Aneurysmal Bone Cyst – Review

Original Article | Volume 6 | Issue 1 | JBST Jan-April 2020 | Page 17-20| DOI: 10.13107/jbst.2020.v06i01.009

Author: Nitin Shetty[1], Prateek Hegde[2], Hemant Singh[3], Ashish Gulia[4]

[1]Department of Radio-Diagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
[2]Department of Surgical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.

Address of Correspondence
Dr. Ashish Gulia
Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai – 400 012, India.
E- mail: aashishgulia@gmail.com

Abstract
Background: Aneurysmal bone cyst (ABC) is a rare, benign, expansile lesion that produces blood-filled cavities inside the bone. The term, ‘Aneurysmal bone cyst’ was first time used by Jaffe and Lichtenstein in 1942 [1]. The name is a misnomer, as they are neither aneurysmal nor are, they truly cystic, as these lesions do not have an endothelial lined cyst wall. ABC is a disease of childhood or young adulthood with a median age of 13 years, with an incidence of 0.14 per 105 individuals with slight female preponderance [2].
Pathophysiology: ABC usually present as a solitary lesion either as a primary neoplasm (translocation driven) or a secondary lesion arising adjacent to previous bony lesions like giant cell tumours (GCT), osteoblastomas, chondroblastomas [3]. Few authors have proposed post traumatic hypothesis whereas others feel it could due to an hemodynamic disturbance especially venous impedance.
Primary ABCs: Primary ABC is one where it occurs in a bone without any previously known lesion. But now there has been identification of TRE17 also known as USP6 (ubiquitin-specific protease 6) gene on chromosome 17p13.Pathogenesis of some primary ABC involves transcriptional up-regulation of USP6 when there is the chromosomal translocation t(16;17)(q22;p13) which fuses the promoter region of the osteoblast cadherin 11 gene (CDH11) on chromosome 16q22 to the entire coding sequence of the ubiquitin protease USP6 gene on chromosome 17p13 [4].
Secondary ABCs: Approximately one third of the ABCs appear secondary to other pre-existing bone tumours, most commonly from GCT, which accounts for 19-39% of these cases [5]. Other common precursor lesions are chondroblastomas, chondromyxoid fibroma, fibrous dysplasia, osteoblastomas, haemangioendothelioma, angioma, fibroxanthoma (nonossifying fibroma), solitary bone cyst, fibrous histiocytoma, eosinophilic granuloma, radiation osteitis, osteosarcoma, trauma (including fracture), fibrosarcoma and even metastatic carcinoma [3, 5].
ABCs have been likened to a “blood-filled sponge”, composed of blood-filled, anastomosing, cavernomatous spaces, separated by a cyst like wall composed of fibroblasts, myofibroblasts, osteoclast like giant cells, osteoid and woven bone.
In approximately one third of cases, a characteristic reticulated lacy chondroid like material, described as a calcified matrix with a chondroid aura, is seen [6]. These are called as “solid aneurysmal bone cyst”. The term “solid aneurysmal bone cyst,” was coined by Sanerkin et al. in 1983 [7].

