A Large Mass over the Foot due to the Coexistence of an Eccrine Poroma and a Poroid Hidradenoma: A Case Report.

Eccrine poroma and poroid hidradenoma are uncommon benign poroid neoplasms derived from eccrine sweat glands. There are four types of poroid neoplasms according to the position within the skin layer: hidroacanthoma simplex, eccrine poroma, dermal duct tumor, and poroid hidradenoma. Poroid neoplasms usually arise as slow-growing solitary lesions and can present different clinical presentations, such as a foot mass, an ulceration lesion, a solid cyst, a bleeding lesion or suspected melanoma. Extremities are the most common sites, especially hands and feet. However, the coexistence of these two tumors in a single lesion is extremely rare. Surgical excision represents the main treatment and can be curative, preventing malignant changes and recurrence. We describe a rare solitary tumor over the foot with clinical and histopathological features of an association of an eccrine poroma and a poroid hidradenoma that was surgically treated with no recurrence at the midterm follow-up. Level of Evidence IV, Case Report.

Does the Addition of Mutations of CTNNB1 S45F to Clinical Factors Allow Prediction of Local Recurrence in Patients With a Desmoid Tumor? A Local Recurrence Risk Model.

BACKGROUND: The initial approach to the treatment of desmoid tumors has changed from surgical resection to watchful waiting. However, surgery is still sometimes considered for some patients, and it is likely that a few patients would benefit from tumor removal if the likelihood of local recurrence could be predicted. However, to our knowledge, there is no tool that can provide guidance on this for clinicians at the point of care. QUESTION/PURPOSE: We sought to explore whether a combined molecular and clinical prognostic model for relapse in patients with desmoid tumors treated with surgery would allow us to identify patients who might do well with surgical excision. METHODS: This was a retrospective, single-center study of 107 patients with desmoid tumors who were surgically treated between January 1980 and December 2015, with a median follow-up of 106 months (range 7 to 337 months). We correlated clinical variables (age, tumor size, and localization) and CTNNB1 gene mutations with recurrence-free survival. Recurrence-free survival was estimated using a Kaplan-Meier curve. Univariate and multivariable analyses of time to local recurrence were performed using Cox regression models. A final nomogram model was constructed according to the final fitted Cox model. The predictive performance of the model was evaluated using measures of calibration and discrimination: calibration plot and the Harrell C-statistic, also known as the concordance index, in which values near 0.5 represent a random prediction and values near 1 represent the best model predictions. RESULTS: The multivariable analysis showed that S45F mutations (hazard ratio 5.25 [95% confidence interval 2.27 to 12.15]; p < 0.001) and tumor in the extremities (HR 3.15 [95% CI 1.35 to 7.33]; p = 0.008) were associated with a higher risk of local recurrence. Based on these risk factors, we created a model; we observed that patients considered to be at high risk of local recurrence as defined by having one or two factors associated with recurrence (extremity tumors and S45F mutation) had an HR of 8.4 compared with patients who had no such factors (95% CI 2.84 to 24.6; p < 0.001). From these data and based on the multivariable Cox models, we also developed a nomogram to estimate the individual risk of relapse after surgical resection. The model had a concordance index of 0.75, or moderate discrimination. CONCLUSION: CTNNB1 S45F mutations combined with other clinical variables are a potential prognostic biomarker associated with the risk of relapse in patients with desmoid tumors. The developed nomogram is simple to use and, if validated, could be incorporated into clinical practice to identify patients at high risk of relapse among patients opting for surgical excision and thus help clinicians and patients in decision-making. A large multicenter study is necessary to validate our model and explore its applicability. LEVEL OF EVIDENCE: Level III, therapeutic study.

Reconstruction with Unconventional Endoprostheses after Resection of Primary Distal Femoral Bone Tumors: Implant Survival and Functional Outcomes.

