Identification of Breast Cancer Patients at Risk for Bone Metastasis – A Case–Control Study

Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 15-19| Purnima Thakur, Vishal Verma, Ekta Dogra, Ankur Gupta, Manish Gupta, Vikas Fotedar. DOI: 10.13107/jbst.2019.v05i02.430

Author Purnima Thakur[1], Vishal Verma[2], Ekta Dogra[3], Ankur Gupta[4], Manish Gupta[1], Vikas Fotedar[1]
[1]Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India,
[2]Department of Orthopedics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India,
[3]Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
[4]Department of Anatomy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Address of Correspondence
Dr. Vishal Verma,
Department of Orthopedics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.

Introduction: Prognostic factors for metastatic breast carcinoma are a less studied topic than a prognostic factor for primary breast cancer. Bone is the most frequent site for metastasis in breast cancer patients. Bone metastasis decreases the survival and impacts the quality of life(QoL)in breast cancer patients. Therefore, the study to identify prognostic factors of this specific group of patients appears to be worthy of more detailed study. To the best of our knowledge, this is the first study of its kind in the North Indian population.
Materials and Methods: A retrospective case–control study was conducted at a tertiary cancer centerin Northern India between January 2011 and December 2015. All patients’ clinical and demographic data were obtained from the medical record of the institute. The incidence and distribution of bone metastases from breast cancer were evaluated, and the correlation between diverse clinical-pathological parameters and bone metastases were analyzed in this study.
Results: A total of 363 patients were recruited, including 94 cases with bone metastases and 269 controls without bone metastases at presentation. Positive axillary lymph node status, higher stage tumors, HER2 neu-negative disease, and histological subtypes of tumor were found significant prognostic factors in univariate analysis associated with higher rates of bone metastasis. Luminal A(estrogen receptor-positive [ER+], progesterone receptor-positive [PR+], HER2–ve, Grade 1,2), and HER 2 enriched (ER –ve, PR–ve, and HER 2+) molecular subtypes are associated with increased risk of bone metastasis. None of the risk factors studied were significantly associated with bonemetastasis in binary logistic regression analysis.
Conclusion: Identification of breast cancer patients at risk for bone metastasis may aid in the prevention, prediction, detection, and early treatment of these lesions, thus providing improved survival and better QoL.
Keywords: Bone metastasis, risk factors, breast cancer.

1. Liede A, Jerzak KJ, Hernandez RK, Wade SW, Sun P, Narod SA, et al. The incidence of bone metastasis after early-stage breast cancer in Canada. Breast Cancer Res Treat 2016;156:587-95.
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20. Yazdani A, Dorri S, Atashi A, Shirafkan H, Zabolinezhad H. Bone metastasis prognostic factors in breast cancer. Breast Cancer (Auckl) 2019;13:1178223419830978.

Dr. Purnima Thakur Dr. Vishal Verma Dr. Ekta Dogra Dr. Ankur Gupta Dr. Manish Gupta Dr. Vikas Fotedar


How to Cite this article: Thakur P, Verma V, Dogra E, Gupta A, Gupta M, Fotedar V. Identification of Breast Cancer Patients at Risk for Bone Metastasis – A Case–Control Study. Journal of Bone and Soft Tissue Tumors May-August 2019;5(2): 15-19.

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Quality of Life and Functional Outcome of Patients Treated with Revision Limb Salvage Surgery and Amputation: A Cross-Sectional Study

Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 11-14| M S Satish, Srinivasan Vijay, Anand Raja, Surendran Veeraiah. DOI: 10.13107/jbst.2019.v05i02.428

Author M S Satish[1], Srinivasan Vijay[1], Anand Raja[2], Surendran Veeraiah[3]
[1]Department of Physiotherapist, Cancer Institute (WIA), Chennai, Tamil Nadu, India,
[2]Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India,
[3]Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.

Address of Correspondence
Dr. M S Satish,
Department of Physiotherapist, Cancer Institute(WIA), Adyar, Chennai, Tamil Nadu, India.

