Current Status of Off-label Use of Denosumab in Bone Tumor and Bone Diseases / 肿瘤防治研究

Denosumab is a monoclonal antibody against the receptor activator of nuclear factor-κB (RANK) ligand (RANKL) that significantly inhibits osteoclast activity and has been approved to treat osteoporosis, giant cell tumor of bone, and prophylactic as well as therapeutic entities for bone metastasis. However, the imbalance of RANKL/RANK/OPG has also been implicated in the pathogenesis of several other rare bone diseases and tumor-like disorders, including aneurysmal bone cyst, fibrous dysplasia of bone, and Langerhans cell histiocytosis. Nevertheless, there have been various clinical reports although these diseases have not been approved for indications. The review aims to summarize the available evidence for the off-label use of denosumab in metabolic bone diseases and tumor-like disorders and provide a reference for clinical diagnosis and treatment.

Research progress of new multifunctional bone cement in bone tumor therapy / 中国修复重建外科杂志

OBJECTIVE@#The research progress of new multifunctional bone cement in bone tumor therapy in recent years was reviewed, in order to provide help for the future research of anti-tumor bone cement.@*METHODS@#The related literature on the treatment of bone tumors with new multifunctional bone cement at home and abroad in recent years was extensively reviewed and summarized.@*RESULTS@#The new multifunctional bone cements include those with the functions of photothermotherapy, magnetic thermotherapy, chemoradiotherapy, and antibacterial after operation, which are discussed from the aspects of anti-tumor, drug controlled release, and cytotoxicity. Controlled drug release has been achieved in multifunctional bone cements by adjusting heat and pH or incorporating particles such as chitosan oligosaccharides and γ-cyclodextrin. At present, multifunctional bone cement with hyperthermia, radiotherapy, and chemotherapy has effectively inhibited the local recurrence and distant metastasis of bone tumors. Broadening the application of bone cement for photothermal and magnetic thermal therapy to deeper bone tumors, investigating more precise controlled release of drug-loaded bone cement, and introducing nanoparticles with both thermal conversion and intrinsic enzymatic activities into bone cement for synergistic anti-tumor therapy are promising research directions.@*CONCLUSION@#The new multifunctional bone cement inhibits bone tumor cells, promotes new bone formation in bone defects, and prevents incision infection after tumor resection. Certain progress has been made in anti-tumor, antibacterial, drug-controlled release, and reduction of cytotoxicity. Expanding the deeper application range of the new multifunctional bone cement, verifying the safety in clinical application, and focusing on the individualized treatment of the new multifunctional bone cement are the problems that need to be solved in the future.

Long-term effectiveness of uncemented allograft-prosthesis composite for reconstruction of bone defects after proximal femur tumor resection / 中国修复重建外科杂志

OBJECTIVE@#To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection.@*METHODS@#Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded.@*RESULTS@#All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients.@*CONCLUSION@#Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.

Ewing sarcoma: A rare report from the Indian pediatric population

Ewing抯 sarcomas are rare, aggressive tumors with a tendency toward recurrence following resection, and early metastasis. Although patients of younger or older age account for almost 30% of instances, peak incidences occur between the ages of 10 and 20. We, hereby, report the case of a 10-year-old girl who presented with a 3-month history of pain in her right hip that was unable to be relieved by non-steroidal anti-inflammatory medicine and physical therapy. On examination, bone mar

Granuloma eosinofílico cervical en el adolescente: reporte de un caso y revisión de la literatura / Cervical eosinophilic granuloma in adolescents: case report and literature review