Objective To evaluate the survival time, the failure rate and its causes, and the functional results of cemented endoprostheses, with a polyethylene body, used after resection of primary bone tumors of the distal femur. Methods A retrospective study including 93 primary and 77 review procedures performed between 1987 and 2014. Survival was obtained by the Kaplan Meyer analysis, and the risk factors for implant failure were assessed through the Cox proportional risk model. The causes of endoprosthesis failure were classified according to Henderson et al. into five types: soft-tissue failure, aseptic loosening, structural fracture, infection, and tumor recurrence. The functional evaluation was performed using the functional classification system of the Musculoskeletal Tumor Society (MSTS) of bone sarcomas of the lower extremity, Brazilian version (MSTS-BR). Results Osteosarcoma was the most common diagnosis; 64.5% of the patients were younger than 20 years of age; the mean follow-up was of 124.3 months. The failure rate of the primary implant was of 54.8%, and the mean survival was of 123 months. The estimated survival of the primary implant was of 63.6%, 43.5%, 24.1%, and 14.5% in 5, 10, 15, and 20 years respectively. The most common cause of failure was type 2 (37.3%). Age ≤ 26 years and right side were risk factors for failure. The mean MSTS-BR score was of 20.7 (range: 14 to 27). Conclusion The results obtained for the failure rate and survival of the implant are in accordance with those of the literature, so the procedure herein studied is adequate and yields satisfactory functional results, even in the long term.

Reconstruction with Unconventional Endoprostheses after Resection of Primary Distal Femoral Bone Tumors: Implant Survival and Functional Outcomes / Reconstrução com endoprótese não convencional após ressecção de tumores ósseos primários de fêmur distal: sobrevida do implante e resultados funcionais

Abstract Objective To evaluate the survival time, the failure rate and its causes, and the functional results of cemented endoprostheses, with a polyethylene body, used after resection of primary bone tumors of the distal femur. Methods A retrospective study including 93 primary and 77 review procedures performed between 1987 and 2014. Survival was obtained by the Kaplan Meyer analysis, and the risk factors for implant failure were assessed through the Cox proportional risk model. The causes of endoprosthesis failure were classified according to Henderson et al. into five types: soft-tissue failure, aseptic loosening, structural fracture, infection, and tumor recurrence. The functional evaluation was performed using the functional classification system of the Musculoskeletal Tumor Society (MSTS) of bone sarcomas of the lower extremity, Brazilian version (MSTS-BR). Results Osteosarcoma was the most common diagnosis; 64.5% of the patients were younger than 20 years of age; the mean follow-up was of 124.3 months. The failure rate of the primary implant was of 54.8%, and the mean survival was of 123 months. The estimated survival of the primary implant was of 63.6%, 43.5%, 24.1%, and 14.5% in 5, 10, 15, and 20 years respectively. The most common cause of failure was type 2 (37.3%). Age ≤ 26 years and right side were risk factors for failure. The mean MSTS-BR score was of 20.7 (range: 14 to 27). Conclusion The results obtained for the failure rate and survival of the implant are in accordance with those of the literature, so the procedure herein studied is adequate and yields satisfactory functional results, even in the long term.

Resumo Objetivo Avaliar o tempo de sobrevida, a taxa de falha e suas causas, e os resultados funcionais de endopróteses cimentadas, com corpo em polietileno, empregadas após ressecção de tumores ósseos primários do fêmur distal. Métodos Estudo retrospectivo, que incluiu 93 procedimentos primários e 77 de revisão, realizados entre 1987 e 2014. A sobrevida foi obtida pela análise de Kaplan Meyer, e os fatores de risco para falha do implante foram avaliados por meio do modelo de riscos proporcionais de Cox. As causas de falha da endoprótese foram classificadas segundo Henderson et al. em cinco tipos: falha de partes moles, soltura asséptica, fratura estrutural, infecção e recorrência do tumor. A avaliação funcional foi realizada por meio do sistema de classificação funcional da Musculoskeletal Tumor Society (MSTS) para sarcomas ósseos da extremidade inferior, versão brasileira (MSTS-BR). Resultados Osteossarcoma foi o diagnóstico mais comum; 64,5% dos pacientes tinham menos de 20 anos; e o seguimento médio foi de 124,3 meses. A taxa de falha do implante primário foi de 54,8%, e a sobrevida média foi 123 meses. A estimativa de sobrevida do implante primário foi de 63,6%, 43,5%, 24,1%, 14,5% em 5, 10, 15 e 20 anos, respectivamente. A causa de falha mais comum foi a do tipo 2 (37,3%). Idade ≤ 26 anos e lado direito foram fatores de risco para falha. A pontuação média no MSTS-BR foi de 20,7 (variação: 14 a 27). Conclusão Os resultados obtidos para a taxa de falha e o tempo de sobrevida do implante estão de acordo com os da literatura, de forma que o procedimento estudado é adequado e apresenta resultados funcionais satisfatórios, inclusive em longo prazo.