References

1. Jaffe HL, Lichtenstein L. Solitary Unicameral Bone Cyst: with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg. 1942;44(6):1004–1025.
2. Leithner A, Windhager R, Lang S, Haas O, Kainberger F, Kotz R. Aneurysmal bone cyst. A population based epidemiologic study and literature review. Clin Orthop 1999; 363:176–179.
3. Bonakdarpour A, Levy WM, Aegerter E. Primary and secondary aneurysmal bone cyst: A radiological study of 75 cases. Radiology. 1978;126(1):75–83.
4. Oliveira AM, Hsi BL, Weremowicz S, Rosenberg AE, Dal Cin P, Joseph N, et al. USP6 (Tre2) fusion oncogenes in aneurysmal bone cyst. Cancer Res. 2004;64:1920–1923.
5. Kransdorf M J and Sweet D E.Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. American Journal of Roentgenology. 1995;164:573-580.
6. Mirra JM. Bonetumors: clinical, radiological and pathologic correlations. Philadelphia: Lea & Fefiger; 1989:1233–1334.
7. Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoblastic, aneurysmal and fibromyxoid elements: “solid” variant of aneurysmal bone cyst. Cancer. 1983;51:2278 –2286.
8. Capanna R, Bettelli G, Biagini R, Ruggieri P, Bertoni F, Campanacci M. Aneurysmal cysts of long bones. Ital J Orthop Traumatol. 1985;11:409–417.
9. Dabska M, Buraczewski J. Aneurysmal bone cyst: Pathology, clinical course and radiologic appearances. Cancer. 1969;23(2):371-389.
10. Mahnken AH, Nolte-Ernsting CC, Wildberger JE, Heussen N, Adam G, Wirtz DC, et al. Aneurysmal bone cyst: Value of MR imaging and conventional radiography. Eur Radiol. 2003;13(5):1118-1124.
11. Rapp TB, Ward JP, Alaia MJ. Aneurysmal bone cyst. J Am Acad Orthop Surg. 2012;20(4):233–241.
12. Kumar V, Abbas AK, Aster JC. Robbins and Cotran pathologic basis of disease. Philadelphia: Elsevier Saunders; 2015.
13. Murphey MD, wan Jaovisidha S, Temple HT, Gannon FH, Jelinek JS, Malawer MM. Telangiectatic osteosarcoma: radiologic-pathologic comparison. Radiology.2003;229(2):545–553.
14. Wallace MT, Henshaw RM. Results of cement versus bone graft reconstruction after intralesional curettage of bone tumors in the skeletally immature patient. J Pediatr Orthop. 2014;34(1):92–100.
15. Reddy KIA, Sinnaeve F, Gaston CL, Grimer RJ, Carter SR.Aneurysmal bone cysts: do simple treatments work? Clin OrthopRelat Res. 2014;472(6):1901–1910.
16. Steffner RJ, Liao C, Stacy G, Atanda A, Attar S, Avedian R, et al. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am. 2011;93(21):1221–1229.
17. Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9(4):435-444.
18. Vergel De Dios AM, Bond JR, Shives TC, McLeod RA, Unni KK. Aneurysmal bonecyst. A clinicopathologic study of 238 cases. Cancer. 1992;69:2921–2931.
19. Flont P, Kolacinska-Flont M, Niedzielski K. A comparison of cyst wall curettage and en bloc excision in the treatment of aneurysmal bone cysts. World J Surg Oncol.2013;11:109.
20. Elsayad K, Kriz J, Seegenschmiedt H, Imhoff D, Heyd R, Eich HT, et al.Radiotherapy for aneurysmal bone cysts: a rare indication. Strahlenther Onkol.2017;193(4):332-340.
21. Batisse F, Schmitt A, Vendeuvre T, Herbreteau D, Bonnard C. Aneurysmal bone cyst: A 19-case series managed by percutaneous sclerotherapy. Orthop Traumatol Surg Res.2016;102(2):213-216.
22. Varshney MK, Rastogi S, KhanSA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res. 2010;468(6):1649-1659.
23. Falappa P, Fassari FM, Fanelli A, Genovese E, Ascani E, Crostelli M, et al. Aneurysmal bone cysts: treatment with direct percutaneous Ethibloc injection: long-term results. Cardiovasc Intervent Radiol.2002;25(4):282–290.
24. Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up.J Bone Joint Surg Br. 2006;88(9):1212–1216.
25. Puri A, Hegde P, Gulia A, Mishil P. (in press). Primary aneurysmal bone cysts – Is percutaneous sclerosant therapy effective? The Bone & Joint Journal.
26. Gupta P, Gamanagatti S. Preoperative transarterial Embolisation in bone tumors. World J Radiol.2012;4(5):186-192.
27. Lange T, Stehling C, Fröhlich B, Klingenhöfer M, Kunkel P, Schneppenheim R, et al. Denosumab: a potential new and innovative treatment option for aneurysmal bone cysts. Eur Spine J.2013;22(6):1417–1422.
28. Brastianos P, Gokaslan Z, McCarthy EF. Aneurysmal bone cysts of the sacrum: a report of ten cases and review of the literature. Iowa Orthop J.2009;29:74–78.
29. Papagelopoulos PJ, Choudhury SN, Frassica FJ, Bond JR, Unni KK, Sim FH. Treatment of aneurysmal bone cysts of the pelvis and sacrum. J Bone Joint Surg Am.2001;83(11):1674–1681.
30. Terzi S, Gasbarrini A, Fuiano M, Barbanti Brodano G, Ghermandi R, Bandiera S, et al. Efficacy and safety of selective arterial embolization in the treatment of aneurysmal bone cyst of the mobile spine: A retrospective observational study. Spine (Phila Pa 1976).2017;42(15):1130-1138.
31. Rossi G, Rimondi E, Batalena T, Gerardi A, Alberghini M, Staals EL,et al. Selective arterial embolization of 36 aneurysmal bone cysts of the skeleton with N-2-butyl cyanoacrylate. Skeletal Radiol.2010;39(2):161–167.
32. Amendola L, Simonetti L, Simoes CE, Bandiera S, De Iure F, Boriani S. Aneurysmal bone cyst of the mobile spine: the therapeutic role of embolization. Eur Spine J. 2013; 22(3):533-541.
33. Donati D, Frisoni T, Dozza B, DeGroot H, Albisinni U, Giannini S. Advance in the treatment of aneurysmal bone cyst of the sacrum. Skeletal Radiol.2011;40(11):1461-1466.
34. Elsayad K, Kriz J, Seegenschmiedt H, Imhoff D, Heyd R, Eich HT, et al.Radiotherapy for aneurysmal bone cysts: a rare indication. Strahlenther Onkol.2017;193(4):332-340.
35. Duivenvoorden WC, Hirte HW, Singh G. Use of tetracycline as an inhibitor of matrix metalloproteinase activity secreted by human bone-metastasizing cancer cells. Invasion Metastasis. 1997;17(6):312–322.
36. Neville-Webbe HL, Holen I, Coleman RE. The anti-tumour activity of bisphosphonates. Cancer Treat Rev.2002;28(6):305–319.
37. Yamagishi T, Kawashima H, Ogose A, Ariizumi T, Sasaki T, Hatano H, et al. Receptor-Activator of Nuclear KappaB Ligand Expression as a New Therapeutic Target in Primary Bone Tumors. PLoS One.2016;11(5):e0154680.

