surgery , Lung Neoplasms/secondary , Teratoma/pathology , Thoracoscopy/methods , Bone Neoplasms/pathology , Tomography, X-Ray Computed , Osteosarcoma/pathology , Retrospective Studies , Sensitivity and Specificity , Hepatoblastoma/pathology , Wilms Tumor/pathology , Kidney Neoplasms/pathology , Liver Neoplasms/pathology , Lung Neoplasms/diagnostic imaging
Braz. oral res. (Online) ; 31: e52, 2017. tab, graf
Article in English | LILACS | ID: biblio-952112


Abstract Great attention has been given to the study of radiolucent periapical lesions to avert possible misdiagnosis of apical periodontitis associated with certain radiolucent non-endodontic lesions. However, there are a significant number of radiopaque lesions found in the periapical region, which could be equally relevant to endodontic practice. The diagnosis and management of these radiopaque/hyperdense lesions could be challenging to the endodontist. These bone alterations could be neoplastic, dysplastic or of metabolic origin. In the context of the more widespread use of cone-beam CT, a detailed review of radiopaque inflammatory and non-inflammatory lesions is timely and may aid clinicians perform a differential diagnosis of these lesions. Distinguishing between inflammatory and non-inflammatory lesions simplifies diagnosis and consequently aids in choosing the correct therapeutic regimen. This review discusses the literature regarding the clinical, radiographic, histological and management aspects of radiopaque/hyperdense lesions, and illustrates the differential diagnoses of these lesions.

Humans , Periapical Diseases/therapy , Periapical Diseases/diagnostic imaging , Jaw Diseases/therapy , Jaw Diseases/diagnostic imaging , Osteomyelitis/pathology , Osteomyelitis/diagnostic imaging , Periapical Diseases/pathology , Bone Neoplasms/pathology , Bone Neoplasms/diagnostic imaging , Radiography, Panoramic , Jaw Diseases/pathology , Disease Management , Diagnosis, Differential , Diagnostic Errors , Cone-Beam Computed Tomography/methods
Braz. oral res. (Online) ; 31: e53, 2017. tab, graf
Article in English | LILACS | ID: biblio-952104


Abstract Peripheral ossifying fibroma (POF) is a reactive lesion of oral tissues, associated with local factors such as trauma or presence of dental biofilm. POF treatment consists of curettage of the lesion combined with root scaling of adjacent teeth and/or removal of other sources of irritants. This study aimed to analyze the clinical and pathological features of POF and to investigate the immunoexpression of Osterix and STRO-1 proteins. Data such as age, gender, and size were obtained from 30 cases of POF. Microscopic features were assessed by conventional light microscopy using hematoxylin-eosin staining and immunohistochemical markers, and by polarized light microscopy using Picrosirius red staining. The age range was 11-70 years and 70% of the patients were female. Moreover, the size of POF varied from 0.2 to 5.0 cm; in 43.33% of the cases, the mineralized content consisted exclusively of bony trabeculae. The immunohistochemical analysis showed nuclear staining for Osterix in 63% and for STRO-1 in 20% of the cases. Mature collagen fibers were observed in mineralized tissue in 76.67% of the cases. The clinical and microscopic features observed were in agreement with those described in the literature. Osterix was overexpressed, while STRO-1 was poorly expressed. Osterix was expressed particularly in cells entrapped in and around mineralized tissue, indicating the presence of a stimulus that triggers the differentiation of these cells into osteoblasts or cementoblasts, i.e., cells that produce mineralized tissue. Based on our results, Osterix may play a role in the pathogenesis of POF.