Tratamento da unha em gancho com a técnica de Bakhach: estudo retrospectivo / Treatment of hook nails using the Bakhach's technique: a retrospective study

Introdução: a causa da unha em gancho é o trauma do hiponíquio. A lâmina ungueal se apresenta com hipercurvatura longitudinal de concavidade volar, causando perda funcional, comprometimento estético e dor. Objetivo: avaliar os resultados na pesquisa de 20 prontuários de pacientes submetidos a cirurgias de correções de unhas em gancho de etiologias traumáticas. Métodos: estudo retrospectivo transversal epidemiológico, de 2010 a 2018, de prontuários de pacientes submetidos à técnica cirúrgica de Bakhach, no ambulatório de Cirurgia da Mão do Hospital do Servidor Público Municipal de São Paulo. Resultados: 20 dedos acometidos. Sete vítimas de acidente com objetos cortantes, cinco com máquinas tipo prensa, cinco com portas, um com janela, um com motocicleta e um por mordida de cachorro. O dedo com maior incidência foi o médio (12 casos); seguido do indicador (cinco casos) e do anelar (três casos). A queixa principal foi estética (11); dor (seis) e funcional (três). Todos tiveram amputações digitais distais transversas do tipo II e foram submetidos a tratamento cirúrgico. A cirurgia de reconstrução ocorreu entre quatro e 25 meses pós-trauma. Conclusão: 15 ficaram satisfeitos, embora dois destes tenham relatado dor: um na articulação interfalângica distal e o outro no hiponíquio. O acompanhamento variou de seis meses a dois anos.

Introduction: The cause of the hook nail is the trauma of the hyponychium. The nail plate presents longitudinal hypercurvature of volar concavity, causing functional loss, aesthetics concerns, and pain. Objective: To evaluate the research results of 20 medical records of patients submitted to hook nail correction surgeries of traumatic etiologies. Methods: Epidemiological, cross-sectional, retrospective study of patients' medical records who were submitted to Bakhach's surgical technique, from 2010 to 2018, in the Hand Surgery Outpatient Clinic of the Hospital do Servidor Público Municipal de São Paulo. Results: We analyzed 20 affected fingers: 7 were victims of accidents with sharp objects, 5 with press machines, 5 with doors, 1 with window, 1 with motorcycle, and 1 due to a dog bite. The finger with the highest incidence was the middle finger (n=12), followed by the index finger (n=5), and ring finger (n=3). The main complaint was aesthetics (n=11); pain (n=6), and functional (n=3). All cases had type II distal digital transverse amputations and underwent surgical treatment. The reconstruction surgery occurred between 4 and 25 months after the trauma. Conclusion: 15 patients were satisfied and two felt pain: one in the distal interphalangeal joint and the other in the hyponychium. The follow-up ranged from 6 months to 2 years

Intraosseous Schwannoma: Case Report and Review of the Literature.

Schwannoma is a benign neural sheath tumor of the soft tissue, and its intraosseous presentation is very rare. It is estimated that intraosseous schwannomas represent 0.2% of all bone tumors. The tumor may affect any site of the skeleton, including the mandible, the sacrum, vertebral bodies, the ulna, the humerus, the femur, the tibia, the patella, the scapula, the ribs, and small bones of the hand. The involvement of the calcaneus has only been reported four times in the literature. The present study reports the case of a 49-year-old male with right hindfoot pain and a radiological finding of an osteolytic bone lesion in the calcaneus. The diagnosis was confirmed by histopathological study. The treatment of choice was an intralesional resection with adjuvant local control, and bone defect substitution with polymethylmethacrylate and fixation with two cannulated screws. The patient had a satisfactory postoperative evolution; after 1 year, he is asymptomatic, with good functional response and no evidence of disease. The present case report shows the clinical, radiological, and pathological features of a rare benign bone neoplasm. Moreover, intraosseous schwannoma should be included in the differential diagnosis of osteolytic calcaneal lesions.

