What Is New in Orthopaedic Tumor Surgery?
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Bone and Soft Tissue Tumors Have Been Treated Separately
EPIDEMIOLOGY z Sarcomas are rare tumors compared to other BONE AND SOFT malignancies: 8,700 new sarcomas in 2001, with TISSUE TUMORS 4,400 deaths. z The incidence of sarcomas is around 3-4/100,000. z Slight male predominance (with some subtypes more common in women). z Majority of soft tissue tumors affect older adults, but important sub-groups occur predominantly or exclusively in children. z Incidence of benign soft tissue tumors not known, but Fabrizio Remotti MD probably outnumber malignant tumors 100:1. BONE AND SOFT TISSUE SOFT TISSUE TUMORS TUMORS z Traditionally bone and soft tissue tumors have been treated separately. z This separation will be maintained in the following presentation. z Soft tissue sarcomas will be treated first and the sarcomas of bone will follow. Nowhere in the picture….. DEFINITION Histological z Soft tissue pathology deals with tumors of the classification connective tissues. of soft tissue z The concept of soft tissue is understood broadly to tumors include non-osseous tumors of extremities, trunk wall, retroperitoneum and mediastinum, and head & neck. z Excluded (with a few exceptions) are organ specific tumors. 1 Histological ETIOLOGY classification of soft tissue tumors tumors z Oncogenic viruses introduce new genomic material in the cell, which encode for oncogenic proteins that disrupt the regulation of cellular proliferation. z Two DNA viruses have been linked to soft tissue sarcomas: – Human herpes virus 8 (HHV8) linked to Kaposi’s sarcoma – Epstein-Barr virus (EBV) linked to subtypes of leiomyosarcoma z In both instances the connection between viral infection and sarcoma is more common in immunosuppressed hosts. -
Chondromyxoid Fibroma-Like Osteosarcoma
Zhong et al. BMC Musculoskeletal Disorders (2020) 21:53 https://doi.org/10.1186/s12891-020-3063-5 CASE REPORT Open Access Chondromyxoid fibroma-like osteosarcoma: a case series and literature review Jingyu Zhong1, Liping Si1, Jia Geng2, Yue Xing2, Yangfan Hu2, Qiong Jiao3, Huizhen Zhang3 and Weiwu Yao1* Abstract Background: Chondromyxoid fibroma-like osteosarcoma (CMF-OS) is an exceedingly rare subtype of low-grade central osteosarcoma (LGCO), accounting for up to 10% of cases and making it difficult to diagnose. CMF-OS is frequently misdiagnosed on a radiological examination and biopsy, even after the initial operation. Its treatment is a controversial issue due to its low-grade classification and actual high-grade behavior. Case presentation: We retrospectively reviewed the medical charts of more than 2000 osteosarcoma patients between 2008 and 2019; 11 patients with CMF-OS were identified, of which six patients were treated by our institution with complete clinical characteristics, including treatment and prognosis, radiological and pathological features were reviewed. Three males and three females with a median age of 46 (range 22–56) years were pathologically proven to have CMF-OS. The radiological presentation of CMF-OS is variable, thus radiological misdiagnoses are common. However, one must not ignore a malignant radiologic appearance. The most distinctive pathological feature conferring the diagnosis of CMF-OS is the presence of osteoid production directly by the tumor cells under a chondromyxoid fibroma (CMF)-like background. Differential diagnoses based on comprehensive data from CMF, LGCO, chondrosarcoma (CHS), conventional osteosarcoma (COS), etc., are needed. All patients were treated with an operation and chemotherapy, and one patient received additional radiotherapy. -
Osteoid Osteoma: Contemporary Management
