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Background: Osteosarcoma and Ewing's sarcoma in children and adolescents require age-specific interdisciplinary diagnosis and treatment to achieve optimal therapeutic outcomes. Methods: The diagnosis and treatment of malignant bone tumors in childhood and adolescence are presented in the light of publications retrieved by a selective search, pertinent guidelines, and the authors' extensive experience in an interdisciplinary cancer center. Results: Bone sarcomas make up approximately 5% of all malignancies in children and adolescents; the most common types are Ewing's sarcoma and osteosarcoma. Patients are often not referred to a specialized center until long after the onset of symptoms, as they and their physicians rarely consider the possibility of a bone tumor, and the symptoms are often trivialized. Bone pain of unknown origin, swelling, and functional limitations should be investigated with conventional x-rays. Lesions of unclear origin should be biopsied after a meticulous clinical and radiologic evaluation. Multimodal treatment consists of neo - adjuvant chemotherapy, limb-preserving resection if possible, and radiotherapy where indicated. In multicenter studies, patients with osteosarcoma achieve event-free survival in 64% of cases if their disease is localized, and 28% if it is metastatic; the corresponding figures for patients with Ewing's sarcoma are 80% and 27%, respectively. Conclusion: With implementation of the current treatment recommendations, most children and adolescents with malignant bone tumors can be treated successfully with curative intent. These patients should be referred to a sarcoma center for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Integrated 2-deoxy-2-[fluorine-18]fluoro-d-glucose (18F-FDG) positron emission tomography (PET)/magnetic resonance (MR) imaging can provide "one stop" local tumor and whole-body staging in one session, thereby streamlining imaging evaluations and avoiding duplicate anesthesia in young children. 18F-FDG PET/MR scans have the benefit of lower radiation, superior soft tissue contrast, and increased patient convenience compared to 18F-FDG PET/computerized tomography scans. This article reviews the 18F-FDG PET/MR imaging technique, reporting requirements, and imaging characteristics of the most common pediatric bone tumors, including osteosarcoma, Ewing sarcoma, primary bone lymphoma, bone and bone marrow metastases, and Langerhans cell histiocytosis. [ABSTRACT FROM AUTHOR]

Bone tumours are a rare and often highly malignant entity. Early clinical diagnosis is the most important step, but the difficulty of detecting and assessing bone malignancies is in its radiological peculiarity and limited experience of non-experts. Since X-ray imaging is the first imaging method of bone tumour diagnostics, the purpose of this study is to develop an artificial intelligence (AI) model to detect and segment the tumorous tissue in a radiograph. We investigated which methods are necessary to cope with limited and heterogeneous data. We collected 531 anonymised radiographs from our musculoskeletal tumour centre. In order to adapt to the complexity of recognizing the malignant tissue and cope with limited data, transfer learning, data augmentation as well as several architectures, some of which were initially designed for medical images, were implemented. Furthermore, dataset size was varied by adding another bone tumour entity. We applied a data split of 72%, 18%, 10% for training, validation and testing, respectively. To provide statistical significance and robustness, we applied a cross-validation and image stratification with respect to tumour pixels present. We achieved an accuracy of 99.72% and an intersection over union of 87.43% for hold-out test data by applying several methods to tackle limited data. Transfer learning and additional data brought the greatest performance increase. In conclusion, our model was able to detect and segment tumorous tissue in radiographs with good performance, although it was trained on a very limited amount of data. Transfer Learning and data augmentation proved to significantly mitigate the issue of limited data samples. However, to accomplish clinical significance, more data has to be acquired in the future. Through minor adjustments, the model could be adapted to other musculoskeletal tumour entities and become a general support tool for orthopaedic surgeons and radiologists. [ABSTRACT FROM AUTHOR]

Introduction. An Ewing Sarcoma is defined as a highly aggressive bone tumor. Its origin is attributed to a vascular endothelial pathology and it is characterized as a tumor made of undifferentiated round cells. Its presence has been described in places, such as the central nervous and paravertebral system. It equally affects children and adolescents. Objective. To implement Nursing Assistance Processes to adolescent patients with Ewing Sarcoma medical diagnoses. Methodology. A clinical case in nursing with a 3-month monitoring period on patients with Ewing sarcoma medical diagnoses. It is performed by applying Imogene King's Theory of Goal Attainment and implementing the Nursing Assistance Process, correlating the diagnostic taxonomy of the North American Nursing Diagnosis Association, describing the expected results of the Nursing Outcomes Classifications and implementing the interventions described in the Nursing Interventions Classification, respectively, when it comes to the expected results. Results. The Nursing Assistance Process is posed with a nursing diagnosis: Deterioration of physical mobility; with the nursing result: Joint movement and nursing interventions: Exercise therapy: Joint mobility. Improvement in the patient's muscular strength is evident. Conclusion. The patient's progress due to the performed interventions was evident. The Nursing Assistance Process, theory of nursing and diagnostic tools, as well as nursing goals and interventions, allowed comprehensively handling the patient. [ABSTRACT FROM AUTHOR]

Skeletal osteochondromas, also known as Osteocartilaginous exostosis are the most common benign bone tumors, while they represent an overall of about 15% of all bone tumors. They can be isolated findings or part of syndromic pathologies. They are typically seen on long bones, while their occurrence on flat bones is rare. The main concern after their identification is malignant transformation therefore size and cartilage thickness are monitored until the maturation of the skeleton and therefore seize of growth (unless malignant). This case report presents a 16 year old girl diagnosed with a benign isolated osteochondroma of the left scapula. X-Rays and MRI scans were used for diagnosis and for monitoring the progression for one year, while a CT scan aided planning for surgical excision for cosmetic purposes. The tumor was removed and histology confirmed its benign nature. Apart from cosmetic proposes and malignancy indications for excision of benign osteochondromas include pressure effect on surrounding tissue, pain and fracture of stalk. In our case the tumor had a typically benign appearance; nevertheless histological examination is always the gold standard for diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: To determine the frequency of locally recurrent Ewing sarcoma on surveillance MRI and the outcome of these patients.Materials and Methods: This retrospective single-center study included all patients with newly diagnosed Ewing sarcoma who underwent surveillance MRI of the primary tumor location after primary treatment between 1997 and 2016.Results: Thirty-two patients underwent a total of 176 local surveillance MRI scans, yielding an average of 5.5 ± 4.4 MRI scans per patient. Follow-up time of surveillance MRI after completion of primary treatment ranged between 1 and 111 months. Surveillance MRI detected five (15.6%) locally recurrent Ewing sarcomas, at 2, 4, 6, 6, and 7 months after completion of primary treatment, of whom three also had simultaneous recurrent (metastatic) disease elsewhere. Two patients had recurrent metastatic disease without any signs of locally recurrent disease on surveillance MRI. All five patients with locally recurrent disease on surveillance MRI died, at 2, 4, 5, 8, and 9 months after local recurrence detection. Patients with locally recurrent disease had a significantly worse overall survival than patients without locally recurrent disease (log-rank test, P < 0.0001).Conclusions: A limited number of patients have locally recurrent Ewing sarcoma on surveillance MRI. These patients often have simultaneous recurrent (metastatic) disease elsewhere, and their outcome is poor. Moreover, some patients present without locally recurrent disease on MRI but disease recurrence elsewhere. Therefore, surveillance MRI currently seems to have little value and should be reconsidered, also given the costs and the repeated exposure of surviving patients to gadolinium-based contrast agents. [ABSTRACT FROM AUTHOR]