Context: Despite the advances in surgical treatments and chemotherapy, obtaining an optimal outcome in the treatment of musculoskeletal tumors or sarcomas is still quite challenging. This can be managed by improving various factors such as survival and recurrence rate, longevity of the prosthesis, functional outcome, and quality of life (QOL) of patients. However, not much attention has been given to this issue in India.
Aims: The aim of the study was to examine the QOL and functional outcome of musculoskeletal cancer patients who were treated with revision limb salvage surgery (LSS) and those who underwent above-knee (AK) amputation followed by rehabilitation with Akprosthesis.
Settings and Design: A cross-sectional study was carried out between May 2015 and April 2016 at Physiotherapy Out patient Department of Cancer Institute, Chennai.
Materials and Methods: Thirty-two patients aged between 15and 60 years, treated with revision LSS (n=15) and those rehabilitated with prosthesis after AK amputation (n=17)were assessed for QOL and functional outcome. Cancer Institute QOL questionnaire was used to assess QOL and Musculoskeletal Tumor Society score was used to find the functional outcome of these patients.
Statistical analysis: Descriptive statistics, student’s t-test, and Chi-square test were used to analyze the data using SPSS version 13.
Results: The revision LSS patients were found to have a better functional outcome as well as QOL than the amputees. Yet another aspect of QOL, namely, fear of recurrence was much lesser among AK amputees than revision LSS patients.
Conclusions: The findings of this study imply that revision LSS has higher advantages in terms of functional outcome and QOL of patients compared to amputation, though patients treated with revision LSS were found to have increased fear of recurrence and pain than the amputees.
Keywords: Revision limb salvage surgery, quality of life, functional outcome, amputation, musculoskeletal tumor.

1. Chauhan A, Joshi GR, Chopra BK, Ganguly M, Reddy GR. Limb salvage surgery in bone tumors: A retrospective study of 50 cases in a single center. Indian J Surg Oncol 2013;4:248-54.
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3. Reddy KI, Wafa H, Gaston CL, Grimer RJ, Abudu AT, Jeys LM, et al. Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins? Bone Joint J 2015;97-B:115-20.
4. Yoshida Y, Osaka S, Kojima T, Taniguchi M, Osaka E, Tokuhashi Y, et al. Revision of tumor prosthesis of the knee joint. Eur J Orthop Surg Traumatol2012;22:387-94.
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6. Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up. Arch Phys Med Rehabil2009;90:634-45.
7. Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: A comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer 2010;54:990-9.
8. Aksnes LH, Bauer HC, Jebsen NL, Follerås G, Allert C, Haugen GS, et al. Limb-sparing surgery preserves more function than amputation: A Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br 2008;90:786-94.
9. Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer 2004;91:1012-4.
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13. Vidhubala E, Kannan RR, Mani SC, Karthikesh K, Muthuvel R, Surendran V, et al. Validation of quality of life questionnaire for patients with cancer Indian scenario. Indian J Cancer 2005;42:138-44.
14. Eiser C, Darlington AS, Stride CB, Grimer R. Quality of life implications as a consequence of surgery: Limb salvage, primary and secondary amputation. Sarcoma 2001;5:189-95.
15. Ruggieri P, Mavrogenis AF, Mercuri M. Quality of life following limb-salvage surgery for bone sarcomas. Expert Rev Pharmacoecon Outcomes Res 2011;11:59-73.
16. Mason GE, Aung L, Gall S, Meyers PA, Butler R, Krüg S, et al. Quality of life following amputation or limb preservation in patients with lower extremity bone sarcoma. Front Oncol 2013;3:210.
17. Hopyan S, Tan JW, Graham HK, Torode IP. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J PediatrOrthop2006;26:405-8.
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19. Malek F, Somerson JS, Mitchel S, Williams RP. Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? Clin OrthopRelat Res 2012;470:2000-6.
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22. Bekkering WP, Vliet Vlieland TP, Koopman HM, Schaap GR, Bart Schreuder HW, Beishuizen A, et al. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol 2011;103:276-82.
23. Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 1994;76:649-56.


Dr. M S Satish Dr. Srinivasan Vijay Dr. Anand Raja Dr. Surendran Veeraiah


How to Cite this article: Satish M S, Vijay S, Raja A, Surendran V. Quality of Life and Functional Outcome of Patients Treated with Revision Limb Salvage Surgery and Amputation: A Cross-Sectional Study. Journal of Bone and Soft Tissue Tumors May-August 2019;5(2): 11-14. 

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Heterotopic Ossification Circumferentia Articularis (HOCA) of Hip Joint: A Case Series and Review of the Literature

Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 8-10| R Vaishya, A Goel, A K Agarwal, A Vaish. DOI: 10.13107/jbst.2019.v05i02.426

R Vaishya[1], A Goel[1], A K Agarwal[1], A Vaish[1]

[1]Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.

Address of Correspondence
Dr. Amit Kumar Agarwal,
Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi – 110 076,India.