INTRODUCCIÓN El granuloma eosinofílico (GE) es una patología infrecuente, sobre todo en adultos, que puede afectar la columna cervical. A pesar de la vasta literatura, esta enfermedad afecta principalmente a la población infantil, y no hay un consenso sobre el manejo en adultos. Con el objetivo de aportar conocimiento respecto a esta patología poco frecuente, se presenta un caso clínico de GE cervical en un paciente de 16 años, a quien se trató de manera conservadora, con buenos resultados y retorno completo a sus actividades. CASO CLÍNICO Un hombre de 16 años, seleccionado de rugby, consultó por dolor cervical axial persistente y nocturno de 6 semanas de evolución, sin trauma evidente. Al examen, destacó dolor a la compresión axial sin compromiso neurológico asociado. Los exámenes de tomografía computarizada (TC) y resonancia magnética (RM) revelaron lesión lítica en el cuerpo de C3 de características agresivas, de presentación monostótica en tomografía por emisión de positrones-tomografía computada (TEP-TC) compatible con tumor primario vertebral. Se decidió realizar biopsia percutánea bajo TC, para definir el diagnóstico y manejo adecuado, la cual fue compatible con células de Langerhans. Al no presentar clínica ni imagenología de inestabilidad ósea evidente o compromiso neurológico, se manejó con tratamiento conservador, inmovilización cervical, analgesia oral, y seguimiento estrecho. A los cuatro meses de evolución, se presentó con una TC con cambios reparativos del cuerpo vertebral y sin dolor, y logró retomar sus actividad habituales. CONCLUSIONES El diagnóstico de GE es infrecuente a esta edad, y se debe plantear entre diagnósticos diferenciales de lesiones líticas agresivas primarias vertebrales. Es necesario el uso de imágenes, y la biopsia vertebral es fundamental para confirmar el diagnóstico. Su manejo va a depender de la sintomatología, del compromiso de estructuras vecinas, y de la estabilidad de la vértebra afectada. El manejo conservador con seguimiento clínico e imagenológico es una opción viable.

INTRODUCTION Eosinophilic granuloma (EG) is a rare, tumor-like lesion, infrequently affecting the cervical spine, particularly in adults. Although vastly described in literature, this pathology mainly affects children, and there is still no consensus on its treatment in older patients. With the goal of contributing to increase the knowledge regarding this infrequent pathology, we present a case of a C3 eosinophilic granuloma in a 16-year-old patient, who was treated conservatively, with good results, including complete return to his previous activities. CLINICAL CASE a 16-year-old male, elite rugby player, presented with a history of persistent neck pain, mainly at night, with no previous trauma. Upon physical examination, he reported neck pain with axial compression of the head, without neurological impairment. Both computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed an aggressive lytic lesion in the C3 vertebral body, a with monostotic presentation on positron emission tomography-computed tomography (PET-CT) compatible with a primary spine tumor. A CT-guided percutaneous biopsy was obtained to establish the diagnosis and provide the proper management. The results were compatible with Langerhans cells. As he presented no symptoms or imaging findings of evident bone instability, as well as no neurological impairment, the patient was treated conservatively, with a cervical brace, oral pain medication and close followup. A CT obtained after four months of treatment showed reparative changes of the C3 vertebral body; at this point, the patient reported no neck pain, so he was able to return to his previous activities. CONCLUSIONS Although an EG is rare at this age, it should be considered in the differential diagnosis of primary vertebral aggressive lytic lesions. Imaging and a vertebral biopsy are paramount to confirm the diagnosis. The treatment modality depends on the symptoms, the involvement of adjacent structures, and the stability of the affected vertebra. Conservative management including clinical and imaging followup is a viable option.

Tratamiento reconstructivo de bajo costo tras resección de tumor de células gigantes de radio distal / Low-cost reconstructive treatment after resection of distal radius giant cell tumor

Resumen: Introducción: El tumor de células gigantes (TCG) es un tumor óseo intramedular benigno que surge con frecuencia en los extremos de los huesos largos. Después del fémur distal y la tibia proximal, el radio distal es el tercer sitio más afectado con tumores, particularmente agresivos. Nuestro objetivo es la presentación del caso clínico de una paciente con diagnóstico de TCG de radio distal clasificada en grado III de Campanacci que recibió un tratamiento ajustado a sus posibilidades económicas. Reporte de caso: Paciente femenino de 47 años, sin solvencia económica y sin ningún servicio médico. El tratamiento incluyó resección en bloque, reconstrucción con autoinjerto de peroné distal y artrodesis radiocarpiana con placa de compresión bloqueada. Dieciocho meses después, la paciente presentaba una buena fuerza de prensión (80% respecto al lado sano) y tenía una función motora fina en la mano. La muñeca presentó estabilidad con pronación de 85o, supinación de 80o, flexión-extensión de 0o y una puntuación de 6.7 en el cuestionario de evaluación de resultados funcionales DASH. Su evolución radiológica a cinco años después de su cirugía continuó sin datos de recidiva local y afectación pulmonar. Conclusión: El resultado en esta paciente, junto con los datos publicados, indican que la técnica de resección tumoral en bloque, más el autoinjerto de peroné distal y la artrodesis con placa de compresión bloqueada proporcionan un resultado óptimo de funcionalidad para el tumor radial distal grado III a bajo costo.