Intraosseous lipomas are rare, benign neoplasms that account for less than 0.1% of all bone tumours. They remain a diagnostic challenge due to their variable clinical and radiological features; consequently only 26 cases in the mandible have been reported in the literature. Here, we report an unusual finding of an intraosseous mandibular lipoma in a 68 year‐old female patient following a history of third molar extraction. We also review the clinical, radiographical and histological findings in previously documented cases of intraosseous mandibular lipomas. [ABSTRACT FROM AUTHOR]

Objective: To assess of the pathologic response of patients of osteosarcoma, after neoadjuvant chemotherapy. Study Design: Descriptive study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore from Jan 2016 to Aug 2016. Material and Methods: A total of 60 cases of osteosarcoma found suitable by inclusion criteria were included in this study. Demographic details such as name, sex and age were collected. All specimens were grossed and staged according to CAP guidelines. Tumor response was assessed by two pathologists and graded as good and poor response. Results: Sixty percent (n=36) of patients were between 7-18 years of age while 40% (n=24) of patients were between 19-45 years of age. Mean age was 17.65 years. A total of 58.33% (n=35) of patients were males and 41.67% (n=25) of patients were females. Thirty percent (n=18) of the patients had good response, while 70% (n=42) of patients had poor response to chemotherapy. Conclusion: We concluded that the assessment of pathologic response of osteosarcoma after neoadjuvant chemotherapy in terms of good response and poor response is a useful tool for the pathologist and the oncologist. It gives us useful information regarding patient's response to neoadjuvant chemo radiotherapy that also helps in determining the further management and overall survival rate of the patient. [ABSTRACT FROM AUTHOR]

Background Ewing sarcoma (ES) is a malignant bone tumor that is most commonly observed in the long bones, the pelvis, and the chest. Primary intracranial localization is extremely rare. Objective In the aim of identifying the prognostic factors of this rare localization, we conducted a systematic review of the literature for patients with primary intracranial peripheral primitive neuroectodermal tumor/ES. Methods A complete MEDLINE search was undertaken for all articles reporting data for primary intracranial peripheral primitive neuroectodermal tumor/ES. We divided the patient population into 2 groups: group I, patients who were free of disease; and group II, patients who died or had uncontrolled disease at the last available follow-up. We conducted a comparative statistical analysis of data between the 2 groups. Results A total of 48 patients were included in the review. There were 32 patients in group I and 12 in group II. Fifty percent of tumors in group II and only 16% of tumors in group I were infratentotorial ( P = 0.03). Signs of bone involvement were observed in 19% of patients in group I and 54% in group II ( P = 0.03). Total removal was accomplished in 29% of patients in group I and in no patients in group II ( P = 0.03). Radiotherapy was performed in 73% of patients in group II and 81% in group I ( P = 0.43). Chemotherapy was administered in 36% of patients in group II and 74% in group I ( P = 0.03). Conclusions Infratentorial localization and the presence of bone involvement were associated with poor prognosis; Surgery seems to be a predictive factor of prognosis; radiotherapy and chemotherapy must be performed whenever the tumor is not totally removed. [ABSTRACT FROM AUTHOR]

Osteosarcoma (OS) is the most common type of malignant bone tumor in children and adolescents. However, the molecular mechanism underlying OS development is unclear. Here, we investigated the contribution of lncRNA-p21, a novel long non-coding RNA, on OS cell proliferation. Our results demonstrated that the expression of lncRNA-p21 was repressed in OS tissue. Growth curves and the cell colony formation assay showed that lncRNA-p21 significantly inhibited the proliferation of OS cell lines. In addition, the expression of lncRNA-p21 increased the protein levels of proliferation markers, such as Ki-67 and cyclin D1. Subsequently, lncRNA-p21 overexpression up-regulated the protein level of phosphatase and tensin homolog deleted on chromosome ten (PTEN), a well-known inhibitor of AKT signaling. Moreover, our gain and loss function assay showed that the promotion of PTEN by lncRNA-p21 was mediated by miR-130b, an oncogene overexpressed in OS tissue. Our findings may provide a novel lncRNA-targeted therapy for patients with OS. [ABSTRACT FROM AUTHOR]

Hemangiosarcoma (HSA) of bone and telangiectatic osteosarcoma (tOSA) can appear similar histologically, but differ in histogenesis (malignant endothelial cells versus osteoblasts), and may warrant different treatments. Immunohistochemistry (IHC) for endothelial cell marker factor VIII-related antigen/von Willebrand factor (FVIII-RAg/vWF) is a well-documented ancillary test to confirm HSA diagnoses in soft tissues, but its use in osseous HSA is rarely described. Archived samples of 54 primary appendicular bone tumours previously diagnosed as HSA or tOSA were evaluated using combination routine histopathology (RHP) and IHC. Approximately 20% of tumours were reclassified on the basis of FVIII-RAg/vWF immunoreactivity, typically from an original diagnosis of tOSA to a reclassified diagnosis of HSA. No sample with tumour osteoid clearly identified on RHP was immunopositive for FVIII-RAg/vWF. RHP alone was specific but not sensitive for diagnosis of HSA, compared with combination RHP and IHC. Routine histopathological evaluation in combination with FVIII-RAg/vWF IHC can help differentiate canine primary appendicular HSA from tOSA. [ABSTRACT FROM AUTHOR]