Intraosseous Schwannoma: Case Report and Review of the Literature / Schwannoma intraósseo: Relato de caso e revisão da literatura

Abstract Schwannoma is a benign neural sheath tumor of the soft tissue, and its intraosseous presentation is very rare. It is estimated that intraosseous schwannomas represent 0.2% of all bone tumors. The tumor may affect any site of the skeleton, including the mandible, the sacrum, vertebral bodies, the ulna, the humerus, the femur, the tibia, the patella, the scapula, the ribs, and small bones of the hand. The involvement of the calcaneus has only been reported four times in the literature. The present study reports the case of a 49-year-old male with right hindfoot pain and a radiological finding of an osteolytic bone lesion in the calcaneus. The diagnosis was confirmed by histopathological study. The treatment of choice was an intralesional resection with adjuvant local control, and bone defect substitution with polymethylmethacrylate and fixation with two cannulated screws. The patient had a satisfactory postoperative evolution; after 1 year, he is asymptomatic, with good functional response and no evidence of disease. The present case report shows the clinical, radiological, and pathological features of a rare benign bone neoplasm. Moreover, intraosseous schwannoma should be included in the differential diagnosis of osteolytic calcaneal lesions.

Resumo Schwannomas são tumores benignos oriundos de células da bainha neural cuja apresentação intraóssea é rara. Estima-se que os schwannomas intraósseos representem 0,2% de todos os tumores ósseos. Schwannomas podem acometer diferentes ossos do esqueleto, como a mandíbula, o sacro, corpos vertebrais, a ulna, o úmero, o fêmur, a tíbia, a patela, a escápula, costelas e ossos da mão. Apenas quatro casos que acometeram o calcâneo foram descritos na literatura. No presente trabalho, os autores relatam o caso de um paciente masculino de 49 anos com dor no retropé direito e com exames de imagem que evidenciaram lesão osteolítica no calcâneo. O estudo histopatológico confirmou o diagnóstico de Schwannoma intraósseo. O tratamento de escolha foi ressecção intralesional com adjuvância local e substituição por polimetilmetacrilato e fixação com parafusos canulados. O paciente evoluiu de forma satisfatória no pós-operatório e, após 1 ano de evolução, encontra-se assintomático, com boa resposta funcional e sem evidência de doença. Com esse relato, os autores desejam chamar atenção para essa patologia rara, sua apresentação clínica, radiológica e patológica, além de reiterar a importância de incluir o schwannoma intraósseo dentre os diagnósticos diferenciais das lesões osteolíticas do calcâneo.

Primary angiosarcoma of the femur in a patient with Takayasu arteritis.

Primary osseous angiosarcoma is a rare entity with variable biological behavior and poor prognosis. Little is known about the oncologic treatment and its etiology is still unknown. This study presents a case of lytic lesion in the right femur with dissemination to other bones, such as the vertebral column and skull, and to the lungs and central nervous system. Orthopedic surgery was performed in order to improve quality of life. Surgical specimen confirmed the diagnosis of high-grade malignant osseous angiosarcoma. Despite oncologic and orthopedic treatment, the patient had rapid and aggressive progression with a poor outcome.

O angiossarcoma ósseo (AO) é uma patologia rara de comportamento biológico variável e com prognóstico reservado. Pouco se conhece sobre o seu tratamento oncológico e sua etiologia ainda é desconhecida. Os autores apresentam um caso de lesão lítica em fêmur proximal que se disseminou para outros ossos (tais como coluna e crânio), pulmão e sistema nervoso central. Foi instituído tratamento ortopédico, com vistas a uma melhoria da qualidade de vida e ao conforto do paciente. O diagnóstico de AO maligno de alto grau foi confirmado pelo espécime cirúrgico. Apesar disso e do tratamento oncológico feito, o paciente apresentou uma evolução rápida e agressiva com desfecho desfavorável.