Abstract: Introduction: Giant cell tumor (GCT) is a benign intramedullary bone tumor that frequently arises at the ends of long bones. After the distal femur and proximal tibia, the distal radius is the third most affected site with particularly aggressive tumors. Our objective is the presentation of the clinical case of a patient diagnosed with distal radius GCT classified in grade III of Campanacci who received a treatment adjusted to her economic possibilities. Case report: A 47-year-old female, without economic solvency and with some medical service. Treatment included block resection, reconstruction with distal fibula autograft, and radiocarpal fusion with blocked compression plate. Eighteen months later, the patient had good grip strength (80% on the healthy side) and had fine motor function in the hand. The wrist presented stability with pronation of 85o, supination of 80o, flexion-extension of 0o and a score of 6.7 in the DASH functional outcomes assessment questionnaire. His radiological evaluation five years after his surgery continued with no evidence of local recurrence and pulmonary involvement. Conclusion: The result in this patient, together with the published data, indicate that the block tumor resection technique, plus distal fibula autograft and arthrodesis with blocked compression plate provide an optimal result of functionality for the grade III distal radial tumor at low cost.

Clinical analysis of 8 cases of desmoplastic fibroma of the jaw / 口腔疾病防治

Objective @#To improve the dentist's understanding of desmoplastic fibroma of the jaw, we investigated the clinical manifestations, pathological features, treatment and prognosis of this disease.@*Methods@#The clinical data of 8 patients with desmoplastic fibroma of the jaw who were admitted to Nanjing Stomatological Hospital from 2011 to 2021 were retrospectively reviewed.@* Results @#The male-female ratio in this group was 3:1, the age of first onset was 32.13±15.00, and the lesions were mainly in the mandible. Histologically, the lesions was composed of mildly atypical fibroblasts and a large number of collagen fibers. The positive rates of Vimentin, α-SMA and β-catenin in the cytoplasm were 100%, 62.5% and 62.5%, respectively. The Ki-67 level in the initial patients was lower than 5%, and the S-100 protein level was 100% negative. The imaging manifestations were single-room or multichamber light-transmitting lesions with clear or irregular boundaries, with or without peripheral sclerosis. Five patients were treated with curettage for the first time; among them, two patients relapsed with poor prognosis. Three patients underwent extended resection, and all had no recurrence.@*Conclusions @# The clinical and imaging features of desmoplastic fibroma of the jaw are not specific. We mainly rely on histopathology to diagnose the disease. It has a high recurrence rate after surgery. At present, the best treatment is to extend surgical resection. Local curettage is easy to relapse and has a poor prognosis.

Leiomiosarcoma primario de hueso en fémur distal metastásico a clavícula: reporte de un caso / Primary leiomyosarcoma of bone in the distal femur with clavicle metastasis: a case report

El leiomiosarcoma (LMS) es un tipo de tumor de células fusiformes de muy baja incidencia, que tiene un comportamiento agresivo, con alta tasa de mortalidad, por lo que el manejo debe ser quirúrgico, con una resección amplia de la lesión. No está claro el papel de la radio ni de la quimioterapia en su manejo. Presentamos a una paciente de 28 años que consultó por dolor de 2 meses en la rodilla derecha. Radiográficamente, se caracterizó como una lesión osteolítica pura en el fémur distal. La resonancia nuclear magnética (RNM) contrastada mostró áreas hipervasculares dentro del tumor. La gammagrafía mostró un marcado aumento en la captación de radiotrazadores. Se tomó una biopsia, con un informe de patología de LMS óseo bien diferenciado. Se trató con 3 ciclos de quimioterapia neoadyuvante preoperatoria con ifosfamida 1.000 mg/m2 en los días 1 a 3, además de doxorrubicina 70 mg/m2 , y resección quirúrgica de la lesión y salvamento de la extremidad con endoprótesis de rodilla. Una vez que se resecó la lesión, la paciente recibió quimioterapia adyuvante con 4 ciclos de gencitabina 1.000 mg/m2 entre los días 1 y 8, y doxetacel 70 mg/m2 el día 1. Durante los dos meses de seguimiento, la paciente presenóa una fractura en el tercio medio de la clavícula, compatible con una lesión patológica en radiografías y tomografía por emisión de positrones (TEP). La biopsia reveló una lesión metastásica de LMS óseo que fue tratada mediante resección quirúrgica de la clavícula. Este es un caso único, dado que, durante el seguimiento, recibió tratamiento adyuvante con quimioterapia y se evaluó con una TEP, con una evolución clínica satisfactoria y sin evidencia de nuevas lesiones