Key Clinical Message Although resection of multilobular tumors of bone can be associated with a good prognosis and long disease-free intervals in dogs, osteosarcomatous transformation should be considered a cause for rapid recurrence of clinical signs. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the imaging characteristics of primary malignant bone tumors in children. The imaging results of 34 children with primary malignant bone tumors confirmed by histopathological diagnosis between March 2008 and January 2014 were retrospectively analyzed. In total, 25 patients had osteosarcoma, with radiography and computed tomography (CT) showing osteolytic bone destruction or/and osteoblastic bone sclerosis, an aggressive periosteal reaction, a soft-tissue mass and cancerous bone. The tumors appeared as mixed magnetic resonance imaging (MRI) signals that were inhomogeneously enhanced. A total of 5 patients presented with Ewing sarcoma, with radiography and CT showing invasive bone destruction and a soft-tissue mass. Of the 5 cases, 2 showed a laminar periosteal reaction. The tumors were shown to have mixed low signal on T1-weighted images (T1WI) and high signal on T2-weighted images (T2WI); 1 case showed marked inhomogeneous enhancement. Another 3 patients exhibited chondrosarcoma. Of these cases, 1 was adjacent to the cortex of the proximal tibia, and presented with local cortical bone destruction and a soft-tissue mass containing scattered punctate and amorphous calcifications. MRI revealed mixed low T1 signal and high T2 signals. Another case was located in the medullary cavity of the distal femur, with radiography revealing a localized periosteal reaction. The tumor appeared with mixed MRI signals, and with involvement of the epiphysis and epiphyseal plates. Radiography and CT of the third case showed bone destruction in the right pubic ramus, with patchy punctate, cambered calcifications in the soft-tissue mass. MRI of the soft-tissue mass revealed isointensity on T1WI and heterogeneous hyperintensity on T2WI. Ossifications and the septum appeared as low T1WI and T2WI. Of the 34 patients, 1 patient presented with lymphoma involving the T12, L1 and L2 vertebrae. CT showed vertebral bone destruction, a soft-tissue mass and a compression fracture of L1. MRI showed a soft-tissue mass with low T1 signal and high T2 signal and marked inhomogeneous enhancement. Overall, osteosarcoma was the most common primary malignant bone tumor, followed by Ewing sarcoma, chondrosarcoma and lymphoma. Osteoblastic or osteolytic bone destruction, an invasive periosteal reaction, soft-tissue masses, a tumor matrix and inhomogeneous enhancement were important imaging features of malignant bone tumors. [ABSTRACT FROM AUTHOR]

Because many bone tumors have a variety of appearances and are uncommon, few radiologists develop sufficient expertise to guide optimal management. Bayesian inference can guide decision-making by computing probabilities of multiple diagnoses to generate a differential. We built and validated a naïve Bayes machine (NBM) that processes 18 demographic and radiographic features. We reviewed over 1664 analog radiographic cases of bone tumors and selected 811 cases (66 diagnoses) for annotation using a quantitative imaging platform. Leave-one-out cross validation was performed. Primary accuracy was defined as the correct pathological diagnosis as the top machine prediction. Differential accuracy was defined as whether the correct pathological diagnosis was within the top three predictions. For the 29 most common diagnoses (710 cases), primary accuracy was 44%, and differential accuracy was 60%. For the top 10 most common diagnoses (478 cases), primary accuracy was 62%, and differential accuracy was 80%. The machine returned relevant diagnoses for the majority of unknown test cases and may be a feasible alternative to machine learning approaches such as deep neural networks or support vector machines that typically require larger training data (our model required a minimum of five samples per diagnosis) and are 'black boxes' (our model can provide details of probability calculations to identify features that most significantly contribute to truth diagnoses). Finally, our Bayes model was designed to scale and 'learn' from external data, enabling incorporation of outside knowledge such as Dahlin's Bone Tumors, a reference of anatomic and demographic statistics of more than 10,000 tumors. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the prevalence of vitamin D deficiency in patients with different types of bone tumors and to elucidate whether or not there are differences in prediagnostic vitamin D levels in patients with malignant compared to benign bone tumors. Prediagnostic serum 25(OH)D levels of 105 consecutive patients that presented with bone tumors and tumor-like lesions to two Orthopedic Level I University Centers in Germany between 2011 and 2016 were measured on admission. We found an alarming and widespread rate of vitamin D deficiency in patients with bone tumors. Specifically, 83% of all patients had low vitamin D levels with a mean 25(OH)D level of 19.82 ng/ml. Notably, patients diagnosed with malignant bone tumors had significantly lower vitamin D levels compared to patients with benign bone lesions (p = 0.0008). In conclusion, it is essential to assess vitamin D levels in patients with tumors involving bone. In addition, there might be an association between vitamin D deficiency and the onset or course of primary malignant bone tumors. [ABSTRACT FROM AUTHOR]

Objective Dental pulp is soft connective tissue maintaining the vitality of the tooth, while odontoblasts form the dentin. Our earlier DNA microarray analysis revealed expression of putative tumour suppressor exostosin 1 (EXT-1) in odontoblasts. EXT-1 is essential for heparan sulphate synthesis, which may play a role in the dentin mineralization. Since the absence of the functional EXT-1 causes bone tumours, expression in odontoblasts is interesting. Our aim was to analyse further the EXT-1 expression in human tooth. Designs DNA microarray and PCR techniques were used to study the EXT-1 expression in mature native human odontoblasts and pulp tissue as well as in newly-differentiated cultured odontoblast-like cells. Immunohistochemistry was performed to study EXT-1 protein in mature human teeth, teeth with incomplete root and developing teeth. Results Markedly higher EXT-1 was observed in mature odontoblasts than in pulp at mRNA level with DNA microarray and PCR techniques. Immunohistochemistry of mature tooth revealed EXT-1 both in odontoblasts and the predentin but not in the dentin. EXT-1 was also observed in the odontoblasts of incomplete root, but the localization of the staining was different. In developing foetal tooth, staining was detected in ameloblasts and the basal lamina. Conclusions The detection of EXT-1 in both mature and newly-differentiated cells indicates a role in the odontoblast function, and EXT-1 staining in the predentin indicates a function in the dentin formation. Detection of EXT-1 in developing teeth indicates a role in tooth development. [ABSTRACT FROM AUTHOR]

Chondroblastoma is a rare primary bone tumor of young people that typically arises in the ends of the long bones. Radiologic investigations show a small, circumscribed, lytic lesion. The tumor is characterized histologically by the proliferation of chondroblasts along with areas of mature cartilage, giant cells, and occasionally, secondary aneurysmal bone cyst formation. Chondroblastoma, however, may also present with atypical features, such as prominent hemosiderin deposition, numerous giant cells, or the presence of a large aneurysmal bone cyst component. Malignant entities such as clear cell chondrosarcoma and chondroblastic osteosarcoma must also be considered. Recently, immunohistochemical stains such as DOG1 and SOX9 have been described in chondroblastoma, and K36M mutations in either the H3F3A or H3F3B genes have also been identified. While generally regarded as a benign entity, chondroblastoma manifests an intermediate type of behavior, given its ability to recur locally, and rarely, metastasize. [ABSTRACT FROM AUTHOR]

Incidental bone lesions are commonly seen on abdominal and pelvic computed tomography (CT) examinations. These incidental bone lesions can be diagnostically challenging to the abdominal radiologist who may not be familiar with their appearance or their appropriate management. The characterization of such bone lesions as non-aggressive or aggressive based on their CT appearance involves similar principles to their morphologic evaluation on radiographs. Knowledge of the age of the patient and the presence of symptoms, mainly bone pain, can improve analysis. Examples of bone lesions that may be encountered include solitary or multifocal bone lesions, osteochondromatous and chondroid tumors, Paget's disease, avascular necrosis/bone infarctions, iatrogenic lesions, and periarticular lesions. This pictorial essay aims to provide a framework for the analysis of incidental bone lesions on CT and when further imaging and clinical work-up should be recommended. [ABSTRACT FROM AUTHOR]