Humans , Male , Female , Child , Adolescent , Adult , Aged , Young Adult , Transcription Factors/physiology , Bone Neoplasms/pathology , Fibroma, Ossifying/pathology , Antigens, Surface/physiology , Osteoblasts/pathology , Transcription Factors/analysis , Immunohistochemistry , Cell Differentiation , Collagen/analysis , Sp7 Transcription Factor , Gingiva/pathology , Microscopy, Polarization , Middle Aged , Antigens, Surface/analysis
Clin. biomed. res ; 37(3): 263-265, 2017. ilus
Article in Portuguese | LILACS | ID: biblio-859867


O sarcoma congênito da família Ewing é uma doença extremamente rara, que se manifesta através do surgimento de uma massa e sinais sistêmicos como dor e febre. Cerca de 70 a 80% dos casos ocorrem antes dos 20 anos de idade. Histologicamente se caracteriza pela presença de pequenas células arredondadas e azuis. Além disso, pode se manifestar em tecidos moles ou osso e em qualquer parte do corpo, sendo a forma congênita mais comumente encontrada nas extremidades. O diagnóstico é estabelecido através de exames de imagem, histopatologia e imuno-histoquímica. Esses tumores costumam ser agressivos e apresentar elevada mortalidade. Aqui, relatamos o caso de um recém-nascido que apresentou uma massa no membro superior esquerdo diagnosticada como sarcoma congênito da família Ewing por biópsia cutânea por punch e pela presença do marcador CD99 (AU)

Congenital Ewing's sarcoma is an extremely rare disease, manifested by the appearance of a mass and systemic signs such as pain and fever. About 70-80% of cases occur before 20 years of age. This condition is histologically characterized by the presence of small round blue cells and can manifest in bone or soft tissue, anywhere in the body, with the congenital form being the most commonly found in the extremities. The diagnosis is established by imaging, histopathology, and immunohistochemistry. These tumors tend to be aggressive and have high mortality rates. Here, we report the case of a newborn who presented a mass in the left upper limb diagnosed as congenital Ewing's sarcoma by punch skin biopsy and the presence of the CD99 marker (AU)

Humans , Male , Infant, Newborn , Sarcoma, Ewing/congenital , Bone Neoplasms/congenital , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/pathology , Neuroectodermal Tumors, Primitive, Peripheral/congenital , Sarcoma, Ewing/diagnostic imaging , Sarcoma, Ewing/pathology
Int. j. med. surg. sci. (Print) ; 3(4): 1031-1034, dic. 2016. ilus
Article in Spanish | LILACS | ID: biblio-1095289


El osteocondroma de la escápula es un tumor beningno muy raro por su ubicación, que produce dolor y disfunción mecánica de la articulación cuando se establece en la superficie ventral de la escápula, afecta principalmente a los varones en los períodos del crecimiento óseo, entre 10 y 30 años de edad, representan el 14,4 % de todos los tumores de la escápula y el 49 % de los tumores benignos de la escápula. Surgen en las regiones metafisarias de los huesos largos (fémur, húmero, tibia), causando irritación mecánica que conduce a impotencia funcional, bursitis, e incluso fractura de la escápula, pocos casos en huesos planos han sido descritos. El diagnostico se realiza con la valoración física, clínica y exámenes complementarios, debiendo ser confirmado por el histopatológo previa biopsia. La indicación quirúrgica incluye la disfunción mecánica de una articulación o tendón en relación con el tamaño de la lesión, y del cambio sarcomatoso siendo el procedimiento de elección la escisión quirúrgica abierta. A continuación se describe el caso de una joven de 11 años a quien se diagnosticó un osteocondroma subescapular, previabiopsia escisional.

Osteochondroma of the scapulais a rare benign tumor in view of its location, which produces pain and mechanical dysfunction of the joint when it is on the ventral surface of the scapula, mainly affecting men during bone growth periods, betweenthe ages of 10 and 30, accounting for 14.4 % of allscapula tumors and 49 % of benign tumors of thescapula. They arise in the metaphyseal regions ofthe long bones (femur, humerus, tibia), causing mechanical irritation leading to functional impotence,bursitis, and fracture of the scapula. Few cases inflat bones have been described. Diagnosis is made with physical, clinical and complementary examinations, and must be confirmed by prior histopathology biopsy. The surgical indication includes mechanical dysfunction of a joint or tendon in relationto the size of the lesion, sarcomatous change being the procedure of choice in open surgical excision. The case of an 11-year-old girl who was diagnosed with a subscapular osteochondroma after previous excisional biopsy, is described below.