Leiomyosarcoma (LMS) is a type of spindle-cell tumor of very low incidence that tumor has an aggressive behavior, with high mortality rates; therefore, its management must be surgical, with a wide resection of the lesion. The role of radio and chemotherapy in its management is not clear. We present the case of a 28-year-old female patient who consulted for pain lasting 2 months in the right knee. Radiographically, it was characterized as a pure osteolytic lesion in the distal femur. Contrast magnetic resonance imaging (MRI) showed hypervascular areas within the tumor. The scintigraphy showed a marked increase in radiotracer uptake. A biopsy was taken, with a pathology report of well-differentiated osseous LMS. It was treated with 3 cycles of preoperative neoadjuvant chemotherapy with ifosfamide 1,000 mg/m2 in the first 3 days, as well as doxorubicin 70 mg/m2 , and surgical resection of the lesion and limb salvage with knee endoprosthesis. Once the lesion was resected, the patient underwent adjuvant chemotherapy, with 4 cycles of gencitabine 1,000 mg/m2 between days 1 and 8, and doxetacel 70 mg/m2 on day 1. During the 2-month follow-up, the patient presented a fracture in the middle third of the clavicle, which was compatible with a pathological lesion on radiographs and positron-emission tomography (PET) scans. The biopsy showed a metastatic lesion of bone LMS, which was treated by surgical resection of the clavicle. This is a unique case, given that, during the follow-up, the patient underwent adjuvant treatment with chemotherapy, and was evaluated with a PET scan, with a satisfactory clinical evolution and no evidence of new lesions.

Result analysis of percutaneous core needle biopsy for bone tumors in upper limbs with pathological fracture / 中国骨伤

OBJECTIVE@#To analyze the results of percutaneous core needle biopsy for bone tumors in upper limbs with pathologic fracture and to find the possible factors that could impact the results.@*METHODS@#The including criteria for this study was the patients who had received percutaneous core needle biopsy and definitive surgery, whose tumor was located at upper limb with pathologic fracture. From January 2015 to December 2019, seventy-seven patients were enrolled. There were 55 males and 22 females. The median age was 27 years old (range:5 to 88 years old). The tumor located at humerus in 67 cases, radius in 8 cases and ulna in 2 cases. If the pathologic diagnosis of core needle biopsy was the same with the definitive surgery, it was defined as "correct". If the pathologic diagnosis of biopsy for benign or malignant was right but the exact diagnostic name was not the same with definitive surgery, it was defined as "supportive". If the pathologic diagnosis of biopsy for benign or malignant was not correct, it was defined as "wrong". We retrospectively analyzed the accuracy and impact factors for core needle biopsy.@*RESULTS@#The result was "correct" in 63 cases(81.8%), "supportive" in 14 cases(18.2%), and "wrong" in 0 cases. We analyzed the gender, age, location, fracture displacement, the destroyed type for bone tumor, soft tissue mass, fluid area in the tumor as the factors. The results showed the rate for "correct" was significantly higher when the tumor had soft tissue mass (@*CONCLUSION@#The accuracy of percutaneous core needle biopsy for upper limb bone tumor with pathologic is high and acceptable. The biopsy chosen the soft tissue mass area can increase the accuracy.

Osteoblastoma con presentación atípica en cuboides / Osteoblastoma with atypical presentation in cuboid bone