Context.--Image-guided, fine-needle aspiration--assisted core needle biopsy with an on-site evaluation by a pathologist (FNACBP) of osseous lesions is not a common practice in pediatric institutions. Objectives.--To evaluate the diagnostic adequacy and accuracy of FNACBP for pediatric osseous lesions and to compare the adequacy with procedures that do not use fine-needle aspiration. Design.--Six-year, retrospective review of 144 consecutive children biopsied for osseous lesions with and without fine-needle aspiration assistance. Results.--Pathologic diagnosis was achieved in 79% (57 of 72) of the core biopsies without an on-site evaluation, 78% (32 of 41) of the open biopsies (9 with intraoperative consultation), and 97% (30 of 31) of the FNACBPs as the initial diagnostic procedure. Three FNACBP cases were preceded by nondiagnostic open biopsies. Among 34 lesions sampled by FNACBP, 33 (97%) succeeded with diagnostic tissue, with most (30 of 33; 91%) being neoplasms, including 16 malignant (48%), 13 benign (39%), and 1 indeterminate (3%) lesions. The mostcommon diagnoses were osteosarcoma (9 of 33; 27%) and Langerhans cell histiocytosis (7 of 33; 21%). In cases with follow-up information available, 93% (28 of 30) of the FNACBP-rendered diagnoses were clinically useful, allowing initiation of appropriate therapy. The FNACBP procedure had 100% specificity, sensitivity, and positive predictive value for all 14 malignant lesions, with the sensitivity being 88% in benign lesions. Most FNACBP procedures (32 of 34; 94%) yielded adequate material for ancillary testing. A gradual upward trend was observed for the choice of FNACBP as an initial diagnostic procedure for osseous lesions. Conclusions.--The FNACBP procedure yields sufficient material for diagnosis and ancillary studies in pediatric, osseous lesions and may be considered an initial-diagnostic procedure of choice. [ABSTRACT FROM AUTHOR]

The article examines the types of breast cancer and cancer staging systems. Topics covered include the molecular subtypes of breast cancer, symptoms of metastatic breast cancer, and treatments for the disease as of May 2017, percentage of newly diagnosed breast cancers in women each year, and factors that attribute to the decrease in breast cancer mortality.

Introduction During cancer progression, more than half of patients develop renal insufficiency, including chronic kidney disease. The primary and secondary objectives of this study were to estimate healthcare resource use and costs, respectively, associated with renal impairment in patients with bone metastases from solid tumors in the United States. Methods and materials This was a retrospective, observational cohort study conducted using administrative claims data for individuals with solid tumors and bone metastases. Control patients were matched to renal impairment patients using propensity scores (ratio up to 3:1) based on demographics, clinical characteristics, and baseline costs. Average per-patient per-year healthcare resource utilization and costs (total costs and cost components; 2013 dollars) were reported. Results In total, 2616 renal impairment patients were matched to 7211 control patients. Renal impairment patients had greater healthcare resource use compared with controls, including a greater mean number of hospital admissions (4.4 versus 2.1), longer average stay per hospital admission (7.4 versus 6.5 days), as well as greater mean number of physician office visits (22.9 versus 18.8), emergency department visits (3.1 versus 2.0), and hospital-based outpatient visits (18.8 versus 16.0) compared with control patients. Total costs were > $50,000 higher among renal impairment patients ($142,267 versus $88,839; P < 0.001), with hospital costs accounting for $72,557 for renal impairment patients, and $27,858 for control patients (P < 0.001). Conclusion The healthcare resource use and costs associated with renal impairment in patients with bone metastases from solid tumors is high; efforts to reduce renal impairment in this population, including the potential avoidance of nephrotoxic agents, are warranted. [ABSTRACT FROM AUTHOR]

Osteoid osteoma in periarticular lesions tends to have an unusual presentation that likely leads to a delayed or missed diagnosis compared with a typical osteoid osteoma in the metaphysis or diaphysis of the long bone. In cases that are unresponsive to conservative treatment, surgical interventions including en bloc resection, computed tomography-guided percutaneous treatment, and arthroscopic resection have been performed; however, these methods frequently result in inadequate tumor resection and recurrence. Here we present a case of a 16-year-old girl with osteoid osteoma in the talar neck presenting as anterior impingement syndrome due to marked synovitis in the ankle joint which was successfully treated without complications by arthroscopic synovectomy and tumor resection followed by intraoperative 3D C-arm-based imaging confirming complete tumor lesion removal. Her pain was relieved immediately after the surgery, and there was no recurrence at 12 months of follow-up. This is the first case report of the surgical treatment of the osteoid osteoma in the talar neck with the combination methods of arthroscopy and 3D C-arm-based imaging. [ABSTRACT FROM AUTHOR]

Few epidemiologic studies have explored risk factors for bone tumors in children, and the role of environmental factors needs to be analyzed. Our objective was to ascertain the association between residential proximity to industrial plants and urban areas and risk of bone tumors in children, taking into account industrial groups and toxic pollutants released. A population-based case-control study of childhood bone cancer in Spain was carried out, covering 114 incident cases obtained from the Spanish Registry of Childhood Tumors (between 1996 and 2011), and 684 controls individually matched by sex, year of birth, and autonomous region of residence. Distances from the subject's residences to the 1271 industries and the 30 urban areas (towns) with ≥ 75,000 inhabitants located in the study area were computed. Unconditional logistic regression models were fitted to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 3 km) to industrial and urban areas, with adjustment for matching variables and sociodemographic indicators. Excess risk (OR; 95%CI) of bone tumors in children was detected for children close to industrial facilities as a whole (2.33; 1.17–4.63 at 3 km) – particularly surface treatment of metals (OR = 2.50; 95%CI = 1.13–5.56 at 2 km), production and processing of metals (OR = 3.30; 95%CI = 1.41–7.77 at 2.5 km), urban waste-water treatment plants (OR = 4.41; 95%CI = 1.62–11.98 at 2 km), hazardous waste (OR = 4.63; 95%CI = 1.37–15.61 at 2 km), disposal or recycling of animal waste (OR = 4.73; 95%CI = 1.40–15.97 at 2 km), cement and lime (OR = 3.89; 95%CI = 1.19–12.77 at 2.5 km), and combustion installations (OR = 3.85; 95%CI = 1.39–10.66 at 3 km)–, and urban areas (4.43; 1.80–10.92). These findings support the need for more detailed exposure assessment of certain toxics released by these facilities. [ABSTRACT FROM AUTHOR]