Introduction: Heterotopic ossification (HO) is often described as the mature, lamellar bone formed in a non-osseous tissue. This new bone formation usually occurs between muscle planes or between muscle and joint capsule. When it surrounds a joint circumferentially, it is known as (HO) Heterotopic Ossification circumferentia articular is circumferential articularis (HOCA). HOCA of the knee has been described earlier in the literature, but this term has never been described for the hip joint in the literature.
Case Presentation: We present a case series of two such patients having HOCA of hip joints. In both the cases, there was a history of brain injury and prolonged intubation, which seems the most likely predisposing factors in the causation of HOCA in these hips.
Conclusion: We believe that in our patient, the responsible factors for the causation of HOCA could be myriad of factors such as prolonged intensive care unit (ICU) stay with mechanical ventilation and hypoxia, long-standing immobilization, and hypomobility with incomplete flaccid paralysis. The surgical excision is quite challenging, extensive and is not advisable in most cases, and they respond symptomatically to conservative methods including analgesics, bisphosphonates, physiotherapy, and radiation.
Keywords: Heterotopic ossification circumferentia articularis, hip joint, neurological injury,

1. Damanski M. Heterotopic ossification in paraplegia. J Bone Joint Surg Br 1961;43:286-99.
2. Roberts P. Heterotopic ossification complicating paralysis of intracranial origin. J Bone Joint Surg Br 1968;50-B:70-7.
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4. Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res 1991;263:13-29.
5. Sakellariou VI, Grigoriou E, Mavrogenis AF, Soucacos PN, Papagelopoulos PJ. Heterotopic ossification following traumatic brain injury and spinal cord injury: Insight into the etiology and pathophysiology. J Musculoskelet Neuronal Interact 2012;12:230-40.
6. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973;55:1629-32.
7. Pape HC, Marsh S, Morley JR, Krettek C, Giannoudis PV. Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br 2004;86:783-7.
8. Dejerne A, Ceiller A. Para-osteo-arthropathies des paraplegiques par lesion medullaire: Etude clinique et radiographique. Ann Med1918;5:497.
9. Bushinsky DA. Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. Am J Physiol 1996;271:F216-22.
10. Singer BR. Heterotopic ossification. Br J Hosp Med 1993;49:247-51, 254-5.
11. Vaishya R, Agarwal AK, Vijay V, Vaish A. Heterotopic ossification circumferentia articularis (HOCA) of both knee joints after guillain-barré syndrome. Cureus 2016;8:e480.
12. Melamed E, Robinson D, Halperin N, Wallach N, Keren O, Groswasser Z, et al. Brain injury-related heterotopic bone formation: Treatment strategy and results. Am J Phys Med Rehabil 2002;81:670-4.
13. Spielman G, Gennarelli TA, Rogers CR. Disodium etidronate: Its role in preventing heterotopic ossification in severe head injury. Arch Phys Med Rehabil 1983;64:539-42.
14. Banovac K, Williams JM, Patrick LD, Haniff YM. Prevention of heterotopic ossification after spinal cord injury with indomethacin. Spinal Cord 2001;39:370-4.
15. Sautter-Bihl ML, Liebermeister E, Nanassy A. Radiotherapy as a local treatment option for heterotopic ossifications in patients with spinal cord injury. Spinal Cord 2000;38:33-6.

Dr. R Vaishya Dr. A Goel Dr. A K agarwal Dr. A Vaish


How to Cite this article: Vaishya R, Goel A, Agarwal AK, Vaish A. Heterotopic Ossification Circumferentia Articularis of Hip Joint: A Case Series and Review of the Literature. Journal of Bone and Soft Tissue Tumors May-August 2019;5(2): 8-10.

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A Giant Parosteal Lipoma with Exostosis of the Right Proximal Humerus

Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 4-7| Abdaud Rasyid, Mujaddid Idulhaq, Pamudji Utomo, Ambar Mudigdo, Handry Tri Handojo. DOI: 10.13107/jbst.2019.v05i02.424

Author Abdaud Rasyid[1],[2], Mujaddid Idulhaq[1],[2], Pamudji Utomo[1],[2], Ambar Mudigdo[3], Handry Tri Handojo[4]

[1]Department of Orthopaedic and Traumatology, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia,
[2]Department of Orthopaedic and Traumatology, Prof. DR. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia,
[3]Department of Anatomical Pathology, Sebelas Maret University, Surakarta, Indonesia,
[4]Department of Radiology, at Prof. DR. R. Soeharso Orthopaedic, Hospital, Surakarta, Indonesia.

Address of Correspondence
Dr. Abdaud Rasyid,
Jalan Ahmad Yani, Pabelan, Kartasura, Sukoharjo, Jawa Tengah, 57162, Indonesia.