Humans , Female , Child , Scapula/surgery , Bone Neoplasms/surgery , Osteochondroma/surgery , Scapula/pathology , Bone Neoplasms/diagnosis , Bone Neoplasms/pathology , Osteochondroma/diagnosis , Osteochondroma/pathology
Rev. chil. ortop. traumatol ; 57(1): 20-25, ene.-abr.2016. ilus
Article in Spanish | LILACS | ID: lil-795859


La mayoría de los tumores óseos primarios pueden ser tratados mediante una resección amplia —muchas veces asociada a terapias adyuvantes— sin comprometer la sobrevida del paciente. La posibilidad de una resección conservadora depende de la localización y tamaño del tumor y de las partes blandas circundantes. Una cuidadosa evaluación de estudios imagenológicos permite al cirujano elaborar un plan quirúrgico que permita una resección con márgenes adecuados, al mismo tiempo que conservar la mayor cantidad de tejido sano, de modo de obtener una extremidad funcional. A veces, la ejecución quirúrgica de lo planeado se hace muy difícil, y la precisión de esta puede resultar afectada. La cirugía guiada por computador se ha constituido en una herramienta útil en estas situaciones. Está basada en la creación de un plan virtual en 3 dimensiones mediante el procesamiento de imágenes de tomografía computada (TC) y resonancia nuclear magnética (RNM). Este plan puede ser reproducido en el escenario quirúrgico mediante la correspondencia entre este escenario virtual y la anatomía real del paciente. Esta tecnología puede permitir una mayor precisión en la ejecución de osteotomías en zonas difíciles como la pelvis, minimizando la resección innecesaria de tejido sano, pero manteniendo un margen oncológico adecuado. Describiremos los principios y el razonamiento que fundamentan el uso de la cirugía guiada por computador en la cirugía de tumores óseos, la cual se ha constituido en una herramienta útil para el manejo de situaciones clínicas específicas...

The majority of primary bone tumours can be effectively treated with wide resection —frequently associated with adjuvant therapy— without compromising the outcome of the patient. The feasibility of limb-sparing surgery in a particular scenario is dependent on the location and size of the tumour, as well as the involvement of the host bone and surrounding soft tissues. Careful evaluation of imaging studies allows the surgeon to plan the resection with adequate margins, while preserving as much normal tissues as possible, in order to achieve a functional limb. At times, the surgical execution of what was planned as resection becomes very difficult, and precision may be less than optimal. Computer-guided surgery has become a useful tool in these situations. It is based on the creation of a three-dimensional virtual plan by means of image processing from computed tomography (CT) and magnetic resonance (MRI) of the clinical situation. This plan is reproduced in the surgical field by means of the interaction between this virtual scenario and the actual anatomy of the patient. This technology could allow better precision in the execution of osteotomies in difficult areas, such as the pelvis, minimising unnecessary resection of normal tissue, while maintaining wide margins. A description is presented of the principles and rationale of computer-guided surgery for bone tumours, which has become a useful tool for the management of selected clinical situations...

Humans , Surgery, Computer-Assisted/methods , Bone Neoplasms/surgery , Orthopedics/methods , Magnetic Resonance Imaging , Bone Neoplasms/pathology , Bone Neoplasms , Preoperative Care , Tomography, X-Ray Computed
Int. j. med. surg. sci. (Print) ; 3(1): 735-740, 2016. ilus
Article in Spanish | LILACS | ID: lil-790599


El tumor óseo de células gigantes (TOCG) es un tumor óseo primario que se presenta con más frecuencia en la tercera edad de la vida, ubicándose principalmente a nivel del fémur distal. El desarrollo de una biopsia para su establecer su diagnóstico y poder comenzar con rapidez el tratamiento adecuado, constituye un procedimiento fundamental para poder establecer la resección quirúrgica lo más temprano posible. En este artículo se presenta un caso de TOCG en una paciente de 30 años. Se discute su etiopatogenia, signos y síntomas, diagnóstico, como así también los procedimientos diagnóstico y terapeútico adecuados para lograr una resolución positiva de esta patología.