How to Cite this article: Shetty N, Hegde P, Singh H, Gulia A. Aneurysmal Bone Cyst – Review. Journal of Bone and Soft Tissue Tumors January-April 2020;6(1): 17-20.

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Editorial IMSOS Issue January – April 2020

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 21 | DOI: 10.13107/jbst.2020.v06i01.010

Author: Dr. Yogesh Panchwagh[1] , Dr. Ashish Gulia[2] & Dr. Ashok Shyam[3, 4]

1. Orthopaedic Oncology Clinic, Pune, India,
2. Orthopedic Oncology Services, Department of Surgical Oncology,
Tata Memorial Hospital, Mumbai,
3. Indian Orthopaedic Research Group, Thane, India,
4. Sancheti Institute for Orthopaedics &Rehabilitation, Pune, India.

Address of Correspondence:
Dr. Yogesh Panchwagh.
Orthopaedic Oncology Clinic, 101, Vasant plot 29, Bharat Kunj
Society -2, Erandwana, Pune – 38, India.
Email: drpanchwagh@gmail.com

We are pleased to bring you the IMSOS issue for 2020. JBST is the official publication of the Indian musculoskeletal oncology society (IMSOS). This is the second consecutive year that we are publishing a special IMSOS issue, which typically coincides with the IMSOS annual conference in early March.

Since the last year, JBST editorial board has 2 IMSOS life members selected as IMSOS representatives. Dr. Akshay Tiwari and Dr. Dominic Putthoor are the current IMSOS representatives on the JBST editorial board. Both have a vast experience of treating bone and soft tissue tumors and bring along considerable credibility to the work published in the issue.

IMSOS annual conference this year is being held at Bengaluru. The organising secretary Dr. Suman Byregowda and his team have put up an exceptional scientific program. The current IMSOS issue being released online to coincide with the annual conference promises to add to the academic value that IMSOS had aimed at. The conference is being held on the background of the Covid 19 scare that is looking to grip India. Hopefully the great academic content, warm hospitality and gracious hosts will not let the scare dampen the fervor and camaraderie.

JBST wishes IMSOS 2020 the very best.

How to Cite this article: Panchwagh Y, Gulia A, Shyam A. Editorial IMSOS Issue January – April 2020. Journal of Bone and Soft Tissue Tumors January-April 2020; 6(1):1.

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Facilitating Timely Access to Highly Specialized Surgery for Children with Extremity Bone and Soft-Tissue Sarcomas in North and Central India

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 2-4 | DOI: 10.13107/jbst.2020.v06i01.005

Author: Rashmi Kumari [1], Akshay Tiwari [2], Ishita Maji [1], Haresh Gupta [1], Poonam Bagai [1], Mohini
Daljeet Singh [3], Ramandeep Singh Arora [1]

1. Quality Care, Research and Impact Division, Cankids…Kidscan, New Delhi, India,
2. Max Institute of Cancer Care, , Max Super Speciality Hospital, Saket, Delhi, India,
3. Founder CEO, Max India Foundation, Delhi, India.