eCommons@AKU Section of Orthopaedic Surgery Department of Surgery 2018 Osteoid osteoma: Contemporary management Shahryar Noordin Aga Khan University, [email protected] Salim Allana Emory University Kiran Hilal Aga Khan University, [email protected] Riaz Hussain Lukhadwala Aga Khan University, [email protected] Anum Sadruddin Pidani Aga Khan University, [email protected] See next page for additional authors Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_orthop Part of the Orthopedics Commons, Radiology Commons, and the Surgery Commons Recommended Citation Noordin, S., Allana, S., Hilal, K., Lukhadwala, R. H., Pidani, A. S., Ud Din, N. (2018). Osteoid osteoma: Contemporary management. Orthopedic Reviews, 10(3), 108-119. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_orthop/92 Authors Shahryar Noordin, Salim Allana, Kiran Hilal, Riaz Hussain Lukhadwala, Anum Sadruddin Pidani, and Nasir Ud Din This article is available at eCommons@AKU: https://ecommons.aku.edu/pakistan_fhs_mc_surg_orthop/92 Orthopedic Reviews 2018; volume 10:7496 Osteoid osteoma: Contemporary management Epidemiology Correspondence: Shahryar Noordin, Orthopaedic Surgery, Aga Khan University, Osteoid osteoma accounts for around Karachi, Pakistan. Shahryar Noordin,1 Salim Allana,2 5% of all bone tumors and 11% of benign Tel.: 021.3486.4384. 4 Kiran Hilal,3 Naila Nadeem,3 bone tumors. Osteoid osteoma is the third E-mail: [email protected] Riaz Lakdawala,1 Anum Sadruddin,4 most common biopsy analyzed benign bone 5 tumor after osteochondroma and nonossify- Key words: Osteoid osteoma; tumor; benign; Nasir Uddin imaging; pathogenesis; management. 1 ing fibroma. Two to 3% of excised primary Orthopaedic Surgery, Aga Khan bone tumors are osteoid osteomas.5 Males University, Karachi, Pakistan; Contributions: SN, SA, study design, data col- are more commonly affected with an lection, manuscript writing; KH, NU, data col- 2 5 Department of Epidemiology, Rollins approximate male/female ratio of 2 to 1. -
Chondromyxoid Fibroma of the Skull Base and Calvarium: Surgical Management and Literature Review
THIEME Case Report e23 Chondromyxoid Fibroma of the Skull Base and Calvarium: Surgical Management and Literature Review Nasser Khaled Yaghi1 Franco DeMonte1 1 Department of Neurosurgery, The University of Texas M.D. Anderson Address for correspondence Franco DeMonte, MD, Department of Cancer Center, Houston, Texas, United States Neurosurgery-Unit 442, M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States J Neurol Surg Rep 2016;77:e23–e34. (e-mail: [email protected]). Abstract Chondromyxoid fibroma (CMF) is an exceedingly rare tumor that represents less than 1% of all primary bone neoplasms. Occurrence in the facial and cranial bones is extremely rare and frequently misdiagnosed. Case Reports We report two cases of CMF, one in the sphenoclival skull base and the other involving the parietal bone in two young female patients. Excision was performed in both cases. Presenting symptoms, treatment, and follow-up are reported. Methods A retrospective review of the literature on cranial CMF was performed. The location, demographics, presenting symptoms, and treatment of all calvarial and skull base CMF cases published since 1990 are summarized. Discussion In our literature review, we found 67 published cases of cranial CMF. Mean age of all calvarial and skull base CMFs at diagnosis was 38.2 years old. Of the cases Keywords affecting the cranium, the sinonasal structures were most commonly involved. To our ► benign knowledge we report only the second case of CMF involving the parietal bone published ► bone neoplasms in an English-language journal. Total resection is the best treatment, and should be the ► cartilage goal of surgical intervention. -
View Presentation Notes
When is a musculoskeletal condition a tumor? Recognizing common bone and soft tissue tumors Christian M. Ogilvie, MD Assistant Professor of Orthopaedic Surgery University of Pennsylvania University of Pennsylvania Department of Orthopaedic Surgery Purpose • Recognize that tumors can present in the extremities of patients treated by athletic trainers • Know that tumors may present as a lump, pain or both • Become familiar with some bone and soft tissue tumors University of Pennsylvania Department of Orthopaedic Surgery Summary • Introduction – Pain – Lump • Bone tumors – Malignant – Benign • Soft tissue tumors – Malignant – Benign University of Pennsylvania Department of Orthopaedic Surgery Summary • Presentation • Imaging • History • Similar conditions –Injury University of Pennsylvania Department of Orthopaedic Surgery Introduction •Connective tissue tumors -Bone -Cartilage -Muscle -Fat -Synovium (lining of joints, tendons & bursae) -Nerve -Vessels •Malignant (cancerous): sarcoma •Benign University of Pennsylvania Department of Orthopaedic Surgery Introduction: Pain • Malignant bone tumors: usually • Benign bone tumors: some types • Malignant soft tissue tumors: not until large • Benign soft tissue tumors: some types University of Pennsylvania Department of Orthopaedic Surgery Introduction: Pain • Bone tumors – Not necessarily activity related – May be worse at night – Absence of trauma, mild trauma or remote trauma • Watch for referred patterns – Knee pain for hip problem – Arm and leg pains in spine lesions University of Pennsylvania -