The giant cell tumor of bone (OCD) is a primary bone tumor that occurs most frequently in the third age of life, being located mainly at the distal femur. The development of a biopsy to establish the diagnosis and to begin appropriate treatment quickly is a fundamental to establish as early as possible surgical resection procedure. In this article a case of TOCG is presented in a patient of 30 years. Its etiology, signs and symptoms, diagnosis, as well as an adequate diagnostic and therapeutic procedures to achieve a positive resolution of this pathology is discussed.

Humans , Female , Adult , Bone Neoplasms/surgery , Bone Neoplasms/pathology , Knee , Giant Cell Tumor of Bone/surgery , Giant Cell Tumor of Bone/pathology , Biopsy
Rev. chil. dermatol ; 32(4): 214-216, 2016. ilus
Article in Spanish | LILACS | ID: biblio-948812


El osteoma cutis (OC) es una lesión compuesta de tejido óseo en dermis y/o hipodermis. Se clasifican en primarios, cuando se desarrollan en piel sana, y secundarios, cuando aparecen sobre lesiones preexistentes. Mujer de 61 años con antecedente de linfoma de Hodgkin en remisión, presentó una lesión de larga data, desarrollada en piel sana, en primer dedo de la mano izquierda, que cursaba con brotes recurrentes y autolimitados de dolor y aumento de temperatura local. La exploración física mostró un nódulo pétreo, con úlcera de fondo calcáreo. El estudio histopatológico de la biopsia escisional reveló tejido óseo, sin otras lesiones cutáneas asociadas. El estudio complementario, incluyendo hemograma, función renal y hepática, calcio y fósforo séricos, PTH, TSH, vitamina D y calciuria fue normal. Descartándose alteraciones en el metabolismo calcio-fosforo y otras lesiones cutáneas preexistentes, se realizó el diagnostico de OC primario en forma de placa. El OC es una lesión benigna, pudiendo ser primario o secundario. Los secundarios representan cerca del 85% y se originan por la osificación de lesiones preexistentes tumorales o inflamatorias. Los OC primarios se presentan aislados o formando parte de síndromes como la fibrodisplasia osificante progresiva, la osteodistrofia hereditaria de Albright y la heteroplasia osificante progresiva. A pesar de la asociación a mutaciones en GNAS de OC y estos síndromes, el diagnóstico de ambos es fundamentalmente clínico. Los OC primarios sin síndrome asociado, se dividen en osteomas miliares de la cara y osteomas en forma de placa (plate-like OC), como este caso. Ante un OC primario, debemos descartar síndromes asociados a osificaciones heterotópicas.

Osteoma cutis (OC) is a lesion composed of bone tissue located in the dermis and/or hypodermis. It is classified as primary when it develops over healthy skin; and secondary when it develops over preexisting lesions. A 61-year-old woman with history of Hodgkin lymphoma in remission, presents a longstanding lesion located on the first finger of her left hand which developed over healthy skin, associated with recurrent and self-limited episodes of pain and increased local temperature. Physical examination reveals a stone-hard nodule, with a calcareous-bottomed ulcer. The histopathological evaluation of the excisional biopsy revealed bone tissue. Complementary studies included: complete blood count, renal and hepatic function, plasma calcium and phosphorus, PTH, TSH, vitamin D, and urinary calcium, all of them in normal ranges. Once systemic disease was ruled out, platelike OC was diagnosed. OC is a benign lesion which can be primary or secondary. Secondary OC represent nearly 85% of cases, and it corresponds to an ossification of preexisting tumoral or inflammatory lesions. Primary OC is less frequent, it appears isolated or as part of syndromes like fibrodysplasia ossificans progressiva, Albright hereditary osteodystrophy, and progressive osseous heteroplasia. GNAS mutations have been described in primary OC as in these syndromes, but the final diagnosis relies on the clinical picture. Isolated primary OC is classified in milliary osteomas of the face and plate-like OC, like our case. When facing primary OC, syndromes that present with heterotopic ossification must be ruled out.