Resumen: Introducción: El osteoblastoma es un tumor osteoblástico benigno, agresivo y poco frecuente. Su localización más frecuente es en elementos posteriores de la columna vertebral y el sacro. La presentación en cuboides es excepcional. Caso clínico: Masculino de 50 años que inició padecimiento en 2005, con dolor y aumento de volumen en región dorsolateral del mediopié. En las radiografías se observa injerto óseo y una lesión en cuboides, radiotransparente, heterogénea, multilobulada, con bordes irregulares que sobrepasa la cortical lateral. Se realizó angiotomografía donde se observó la lesión hipervascularizada; en la gammagrafía se observó captación del tecnecio 99 y en la resonancia magnética se reporta una lesión con cambios postquirúrgicos, quística, multilobulada. Se tomó biopsia transquirúrgica con abundante tejido fibroconectivo, osteoblastos, nidos de tejido osteoide e hipervascularidad del estroma, aumento de celularidad sin atipias y escasas células gigantes multinucleadas. Se clasificó Enneking 2. Se inició tratamiento con resección y curetaje del tumor, crioterapia y colocación de injerto tricortical en el defecto óseo. Mostró buena evolución postquirúrgica. A los tres años del procedimiento quirúrgico se encuentra sin datos de actividad tumoral y asintomático. A pesar de que el osteoblastoma no se presenta de forma habitual en cuboides, debe tomarse en cuenta como diagnóstico diferencial. Conclusión: Los tumores óseos, a pesar de tener localizaciones habituales, pueden presentarse en zonas poco frecuentes y por lo tanto, el estudio completo clínico radiográfico e histopatológico en cada paciente es fundamental.

Abstract: Introduction: Osteoblastoma is a benign, aggressive and rare osteoblastic tumor. Its most common location is in later elements of the spine and sacrum. The cuboid presentation is exceptional. Case report: A 50-year-old male who began her condition in 2005, with pain and increased volume in the dorsolateral region of the middle foot. X-rays show bone grafting and a cuboid lesion, radiotransparent, heterogeneous, multilobed, with irregular edges that exceeds the lateral cortical. Angiotomography was performed where hypervascularized injury was observed; bone scan showed uptake of technetium 99, and MRI reported an injury with post-surgical, cystic and multilobed changes. Trans surgical biopsy was taken, increased atypia-free cellularity and few multinucleated giant cells were reported and Enneking 2 qualified. Treatment was initiated with resection of the tumor, cryotherapy, and placement of tricortical graft in the bone defect. He exhibited good post-surgical evolution. At three years of the surgical procedure, he`s without tumor and asymptomatic. Although osteoblastoma does not usually occur in cuboid, it should be taken into account as a differential diagnosis. Conclusion: Bone tumors, despite having common locations, can occur in rare areas and therefore the complete radiographic and histopathological clinical study in each patient is critical.

Heme oxygenase-1 in osteosarcoma

Aim of Study: The present study was planned to analyze serum heme oxygenase-1 levels in osteosarcoma patients. Materials and Methods: Twenty five histopathologically confirmed cases of osteosarcoma localized without metastasis of all the ages attending the Orthopedic Clinics were included in the study group and twenty five patients having musculoskeletal pain (age and sex matched) served as control. Five ml of venous blood was collected aseptically from antecubital vein and serum was be separated by centrifugation and analyzed the same day. Routine biochemistry investigations were performed as per standard enzymatic methods by autoanalyzer. Serum Heme oxygenase-1 was analyzed by enzyme-linked immunosorbent assay. Results: In osteosarcoma patients, serum HO-1 levels were increased as compared to patients having musculoskeletal pain (P < 0.05). Workers have found that HO-1 induction in prostate cancer cell lines (PC3) cells restored the proliferation of osteoblasts, which was inhibited during co-culture with parental prostate cancer cell line PC3 cells. However, no concrete data are available on blood levels of HO in osteosarcoma. Major role of HO-1 is the protection against oxidative injury, additionally, it regulates cell proliferation, modulates inflammatory response and facilitates angiogenesis. Conclusion: Findings of the present study suggests that pharmacological agents that regulate HO activity or HO-1 gene silencing may become powerful tools for preventing the onset or progression of various cancers and sensitize them to anticancer therapies

Application of modified closed biopsy in rabbit model of VX2 transplanted bone tumor / 解放军医学杂志