Chondromyxoid Fibroma of Bone
Arch Orthop Trauma Surg (2000) 120:42–47 © Springer-Verlag 2000 ORIGINAL ARTICLE H. R. Dürr · A. Lienemann · A. Nerlich · B. Stumpenhausen · H. J. Refior Chondromyxoid fibroma of bone Received: 18 January 1999 Abstract Chondromyxoid fibroma is a benign, although [15], approximately 500 cases have been reported. It usu- potentially aggressive tumor, with a cartilage-like matrix, ally affects the metaphyseal region of the long bones in accounting for approximately 1% of all bone tumors. It children and young adults, particularly near the growth usually affects the metaphyseal region of long bones of plate of the proximal tibia [31]. Although it is a benign tu- patients in their first or second decade of life. An addi- mor, recurrence after intralesional treatment may range tional peak of incidence has been observed between 50 from 10% to 80% [10, 11, 27, 28, 32]. We present three and 70 years of age. Three cases are presented here: 10-, cases of chondromyxoid fibroma involving the proximal 13-, and 52-year-old patients, with lesions in the proximal humerus, femur, and tibia observed in our clinic between tibia, the proximal humerus, and the proximal femur, re- 1980 and 1996. spectively. The literature is reviewed in terms of clinical behavior, diagnostic procedures, prognostic factors, treat- ment, and outcome. Preferred treatment is complete local Case reports excision with tumor-free margins. Intralesional curettage with or without local adjuvants shows a local recurrence Case 1 rate of approximately 25%. Radiation therapy may be A 13-year-old girl was admitted to our hospital with a 2-month his- useful in nonresectable cases but bears the well docu- tory of a progressive and slightly painful swelling of the left proxi- mented risk of radiation-induced malignancies. -
A Rare Case of Chondromyxoid Fibroma of the Scapula Jay B
A Case Report & Literature Review A Rare Case of Chondromyxoid Fibroma of the Scapula Jay B. Jani, MD, Kathleen S. Beebe, MD, Meera Hameed, MD, and Joseph Benevenia, MD hondromyxoid fibroma (CMF) is a rare benign Plain radiography (Figures 1A, 1B) and computed tumor, apparently derived from cartilage-forming tomography (CT) scan (Figure 2) revealed an expansile connective tissue. The name is highly descriptive lesion of the right scapula with central calcification sug- of this distinctive tumor and has gained accep- gesting chondroid-type matrix. There was some thinning Ctance.1 The entity was first described in 1948 by Jaffe and of the cortex but no obvious cortical breach or associated Lichtenstein,2 who presented 8 cases and emphasized the soft-tissue mass. MRI (Figure 3) revealed a 5×3×2.5- danger of mistaking this benign neoplasm for a malignant cm expansile lesion involving the inferior border of the lesion, chondrosarcoma in particular. Approximately two scapula. T2-weighted images showed a heterogeneous thirds of the recorded cases of this tumor have been in the mass with bright signal intensity. There was considerable long tubular bones and one third in the proximal tibia.1,3,4 A edema in the teres minor and subscapularis muscle bel- scapular origin of this tumor is exceedingly rare.1,5-10 lies. No fluid–fluid levels were seen. Additional workup We report the case of a 13-year-old girl with chondro- included a chest CT scan and a whole-body bone scan. myxoid fibroma of the scapula. This case is of interest The bone scan revealed increased focal uptake to the right because of the rarity and unusual location of the tumor. -
Chondroblastoma and Chondromyxoid Fibroma