Address of Correspondence
Dr. Ramandeep Singh Arora,
Department of Musculoskeletal Oncology, Max Institute of Cancer Care, Max Super
Speciality Hospital, Saket, New Delhi – 110 017, India.
E-mail: childhoodcancer@gmail.com

Abstract

Background: Optimal management of bone and soft-tissue sarcomas (BSTSs) of the extremity in low- and middle-income countries like India remains a challenge due to the paucity of surgical expertise and other resource limitations. In this study, we aimed to develop a multiple stakeholder model where children with extremity BSTS in North and Central India can access specialized surgery without experiencing cost and delays.
Materials and Methods: The model brought together four stakeholders and developed a pathway of identifying eligible patients, facilitating timely referral, providing specialized surgery, and sharing the cost. Services were offered for 1 year (2018–2019) under this model.
Results: Sixteen non-metastatic patients (69% osteosarcoma, 18% soft-tissue sarcoma, and 13% Ewing sarcoma) from five hospitals received specialized extremity BSTS surgery under this model. About 69% had limb salvage surgeries, 19% rotationplasty, and 12% amputation. Surgery was done at a median interval of 16.9 weeks (range 7.3–33.6 weeks) from the date of diagnosis. None of the patients abandoned treatment. The total cost for the facilitation of the surgery, supportive care and social support for the entire cohort was INR 38.7 lakh (USD 54,180) with
an average of INR 2.8 lakh per patient (USD 3920). The patient had to bear no cost toward the surgery.
Conclusions: In this study, we developed a model systematically bringing together four stakeholders and identifying eligible patients, facilitating timely referral, providing specialized surgery at zero cost to the patient, and ensuring completion of treatment and follow-up. Our next goal is to increase the capacity of this model by amplifying its scope and replicating it in other parts of India.
Keywords: Child, Health services accessibility, India, Sarcoma.

References
1. AroraRS. Epidemiology of cancers in children. In: GuptaP, MenonPS, RamjiA, LodhaR, editors. PG Textbook of Pediatric. 2015. p. 2416-20.
2. AroraRS, AlstonRD, EdenTO, GeraciM, BirchJM. The contrasting ageincidence patterns of bone tumours in teenagers and young adults: Implications for aetiology.Int J Cancer2012;131:1678-85.
3. McDowellHP. Update on childhood rhabdomyosarcoma.Arch Dis Child2003;88:354-7.
4. SmithMA, SeibelNL, AltekruseSF, RiesLA, MelbertDL, O’LearyM, et al. Outcomes for children and adolescents with cancer: Challenges for the twenty-first century.J Clin Oncol2010;28:2625-34.
5. SiddiquiYS, SherwaniMK, KhanAQ, ZahidM, AbbasM, AsifN. Neglected orthopedic oncology-causes, epidemiology and challenges for management in developing countries.Indian J Cancer2015;52:325-9.
6. HasanO, ZubairiA, NawazZ, UmerM. Establishing musculoskeletal oncology service in resource constrained country: Challenges and solutions.Int J Surg Oncol (N Y)2017;2:e50.
7. GoodladJR, FletcherCD, SmithMA. Surgical resection of primary softtissue sarcoma. Incidence of residual tumour in 95 patients needing reexcision after local resection.J Bone Joint Surg Br1996;78:658-61.
8. FriedrichP, OrtizR, StraitK, FuentesS, GamboaY, ArambúI, et al. Pediatric sarcoma in Central America: Outcomes, challenges, and plans for improvement.Cancer2013;119:871-9.
9. FriedrichP, OrtizR, FuentesS, GamboaY, AhChu-Sanchez MS, ArambúIC, et al. Barriers to effective treatment of pediatric solid tumors in middle-income countries: Can we make sense of the spectrum of nonbiologic factors that influence outcomes?Cancer2014;120:112-25.
10. PapyanR, TamamyanG, DanielyanS, TananyanA, MuradyanA, SaabR. Identifying barriers to treatment of childhood rhabdomyosarcoma in resource-limited settings: A literature review.Pediatr Blood Cancer 2019;66:e27708. 11. HowardSC, PedrosaM, LinsM, PedrosaA, PuiCH, RibeiroRC, et al. Establishment of a pediatric oncology program and outcomes of childhood a c u t e l y m p h o b l a s t i c l e u k e m i a i n a r e s o u r c e – p o o r area.JAMA2004;291:2471-5.
12. MostertS, SitaresmiMN, GundyCM, JanesV, Sutaryo, VeermanAJ. Comparing childhood leukaemia treatment before and after the introduction of a parental education programme in Indonesia.Arch Dis Child2010;95:20-5.
13. IsraelsT, PaintsilV, NyirendaD, KouyaF, MbahAfungchwi G, HesselingP, et al. Improved outcome at end of treatment in the c o l l a b o r a t i v e w i l m s t u m o u r A f r i c a p r o j e c t . P e d i a t r B l o o d Cancer2018;65:e26945.