Humans , Female , Middle Aged , Osteoma/pathology , Bone Neoplasms/pathology , Ossification, Heterotopic/pathology , Osteoma/diagnostic imaging , Physical Examination , Biopsy , Clinical Laboratory Techniques
Article in English | WPRIM | ID: wpr-110200


OBJECTIVE: Our aim was to evaluate the cartilage cap of osteochondromas using T2 maps and to compare these values to those of normal patellar cartilage, from age and gender matched controls. MATERIALS AND METHODS: This study was approved by the Institutional Review Board and request for informed consent was waived. Eleven children (ages 5-17 years) with osteochondromas underwent MR imaging, which included T2-weighted fat suppressed and T2 relaxation time mapping (echo time = 9-99/repetition time = 1500 msec) sequences. Lesion origins were femur (n = 5), tibia (n = 3), fibula (n = 2), and scapula (n = 1). Signal intensity of the cartilage cap, thickness, mean T2 relaxation times, and T2 spatial variation (mean T2 relaxation times as a function of distance) were evaluated. Findings were compared to those of patellar cartilage from a group of age and gender matched subjects. RESULTS: The cartilage caps showed a fluid-like high T2 signal, with mean thickness of 4.8 mm. The mean value of mean T2 relaxation times of the osteochondromas was 264.0 +/- 80.4 msec (range, 151.0-366.0 msec). Mean T2 relaxation times were significantly longer than the values from patellar cartilage (39.0 msec) (p < 0.0001). These findings were observed with T2 spatial variation plots across the entire distance of the cartilage cap, with the most pronounced difference in the middle section of the cartilage. CONCLUSION: Longer T2 relaxation times of the cartilage caps of osteochondromas should be considered as normal, and likely to reflect an increased water content, different microstructure and component.

Adolescent , Bone Neoplasms/pathology , Cartilage, Articular/pathology , Child , Child, Preschool , Female , Femur , Humans , Magnetic Resonance Imaging/methods , Male , Osteochondroma/pathology , Patella/pathology , Retrospective Studies , Tibia
Clinics ; 70(8): 535-540, 08/2015. tab, graf
Article in English | LILACS | ID: lil-753965


OBJECTIVE: Typically, bone metastasis causes osteolytic and osteoblastic lesions resulting from the interactions of tumor cells with osteoclasts and osteoblasts. In addition to these interactions, tumor tissues may grow inside bones and cause mass lesions. In the present study, we aimed to demonstrate the negative impact of a tumor mass in a large cohort of patients with bone metastatic cancer. METHODS: Data from 335 patients with bone metastases were retrospectively reviewed. For the analysis, all patients were divided into three subgroups with respect to the type of bone metastasis: osteolytic, osteoblastic, or mixed. The patients were subsequently categorized as having bone metastasis with or without a tumor mass, and statistically significant differences in median survival and 2-year overall survival were observed between these patients (the median survival and 2-year overall survival were respectively 3 months and 16% in patients with a tumor mass and 11 months and 26% in patients without a tumor mass; p<0.001). RESULTS: According to multivariate analysis, the presence of bone metastasis with a tumor mass was found to be an independent prognostic factor (p=0.011, hazard ratio: 1.62, 95% confidence interval: 1.11–1.76). Bone metastasis with a tumor mass was more strongly associated with osteolytic lesions, other primary diseases (except for primary breast and prostate cancers), and spinal cord compression. CONCLUSION: Bone metastasis with a tumor mass is a strong and independent negative prognostic factor for survival in cancer patients. .

Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Bone Neoplasms/mortality , Bone Neoplasms/secondary , Bone Neoplasms/pathology , Epidemiologic Methods , Osteoblasts/pathology , Osteoclasts/pathology , Prognosis , Reference Values , Spinal Cord Compression/etiology , Time Factors , Tumor Burden