Primary intraosseous papillary intralymphatic angioendothelioma of the distal femoral epiphysis: a case report with literature review.

INTRODUCTION: Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal extremities in children. Only four intraosseous PILA cases have been reported until now in English language literature. CASE REPORT: We present a case of PILA arising in the distal femoral epiphysis of a 50-year-old female patient. It started as a relentless pain in her left knee. A plain radiography revealed a radiolucent area in the left internal femoral condyle. Computerized tomography revealed a 1-cm lytic lesion with a sclerotic rim. Magnetic resonance images showed a significant bone marrow edema signal focused on a 1-cm subchondral lesion suggestive of an intraarticular osteoid osteoma. Histologically, the tumor contained vascular channels covered by a single endothelial layer with intraluminal papillary endothelial structures lined with hobnail cells. Immunohistochemically, the cells were positive for ERG, CD31, and D2-40. The tumor underwent cryoablation and 6 months later, after local recurrence or tumor persistence, a wide tumor resection was referred. After 7 years of follow-up, the patient displayed neither local recurrence nor distant metastases. CONCLUSION: Primary intraosseous PILAs are exceedingly rare tumors that should be considered in the differential diagnosis of vascular bone tumors.

[Translated article] Oligometastases in oncological orthopaedic surgery. Our experience.

OBJECTIVE: To analyse the incidence and survival of patients with oligometastases (solitary and normal) when they are treated in centres that are experts in multidisciplinary approach to patients with sarcoma. MATERIAL AND METHOD: Retrospective analysis of 414 patients with bone metastases secondary to carcinomas at Hospital Universitario La Paz and Hospital MD Anderson Cancer Centre (Madrid) between May 2006 and May 2019. Metastases located in the pelvis and axial skeleton were excluded, analyzing a total of 28 patients who met the criterion for solitary metastases or oligometastases with normal criteria. The study survival estimate was carried out following the Kaplan-Meier statistical method. RESULTS: The survival of the patients following the oligometastases criteria (solitary and normal) was 53%. Breast cancer was the most prevalent and had a survival rate of more than 70%. The average age of the patients was 58 years old. DISCUSSION: Systemic treatments in cancer treatment have managed to improve disease-free survival curves and lead us to redirect on the paradigm for the treatment of oligometastases, stating that treatment should be carried out in the centres that are experts in the treatment of sarcomas. CONCLUSIONS: The choice of surgical treatment for patients with oligometastases in the strict sense (solitary) and normal should be evaluated by multidisciplinary teams according to the prognoses of the patient, anatomical location and histotype of the neoplasm.

Calidad de vida en pacientes con fémur corto congénito / Quality of life in patients with congenital short femur

Objetivo. Valorar la calidad de vida en personas con defecto congénito de fémur. Material y método. Se trata de un estudio transversal. La población está formada por 92 pacientes diagnosticados de fémur corto congénito desde 1969. Los criterios de inclusión fueron tener 15 años de edad o más y tener datos de domiciliación o de teléfono de contacto. La calidad de vida se midió con el cuestionario de salud SF-12 aplicado de mayo a octubre de 2003 telefónicamente, previa petición de consentimiento informado. Los resultados fueron comparados con una población de referencia. Resultados. Sólo 39 pacientes se incluyeron en el estudio. La media de edad fue de 26,2 años (hombres 24,8 años; mujeres 27,6 años). El 48,7% eran hombres y el 51,3% mujeres. No se detectaron diferencias en las medias de los componentes físico (PCS) y mental (MCS) entre hombres y mujeres, ni entre los distintos estratos de edad. El 100% obtuvo una puntuación MCS considerada como normal y el 20,5% obtuvo una puntuación PCS anormal. Conclusión. La calidad de vida de estos pacientes para el componente físico es anormal en los pacientes más jóvenes. Sorprende que el componente mental sea normal en todos. Podría deberse al hecho de ser un trastorno que se padece desde el mismo momento del nacimiento, y no tener un impacto psicosocial tan fuerte como con otro tipo de problemas

Materials and methods. This was a cross-sectional study. The study population was 92 patients diagnosed since 1969 with congenital short femur. Inclusion criteria were: patients should be over 15 years of age and possess a known address or telephone number. Quality of life was determined from May to October 2003 by means of telephone interviews, carried out after obtaining informed consent, using Health Questionnaire SF-12. The results were compared to those obtained in a reference population. Results. Only 39 patients participated in the study, of whom 48.7% were male and 51.3% were female. Mean age: 26.2 years (men: 24.8 years; women: 27.6 years). No differences were detected between men and women, nor across different age groups, with reference to the mean physical (PCS) and mental (MCS) variables. One hundred percent of the population had a normal MCS and 20.5% had an abnormal PCS. Conclusion. Quality of life based on PCS is abnormal in younger patients. It is surprising that MCS should be normal in all patients. This could be due to the fact that this condition is present from birth and therefore does not have such a strong psychosocial impact as other conditions

Resultados del tratamiento conservador de las fracturas de cotilo / Results of the conservative treatment of acetabular fractures

Objetivos. Estudiar la evolución de pacientes con fracturas de cotilo tratadas de forma conservadora. Material y método. Se recogieron de forma consecutiva 37 casos de fracturas de cotilo, tratados de forma conservadora con un seguimiento mínimo de 5 años. Las fracturas se trataron con reposo en cama y tracción seguido de un período de descarga y otro de carga parcial. Los pacientes se valoraron clínica y radiográficamente. El tipo de tratamiento fue evaluado según la tracción empleada, el tiempo de descarga y de carga parcial. Se evaluó el grado de desplazamiento y su relación con la evolución posterior. Resultados. Veinte fracturas no presentaron desplazamiento, 8 un desplazamiento entre 2-5 mm y en 9 casos fue superior a 5 mm. Al final del seguimiento 8 pacientes presentaron dolor, 15 movilidad limitada y 8 signos radiográficos de artrosis. El grado de desplazamiento se correlacionó con el resultado final. Conclusiones. El tratamiento conservador puede ser una indicación en las fracturas de cotilo cuando el estado del paciente, el tipo de fractura o la calidad de hueso no permitan una osteosíntesis (AU)

Purpose. To study the evolution of patients with acetabular fractures treated conservatively Material and methods. A series of 37 consecutive cases treated conservatively was analyzed. The minimum follow-up was 5 years. Fractures were treated with bed rest and traction, which were followed by a non weight-bearing period and a partial weight period. Patients were clinically and radiographically assessed. The different kinds of treatment were evaluated on the basis of the type of traction used, the length of the non weight-bearing period and the duration of the partial weight bearing one. The degree of displacement was also considered, in particular as it related with the patients’ subsequent evolution. Results. Twenty fractures did not undergo any sort of displacement, 8 had a displacement of 2-5 mm, with 9 cases having a displacement higher than a 5 mm. At the end of follow-up, 8 patients experienced pain, 15 limited mobility and 8 had radiographic signs of osteoarthritis. The degree of displacement was correlated with the final result obtained. Conclusions. Conservative treatment can be an appropriate indication for acetabular fractures when the patient’s condition, the type of fracture or bone quality advise against performing an osteosynthetic procedure (AU)