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/236096923 Chondroblastoma and Chondromyxoid Fibroma Article in The Journal of the American Academy of Orthopaedic Surgeons · April 2013 DOI: 10.5435/JAAOS-21-04-225 · Source: PubMed CITATIONS READS 8 90 4 authors, including: Camila Bedeschi Rego De Mattos Chanika Angsanuntsukh Hospital Estadual da Criança Ramathibodi Hospital 5 PUBLICATIONS 23 CITATIONS 8 PUBLICATIONS 58 CITATIONS SEE PROFILE SEE PROFILE Alexandre Arkader Children's Hospital Los Angeles 57 PUBLICATIONS 474 CITATIONS SEE PROFILE All content following this page was uploaded by Camila Bedeschi Rego De Mattos on 10 July 2015. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately. Review Article Chondroblastoma and Chondromyxoid Fibroma Abstract Camila B. R. De Mattos, MD Chondroblastoma and chondromyxoid fibroma are benign but Chanika Angsanuntsukh, MD locally aggressive bone tumors. Chondroblastoma, a destructive lesion with a thin radiodense border, is usually seen in the Alexandre Arkader, MD epiphysis of long bones. Chondromyxoid fibroma presents as a John P. Dormans, MD bigger, lucent, loculated lesion with a sharp sclerotic margin in the metaphysis of long bones. Although uncommon, these tumors can be challenging to manage. They share similarities in pathology that could be related to their histogenic similarity. Very rarely, From the Department of chondroblastoma may lead to lung metastases; however, the Orthopaedic Surgery, The Children’s Hospital of Philadelphia, mechanism is not well understood. -
Osteoid Osteoma and Your Everyday Practice
n Review Article Instructions 1. Review the stated learning objectives at the beginning cme ARTICLE of the CME article and determine if these objectives match your individual learning needs. 2. Read the article carefully. Do not neglect the tables and other illustrative materials, as they have been selected to enhance your knowledge and understanding. 3. The following quiz questions have been designed to provide a useful link between the CME article in the issue Osteoid Osteoma and your everyday practice. Read each question, choose the correct answer, and record your answer on the CME Registration Form at the end of the quiz. Petros J. Boscainos, MD, FRCSEd; Gerard R. Cousins, MBChB, BSc(MedSci), MRCS; 4. Type or print your full name and address and your date of birth in the space provided on the CME Registration Form. Rajiv Kulshreshtha, MBBS, MRCS; T. Barry Oliver, MBChB, MRCP, FRCR; 5. Indicate the total time spent on the activity (reading article and completing quiz). Forms and quizzes cannot be Panayiotis J. Papagelopoulos, MD, DSc processed if this section is incomplete. All participants are required by the accreditation agency to attest to the time spent completing the activity. educational objectives 6. Complete the Evaluation portion of the CME Regi stration Form. Forms and quizzes cannot be processed if the Evaluation As a result of reading this article, physicians should be able to: portion is incomplete. The Evaluation portion of the CME Registration Form will be separated from the quiz upon receipt at ORTHOPEDICS. Your evaluation of this activity will in no way affect educational1. -
Craniofacial Chondrosarcomas: Imaging Findings in 15 Untreated Cases
165 Craniofacial Chondrosarcomas: Imaging Findings in 15 Untreated Cases Ya-Yen Lee1 Radiographic findings of 15 untreated chondrosarcomas of the cranial and facial Pamela Van Tassel bones were reviewed. These tumors have a propensity to occur in the wall of a maxillary sinus, at the junction of sphenoid and ethmoid sinuses and vomer, and at the undersur face of the sphenoid bone. Because of its slow-growing nature, chondrosarcomas tend to be large, multi lobulated, and sharply demarcated when detected. Frequent bone changes are a combination of erosion and destruction, with sharp transitional zones and absent periosteal reaction. Tumor matrix calcifications, not necessarily chondroid, are almost always present. Both CT and MR may be necessary for thorough evaluation of tumor extent. Chondrosarcoma, a malignant but usually slow-growing cartilaginous tumor, constitutes approximately 11 % of malignant bone tumors [1] but rarely occurs in the craniofacial region . Because of its propensity to occur in the deep facial structures or base of the skull, the true extent and origin of the tumor may be overlooked if not properly evaluated radiographically. We review a relatively large series of craniofacial chondrosarcomas and discuss the differential diagnosis and choice of imaging technique. Materials and Methods This retrospective radiologic review was based on the pretreatment radiographic studies of 15 patients with craniofacial chondrosarcomas seen at our institution over a period of 40 years , excluding three intracranial dural chondrosarcomas, which are to be reported sepa rately. An attempt was also made to correlate the radiographic findings with the hi stologic grades of the tumors. The ages of the patients ranged from 10 to 73 years , with a mean of 40 years. -
