Infantile Fibrosarcoma in Older Child at Right Lower Leg: A Case Report.

BACKGROUND Infantile fibrosarcoma (IFS) is a rare tumor. The highest prevalence is in the first 2 years of life. Cases typically manifest in the extremities, with rapid initial growth, are non-tender, and are a poorly delimited masses that vary in size or consistency and lack sensitivity. The treatment for IFS is a multimodal approach, and surgical excision has become the main treatment. This report aims to present the results of our work on IFS cases. CASE REPORT A 4-year-old girl was admitted to our hospital with a chief concern of a mass in the right lower leg that first appeared 3 years ago. Physical examination showed a single mass with dense-rubbery consistency, tenderness, and limited range of motion. Plain radiography was performed, and a soft-tissue mass was seen on the anterior 1/3 distal cruris of the right side. CT angiography showed a bulging soft-tissue mass, solid (38 HU), with size ±2.8×3.1×4.7 cm. MRI examination revealed an aggressive superficial soft-tissue mass in the cutaneous-subcutaneous compartment. Biopsy and immunohistochemistry were performed, and the results were consistent with IFS. A local excision was made to assess for pathological anatomy. CONCLUSIONS Infantile fibrosarcoma (IFS) is an uncommon tumor in early childhood. It tends to mimic other tumors, which may interfere with the correct diagnosis, which may contribute to its rarity. Local excision is the first treatment choice, with a good prognosis for IFS.

Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia.

Background: Osteoporosis is characterized by a low bone mass of bone tissue. If osteoporosis is not treated properly, it will increase the high risk of fracture. The common causes of fracture on osteoporosis condition due to falls. This study aims to find the correlation between the risk of osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk (FRAX). Methods: This study is an analytic study with a cross-sectional method. We collected the sample using random cluster sampling in the six primary health care in Malang on different times service since August-September 2021. Total patient 139, however only 132 patients were included in this study. After collecting data is complete, we analyze using Chi-square tests. Results: The mean age of participants was 63.9 ± 7.14. with the age group was dominated by the range of 60-64. It was found that the result of the FRAX SCORE had a low-risk category for major fracture osteoporosis and risk hip fracture. In contrast, from the OSTA score in this study, more than 68 participants (50.8%) were found medium and high-risk scores. Then, in ONTARIO score of the risk fall assessment, and high score in 57 participants (43.2%). If compared between OSTA and ONTARIO, there was a significant relationship between OSTA score and ONTARIO score (p < 0.000) with high-risk OSTA have a significant relationship with a high risk of falling and vice versa. Conclusion: In this study, there was a relationship between the risk of high osteoporosis and the risk of falling.

Emergency Surgery in High Volume Osteosarcoma of Left Proximal Humerus Due to Vascular Compromise: A Case Report.

BACKGROUND Osteosarcoma is the most common type of malignant bone tumor arising from mesenchymal stem cell. When occurring on the proximal humerus, it is associated with poor outcomes; there are numerous neurovascular structures around proximal humerus. Unfortunately, the degree of vascular involvement in osteosarcoma is rarely evaluated and reported. Thus, we would like to highlight our case. CASE REPORT We reported a case of left proximal humerus osteosarcoma causing dead limb in a 14-year-old boy. The dead limb progressed in the span of 3 weeks. An emergency forequarter amputation (FQA) was conducted to prevent further complications such as septicemia and mortality. Two months after the surgery, the patient had improved quality of life. One year after, the patient had no local recurrence. However, there was a lung metastasis detected 9 months after the surgery. The patient died 13 months after the surgery. CONCLUSIONS Osteosarcoma of the proximal humerus can potentially compromise vascular structures. Early diagnosis and treatment are mandatory to prevent such complications.

Free non-vascularized fibular graft reconstruction after resection of metacarpal unicameral bone cyst: A case report.

Unicameral bone cyst (UBC) or simple bone cyst (SBC) is a benign cystic lesion commonly found in the humerus and femur that is mainly encountered during childhood. The currently available treatments for UBC of the hand commonly involve curettage, bone grafting, partial resection with or without grafting, multiple drilling, fracture immobilization and observation alone, and steroid injection. We herein report a case treated with total resection of the cyst and non-vascularized fibular graft in a 9-year-old right-handed female patient. The patient presented with a chief complaint of a large, fast growing lump over the first metacarpal of the left hand. Flexion of the first metacarpophalangeal joint was limited. After the diagnosis was established with plain radiographs followed by biopsy, the cyst was completely removed by resecting the shaft of the metacarpal bone with preservation of the epiphyseal plate. A bone graft was obtained from the fibula and inserted in the gap, distally attached to the epiphyseal plate of the metacarpal and fixed with a Kirshner wire proximally. Radiographs revealed solid union of the bone graft to the epiphyseal plate at the head after 7 weeks, with improving function of the thumb. SBC or UBC of the metacarpal bone is very rare. A more aggressive method, such as in the case presented herein, may be necessary to treat this condition.

Imatinib mesylate inhibits tumorigenicity of malignant fibrous histiocytoma cells in vivo.

BACKGROUND: Malignant fibrous histiocytoma (MFH) is one of the most diffuse and aggressive tumors among soft tissue sarcomas in adults, but still poorly characterized from the molecular viewpoint. MFH cell proliferation is inhibited selectively by imatinib mesylate, a tyrosine kinase inhibitor. The expressions of platelet-derived growth factor receptors (PDGFRs) and c-Kit have been previously examined in MFH cell lines and the inhibitory effect of imatinib mesylate on the MFH cell proliferation was tested. MFH cell lines showed various patterns of PDGFRs and c-Kit expression. Imatinib mesylate inhibited the proliferation of MFH cells that expressed PDGFRs and/or c-Kit. MATERIALS AND METHODS: Four MFH cell lines were used (Nara H, Nara F, GBS-1 and TNMY1). The mRNA expression of PDGFRs and c-Kit was analyzed using RT-PCR; cell proliferation was analyzed using the MTS assay. Immunohistochemistry was used to analyze the inhibitory effect of imatinib mesylate on phosphorylation of PDGFRs and c-Kit in vivo. The Nara H and TNMY1 cell lines were implanted into nude mice and tumor growth was evaluated daily by measuring the two-dimensional diameters of the tumor nodule. RESULTS: PDGFRs and c-Kit were expressed in Nara F, GBS-1 and TNMY1, but not in Nara H cells. Imatinib mesylate inhibited PDGFRs and c-Kit phosphorylation in TNMY1 cells affecting the tumorigenicity, in the control group (139 mm3 SD +/- 1.03) and treatment group (126.2 mm3 SD +/- 1.63) but did not affect the tumorigenicity of Nara H cells. CONCLUSION: Imatinib mesylate reduced in vivo tumor growth of MFH that express PDGFRs and c-Kit associated with phosphorylation suppression.