 

How to Cite this article: Kumari R, Tiwari A, Maji I, Gupta H, Bagai P, Singh MD, Arora RS | Facilitating Timely Access to Highly Specialized Surgery for Children with Extremity Bone and Soft-Tissue Sarcomas in North and Central India | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 2-4.

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An Interesting Reconstruction Option after Resection for a Distal Fibular Osteosarcoma: A Case Report

Case Report | Volume 6 | Issue 1 | JBST  Jan-April 2020 | Page 13-16 | DOI: 10.13107/jbst.2020.v06i01.008

Author:  Manish Pruthi [1], Jagandeep Singh Virk [2], Lokesh Garg [1], Sumit Goyal [4], Anila Sharma [3]

1. Department of Orthopaedic Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi,Delhi, India,
2. Department of Orthopaedic Oncology, Paras Hospitals, Panchkula,Haryana, India,
3. Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India,
4. Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi,India

Address of Correspondence
Dr. Jagandeep Singh Virk,
Department of Orthopaedic Oncology, Paras Hospitals, Panchkula,Haryana, India.
E-mail: jaganvirk_09@yahoo.co.in

Abstract

Fibula is an expandable bone in the body, but tumors arising from the distal part which require a wide resection of the distal fibular part require some form of reconstruction for preventing lateral ankle instability. Many methods involving either bony or soft tissue reconstruction techniques have been described in literature, but consensus regarding which one is optimal for a good oncological and functional outcome is lacking. In this case report, we make use of a biological soft tissue technique involving use of peroneus brevis autograft reconstruction for providing lateral ankle support for a patient suffering from distal fibular osteosarcoma who underwent resection of the distal fibula. The patient went on to have an excellent functional outcome. This technique, although reported in literature, is in the form of only a few cases with a limited follow-up with none reported from the Indian subcontinent.
Keywords: Fibula, Sarcomas, Limb salvage, Reconstruction.

References

1. UnniKK. Dahlin’s Bone Tumors: General Aspects and Data on 11087 Case. 5th ed. Philadelphia, PA: Lippincott-Raven; 1996. p. 1-9.
2. PerisanoC, MarzettiE, SpinelliMS, GraciC, FabbricianiC, MaffulliN, et al.Clinical management and surgical treatment of distal fibular tumours: A case series and review of the literature.Int Orthop2012;36:1907-13.
3. SchneiderbauerMM, GullerudR, HarmsenWS, ScullySP. Fibular osteosarcomas: Contaminated margins may not impact survival.Clin OrthopRelat Res2007;456:182-7.
4. LaitinenM, HardesJ, AhrensH, GebertC, LeidingerB, LangerM, et al. Treatment of primary malignant bone tumours of the distal tibia.Int Orthop2005;29:255-9.
5. DieckmannR, AhrensH, StreitbürgerA, BudnyTB, HenrichsMP, ViethV, et al.Reconstruction after wide resection of the entire distal fibula in malignant bone tumours.Int Orthop2011;35:87-92.
6. MonsonDK, VojdaniS, DeanTJ, Louis-UgboJ. Lateral ankle stabilization after distal fibular resection using a novel approach: A surgical technique.Clin OrthopRelat Res2014;472:1262-70.
7. EnnekingWF, DunhamW, GebhardtMC, MalawarM, PritchardDJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.Clin OrthopRelat Res1993;286:241-6.
8. MohlerDG, CunninghamDC.Adamantinoma arising in the distal fibula treated with distal fibulectomy: A case report and review of the literature.Foot Ankle Int1997;18:746-51.
9. Norman-TaylorFH, SweetnamDI, FixsenJA. Distalfibulectomy for Ewing’s sarcoma.J Bone Joint Surg Br1994;76:559-62.
10. KanayaK, WadaT, KuraH, YamashitaT, UsuiM, IshiiS.Valgus deformity of the ankle following harvesting of a vascularized fibular graft in children.J ReconstrMicrosurg2002;18:91-6.
11. JonesRB, IshikawaSN, RichardsonEG, MurphyGA. Effect of distal fibular resection on ankle laxity.Foot Ankle Int2001;22:590-3.
12. MannRA, RongstadKM. Arthrodesis of the ankle: A critical analysis.Foot Ankle Int1998;19:3-9.
13. DurakK, BilgenO, KaleliT, AydinliU. Distal fibula resection in osteochondroma.J Int Med Res1996;24:381-6.
14. deGauzy JS, KanyJ, CahuzacJP. Distal fibular reconstruction with pedicled vascularized fibular head graft: A case report.J PediatrOrthop B2002;11:176-80.
15. EgerW, SchörleC, ZeilerG. Giant cell tumor of the distal fibula: Fifteenyear result after en bloc resection and fibula reconstruction.Arch Orthop Trauma Surg2004;124:56-9.
16. PickeringR. Arthrodesis of ankle, knee, and hip. In: PickeringRM, editors. Campbell’s Operative Orthopaedics. 10th ed. St Louis, MO, USA: Mosby; 2003.
17. SaridisAG, MegasPD, GeorgiouCS, DiamantakisGM, TyllianakisME. Dual-fibular reconstruction of a massive tibial defect after Ewing’s sarcoma resection in a pediatric patient with a vascular variation.J PediatrOrthop2011;31:297-302.
18. VaseenonT, SaengsinJ, KamintaA, PattamapaspongN, SettakornJ, PruksakornD.Ankle ligament reconstruction after wide resection of the osteosarcoma of the distal fibula: A case report.BMC Res Notes2017;10:769.