Lipoma arborescens of the elbow: a case with features of a high-grade tumor.

Lipoma arborescens (LA) is an uncommon non-neoplastic disorder that may affect almost any joint, mainly the knee. LA is very rare in the elbow, and there are only a few cases reported in the literature. This study aimed to describe a case of LA in the elbow, presenting with features of a high-grade tumor. The authors report the case of a 51-years-old male who presented to this institution with pain and swelling on the left elbow. The patient had a seven-year history of investigation, with inconclusive diagnosis. Magnetic resonance imaging (MRI) showed an expansive mass with local aggressiveness. Due to these characteristics, it was not possible to discard soft tissue sarcoma at the differential diagnosis. After biopsy and a multidisciplinary team meeting, the authors opted for surgical resection. The final anatomopathological result confirmed the diagnosis of LA. Despite not being a true neoplasm, LA can cause many symptoms and functional impairment of the affected joint. It is important to keep this diagnosis in mind when any expansive mass surrounding a joint is observed.

O lipoma arborescens (LA) é uma doença não-neoplásica incomum que pode afetar quase todas as articulações, principalmente o joelho. O LA é muito raro no cotovelo e há apenas alguns casos relatados na literatura. O objetivo deste estudo é descrever um caso de LA no cotovelo, apresentando características de tumor de alto grau. Os autores relatam o caso de um homem de 51 anos de idade que se apresentou à instituição com dor e inchaço no cotovelo esquerdo. O paciente tinha sete anos de história de investigação com diagnóstico inconclusivo. As características da ressonância magnética (RM) mostraram uma massa expansiva com agressividade local. Devido a estas características, não foi possível descartar sarcoma de tecido mole no diagnóstico diferencial. Após a biópsia e uma reunião de equipe multidisciplinar, optou-se pela ressecção cirúrgica. O resultado anatomopatológico final confirmou o diagnóstico de LA. Mesmo que não seja uma neoplasia verdadeira, o LA pode causar muitos sintomas com comprometimento funcional da articulação afetada. É importante ter em mente este diagnóstico quando qualquer massa expansiva em torno de uma articulação for observada.

Primary angiosarcoma of the femur in a patient with Takayasu arteritis / Angiossarcoma primário do fêmur em um paciente com arterite de Takayasu

ABSTRACT Primary osseous angiosarcoma is a rare entity with variable biological behavior and poor prognosis. Little is known about the oncologic treatment and its etiology is still unknown. This study presents a case of lytic lesion in the right femur with dissemination to other bones, such as the vertebral column and skull, and to the lungs and central nervous system. Orthopedic surgery was performed in order to improve quality of life. Surgical specimen confirmed the diagnosis of high-grade malignant osseous angiosarcoma. Despite oncologic and orthopedic treatment, the patient had rapid and aggressive progression with a poor outcome.

RESUMO O angiossarcoma ósseo (AO) é uma patologia rara de comportamento biológico variável e com prognóstico reservado. Pouco se conhece sobre o seu tratamento oncológico e sua etiologia ainda é desconhecida. Os autores apresentam um caso de lesão lítica em fêmur proximal que se disseminou para outros ossos (tais como coluna e crânio), pulmão e sistema nervoso central. Foi instituído tratamento ortopédico, com vistas a uma melhoria da qualidade de vida e ao conforto do paciente. O diagnóstico de AO maligno de alto grau foi confirmado pelo espécime cirúrgico. Apesar disso e do tratamento oncológico feito, o paciente apresentou uma evolução rápida e agressiva com desfecho desfavorável.