Objective To explore the application value of modified closed biopsy technique in puncture biopsy of rabbit model of VX2 transplanted bone tumor. Methods VX2 tumor tissue was cut from rabbit with VX2 tumor and transplanted into the bilateral tibia of 30 rabbits through the tibial plateau to make the model of VX2 transplanted bone tumor. Seven days after modeling, the proximal tibia puncture biopsy was performed under the guidance of X-ray, and the biopsy specimen was examined pathologically. The left leg was biopsied with modified closed biopsy technique (experimental group), and the right leg was biopsied with hollow needle (control group). On the 14th day after modeling, all rabbits were executed after X-ray examination around the puncture hole, and the soft tissue around the puncture hole was taken for pathological examination. Results By the end of the experiment, a total of 3 rabbits died, and finally 27 rabbits were included in the study. Tumor cells were detected in all the intramedullary specimens obtained by puncture biopsy. On the 14th day after modeling, X-ray examination showed that, compared with control group, the incidence of periosteal reaction and extraosseous high density shadow around the puncture hole, and the tumor cell metastasis rate were lower [14.81%(4/27) vs. 40.74%(11/27); 29.63%(8/27) vs. 100.00%(27/27)], the differences were statistically significant (P<0.05). Conclusions Both the modified closed biopsy technique and puncture needle aspiration biopsy can provide sufficient biopsy tissue for diagnosis of VX2 transplanted bone tumor in rabbits. Meanwhile, the improved closed biopsy technique can prevent local metastasis of tumor cells along the puncture channel to some extent.

Biological reconstruction of large bone defects after resection of malignant tumor of extremities / 中国组织工程研究

BACKGROUND: With the development of medical technology, limb salvage surgery for malignant bone tumors has gradually become the main trend, so various biological reconstruction methods can be cited in the clinic. OBJECTIVE: To review the biological reconstruction of large bone defects after resection of malignant tumor of extremities. METHODS: The literature about the biological reconstruction of large bone defects after resection of malignant tumor of extremities was reviewed in PubMed, Web of Science, Wanfang, and CNKI from 2000 to 2020 by the first author using computer. The English key words were “malignant bone tumor, bone defect, biological reconstruction, limb salvage”, and the Chinese key words were “malignant bone tumor, limb salvage, biological reconstruction”. The documents that did not match the central words were eliminated, and the advantages and disadvantages of various biological reconstruction surgery methods were summarized. RESULTS AND CONCLUSION: (1) Analyzing the in-situ devitalized tumor-bearing bone, biological reconstruction after resection of juxta-articular osteosarcoma segmental bone tumor, each has its advantages and disadvantages. Surgeons should choose different operation methods based on its different indications. (2) Biological reconstruction provides vital methods for limb salvage of malignant tumor of extremities.

Polymer nanomedicines for osteosarcoma therapy / 中国组织工程研究

BACKGROUND: In recent years, various polymer nanoparticles have been developed as anticancer drug carriers to prolong blood circulation time and Improve intratumoral accumulation, and then enhance the therapeutic efficacy on osteosarcoma. OBJECTIVE: To review the application and development of polymer nanomedicines for treatment of osteosarcoma based on latest related studies. METHODS: A computer-based online search of Web of Science, NCBI, and PubMed was performed to search publications published between January 1900 and June 2019 with the search terms “osteosarcoma; polymer; nanopartlcle; controlled drug delivery; tumor therapy”. A total of 265 publications were screened out, and 107 of them regarding polymer nanoparticles for treatment of osteosarcoma were included in the final analysis. RESULTS AND CONCLUSION: Osteosarcoma is the most common primary malignant bone tumor, mainly affecting children and adolescents. The long-term survival rate of osteosarcoma patients is low due to early lung metastasis and high local invasiveness. Although chemotherapy increases the survival rates of patients with osteosarcoma, its application potential is limited by severe side effects and drug resistance. Compared with traditional chemotherapy, polymer nanomedicines reduce the toxicity to healthy tissues, prolong the blood circulation time in vivo, and provide continuous release of chemotherapy drugs at the tumor sites, thereby Improving the therapeutic efficacy. Therefore, polymer nanomedicines have great application prospects In the treatment of osteosarcoma because of their unique advantages.

Wnt/beta-catenin signaling pathway: Multiple roles in osteosarcoma, bone remodeling and angiogenesis / 中国组织工程研究