 

How to Cite this article: Pruthi M, Virk J D, Garg L, Goyal S, Sharma A | An Interesting Reconstruction Option after Resection for a Distal Fibular Osteosarcoma: A Case Report | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 13-16.

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Local Recurrences of Giant Cell Tumor of Bones after Extended Surgical Curettage – A Retrospective Cohort Study

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 9-12 | DOI: 10.13107/jbst.2020.v06i01.007

Author: Dominic K Puthur [1], Dijoe Davis [1], N Sanjay [1]

1. Department of Orthopaedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Address of Correspondence
Dr. Dijoe Davis,
Department of Orthopaedics, Amala Institute of Medical Sciences,
Cloud Nine, Kollannur Villas, Jasmin Road, Near Water Tank Street
Nehrunagar, Kuriachira P.O, Thrissur – 680 006, Kerala, India.
E-mail: dr.dijoe@gmail.com

Abstract

Introduction: Giant cell tumor of bone (GCTB) is a locally aggressive tumor well known for recurrence after surgical treatment. Local recurrence rate ranged from 10 to 25%. The objectives of this study are to find out the incidence of recurrence in GCT after extended surgical curettage, factors affecting recurrence, and also to find the best modality of treatment available for the recurred GCT.
Materials and Methods: It was a retrospective cohort study of 225 patients diagnosed and treated by extended surgical curettage in the Orthopaedic Department of a Tertiary Care Hospital in South India, between January 2003 and December 2017. Patients were followed up clinically and radiologically for diagnosis of recurrence. Factors affecting the recurrence were analyzed. These recurrent cases were further followed up. IBM SPSS v23 was used for data analysis such as age, gender, site of lesion and side, and material used to fill the defect after curettage. Descriptive statistics was elaborated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Fisher’s exact test is used for comparison.
Results: Recurrence was found in 27 patients of 225 cases of GCTB treated by extended surgical curettage. These include 9 of 135 cases initially treated by extended curettage and bone cement and 18 of 88 cases initially treated by curettage and bone graft. Recurrence was found to be more common in males than females.
Conclusions: Local recurrence is significantly lower in patients treated by cementation following extended surgical curettage than bone graft which makes bone cement as a better filling material with regard to recurrence.
Keywords: Giant cell tumor, Curettage, Bone cement, Bone graft, South India.

