Vertebral Osteosarcoma – A Report of Five Cases

Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 13-15 | Chitturi Ramya, Jayasree Kattoor, Narayanan Geetha, Muraleedharan Venugopal. DOI:0.13107/jbst.2021.v07i03.59

Author: Chitturi Ramya [1], Jayasree Kattoor [2], Narayanan Geetha [3], Muraleedharan Venugopal [4]

[1] Department of Pathology, NRI Medical College, Chinakakani, Andhra Pradesh, India.

[2] Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India.

[3] Department of Medical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India.

[4] Department of Radiology, Regional Cancer Centre, Trivandrum, Kerala, India.

Address of Correspondence
Dr. Jayasree Kattoor,
Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India.
E-mail: jayasreeramdas@gmail.com

Abstract

Background: Vertebral osteosarcoma is rare, accounting for 3%–5% of all osteosarcomas. It tends to occur in a slightly older age group. The prognosis is poor compared to osteosarcoma of extremities.
Case Report: We present five cases of vertebral osteosarcomas. The patient’s age ranged from 16 years to 54 years. There were four females and one male. They presented with pain, swelling, or weakness of limbs. Destructive lesions, mixed lytic and sclerotic lesions involving vertebral bodies, and/or pedicles were seen on imaging. A definitive diagnosis could not be made in two cases. On histopathological examination, all the cases turned out to be osteosarcomas.
Conclusion: Osteosarcoma of vertebrae has high rate of recurrence, metastasis, and mortality. Differentiation of vertebral osteosarcoma from other common bony lesions involving the spine is of utmost importance as the treatment is entirely different. Combination therapies including surgery, radiation, and chemotherapy achieve adequate short-term survival rates for vertebral osteosarcoma.

Keywords: Osteosarcoma, Spine, Vertebra.

References:

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11. Sundaresan N, Rosen G, Huvos AG, Krol G. Combined treatment of osteosarcoma of the spine. Neurosurgery 1988;23:714-9.
12. Kokubo Y, Uchida K, Kobayashi S, Yayama T, Sato R, Kakuyama M, et al. Primary osteosarcoma of the thoracic spine: Report of an unusual elderly patient with autopsy findings. Spinal Cord 2005;43:508-11.

 

How to Cite this article: Ramya C, Kattoor J, Geetha N, Venugopal M | Vertebral Osteosarcoma – A Report of Five Cases. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 13-15.

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Trabecular Metal Augmented Reconstruction of Acetabular Defect after Removal of Periacetabular Giant Cell Tumors in A Young Male: A Case Report with Review of Literature

Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 8-12 | Apurv Gabrani, Hitesh Dawar, Surbhit Rastogi, Deepak Raina. DOI:0.13107/jbst.2021.v07i03.57

Author: Apurv Gabrani [1], Hitesh Dawar [1], Surbhit Rastogi [1], Deepak Raina[1]

[1] Department of Orthopedic, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India

Address of Correspondence
Dr. Apurv Gabrani,
Department of Orthopedic, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India.
E-mail: apurvgabrani@gmail.com

Abstract

Introduction: Giant cell tumors (GCTs) are benign, epiphyseal, locally aggressive bone tumors. Pelvic GCTs are sparingly encountered and present a challenging scenario for the surgeon to not only diagnose but also to treat appropriately. Multiple treatment options are available as per the literature but no single approach is universally accepted. Moreover, due to the complex anatomy of the pelvis, novel treatment options have also been tried.
Case Report: A 30-year-old male presented to the outpatient clinic with complaints of gradually progressive dull aching pain in his right hip for 6 months. On radiological investigation, he was found to have a lytic lesion in the right periacetabular region. Image-guided biopsy revealed GCT on histopathological examination. The final management included extended curettage of the tumor and reconstruction of the remaining defect with trabecular metal (TM) augment supplemented with reconstruction plate. The patient resumed full activity and remains asymptomatic and disease free at 5 years follow-up.
Conclusion: To the best of our knowledge, this is the first reported case for the use of TM augment in reconstruction of bone defect following curettage for GCT in pelvis.

Keywords: Giant cell tumor pelvis, trabecular metal, acetabular reconstruction.

References:

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11. Zheng K, Yu X, Hu Y, Wang Z, Wu S, Ye Z. Surgical treatment of pelvic giant cell tumor: Amulti-center study. World J Surg Oncol 2016;14:104.
12. Zheng K, Wang Z, Wu S, Ye Z, Xu S, Xu M, et al. Giant cell tumor of the pelvis: Asystematic review. Orthop Surg 2015;7:102-7.

