Metastasectomy for oligometastatic bone disease of the appendicular skeleton: A concise review.

As the life expectancy of patients with carcinomas improves, there is an associated increase in the risk of development of metastatic bone disease. Patients with solitary or oligometastatic bone disease of the appendicular skeleton may benefit from metastasectomy and reconstruction to improve overall survival. Specifically, patients with renal cell carcinoma and a solitary metastatic bone lesion will have long-term survival benefit from metastasectomy and reconstruction. There remains controversy in the literature about metastasectomy for solitary metastatic bone disease in other common carcinomas, such as breast and thyroid.

Conventional Cartilaginous Tumors: Evaluation and Treatment.

¼: Enchondromas are benign cartilaginous lesions that rarely require surgical intervention. ¼: Atypical cartilaginous tumors (ACTs), also referred to as grade-1 chondrosarcomas, may be managed without any intervention or with extended intralesional curettage and bone-void filling. ¼: High-grade chondrosarcomas, or grade-2 and 3 chondrosarcomas, should be managed aggressively with wide resection. ¼: Chemotherapy and radiation do not currently play a role in the treatment of chondrosarcomas. ¼: Differentiating an enchondroma from an ACT and an ACT from a high-grade chondrosarcoma can be difficult and requires clinical experience, radiographic and advanced imaging, and possibly a biopsy. Ultimately, a multidisciplinary team that includes a musculoskeletal oncologist, a radiologist, and a pathologist is needed to make the most appropriate diagnosis and treatment plan for each patient.

The Educational Impact of a Fellowship-trained Orthopaedic Oncologist.

INTRODUCTION: Musculoskeletal oncology is a subspecialty of orthopaedics with few fellowship-training locations. Although orthopaedic oncologists comprise a minority within the field of orthopaedic surgery, most work at academic centers and serve in leadership roles with notable impact on patients and the training of residents. This article investigates the objective impact orthopaedic oncologists have regarding resident operative case volume and performance on in-training examinations. METHODS: The William Beaumont Army Medical Center and Texas Tech University Health Sciences Center of El Paso combined orthopaedic residency program's case logs and Orthopaedic In-Training Examination (OITE) scores between 2013 and 2018 were reviewed. This provided 3 academic years of data before and after an orthopaedic oncology faculty member arrived in 2016. The case volume and OITE examination performance before and after the addition of the orthopaedic oncology faculty member were compared. RESULTS: After the addition of an orthopaedic oncology faculty member, a significant increase was observed in the program's OITE overall correctly answered questions (171.30 versus 181.03, P = 0.004) and oncology subsection percentile (56th to the 66th percentile, P = 0.038). An increase was also observed in resident oncology case volume from 29 oncology cases per year to 138 cases on average (P = 0.022). DISCUSSION: The addition of a fellowship-trained orthopaedic oncologist results in increased exposure to orthopaedic oncology cases and improved resident performance on the OITE. This may correlate to improved American Board of Orthopaedic Surgeons Part I pass rates and improved overall resident satisfaction.

Pilomatrix Carcinoma of the Antecubitum.

We present the case of a 46-year-old male with atypically large left elbow pilomatrix carcinoma present for 10 years with emergent excision after developing life-threatening hemorrhage. Pilomatrix carcinoma is a dermal-based malignant tumor typically of the head and neck region. Histopathology shows islands of basaloid cells, shadow cells, and fibromyxoid fibroma. Reoccurrence is seen in 23% of cases on an average of six months after primary excision. The current standard of care is wide excision with close follow-up.

Modeling synovial sarcoma metastasis in the mouse: PI3'-lipid signaling and inflammation.

Solid tumor metastasis is a complex biology, impinged upon by a variety of dysregulated signaling pathways. PI3'-lipid signaling has been associated with metastasis and inflammation in many cancers, but the relationship between tumor cell-intrinsic PI3'-lipid signaling and inflammatory cell recruitment has remained enigmatic. Elevated PI3'-lipid signaling associates with progression of synovial sarcoma, a deadly soft tissue malignancy initiated by a t(X;18) chromosomal translocation that generates an SS18-SSX fusion oncoprotein. Here, we show in genetically engineered mouse models of locally induced expression of SS18-SSX1 or SS18-SSX2 that Pten silencing dramatically accelerated and enhanced sarcomagenesis without compromising synovial sarcoma characteristics. PTEN deficiency increased tumor angiogenesis, promoted inflammatory gene expression, and enabled highly penetrant spontaneous pulmonary metastasis. PTEN-deficient sarcomas revealed infiltrating myeloid-derived hematopoietic cells, particularly macrophages and neutrophils, recruited via PI3'-lipid-induced CSF1 expression in tumor cells. Moreover, in a large panel of human synovial sarcomas, enhanced PI3'-lipid signaling also correlated with increased inflammatory cell recruitment and CSF1R signal transduction in both macrophages and endothelial cells. Thus, both in the mouse model and in human synovial sarcomas, PI3'-lipid signaling drives CSF1 expression and associates with increased infiltration of the monocyte/macrophage lineage as well as neutrophils.

MicroRNAs in osteosarcomagenesis.

The etiology of osteosarcoma (OS) remains enigmatic. Particular clinical and molecular patterns, observed with high frequency in OS, suggest that it results from some yet-to-be-discovered central driver. How else can biology generate such an aggressive, metastatic, genetically and chromosomally unstable malignancy with virtually no apparent precursor neoplasms that are partway along a disease path toward OS? With this conundrum as a backdrop, the discovery of every new native molecule with power to impact a cell's biology is usually quickly followed by a search to see if this type of molecule contains the key to unlock OS biology.