Background: Percutaneous biopsy is the reference diagnostic procedure for adult musculoskeletal tumors. Its place in pediatrics is controversial and open biopsy remains recommended.Objective: To assess diagnostic performance and feasibility of percutaneous biopsy performed on children and young adults for suspected malignant bone tumors.Materials and Methods: We conducted a 5-year retrospective study including patients ≤21 years who underwent a bone biopsy for a suspected malignant bone tumor. We assessed diagnostic yield (percentage of analyzable biopsies), accuracy (percentage of accurate diagnoses among all analyzable biopsies) and efficacy (percentage of accurate diagnoses among all biopsies), costs, anesthetic requirements and sample availability for biomedical research. Patients diagnosed with an open biopsy were used to compare diagnostic performances, anesthetic requirements and costs.Results: We included 90 percutaneous and 27 open biopsies in 117 patients. For percutaneous biopsy, diagnostic yield was 95.5% (95% confidence interval [CI] 88.8-98.7%), accuracy was 96.2% (95% CI 86.8-99.5%) and efficacy was 89.3% (95% CI 78.1-96.0%). There was no statistical difference with open biopsy (Fisher exact test, P > 0.05). Mean costs were reduced with percutaneous biopsy: €1,937 (standard deviation [SD] €2,408) versus €6,362 (SD €5,033; Mann-Whitney, P < 0.0001). Thirty-two of the 48 (67%) patients included in clinical trials and diagnosed with percutaneous biopsy had suitable samples for ancillary analyses.Conclusion: Percutaneous biopsy is a valid alternative to open biopsy for diagnosing pediatric and young adult primary malignant bone tumors. [ABSTRACT FROM AUTHOR]

A 25-year-old man presented with chronic low back pain and occasional radiation to the right lower limb. Magnetic resonance imaging and computed tomography (CT) of the lumbar spine showed an osteolytic expansile lesion with a central sclerotic nidus in the right superior facet of the L5 vertebra and surrounding marrow oedema. The diagnosis of osteoblastoma was made based on imaging findings and confirmed after CT-guided biopsy. Radiofrequency ablation of the lesion was successfully performed. The patient tolerated the procedure well and showed symptomatic relief. The imaging features and management of osteoblastoma are discussed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the CT and MR imaging findings and differential diagnosis of malignant vascular tumors of bone. Materials and methods: CT and MR imaging findings of 18 patients with histopathology-proven malignant vascular tumors of bone were examined. Assessed image features included age, sex, location, CT findings, and MR imaging appearances and dynamic contrast-enhanced MR imaging. Results: The study group comprised 18 cases, of which 7 were categorized as low-grade malignant vascular tumors (LMT), and 11 were categorized as high-grade malignant vascular tumors (HMT). Malignant vascular tumors of bone showed osteolytic lesions with heterogeneous signs and enhancement, and frequently associated with soft tissue masses and peritumorous edema. The mean age of patient was respectively 34.7 years in LMT with 3 patients younger than 20 and 49.9 years in HMT with 3 patients older than 60 years. The mean lesion diameter was 3.6 cm (range 2-7.2) in LMT with two lesions <3 cm and 7.1 cm (range 3-13) in HMT with 3 lesions greater than 10 cm. LMT showed multifocal (57.1 %) and well-defined (71.5 %) lesions with residual bone (57.1 %), peripheral sclerosis (85.7 %), and slightly hetergeneous enhancement (71.4 %), compared to those of HMT with 9.1, 45.5, 27.3, and 72.7 %, and 9.1 % respectively. Also, HMT appeared as expansive (54.5 %), ill-defined (54.5 %), macroscopic necrosis/cystic (81.8 %) or hemorrhagic (27.3 %) lesion with pathological fracture (27.3 %), and often presented with obviously hetergeneous enhancement (81.8 %), compared to those of LMT with 42.9, 28.6, 42.9, 0, 14.3 and 14.3 % respectively. Conclusions: There are some differences in the imaging features between LMT and HMT, while unifocal/multifocal, expansive, ill-defined, necrosis/cystic, hemorrhagic features with age, lesion diameter, peripheral sclerosis, residual bone tissue, pathological fracture and slightly/obviously hetergeneous enhancement highly suggest their differential diagnosis. [ABSTRACT FROM AUTHOR]

Breast cancer metastasis to the bone continues to be a major health problem, with approximately 80% of advanced breast cancer patients expected to develop bone metastasis. Although the problem of bone metastasis persists, current treatment options for metastatic cancer patients are limited. In this study, we investigated the preventive role of the active vitamin D metabolite, 1α,25-dihydroxyvitamin D (1,25(OH)2D), against the metastatic potential of breast cancer cells using a novel three-dimensional model (rMET) recapitulating multiple steps of the bone metastatic process. Treatment of MCF10CA1a and MDA-MB-231 cells inhibited metastasis in the rMET model by 70% (±5.7%) and 21% (±6%), respectively. In addition, 1,25(OH)2D treatment decreased invasiveness (20 ± 11% of vehicle) and decreased the capability of MCF10CA1a cells to survive in the reconstructed bone environment after successful invasion through the basement membrane (69 ± 5% of vehicle). An essential step in metastasis is epithelial–mesenchymal transition (EMT). Treatment of MCF10CA1a cells with 1,25(OH)2D increased gene (2.04 ± 0.28-fold increase) and protein (1.87 ± 0.20-fold increase) expression of E-cadherin. Additionally, 1,25(OH)2D treatment decreased N-cadherin gene expression (42 ± 8% decrease), a marker for EMT. Collectively, the present study suggests that 1,25(OH)2D inhibits breast cancer cell metastatic capability as well as inhibits EMT, an essential step in the metastatic process. [ABSTRACT FROM AUTHOR]

Background: Malignant thymomas are rarely associated with bone metastasis and T-cell lymphocytosis.Case Presentation: A 47-year-old female patient was admitted to our hospital for ptosis. A diagnosis of malignant thymoma was made based on the thymectomy and pathological result. Peripheral T-cell lymphocytosis and bone metastasis were found later. T-cell lymphocytosis was relived after surgical and radiation therapy to the metastasis.Conclusion: Peripheral T-cell lymphocytosis is a rare paraneoplastic phenomenon associated with thymomas. This report is the first to describe an invasive thymoma with late bone metastasis accompanied with T-cell lymphocytosis. We should be aware of peripheral T-cell lymphocytosis in thymomas and it may contribute to a better understanding of the complex physiology and pathogenesis of thymoma. [ABSTRACT FROM AUTHOR]

Iliac bone destruction in children is uncommon and presents various imaging features. Correct diagnosis based on clinical and imaging features is difficult. This research aimed to retrospectively explore the clinical features, imaging, and histopathological diagnosis of children with iliac bone destruction. A total of 22 children with iliac bone destruction were enrolled in this retrospective analysis from two children’s hospitals during July 2007 to April 2015. Clinical features, imaging, and histopathological findings were analysed. The mode of iliac bone destruction, lesion structure, and the relationship between the range of soft tissue mass and cortical destruction were determined based on imaging data. The data were analysed using descriptive methods. Of the iliac bone destruction cases, eight cases were neuroblastoma iliac bone metastasis, seven cases were bone eosinophilic granuloma, two cases were Ewing’s sarcoma, two cases were osteomyelitis, one case was bone cyst, one case was bone fibrous dysplasia, and one case was non-Hodgkin’s lymphoma. Iliac bone destruction varies widely in children. Metastatic neuroblastoma and eosinophilic granuloma are the most commonly involved childhood tumours. [ABSTRACT FROM AUTHOR]