13. Breitenseher M, Dominkus M, Scharitzer M, Lechner M, Trieb K, Imhof H, et al. Diagnostic imaging of giant cell tumors. Radiologe 2001;41:568.
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16. Caudell JJ, Ballo MT, Zagars GK, Lewis VO, Weber KL, Lin PP, et al. Radiotherapy in the management of giant cell tumor of bone. Int J Radiat Oncol Biol Phys 2003;57:158-65.
17. Marcove RC, Weis LD, Vaghiawalla MR, Pearson R. Cryosurgery in the treatment of giant cell tumors of bone: A report of 52 consecutive cases. Clin Orthop Relat Res 1978;134:275-89.
18. Guo W, Sun X, Zang J, Qu H. Intralesional excision versus wide resection for giant cell tumor involving the acetabulum: Which is better? Clin Orthop Relat Res 2012;470:1213-20.
19. Leggon RE, Zlotecki R, Reith J, Scarborough MT. Giant Cell tumor of the pelvis and sacrum: 17 Cases and analysis of the literature. Clin Orthop Relat Res 2004;423:196-207.
20. Labs K, Perka C, Schmidt RG. Treatment of stages 2 &3 giant cell tumor. Arch Orthop Traum Surg 2001;121:83-6.
21. Thomas JL, Jaffe KA. Use of polymethylmethacrylate in large osseous defects in the foot and ankle following tumor excision. J Foot Ankle Surg 1999;38:208-13.
22. Patradul A, Kitidurmrongsook P, Parkpian V, Ngarmukos C. Allograft replacement in giant cell tumor of the hand. Hand Surg 2001;6:59-65.

23. Meneghini RM, Meyer C, Buckley CA, Hanssen AD, Lewallen DG. Mechanical stability of novel highly porous metal acetabular components in revision total hip arthroplasty. J Arthroplasty 2010;25:337-41.
24. Grappiolo G, Loppini M, Longo UG, Traverso F, Mazziotta G, Denaro V. Trabecular metal augments for the management of paprosky Type III defects without pelvic discontinuity. J Arthroplasty 2015;30:1024-9.
25. Horisberger M, Paul J, Wiewiorski M, Henninger HB, Khalifa MS, Barg A, et al. Commercially available Trabecular metal ankle interpositional spacer for tibiotalocalcaneal arthrodesis secondary to severe bone loss of the ankle. J Foot Ankle Surg 2014;53:383-7.
26. Sporer SM, Paprosky WG. The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects. J Arthroplasty 2006;21 Suppl 6:83-6.
27. Balke M, Streitbuerger A, Budny T, Henrichs M, Gosheger G, Hardes J. Treatment and outcome of giant cell tumors of the pelvis. Acta Orthop 2009;80:590-6.
28. Huang HC, Hu YC, Lun DX, Ma J, Xia Q, Ji J, et al. The clinical application of femoral head exclusion after resection of pelvic tumors around acetabulum. Zhonghua Gu Ke Za Zhi 2011;31:635-9.
29. Mori Y, Tsuchiya H, Karita M, Nonomura A, Nojima T, Tomita K. Malignant transformation of a giant cell tumor 25 years after initial treatment. Clin Orthop Relat Res 2000;381:185-91.
30. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am 1987;69:106-14.

How to Cite this article: Gabrani A, Dawar H, Rastogi S, Raina D | Trabecular metal augmented reconstruction of acetabular defect after removal of periacetabular giant cell tumors in a young male: A case report with review of literature. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 8-12.

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Elderly patients with pathological fractures in distal third femur treated with intramedullary nailing: A case series

Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 5-7 | Neetin P Mahajan, Pranay Pravin Kondewar, Sudip Subhash Chavan, Habung Chobing, Lalkar Gadod. DOI:10.13107/jbst.2021.v07i03.55

Author: Neetin P Mahajan [1], Pranay Pravin Kondewar[1], Sudip Subhash Chavan[1], Habung Chobing[1], Lalkar Gadod [1]

[1] Department of Orthopaedics, Grant Govt. Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Pranay Pravin Kondewar,
Department of Orthopaedics, Grant Govt. Medical College and Sir J.J. Hospital, Mumbai, Maharashtra, India.
E-mail: pranaypk1@gmail.com