Bone and Soft Tissue Sarcomas
Bone and Soft Tissue Sarcomas Changes to Pathology Codes in the 4th Edition of the World Health Organisation Classification of Bone and Soft Tissue Sarcomas September 2013 Page 1 of 17 Authors Mr Matthew Francis Cancer Analysis Development Manager, Public Health England Knowledge & Intelligence Team (West Midlands) Dr Nicola Dennis Sarcoma Analyst, Public Health England Knowledge & Intelligence Team (West Midlands) Ms Jackie Charman Cancer Data Development Analyst Public Health England Knowledge & Intelligence Team (West Midlands) Dr Gill Lawrence Breast and Sarcoma Cancer Analysis Specialist, Public Health England Knowledge & Intelligence Team (West Midlands) Professor Rob Grimer Consultant Orthopaedic Oncologist The Royal Orthopaedic Hospital NHS Foundation Trust For any enquiries regarding the information in this report please contact: Mr Matthew Francis Public Health England Knowledge & Intelligence Team (West Midlands) Public Health Building The University of Birmingham Birmingham B15 2TT Tel: 0121 414 7717 Fax: 0121 414 7712 E-mail: [email protected] Acknowledgements The Public Health England Knowledge & Intelligence Team (West Midlands) would like to thank the following people for their valuable contributions to this report: Dr Chas Mangham Consultant Orthopaedic Pathologist, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust Professor Nick Athanasou Professor of Musculoskeletal Pathology, University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences Copyright @ PHE Knowledge & Intelligence Team (West Midlands) 2013 1.0 EXECUTIVE SUMMARY Page 2 of 17 The 4th edition of the World Health Organisation (WHO) Classification of Tumours of Soft Tissue and Bone which was published in 2012 contains notable changes from the 2002 3rd edition. The key differences between the 3rd and 4th editions can be seen in Table 1. -
Primary Tumors of the Spine
280 Primary Tumors of the Spine Sebnem Orguc, MD1 Remide Arkun, MD1 1 Department of Radiology, Celal Bayar University, Manisa, Türkiye Address for correspondence Sebnem Orguc, MD, Department of 2 Department of Radiology, Ege University, İzmir, Türkiye Radiology, Celal Bayar University, Manisa, Türkiye (e-mail: [email protected]; [email protected]). Semin Musculoskelet Radiol 2014;18:280–299. Abstract Spinal tumors consist of a large spectrum of various histologic entities. Multiple spinal lesions frequently represent known metastatic disease or lymphoproliferative disease. In solitary lesions primary neoplasms of the spine should be considered. Primary spinal tumors may arise from the spinal cord, the surrounding leptomeninges, or the extradural soft tissues and bony structures. A wide variety of benign neoplasms can involve the spine including enostosis, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, giant cell tumor, and osteochondroma. Common malignant primary neo- plasms are chordoma, chondrosarcoma, Ewing sarcoma or primitive neuroectodermal Keywords tumor, and osteosarcoma. Although plain radiographs may be useful to characterize ► spinal tumor some spinal lesions, magnetic resonance imaging is indispensable to determine the ► extradural tumor extension and the relationship with the spinal canal and nerve roots, and thus determine ► magnetic resonance the plan of management. In this article we review the characteristic imaging features of imaging extradural spinal lesions. Spinal tumors consist of a large spectrum of various histo- Benign Tumors of the Osseous Spine logic entities. Primary spinal tumors may arise from the spinal cord (intraaxial or intramedullary space), the sur- Enostosis rounding leptomeninges (intradural extramedullary space), Enostosis, also called a bone island, is a frequent benign or the extradural soft tissues and bony structures (extra- hamartomatous osseous spinal lesion with a developmental dural space).