Osteomas attached to the meninges unrelated to bone are extremely rare and their etiology has not been discussed previously in the English literature. Here, we report the case of a 54-year-old male patient with a right frontal subdural osteoma. The patient presented with a ∼5-month history of intermittent dizziness. Non-contrasted computerized tomography demonstrated a densely calcified mass attached to the inner surface of the right frontal skull. Magnetic resonance imaging (MRI) revealed this mass could be enhanced by contrast MRI. Intraoperatively, the hard mass was noted to be attached to the inner layer of the dura mater, and not associated with the bone. Histopathological examination revealed lamellated bony trabeculae lined by osteoblasts and the intertrabecular marrow spaces occupied by adipose tissue, which contributed to the MRI enhancement. It was speculated that subdural osteomas arose from ectopic osteoblasts derived from the embryological neural crest cells. The context of intertrabecular bone marrow contributed to the enhancement on MRI. Simple excision is the treatment of choice for symptomatic lesions. [ABSTRACT FROM AUTHOR]

Osteoblastomas are biologically benign tumors with limited growth potential and may show a wide range of clinical, radiographic and histopathological findings. Osteoblastomas of the jaw may resemble other gnathic lesions including osteoid osteoma, cementoblastoma, cement-ossifying fibroma, cemento-osseous dysplasia and osteosarcoma, offering a unique diagnostic conundrum. Aggressive osteoblastoma, a rare variant of osteoblastoma characterized by the presence of atypical histopathological features like epithelioid osteoblasts and exhibiting locally aggressive behavior is rarely reported in the jaw bones. The accurate diagnosis and delineation of this entity from malignant bone tumors sometimes may be a challenge. The case report emphasizes this entity, which has to be differentiated from low-grade osteosarcoma and highlights the gravity of clinico-pathologic correlation in such lesions. [ABSTRACT FROM AUTHOR]

Osteosarcoma (OSA) is a malignant heterogeneous primary bone tumor responsible for up to 90% of all primary bone tumors in dogs. In this study, osteocalcin (OC) and osteonectin (ON) immunoreactivity was evaluated in 23 canine OSAs, 4 chondrosarcomas, 4 fibrosarcomas, 2 hemangiosarcomas, and 4 histiocytic sarcomas. The effects of three different decalcification agents (ethylenediaminetetraetic acid [EDTA], formic acid and hydrochloric acid [HCl]) on the immunoreactivity for OC and ON was also assessed. Immunoreactivity to OC was present in 19/23 (83%) cases of OSA and all cases of chondrosarcoma. In three OSAs the extracellular matrix showed immunoreactivity to OC. None of the fibrosarcomas, histiocytic sarcomas or hemangiosarcomas showed immunoreactivity to OC. The sensitivity and specificity for OC in canine OSA in this study was 83% and 71% respectively. For ON, 100% of both OSAs (23/23) and non-OSAs (14/14) showed cytoplasmic immunoreactivity to this antibody, giving a sensitivity of 100% but a complete lack of specificity. There were no significant differences in immunoreactivity for OC and ON between the different decalcification agents used. In conclusion, OC showed high sensitivity for identifying OSA but it failed to distinguish between OSA and chondrosarcoma, and the osteoid produced by neoplastic cells in most cases did not show immunoreactivity to OC. These factors may limit the practical utility of OC in the diagnosis of OSA in dogs when chondrosarcoma is a differential diagnosis. ON showed no specificity in detecting OSA and has little practical application for the diagnosis of OSA in dogs. [ABSTRACT FROM AUTHOR]

Balancing the assessment of musculoskeletal dysfunctions with a high level of suspicion for nonmechanical origins can be a challenge for the clinician examining a sports injury. Without timely diagnosis, nonmechanical complaints could result in surgery or loss of limb. This case describes the discovery of a Giant Cell Tumor of Bone (GCTB) following the re-evaluation of an athlete who had undergone five years of conservative management for patellofemoral pain syndrome (PFPS). Knee injuries account for 32.6% of sports injuries with PFPS being the most common and most likely diagnosis for anterior knee pain. GCTB is a benign aggressive bone tumor with a predilection for the juxta-articular region of the knee, comprising up to 23% of all benign bone tumors, and commonly occurs in the second to fourth decades. This case report illustrates the difficulty in accurately diagnosing healthy athletes, reviews common differentials for knee complaints and explores helpful diagnostic procedures. [ABSTRACT FROM AUTHOR]

Objectives: To compare the diagnostic accuracy of (111)In-pentetreotide-scintigraphy with (68)Ga-DOTATOC-positron emission tomography (PET)/computed tomography (CT) in patients with metastatic-neuroendocrine tumour (NET) scheduled for peptide receptor radionuclide therapy (PRRT). Incremental lesions (ILs) were defined as lesions observed on only one modality.Methods: Fifty-three metastatic-NET-patients underwent (111)In-pentetreotide-scintigraphy (24 h post-injection; planar+single-photon emission CT (SPECT) abdomen) and whole-body (68)Ga-DOTATOC-PET/CT. SPECT and PET were compared in a lesion-by-lesion and organ-by-organ analysis, determining the total lesions and ILs for both modalities.Results: Significantly more lesions were detected on (68)Ga-DOTATOC-PET/CT versus (111)In-pentetreotide-scintigraphy. More specifically, we observed 1,098 lesions on PET/CT (range: 1-105; median: 15) versus 660 on SPECT (range: 0-73, median: 9) (p<0.0001), with 439 PET-ILs (42/53 patients) and one SPECT-IL (1/53 patients). The sensitivity for PET/CT was 99.9 % (95 % CI, 99.3-100.0), for SPECT 60.0 % (95 % CI, 48.5-70.2). The organ-by-organ analysis showed that the PET-ILs were most frequently visualized in liver and skeleton.Conclusion: Ga-DOTATOC-PET/CT is superior for the detection of NET-metastases compared to (111)In-pentetreotide SPECT.Key Points: Somatostatin receptor PET is superior to SPECT in detecting NET metastases. PET is the scintigraphic method for accurate depiction of NET tumour burden. The sensitivity of PET is twofold higher than the sensitivity of SPECT. [ABSTRACT FROM AUTHOR]