Lipoma arborescens of the elbow: a case with features of a high-grade tumor / Lipoma arborescens do cotovelo: um caso com características de tumor de alto grau

ABSTRACT Lipoma arborescens (LA) is an uncommon non-neoplastic disorder that may affect almost any joint, mainly the knee. LA is very rare in the elbow, and there are only a few cases reported in the literature. This study aimed to describe a case of LA in the elbow, presenting with features of a high-grade tumor. The authors report the case of a 51-years-old male who presented to this institution with pain and swelling on the left elbow. The patient had a seven-year history of investigation, with inconclusive diagnosis. Magnetic resonance imaging (MRI) showed an expansive mass with local aggressiveness. Due to these characteristics, it was not possible to discard soft tissue sarcoma at the differential diagnosis. After biopsy and a multidisciplinary team meeting, the authors opted for surgical resection. The final anatomopathological result confirmed the diagnosis of LA. Despite not being a true neoplasm, LA can cause many symptoms and functional impairment of the affected joint. It is important to keep this diagnosis in mind when any expansive mass surrounding a joint is observed.

RESUMO O lipoma arborescens (LA) é uma doença não neoplásica incomum que pode afetar quase todas as articulações, principalmente o joelho. O LA é muito raro no cotovelo e há apenas alguns casos relatados na literatura. O objetivo deste estudo é descrever um caso de LA no cotovelo que apresentava características de tumor de alto grau. Os autores relatam o caso de um homem de 51 anos que se apresentou à instituição com dor e inchaço no cotovelo esquerdo. O paciente tinha sete anos de história de investigação com diagnóstico inconclusivo. As características da ressonância magnética (RM) mostraram uma massa expansiva com agressividade local. Devido a essas características, não foi possível descartar sarcoma de tecido mole no diagnóstico diferencial. Após a biópsia e uma reunião de equipe multidisciplinar, optou-se pela ressecção cirúrgica. O resultado anatomopatológico final confirmou o diagnóstico de LA. Mesmo que não seja uma neoplasia verdadeira, o LA pode causar muitos sintomas com comprometimento funcional da articulação afetada. É importante ter em mente esse diagnóstico quando qualquer massa expansiva em torno de uma articulação for observada.

Isolated Scapular Metastasis in a Patient with Malignant Struma Ovarii: A Case Report.

CASE: We report the case of a 38-year-old woman who presented with a lytic bone lesion in the left scapula. A biopsy showed a tumor with the histologic appearance of thyroid tissue. She also was found to have a thyroid nodule and an enlarged ovary, both of which were excised. The thyroid nodule turned out to be a benign colloid nodule, and the ovary contained a monodermal teratoma composed of thyroid tissue (struma ovarii). The lesion in the scapula eventually was proven to be metastatic malignant struma ovarii. CONCLUSION: Malignant struma ovarii with bone metastases is very rare, and its diagnosis is a challenge. There are some documented cases with bone metastases, mostly to the thoracic and lumbar spine. The optimal treatment of choice for the bone lesion is unknown because of the rarity of its presentation.

Osteoid osteoma - radiofrequency ablation treatment guided by computed tomography: a case series.

The osteoid osteoma is a benign primary bone tumor that affects mainly males in the second and third decades of life. Radiographic findings show a radiolucent nidus surrounded by reactive sclerotic bone, particularly in the long bones of the lower extremity. Clinically, it presents persistent pain, which is worse at night and improves with salicylates. It can be a self-limiting injury, with an average duration of three years, but because of pain intensity and intolerance to prolonged use of nonsteroidal anti-inflammatories, surgical treatment is an option. The diagnosis is suspected according to the history and radiographic findings, and the confirmation is made by histological analysis. The traditional surgical treatment is the complete excision of the nidus, but some disadvantages have been described, such as difficulties in localizing the lesion and risk of fracture during the procedure, hospital stay for pain control, and unfavorable esthetic outcome. The authors report a series of cases treated with thermal radiofrequency ablation guided by computed tomography in this service. It is a safe and an effective percutaneous method that aims to cure, minimizing the trauma and morbidity when compared with the conventional block-resection method.