References

1. Fletcher CD. Who Classification of Tumours of Soft Tissue and Bone. Geneva: World Health Organization; 2013.
2. Puri A, Agarwal M. Treatment of giant cell tumor of bone: Current concepts. Indian J Orthop 2007;41:101-8.
3. Sobti A, Agrawal P, Agarwala S, Agarwal M. Giant cell tumor of bone-an overview. Arch Bone Jt Surg 2016;4:2-9.
4. Rao PT. Management of giant cell tumor of bone. Kini memorial oration. Indian J Orthop 1993;27:96-100.
5. Huvos AG. Bone Tumors: Diagnosis, Treatment and Prognosis. 2nd ed. Philadelphia, PA: WB Saunders Co.; 1991. p. 429.
6. Reddy CR, Rao PS, Rajakumari K. Giant cell tumour of bone in South India. J Bone Joint Surg 1974;56:617-9, 106-114.
7. Ghert MA, Rizzo M, Harrelson JM, Scully SP. Giant-cell tumor of the appendicular skeleton. Clin Orthop Relat Res 2002;400:201-10.
8. Saiz P, Virkus W, Piasecki P, Templeton A, Shott S, Gitelis S. Results of giant cell tumor of bone treated with intralesional excision. Clin Orthop Relat Res 2004;424:221-6.
9. Cavanna L, Biasini C, Monfredo M, Maniscalco P, Mori M. Giant cell tumor of bone. Oncologist 2014;19:1207.
10. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am 2006;37:35-51.
11. Nelson DA, Barker ME, Hamlin BH. Thermal effects of acrylic cementation at bone tumour sites. Int J Hyperthermia 1997;13:287-306.
12. Nicholson NC, Ramp WK, Kneisl JS, Kaysinger KK. Hydrogen peroxide inhibits giant cell tumor and osteoblast metabolism in vitro. Clin Orthop Relat Res 1998;347:250-60.
13. Quint U, Müller RT, Müller G. Characteristics of phenol. Instillation in intralesional tumor excision of chondroblastoma, osteoclastoma and enchondroma. Arch Orthop Trauma Surg 1998;117:43-6.
14. Balke M, Ahrens H, Streitbuerger A, Koehler G, Winkelmann W, Gosheger G, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol 2009;135:149-58.
15. Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Recurrent giant cell tumor of long bones: Analysis of surgical management. Clin Orthop Relat Res 2011;469:1181-7.
16. Puthoor DK, Puthezhath K. Management of giant cell tumor of bone: Computerized tomography based selection strategy and approaching the lesion through the site of cortical break. Orthop Surg 2012;4:76-82.
17. Puthoor D, Iype W. Giant cell tumor: Curettage and bone grafting. Indian J Orthop 2007;41:121-3.
18. Dominic K, Dijoe D, Aravind R. Extended curettage and reconstruction with proximal fibula for treating giant cell tumor of lateral femoral condyle: A prospective study. Arch Clin Exp Surg 2017;6:1.
19. Puthoor DK, Davis D, Francis L. The incidence and distribution of pathological fractures in giant cell tumour of bone-a retrospective study. Kerala J Orthop 2018;31920:27-31.
20. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.
21. Lausten GS, Jensen PK, Schiødt T, Lund B. Local recurrences in giant cell tumour of bone. Long-term follow up of 31 cases. Int Orthop 1996;20:172-6.
22. Vult von Steyern F, Bauer HC, Trovik C, Kivioja A, Bergh P, Holmberg Jörgensen P, et al. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian sarcoma group
study. J Bone Joint Surg Br 2006;88:531-5.
23. Turcotte RE, Wunder JS, Isler MH, Bell RS, Schachar N, Masri BA, et al. Giant cell tumor of long bone: A Canadian sarcoma group study. Clin Orthop Relat Res 2002;397:248-58.
24. Nahal A, Ajlan A, Alcindor T, Turcotte R. Dedifferentiated giant cell tumour of bone in the form of low-grade fibroblastic osteogenic sarcoma: Case report of a unique presentation with follow-up. Curr Oncol
2010;17:71-6.
25. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer 2003;97:2520-9.
26. Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP. Giant cell tumor of bone. Am J Clin Oncol 2006;29:96-9.
27. Tubbs WS, Brown LR, Beabout JW, Rock MG, Unni KK. Benign giantcell tumor of bone with pulmonary metastases: Clinical findings and radiologic appearance of metastases in 13 cases. AJR Am J Roentgenol
1992;158:331-4.
28. Dahlin DC. Caldwell lecture. Giant cell tumor of bone: Highlights of 407 cases. AJR Am J Roentgenol 1985;144:955-60.

 

How to Cite this article: Puthur D K, Davis D, Sanjay N | Local Recurrences of Giant Cell Tumor of Bones After Extended Surgical Curettage– A Retrospective Cohort Study | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2020; 6(1): 9-12.

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Factors Predicting Massive Blood Loss in Patients Undergoing Pelvic Resection: A Tertiary Referral Center Experience from North India

Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 5-8 | DOI: 10.13107/jbst.2020.v06i01.006

Author: Devansh Goyal [1], Venkatesan Sampath Kumar [1], Roshan Banjara [1], Abdul Majeed [1],
R Namith [1], Shah Alam Khan [1]

1. Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Address of Correspondence
Dr. Venkatesan Sampath Kumar,
Department of Orthopaedics, All India Institute of Medical
Sciences, Ansari Nagar, New Delhi – 110 029, India.
E-mail: venkatortho4@gmail.com