A 28-year-old man visited our hospital with the chief complaint of trismus. Computed tomography revealed a well-defined, soft tissue tumor, 66 × 45 × 21 mm, with a distinct boundary in the inner region of the zygomatic arch. The mass contained various sizes of bone-like hard tissue, some of which adhered to the right coronoid process. A contrast-enhanced magnetic resonance image showed that the mass was composed mainly of adipose tissue. Tumorectomy was performed, and the histopathological diagnosis was osteolipoma. At 2-year follow-up, mouth opening had increased from 31 mm to 50 mm. (J Oral Sci 58, 141-144, 2016). [ABSTRACT FROM AUTHOR]

Intraosseous ganglion cyst is a rare bone tumor and the lesion could often be missed. The diagnosis could be delayed so proper radiologic investigation and index of suspicion is necessary .Differential diagnoses of painful cystic radiolucent carpal lesion are osteoid osteoma, osteoblastoma and intraosseous ganglion. Curettage of the scaphoid lesion and filling of void with bone graft provides good functional outcomes. The cyst contains mucoid viscous material without epithelial or synovial lining. We present a case of 30 years old male with intraosseous ganglion cyst of scaphoid which was treated with curettage and bone grafting. Rarely ganglion cyst is found in small bones of hand and should be considered as differential diagnosis of chronic radial wrist pain. [ABSTRACT FROM AUTHOR]

Giant cell tumor (GCT) of bone is an uncommon primary neoplasm that rarely occurs in the skull. The sphenoid and temporal bones are common sites in the skull for these tumors. GCTs of the temporal bone usually grow with medial extension and induce reactive bone changes. In this article, we describe a case of GCT presenting as a bulging preauricular mass with aggressive bone destruction. [ABSTRACT FROM AUTHOR]

The article offers updates in orthopaedic oncology as of December 2015. Topics include the association of Ewing sarcoma with balanced translocations of the EWS and ETS genes that produce a fusion protein that binds DNA affecting transcription, prognostic biomarkers in soft-tissue sarcoma, and the management of tenosynovial giant cell tumor.

Background: In a previous report, we described a method of reconstruction using tumor-bearing autograft treated by liquid nitrogen for malignant bone tumor. Here we present the first case of bone deformity correction following a tumor-bearing frozen autograft via three-dimensional computerized reconstruction after multiple surgeries.Case Presentation: A 16-year-old female student presented with pain in the left lower leg and was diagnosed with a low-grade central tibial osteosarcoma. Surgical bone reconstruction was performed using a tumor-bearing frozen autograft. Bone union was achieved at 7 months after the first surgical procedure. However, local tumor recurrence and lung metastases occurred 2 years later, at which time a second surgical procedure was performed. Five years later, the patient developed a 19° varus deformity and underwent a third surgical procedure, during which an osteotomy was performed using the Taylor Spatial Frame three-dimensional external fixation technique. A fourth corrective surgical procedure was performed in which internal fixation was achieved with a locking plate. Two years later, and 10 years after the initial diagnosis of tibial osteosarcoma, the bone deformity was completely corrected, and the patient's limb function was good.Conclusion: We present the first report in which a bone deformity due to a primary osteosarcoma was corrected using a tumor-bearing frozen autograft, followed by multiple corrective surgical procedures that included osteotomy, three-dimensional external fixation, and internal fixation. [ABSTRACT FROM AUTHOR]

Image-guided biopsies play an important role for pathologic diagnosis of bone tumors. Recently, motorized, battery powered bone marrow biopsy devices have been used to biopsy focal bone lesions with high accuracy. We present here two cases of densely blastic metastases where the biopsy sample could not be removed from the needle. These two cases suggest that if the lesion is densely blastic, then the sample should be small (<5 mm) to ensure that the biopsy specimen will not be stuck within the biopsy needle. [ABSTRACT FROM AUTHOR]

Background: A primary chondromyxoid fibroma (CMF) arising from sternum is quite uncommon tumor in thoracic surgery. Removal of giant sternal tumors requires extensive resection of the anterior chest wall, and results in deformity and paradoxical movement.Case Presentation: A 40-year-old female presented a progressively enlarging mass of her anterior chest wall. Computed tomography revealed an osteolytic lesion with discrete calcification in the bone marrow of the sternum. The tumor extended across the destroyed cortex to the parietal and visceral soft aspects, involving some of the costal cartilage and most of the sternal body. Partial sternal resection was performed successfully and an individual-specific stainless steel plate was used to reconstruct the anterior chest wall. The early result was good, however, nine months after the first surgery, fractures of plate were found at bilateral plate-clavicular junction. The plate had to be removed, and a titanium mesh was used to reconstruction of the chest wall. The patient has been of disease free for more than 18 month after the second surgery.Conclusions: Our experience indicated that the individual-specific plate may not be suitable for reconstructing both the anterior chest wall as well as the sternoclavicular joint after subtotal sternum resection. [ABSTRACT FROM AUTHOR]

Background: The Swedish Cancer Registry (founded in 1958) constitutes a unique resource for epidemiological studies of giant cell tumor of bone with potential for use for population-based studies of incidence over time. The aim of this study was to provide what we believe is the first modern population-based assessment of the incidence trends of giant cell tumor, a unique osteoclastogenic lytic stromal tumor with both benign and malignant histological forms, and to compare the findings with data from the same registry on osteosarcoma, a tumor that may display similar histological characteristics.Methods: Cases were identified with use of codes for pathological bone tumor (International Classification of Diseases [ICD]-7 196). Specific morphological coding distinguishes benign (PAD 741) from malignant giant cell tumor (PAD 746) and osteosarcoma (PAD 766).Results: During the period of 1958 to 2011, 4625 bone tumors were reported, including 505 giant cell tumors (383 benign and 122 malignant) and 1152 osteosarcomas. From 1958 to 1982 the ratio of malignant to benign giant cell tumors was 1.3, whereas from 1983 to 2011 the ratio inverted to 0.09, suggesting a change in the reporting or diagnosis of malignant or benign cases. Cases of giant cell tumor diagnosed from 1983 to 2011 displayed an age and sex distribution (median age at diagnosis, 34.0 years; 54% female) that were consistent with those in large published case series but differed from those in 1958 to 1982 (median age at diagnosis, 31.5 years; 48% female). The most current data (1983 to 2011) showed the giant cell tumor incidence in Sweden to be 1.3 per million per year, while the osteosarcoma incidence was 2.3 per million per year.Conclusions: Early Swedish Cancer Registry data (1958 to 1982) revealed a higher proportion of malignant giant cell tumors than seen in large sequential case series and a distinct age and sex profile compared with more recent data (1983 to 2011). This likely represents changes in the diagnostic workup and introduction of multidisciplinary review of giant-cell-containing tumors around 1982. Recent data may reflect the impact of expert centralized biopsy and multidisciplinary case review and more comprehensive reporting of benign giant cell tumors. [ABSTRACT FROM AUTHOR]