Introduction: Lipomas are the most frequent benign soft-tissue tumors. Soft -tissue lipomas are categorized by anatomic location as either superficial (subcutaneous) or deep (intermuscular). Deep lipomas can be located in any part of the body, including the superior extremities. Lipomas typically reach a diameter of several centimeters and are localized in a single anatomical region. Parosteal lipoma is a rare subtype of deep lipoma that has a broad attachment to the underlying periosteum that forms an exostoses-like bone prominence. There has been no reliable literature; about two pathological processes occur in one extremity at the same time.
Case Presentation: A 49-years -old female presented at our institution with a painless, slow -growing lump in her right shoulder region since for 2 years ago, with no other symptoms, and no history of trauma. A palpable non-tender mobile mass was present on the right shoulder region. Plain radiographs showed a well-delineated ovoid radiolucent lesion and a radiopaque lesion over the right proximal humerus. The fine -needle biopsy result suggested a liposarcoma. Wide-excision surgery was performed for both the masses. On contrary, the histological examination of the specimen confirmed a giant lipoma with pieces of adult bone tissues.
Conclusion: Deep-seated lipomas are most commonly discovered in men between the ages of thirties 30s and sixties60s. In our patient, the lipoma also accompanied with an exostoses-like cartilaginous mass over the proximal humerus as in parosteal lipoma. Plain radiographs study of parosteal lipoma is associated with a false osteochondroma appearance, which also found in this patient. Histological examination suggested a giant lipoma for this patient, but the possibility of two pathological processes is still in question.
Keywords: Giant lipoma, shoulder, exostosis, surgery.

1. Slavchev S, Georgiev PP, Penkov M. Giant lipoma extending between the heads of biceps brachii muscle and the deltoid muscle: Case report. J Curr Surg 2012;2:146-8.
2. Stevenson J, Parry M. Tumours. In: Apley and Solomon’s System of Orthopaedics and Trauma, 10th ed. Vol. 9. Ch. 9. Florida: CRC Press; 2018. p. 223-4.
3. Singh V, Kumar V, Singh AK. Case report: A rare presentation of giant palmar lipoma. Int J Surg Case Rep 2016;26:21-3.
4. Elbardouni A, Kharmaz M, Salah Berrada M, Mahfoud M, Elyaacoubi M. Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases. Orthop Traumatol Surg Res 2011;97:152-8.

How to Cite this article: Rasyid A, Idulhaq M, Utomo P, Mudigdo A, Handojo H T. A Giant Parosteal Lipoma with Exostosis of the Right Proximal Humerus. Journal of Bone and Soft Tissue Tumors May-August 2019;5(2): 4-7.

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Sternal Mass with Respiratory Compromise in a 10-year-old Child

Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 2-3| Ranjit K Sahu, Alok K Sharma, Surendra Patel, Prakash Kala, Amit Goyal, Sourabha K Patro. DOI: 10.13107/jbst.2019.v05i02.422

Author: Ranjit K Sahu[1], Alok K Sharma[2], Surendra Patel[2], Prakash Kala[1], Amit Goyal[3], Sourabha K Patro[3]

[1]Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,
[2]Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,
[3]Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.

Address of Correspondence
Dr. Sourabha Kumar Patro,
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur – 342 005, Rajasthan, India.

Context: Enlarging sternal masses are critical to manage due to proximity of various vital structures nearby. Association of respiratory compromise or vascular compression still worsens the issue. We here present a case of multiple enchondromas primarily affecting the ribs and upper part of sternum and presented as a swelling in upper chest and lower neck with a history of compressive respiratory compromise. The child was later taken for shaving off of the lesion for relieving the respiratory compromise. Absence of the swelling was a definite cosmetic outcome for the child and the parents; however, relieve of respiratory compromise was a worthy addressed need.
Keywords: Enchondroma, multiple enchondroma, Ollier’s disease, giant sternal mass, sternal mass with respiratory compromise.

1. Demetriou GA, Marcou M, Demetriou A, Kyriakides C. A fast growing sternal mass. BMJ case Rep 2013;2013:bcr2013008673.
2. Sunny G, Hoisala VR, Cicilet S, Sadashiva S. Multiple enchondromatosis: Olliers disease-a case report. J Clin Diagn Res 2016;10:1-2.
3. Pansuriya TC, Kroon HM, Bovee JV. Enchondromatosis: Insights on the different subtypes. Int J Clin Exp Pathol 2010;3:557-69.
4. Wee HE, Akbar FA, Rajapaksha K, Aneez DB. Anterior chest wall resection and reconstruction for locally advanced breast cancer. Multimed Man Cardiothorac Surg. 2015 Sep 11;287(6)
5. Chen C, Huang X, Chen M, Yu F, Yin B, Yuan Y. Surgical management of a giant sternal chondromyxoid fibroma: a case report. Journal of cardiothoracic surgery. 2015 Dec;10(1):178.

How to Cite this article: Sahu R K, Sharma A K, Patel S, Kala P, Goyal A, Patro S K. Sternal Mass with Respiratory Compromise in a 10-year-old Child. Journal of Bone and Soft Tissue Tumors May-August 2019;5(2): 2-3.

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