BACKGROUND: The Wnt/β-catenin signaling pathway plays a key role in osteosarcoma tumorigenesis and bone remodeling, and its roles in angiogenesis and immune surveillance are the two key mechanisms of metastatic dissemination. OBJECTIVE: To review the role of Wnt/β-catenin pathway in the occurrence and development of osteosarcoma and its regulatory role in specific microenvironment. METHODS: PubMed database was searched for relevant articles on the relationship between Wnt/β-catenin pathway and bone tumors using the search terms of “Wnt/β-catenin; bone tumors.” The search time for publications was from 2000 to 2020. RESULTS AND CONCLUSION: The typical Wnt/β-catenin signaling pathway plays an important role in the growth and metastasis of osteosarcoma by directly acting on osteosarcoma cells and indirectly regulating cell activity in osteosarcoma. The Wnt/β-catenin pathway also participates in the hijacking of the bone tumor microenvironment by osteosarcoma cells, promotes the regulation of extracellular matrix, makes the tumor cells invasive, induces immune tolerance and angiogenesis in tumor cells, and eventually augments metastatic spread. In addition, the typical Wnt signaling pathway abnormally activated in osteosarcoma cells seems to be closely related to cell proliferation, induction of epithelial-mesenchymal transition-like processes, acquisition of osteosarcoma-promoting tumor cell stem cell characteristics, and metastatic spread.

Tumor de células gigantes en el antebrazo / Forearm giant cell tumor

RESUMEN El tumor de células gigantes se define como un tumor óseo benigno que invade las partes blandas localmente de forma agresiva. Se presenta una paciente con un tumor de células gigantes recidivante en el tercio distal del radio derecho, con signos de necrosis superficial e infección sobreañadidos, la cual, dada la magnitud y severidad de la lesión, requirió una amputación supracondílea de la extremidad. Presentó una evolución postoperatoria favorable, con recuperación física y psicológica(AU)

ABSTRACT Giant cell tumor is defined as a benign bone tumor that aggressively invades soft tissue locally. We present a patient with a recurrent giant cell tumor in the distal third of the right radius, showing signs of superimposed necrosis and infection, which, given the injury magnitude and severity, required supracondylar amputation of the limb. Her postoperative evolution was favorable, and this patient underwent physical and psychological recovery(AU)

RÉSUMÉ La tumeur à cellules géantes est définie comme une tumeur osseuse bénigne qui envahit agressivement les parties molles locales. Une patiente atteinte de tumeur récidivante à cellules géantes au niveau du tiers distal du radius droit, avec signes de nécrose superficielle et d'infection surajoutés, laquelle a requis une amputation supracondylienne du membre, due à la magnitude et à la sévérité de la lésion, est présentée. Elle a montré une évolution postopératoire favorable, avec une bonne récupération physique et psychologique.

Osteoid Osteoma of the Sacrum: A Case Report

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.

Effectiveness of free vascularized fibular graft for bone defect after resection of lower limb malignant tumor / 中国修复重建外科杂志

Objective: To analyze the effectiveness of free vascularized fibula grafts (FVFG) for extensive bone defects after resection of lower limb malignant bone tumors. Methods: Between November 2015 and July 2018, 15 cases of lower limb malignant bone tumors were treated. There were 12 males and 3 females with an average age of 12.3 years (range, 9-21 years). There were 11 cases of osteosarcoma and 4 cases of Ewing's sarcoma. The tumor located at middle femur in 8 cases, lower femur in 4 cases, and middle tibia in 3 cases. The disease duration was 2-6 months (mean, 3.2 months). The tumor was completely removed, and the length of the bone defect was 8-23 cm (mean, 17.7 cm). The bone defect was repaired by FVFG, and combined inactivated tumor bone was used in 8 cases of femoral bone defect. Results: The average operation time was 280 minutes (range, 180-390 minutes). The average blood loss was 310 mL (range, 200-480 mL). All incisions healed by first intention. All patients were followed up 2-24 months with an average of 14.5 months. Bone healing achieved in all patients at 9-18 months (mean, 12.3 months) after operation except 1 patient which was followed up only 2 months. The fibula grafts had active metabolism and the average bone metabolism score was 184 (range, 111-257) in effected side and 193 (range, 127-259) in contralateral side. There was no difference between bilateral sides. The average Enneking score was 24.6 (range, 20-30) at last follow-up. No ankle instability or paralysis of common peroneal nerve occurred. Conclusion: FVFG appeared very efficient in repair of extensive bone defect after resection of lower limb malignant bone tumor.