Background: In this era of individualized cancer treatment, data that could be applied to predicting the survival of patients with osteosarcoma are still limited because of the rarity of the disease and the difficulty in accumulating a sufficient number of patients. Therefore, a multi-institutional collaboration was implemented to develop and externally validate nomograms that would predict metastasis-free survival (MFS) and overall survival (OAS) for patients with nonmetastatic osteosarcoma.Methods: This study retrospectively examined 1070 patients treated with neoadjuvant chemotherapy and surgery for nonmetastatic osteosarcoma. Data from Japanese patients (n = 557) were used to develop multivariate nomograms based on Cox regression. Six clinical and pathologic variables were built into nomograms estimating the probability of MFS and OAS 3 and 5 years after diagnosis. The model was internally validated for discrimination and calibration with bootstrap resampling and was externally validated with an independent patient cohort from Korea (n = 513).Results: A patient's age, tumor site, and histologic response were found to have a stronger influence on MFS and OAS in the model than sex, tumor size, or pathologic fracture. The nomograms and calibration plots based on these results well predicted the probability of MFS (concordance index, 0.631) and OAS (concordance index, 0.679). The concordance indices for external validation were 0.682 for MFS and 0.665 for OAS.Conclusions: The nomograms were externally validated and verified to be useful for the prediction of MFS and OAS and for the assessment of the postoperative prognosis. They can be used for counseling patients and for establishing appropriate surveillance strategies after surgery. [ABSTRACT FROM AUTHOR]

Osteoid osteoma is a benign bone tumor, which represents approximately 10% of all benign bone tumors. When localized to the carpus, osteoid osteomas are most often seen in the scaphoid and capitate. Rarely, these tumors can also be observed in the trapezium. Given the infrequency with which osteomas are located in the trapezium and often nonspecific presenting symptoms, diagnosis of this tumor can be challenging and requires a high index of suspicion. [ABSTRACT FROM AUTHOR]

Enchondroma is a type of benign cartilaginous bone tumor. Enchondroma of the spine is very rare. There are only a few cases of enchondromas located in the lamina of the cervical spine have been reported. Therefore, we report a case of enchondroma in the cervical spine. A 24 year old female patient presented with a history of neck pain, restriction of neck movement, pain and numbness along the right scapula, and weakness accompanied by wasting of the right hand. Presumptive diagnoses included bony tumors such as an aneurysmal bone cyst or a giant cell tumor. Radiologic examinations revealed a round tumor in the right lamina of C4 with extracortical extension and foramen of C45. C4 right hemilaminectomy and facetectomy were performed with near complete removal of the tumor. On histological examination, the tumor was confirmed to be an enchondroma. At the 6 month follow up, a computed tomography scan showed no recurrence with good alignment. [ABSTRACT FROM AUTHOR]

Surface primary bone tumors may appear similar to their intramedullary counterpart, but because they are rare, they may pose diagnostic challenges when showing different characteristics compared to their intramedullary counterpart. It is important for radiologists to recognize the imaging findings for various uncommon surface primary bone tumors, which may help to reduce the differential diagnosis or to lead to a specific diagnosis. Radiography is typically used for first-line imaging. If necessary, it is followed by CT or MRI for evaluation and characterization of surface bone tumors. The aim of this article is to review the imaging findings and differential diagnosis for surface primary bone tumors. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 51-year-old nonsmoker Asian woman who experienced pain in her left hip for the past 4 months. It states that the patient complains of appetite loss and chills while her left hip pain affects her usual daily activities. It has been ruled out that the patient has an osteolytic metastasis in the acetabulum after receiving multidisciplinary treatment and gefitinib for her lung cancer.

Context.— Although primary bone tumors are extremely rare, the literature suggests that there are variations in the epidemiologic characteristics in different populations. The most frequently cited epidemiologic characteristics of primary bone tumors are derived from a large US series (Mayo Clinic), with no comparable study thus far performed in China. Objective.— To identify any potential epidemiologic differences between Chinese patients and a US series of patients. Design.— We performed a comparison study between 9200 patients treated at Beijing Ji Shui Tan Hospital (JST) and 10 165 patients treated at Mayo Clinic (MC), Rochester Minnesota. Detailed epidemiologic features were analyzed. Results.— We found that giant cell tumor and osteosarcoma have significantly higher incidences in the JST than the MC patients (P < .001). However, JST patients had a significantly lower incidence of Ewing sarcoma, chordoma, fibrosarcoma, myeloma, and malignant lymphoma (P < .001). For most benign and malignant bone tumors, the Chinese cohort had a more distinct male predominance than the US cohort. Malignant bone tumors had a monomodal age distribution in the JST patient group, with a bimodal age distribution in the MC cohort. Also, there were was a predilection for tumors of the femur and tibia among the JST patients (P < .001). Conclusions.— Our data confirm that epidemiologic variations of primary bone tumors exist in different populations. Factors that may contribute to these observed differences are proposed and discussed. [ABSTRACT FROM AUTHOR]

Objective: To assess if diffusion-weighted MRI (DWI) can differentiate between central enchondromas and chondrosarcomas (CS) and if DWI can distinguish low-grade chondroid lesions from high-grade CS. Materials and methods: Fifty-two patients with central cartilage tumors were included. Patients underwent conventional MRI and DWI with ADC mapping. The slice on MRI with the most aggressive imaging feature was identified. The corresponding mean and minimum ADC maps of the tumor at this position were measured. Results: There were 24 enchondromas, five atypical cartilaginous lesions, 15 grade 1, three grade 2, two grade 3, and three dedifferentiated CS. Mean ADC values (×10 mm/s) for enchondromas, atypical cartilaginous tumors, grade 1 CS, grade 2, CS, grade 3 CS and dedifferentiated CS were 1,896, 2,048, 2,152, 2,170, 2,076, and 1,261, respectively. Minimum ADC values (×10 mm/s) for enchondromas, atypical cartilaginous tumors, grade 1 CS, grade 2, CS, grade 3 CS and dedifferentiated CS were 1,820, 1,752, 2,010, 1,829, 1,752, and 767, respectively. ANOVA test demonstrated a statistically significant difference in mean and minimum ADC values in all groups. Post hoc analysis revealed this was due to difference in mean and minimum ADC values in dedifferentiated CS. The mean ADC value in low-grade chondroid lesions was 2,001, while the ADC value for high-grade CS were 2,132. The minimum ADC value for low-grade chondroid lesions was 1,896, while the minimum ADC for high-grade CS was 1,837. The difference in minimum and mean ADC values was not statistically significant. Conclusions: DWI cannot differentiate between enchondromas and CS and DWI does not aid in the distinction of low-grade chondroid tumors from high-grade CS. [ABSTRACT FROM AUTHOR]

Chordomas are rare malignant bone tumours with a predilection for the axial skeleton, especially the sacrum and skull base. Median survival in patients with metastatic disease is usually dismal. Treatment is challenging due to the propensity for local recurrence, metastatic disease as well as lack of clear consensus regarding the optimal management. Our case report highlights two cases of sacral chordoma with locally recurrent and widespread metastatic disease, stable on molecular targeted therapy. [ABSTRACT FROM AUTHOR]