O osteoma osteoide é um tumor ósseo primário benigno que acomete mais o sexo masculino na segunda e terceira décadas da vida. Radiograficamente, caracteriza-se por um nicho radiolucente cercado por osso esclerótico reativo, principalmente em ossos longos da extremidade inferior. Clinicamente, apresenta uma dor persistente de longa duração, com pioria noturna e melhoria com salicilatos. Embora possa ser uma lesão autolimitada, com duração média de três anos, a ressecção da lesão é uma opção de tratamento devido à intensidade da dor e intolerância ao uso prolongado de anti-inflamatórios não hormonais. Sua suspeita diagnóstica baseia-se principalmente na história clínica e nos achados radiográficos, a confirmação é feita pelo estudo anatomopatológico. O tratamento cirúrgico clássico é a excisão cirúrgica completa do nicho, porém são descritas desvantagens como a dificuldade para a localização intraoperatória da lesão, risco de fratura durante o procedimento, tempo de internação hospitalar para controle álgico e resultado estético desfavorável. Relatamos uma série de casos tratados com termoablação por radiofrequência guiada por tomografia computadorizada em nosso serviço. Trata-se de um método percutâneo seguro e eficaz que tem como objetivo a cura, minimiza o trauma e a morbidade do procedimento, quando comparado com o método convencional de ressecção em bloco.

Osteoid osteoma - radiofrequency ablation treatment guided by computed tomography: a case series / Osteoma osteoide - Tratamento com radioablação guiada por tomografia computadorizada: uma série de casos

ABSTRACT The osteoid osteoma is a benign primary bone tumor that affects mainly males in the second and third decades of life. Radiographic findings show a radiolucent nidus surrounded by reactive sclerotic bone, particularly in the long bones of the lower extremity. Clinically, it presents persistent pain, which is worse at night and improves with salicylates. It can be a self-limiting injury, with an average duration of three years, but because of pain intensity and intolerance to prolonged use of nonsteroidal anti-inflammatories, surgical treatment is an option. The diagnosis is suspected according to the history and radiographic findings, and the confirmation is made by histological analysis. The traditional surgical treatment is the complete excision of the nidus, but some disadvantages have been described, such as difficulties in localizing the lesion and risk of fracture during the procedure, hospital stay for pain control, and unfavorable esthetic outcome. The authors report a series of cases treated with thermal radiofrequency ablation guided by computed tomography in this service. It is a safe and an effective percutaneous method that aims to cure, minimizing the trauma and morbidity when compared with the conventional block-resection method.

RESUMO O osteoma osteoide é um tumor ósseo primário benigno que acomete mais o sexo masculino na segunda e terceira décadas da vida. Radiograficamente, caracteriza-se por um nicho radiolucente cercado por osso esclerótico reativo, principalmente em ossos longos da extremidade inferior. Clinicamente, apresenta uma dor persistente de longa duração, com pioria noturna e melhoria com salicilatos. Embora possa ser uma lesão autolimitada, com duração média de três anos, a ressecção da lesão é uma opção de tratamento devido à intensidade da dor e intolerância ao uso prolongado de anti-inflamatórios não hormonais. Sua suspeita diagnóstica baseia-se principalmente na história clínica e nos achados radiográficos, a confirmação é feita pelo estudo anatomopatológico. O tratamento cirúrgico clássico é a excisão cirúrgica completa do nicho, porém são descritas desvantagens como a dificuldade para a localização intraoperatória da lesão, risco de fratura durante o procedimento, tempo de internação hospitalar para controle álgico e resultado estético desfavorável. Relatamos uma série de casos tratados com termoablação por radiofrequência guiada por tomografia computadorizada em nosso serviço. Trata-se de um método percutâneo seguro e eficaz que tem como objetivo a cura, minimiza o trauma e a morbidade do procedimento, quando comparado com o método convencional de ressecção em bloco.

Biópsia percutânea de lesões ósseas guiada por tomografia computadorizada: taxas de definição diagnóstica e complicações / Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications

Objetivo: Determinar taxas de definição diagnóstica e complicações da biópsia percutânea guiada por tomografia computadorizada (TC) de lesões ósseas suspeitas de malignidade. Materiais e Métodos: Estudo retrospectivo que incluiu 186 casos de biópsia percutânea guiada por TC de lesões ósseas no período de janeiro de 2010 a dezembro de 2012. Todas as amostras foram obtidas usando agulhas de 8 a 10 gauge. Foram coletados dados demográficos, história de neoplasia maligna prévia, dados relacionados à lesão, ao procedimento e ao resultado histológico. Resultados: A maioria dos pacientes era do sexo feminino (57%) e a idade média foi 53,0 ± 16,4 anos. Em 139 casos (74,6%) a suspeita diagnóstica era metástase e os tumores primários mais comuns foram de mama (32,1%) e próstata (11,8%). Os ossos mais envolvidos foram coluna vertebral (36,0%), bacia (32,8%) e ossos longos (18,3%). Houve complicações em apenas três pacientes (1,6%), incluindo uma fratura, um caso de parestesia com comprometimento funcional e uma quebra da agulha necessitando remoção cirúrgica. Amostras de 183 lesões (98,4%) foram consideradas adequadas para diagnóstico. Resultados malignos foram mais frequentes nos pacientes com suspeita de lesão secundária e história de neoplasia maligna conhecida (p < 0,001) e nos procedimentos orientados pela PET/CT (p = 0,011). Conclusão: A biópsia percutânea guiada por TC é segura e eficaz no diagnóstico de lesões ósseas suspeitas. .

Objective: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. .

Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications.

OBJECTIVE: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. MATERIALS AND METHODS: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. RESULTS: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paresthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). CONCLUSION: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions.

OBJETIVO: Determinar taxas de definição diagnóstica e complicações da biópsia percutânea guiada por tomografia computadorizada (TC) de lesões ósseas suspeitas de malignidade. MATERIAIS E MÉTODOS: Estudo retrospectivo que incluiu 186 casos de biópsia percutânea guiada por TC de lesões ósseas no período de janeiro de 2010 a dezembro de 2012. Todas as amostras foram obtidas usando agulhas de 8 a 10 gauge. Foram coletados dados demográficos, história de neoplasia maligna prévia, dados relacionados à lesão, ao procedimento e ao resultado histológico. RESULTADOS: A maioria dos pacientes era do sexo feminino (57%) e a idade média foi 53,0 ± 16,4 anos. Em 139 casos (74,6%) a suspeita diagnóstica era metástase e os tumores primários mais comuns foram de mama (32,1%) e próstata (11,8%). Os ossos mais envolvidos foram coluna vertebral (36,0%), bacia (32,8%) e ossos longos (18,3%). Houve complicações em apenas três pacientes (1,6%), incluindo uma fratura, um caso de parestesia com comprometimento funcional e uma quebra da agulha necessitando remoção cirúrgica. Amostras de 183 lesões (98,4%) foram consideradas adequadas para diagnóstico. Resultados malignos foram mais frequentes nos pacientes com suspeita de lesão secundária e história de neoplasia maligna conhecida (p < 0,001) e nos procedimentos orientados pela PET/CT (p = 0,011). CONCLUSÃO: A biópsia percutânea guiada por TC é segura e eficaz no diagnóstico de lesões ósseas suspeitas.

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats.

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350 g (321.29 ± 11.3 1g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3 ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3 ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350g (321.29±11.31g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.(AU)

Influence of the peritoneal lavage with bupivacaine on the survival and resistance of colonic anastomoses performed under fecal peritonitis in rats

PURPOSE: To evaluate the effects of peritoneal lavage with bupivacaine on survival and initial resistance of anastomosis on distal colon, performed under peritonitis or not. METHODS: Forty rats, weighing from 300 to 350g (321.29±11.31g), were randomly divided in four groups and underwent laparotomy and anastomosis on the distal colon six hours after induction of peritonitis by intraperitoneal injection of autologous fecal material or not. Group 1: No peritonitis and lavage with 3ml NS; Group 2: No peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS; Group 3: Peritonitis and lavage with 3ml NS; Group 4: Peritonitis and lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS. Necropsies were performed on the animals that died and the time of death was recorded. Surviving animals were submitted to euthanasia on the fifth post-operative day and Total Energy of Rupture biomechanical test (TER) was applied. RESULTS: Group 4 showed survival increase compared to Group 3, without statistical significance. Group 3 presented the smallest average TER, with statistical significance. CONCLUSION: Peritonitis increased mortality and influenced negatively the resistance of colic anastomosis in rats. Peritoneal lavage with bupivacaine increased anastomotic resistance.