Abstract

Background: Pelvic resections are challenging procedures with significant risk of morbidity, especially massive blood loss. Risk factors for massive blood loss are understudied due to the rarity of such procedures.
Materials and Methods: A cross-sectional study was performed on pelvic resections performed between January 2018 and October 2019. Intraoperative and perioperative data were collected from prospectively collected database and hospital medical records. Patients were divided into two groups– Group 1 with intraoperative blood loss <2 L and Group 2 with blood loss 2 L or more. Demographic data, tumor characteristics, surgical procedure, and perioperative outcomes were studied between the two groups. Patients in whom only soft-tissue resections were performed and those who did not have complete data were excluded from the study.
Results: Of the 27 patients identified, 2 had soft-tissue recurrence resections only and 4 had incomplete data and were excluded from the study. Of the remaining 21 patients, 8 were classified into Group 1 and 13 into Group 2. On studying the various characteristics, tumor type, tumor volume, type of pelvic resection, and duration of procedure were significantly different between the two groups. Although wound complications, 30-day mortality, and read missions were higher in Group 2, this difference was not statistically significant.
Conclusion: Massive blood loss was more common in chondrosarcoma patients, with tumor volume more than 300 cc and the duration of procedure more than 4 h with resection involving the acetabulum and pubis (Type I/II/III and Type I/II/III/IV).
Keywords: Blood loss, Pelvic resections, Perioperative morbidity, Pelvic tumor surgery, Tumor volume.

References

1. AbuduA, GrimerRJ, CannonSR, CarterSR, SneathRS. Reconstruction of the hemipelvis after the excision of malignant tumours. Complications and functional outcome of prostheses.J Bone Joint Surg Br1997;79:773-9.
2. WurtzLD, PeabodyTD, SimonMA. Delay in the diagnosis and treatment of primary bone sarcoma of the pelvis.J Bone Joint Surg Am1999;81:317- 25.
3. CarterSR, EastwoodDM, GrimerRJ, SneathRS. Hindquarter amputation for tumours of the musculoskeletal system.J Bone Joint Surg Br1990;72:490-3.
4. EnnekingWF, DunhamWK. Resection and reconstruction for primary neoplasms involving the innominate bone.J Bone Joint Surg Am1978;60:731-46.
5. KawaiA, KadotaH, YamaguchiU, MorimotoY, OzakiT, BeppuY. Blood loss and transfusion associated with musculoskeletal tumor surgery.J Surg Oncol2005;92:52-8.
6. SatcherRL Jr., O’DonnellRJ, JohnstonJO. Reconstruction of the pelvis after resection of tumors about the acetabulum.Clin OrthopRelat Res2003;409:209-17.
7. GutierrezG, ReinesHD, Wulf-GutierrezME. Clinical review: Hemorrhagic shock.Crit Care2004;8:373-81.
8. EnnekingWF, SpanierSS, GoodmanMA. A system for the surgical staging of musculoskeletal sarcoma.Clin OrthopRelat Res1980;153:106- 20.
9. AliAlgadiem E, AleisaAA, AlsubaieHI, BuhlaiqahNR, AlgadeebJB, AlsneiniHA. Blood loss estimation using gauze visual analogue.Trauma Mon2016;21:e34131.
10. GöbelV, JürgensH, EtspülerG, KemperdickH, JungblutRM, StienenU, et al. Prognostic significance of tumor volume in localized Ewing’s sarcoma o f b o n e i n c h i l d r e n a n d a d o l e s c e n t s . J C a n c e r R e s C l i n
Oncol1987;113:187-91.
11. RiedelRF, LarrierN, DoddL, KirschD, MartinezS, BrigmanBE. The clinical management of chondrosarcoma.Curr Treat Options Oncol2009;10:94-106.
12. TangX, GuoW, YangR, TangS, JiT. Evaluation of blood loss during limb salvage surgery for pelvic tumours.Int Orthop2009;33:751-6.
13. AljassirF, BeadelGP, TurcotteRE, GriffinAM, BellRS, WunderJS, et al. Outcome after pelvic sarcoma resection reconstructed with saddle prosthesis.Clin OrthopRelat Res2005;438:36-41.
14. BeneveniaJ, CyranFP, BiermannJS, PattersonFR, LeesonMC. Treatment of advanced metastatic lesions of the acetabulum using the saddle prosthesis.Clin OrthopRelat Res2004;426:23-31.
15. VenaVE, HsuJ, RosierRN, O’KeefeRJ. Pelvic reconstruction for severe periacetabular metastatic disease.Clin OrthopRelat Res1999;362:171-80.

 

How to Cite this article:  Goyal D, Kumar VS, Banjara R, Majeed A, Namith R, Khan SA | Factors Predicting Massive Blood Loss in Patients Undergoing Pelvic Resection: A Tertiary Referral Center Experience from North India | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 5-8.

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