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Background: Breast cancer is the most common cancer and second cause of death in women worldwide. Patients with breast cancer are classified into subgroups based on the presence or absence of hormone receptors and the human epidermal growth factor 2-neu (HER-2) marker, the different molecular profiles come with an associated prognosis and variety of possible treatment options. Patients with triple negative cancer have a worse prognosis, a more aggressive behavior, higher likelihood of spreading, a higher risk of recurrence and a poorer outcome overall. Intramedullary rod fixation has proven to provide a good outcome and function in patients with metastatic breast cancer, but no study has addressed the receptor-status potential outcome differences that may affect disease progression at an orthopaedic surgery site., Questions/purposes: (1) Do patients with triple negative breast cancer have a higher revision rate of intramedullary rod fixation of bone metastases? (2) Do patients with metastatic triple negative breast cancer have a higher revision rate of intramedullary rod fixation due to local disease progression?, Methods: This was a single-center, observational, retrospective cohort study. Fifty-seven patients with a diagnosis of breast cancer metastatic to long bones who underwent surgical fixation with an intramedullary rod for a pathological fracture or an impending fracture due to a bone metastasis with a Mirels' score equal or above 8 between January 2004 and December 2016 at our institution were included. All implants used were from the same manufacturer (Stryker Corp., Mahwah, NJ, USA). Patients were divided into two groups based on the receptor status of the tumor and were classified either as triple negative, when the tumor lacked progesterone, estrogen and HER-2 receptors, or as receptor-positive when the presence of one or a combination of either three was proven. In the triple-negative tumor group the mean follow up time was 26 months (SD 29) and median follow up time was 16 months. In the receptor-positive tumor group mean follow up was 27 months (SD 24) with a median follow up of 19 months. To assess possible associations between different factors and the outcomes of interest, we used either the chi-square test or Fisher's exact test for categorical variables and the ANOVA test for continuous variables. For the survival assessment, a Kaplan-Meier analysis was performed and for the cumulative incidence a competing risk analysis was utilized., Results: The intramedullary rod revision rate for patients in the triple-negative tumor group was 17%, while for the receptor-positive group it was 12%, this was not statistically different for our sample size. The mean time for revision of the intramedullary rod in the whole sample was 19 months (SD 11, range 6-40). The causes of revision were disease progression (43%), nonunion (29%) and surgeon error (29%). The cumulative incidence of revision surgery was 6% (CI 95%, 2-14%) at 12 months and 20% (CI 95%, 8-36%) at 60 months., Conclusions: Intramedullary rodding can be considered for the treatment of long bones metastases in breast cancer patients for an impending or actual pathological fracture. There is no difference in the intramedullary rod revision rate among patients with different receptor-status when comparing triple-negative tumor patients and receptor-positive ones., Level of Evidence: Level III, therapeutic study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Tenosynovial giant cell tumors are extremely rare tumors with highly nonspecific symptoms. This benign but aggressive disease has a slow course of progression; however, it can ultimately lead to irreversible damage to a joint. Here we describe a case of a 45-year-old female with a diagnosis of tenosynovial giant cell tumors of the distal tibiofibular joint, the second case described in the literature for such location. Appropriate imaging studies and ultimately histologic studies are necessary for the correct diagnosis. Some locations are particularly unusual for these tumors making a high level of suspicion as well as treatment by an oncology orthopedic surgery specialist at a high-volume center paramount., (© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Melanocytic schwannoma is a rare nerve tumor characterized by melanin-producing neoplastic Schwann cells. Wide surgical resection is the management of choice for this tumor; however, anatomical location and proximity to nerve roots can make locating this tumor and the surgical resection challenging. Here we describe the case of 49-year-old male with a melanocytic schwannoma in the presacral area adjacent to the second sacral nerve root that was managed by wide resection aided by computer-assisted navigation due to the difficulty in identifying its location intraoperatively. The utilization of computer-assisted navigation improves accuracy and precision through the creation of a virtual continuous tridimensional map, particularly useful when oftentimes tumor margins may seem equivocal and further resection would compromise the patient's functionality. The value of computer-assisted navigation for soft tissue tumor resections in orthopedic oncology is still in its infancy, though, in certain scenarios it may advance the technique for some soft tissue resections., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Intraosseous lipomas are rare primary benign bone tumors which present with highly nonspecific radiographic features that may lead to equivocal diagnoses. Advanced imaging studies such as MRI with and without contrast and, in some selected cases, tissue sample analyses are required in the diagnostic pathway. Here we describe the second case in the literature of an intraosseous lipoma of the clavicle and the first with extraosseous extension. Subsequent to histologic confirmation the lesion was monitored with clinical and radiologic evaluation., (© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Atypical hemangiomas of the spine can mimic metastatic lesions on magnetic resonance imaging, therefore making this distinction is a diagnostic challenge. In most cases, this conundrum can usually be solved with positron emission tomography/computed tomography images, because hemangiomas do not usually present with increased uptake while metastatic lesions do. Here we present a case of a patient with a unique diagnosis, myxoid liposarcoma, in which the vertebral metastatic lesion did not present with increased uptake in positron emission tomography/computed tomography scans. While keeping the imaging particularity of this rare sarcoma in mind, proceeding with a biopsy when the suspicion of metastasis remains high will help elucidate the diagnosis and allow for proper management., (© 2019 The Authors.)

Intramuscular myxomas (IM) are rare benign tumors of mesenchymal origin. These tumors have a high myxoid content and a nonspecific radiologic appearance. Here we describe the case of a patient with an IM in an infrequent location; within the obturator externus muscle. A singular approach was utilized for the resection of this tumor in such rare location. Despite IM being benign tumors, patients may require a surgical excision due to the difficulty of differentiating these tumors, with unreliable imaging features, from other myxoid soft tissue masses.

Parachordoma is a rare entity with less than 50 cases described in the literature. This soft-tissue tumor resembles chordomas as well as extraskeletal myxoid chondrosarcomas and has only recently been fully characterized. Here we describe the case of a patient with a lower back parachordoma and its subsequent postresection recurrence 9 years after the initial procedure, emphasizing the importance of long-term follow-up in individuals with this diagnosis.