Application of pasteurized tumor-bearing bone replantation for primary malignant bone tumor of extremities / 中国修复重建外科杂志

Objective: To assess the effectiveness of the pasteurized tumor-bearing bone replantation in treatment of primary malignant bone tumor of extremities. Methods: Between February 2012 and June 2016, 13 patients with primary malignant bone tumor of extremities were treated with pasteurized tumor-bearing bone replantation after extensive excision. There were 8 males and 5 females, aged from 11 to 27 years, with an average of 17.4 years. Tumors were located at the mid-upper humerus in 2 cases, the mid-upper femur in 2 cases, the mid-lower femur in 6 cases, the mid-upper tibia in 2 cases, and the middle tibia in 1 case. According to Enneking staging system, 3 patients were classified as stage ⅠB, 5 patients as stage ⅡA, and 5 patients as stage ⅡB. There were 11 cases of osteosarcoma and 2 cases of chondrosarcoma. The disease duration ranged from 3 to 8 months, with an average of 4.8 months. The length of the tumor-bearing bone ranged from 8 to 16 cm, with an average of 12.5 cm. Postoperative follow-up was conducted regularly to evaluate the status of inactivated bone and complications. The limb function was assessed by the Musculoskeletal Tumor Society 93 (MSTS-93) scoring system. Results: All 13 patients were followed up 26-79 months, with an average of 50.5 months. Eleven patients survived without tumors. Two patients had local soft tissue recurrence and underwent amputation, 1 had lung metastasis after amputation and died. All patients had no complications of bone resorption, shortening, and internal fixation disorder. The nonunion of osteotomy occurred in 4 cases. Among them, 3 cases were successfully healed after autologous iliac bone grafting, and 1 case was treated conservatively. The healing time of metaphyseal osteotomy end was 10-15 months (mean, 12.6 months), the healing rate was 90.9% (10/11); the healing time of diaphyseal osteotomy end was 12-21 months (mean, 17.0 months), the healing rate was 72.7% (8/11); and the total healing rate of osteotomy end was 81.8% (18/22). One case had inactivated bone fracture and 1 case had incision dehiscence and infection after operation. At last follow-up, the MSTS-93 score of affected limb ranged from 21 to 28, with an average of 25.3. Conclusion: The procedure of the pasteurized tumor-bearing bone replantation is an effective, simple, and economic way in repair of massive segmental bone defect to save limb function for primary malignant bone tumor of extremities.

Canine periosteal osteosarcoma / Osteosarcoma periosteal en perro

ABSTRACT Osteosarcoma is the most common bone tumor in dogs. The periosteal osteosarcoma is a subtype of osteosarcoma, and is considered rare in the canine species. The purpose of the present study was to describe a 14-year-old female dog with an ulcerated mass located in the right tibia and 30-days of evolution. The patient was submitted to complementary exams (blood count analysis, dosage of biochemical enzymes - creatinine and alanine aminotransferase, thoracic radiographs, and abdominal ultrasonography) to perform complete staging of the disease. Radiography of the right tibia revealed proliferative and lytic periosteal reaction. The cytological analysis of the mass suggested a round cell tumor. The clinical and the radiological findings indicated the presence of a bone tumor. Pelvic limb amputation was the initial surgical treatment suggested to the client. The histopathological examination revealed the presence of periosteal osteosarcoma with free margins and lymph nodes without evidence of tumor cells. Clinical follow-up was performed through imaging exams without evidence of metastatic disease. The dog had a nine-month survival free time from diagnosis.

RESUMEN El osteosarcoma es el tumor óseo más común en los perros. Osteosarcoma periosteal es un subtipo de osteosarcoma y se considera raro en la especie canina. El objetivo del presente estudio fue describir un caso de una perra mestiza de 14 años de edad con una masa ulcerada y localizada en la tibia derecha y 30 días de evolución. Él paciente se sometió a exámenes adicionales (análisis de sangre, dosis de enzimas bioquímicas - creatinina y alanina aminotransferasa, radiografías torácicas y ultrasonografía abdominal) para la estadificacion completa de la enfermedad. La radiografía de la tibia derecha reveló reacción perióstica proliferativa y lítica. Él examen citológico de la masa sugirió un tumor de celulas redondas. La evaluación clínica y hallazgos radiológicos sugieren la presencia de una neoplasia ósea. La amputación de la extremidad pélvica derecha fue el tratamiento quirúrgico inicial sugerido al cliente. Él examen histopatológico reveló la presencia de osteosarcoma periosteal con márgenes libres y ganglios linfáticos sin evidencia de células tumorales. El seguimiento clínico se realizó a través de exámenes de imágenes sin evidencia de enfermedad metastásica. El perra tenía un tiempo de sobrevida de nueve meses desde el diagnóstico.