Abstract

Introduction: Pathological fractures of femur are rare and are difficult to manage. Proximal weight bearing portion is more common site for these fractures and are least common in distal third of shaft. Depending on the location and origin of primary tumor or benign lesion, we decide the management. At risk, bone with impending fracture can be managed conservatively. Displaced fractures need surgical intervention. MIREL scoring is used to decide plan of management. Closed technique like intramedullary nailing is preferred over the open technique and gives good results without post-operative morbidity. Radiological investigations are necessary to find out the primary tumor source in metastatic lesions these includes plain radiographs, CT scan, MRI and PET scan. Lab investigations also aid in finding source of primary tumor.
Case Report: This is a case series of 3 patients who had a pathological fracture of the distal third shaft of femur. These patients had metastasis from primary tumor elsewhere in body. All the patients were operated with intramedullary nailing and fixation was done with the aim of reducing pain, avoiding complications such as bed sore, infection, deep venous thrombosis, and regaining the functional outcome as much as possible and improves the quality of life.
Conclusion: All 3 patients with a pathological femur fracture operated with intramedullary nailing were shown to have a significant reduction of pain, regaining of the range of motion of the knee joint and a better quality of life with improvement in performance of activities of daily living.

Keywords: Bony metastasis, pathological fracture, intra-medullary nail, palliative surgery.

References:

1. Feng H, Wang J, Xu J, Chen W, Zhang Y. The surgical management and treatment of metastatic lesions in the proximal femur: A mini review. Medicine (Baltimore) 2016;95:e3892.
2. Issack PS, Barker J, Baker M, Kotwal SY, Lane JM. Surgical management of metastatic disease of the proximal part of the femur. J Bone Joint Surg Am 2014;96:2091-8.
3. Coleman RE. Bone cancer in 2011: Prevention and treatment of bone metastases. Nat Rev Clin Oncol 2012;9:76-8.
4. Yin JJ, Selander K, Chirgwin JM, Dallas M, Grubbs BG, Wieser R, et al. TGF-beta signaling blockade inhibits PTHrP secretion by breast cancer cells and bone metastases development. J Clin Invest 1999;103:197-206.
5. Piccioli A, Ventura A, Maccauro G, Spinelli MS, Del Bravo V, Rosa MA. Local adjuvants in surgical management of bone metastases. Int J Immunopathol Pharmacol 2011;24 Suppl 1:129-32.
6. Heisterberg L, Johansen TS. Treatment of pathological fractures. Acta Orthop Scand 1979;50:787-90.
7. Feng H, Feng J, Li Z, Feng Q, Zhang Q, Qin D, et al. Percutaneous femoroplasty for the treatment of proximal femoral metastases. Eur J Surg Oncol 2014;40:402-5.
8. Hunt KJ, Gollogly S, Randall RL. Surgical fixation of pathologic fractures: An evaluation of evolving treatment methods. Bull Hosp Jt Dis 2006;63:77-82.
9. Ruggieri P, Mavrogenis AF, Casadei R, Errani C, Angelini A, Calabrò T, et al. Protocol of surgical treatment of long bone pathological fractures. Injury 2010;41:1161-7.
10. Willeumier JJ, van der Linden YM, van de Sande MA, Dijkstra PS. Treatment of pathological fractures of the long bones. EFORT Open Rev 2016;1:136-45.
11. Sarahrudi K, Greitbauer M, Platzer P, Hausmann JT, Heinz T, Vécsei V. Surgical treatment of metastatic fractures of the femur: A retrospective analysis of 142 patients. J Trauma 2009;66:1158-63.

How to Cite this article: Mahajan NP, Kondewar PP, Chavan SS, Gadod L | Elderly patients with pathological fractures in distal third femur treated with intramedullary nailing: A case series. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 5-7.

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Intraosseous Schwannoma of the Thoracic Spine: A Case Report

Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 2-4 | Ikuo Kudawara, Hiroyuki Aono. DOI: DOI:10.13107/jbst.2021.v07i03.53

Author: Ikuo Kudawara[1], Hiroyuki Aono[1]

[1] Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.

Address of Correspondence
Dr. Ikuo Kudawara,
Department of Orthopaedic Surgery, National Hospital Organization Osaka National Hospital, Japan.
E-mail: kudawara.ikuo.rf@mail.hosp.go.jp

Abstract

Introduction: Primary schwannoma of the bone is extremely rare. Spinal schwannoma usually rises in the nerve root or the cauda equina and their branches that occasionally scallop on the adjacent bone. On radiology, their features often mimic those of bone tumors such as osteoblastoma, hemangioma, aneurysmal bone cyst, plasmacytoma, or bone metastasis. Therefore, the diagnosis of pure spinal schwannoma of the bone should be evaluated carefully when referring to radiological and histopathological findings.
Case Report: A 64-year-old female presented with back pain and lower leg dysesthesia. The tumor within the left lamina of the 12th thoracic spine showed an expansile and lytic lesion on computed tomography (CT) and intermediate signals on the T1-weighted image and high signals on the T2-weighted image on magnetic resonance imaging. In addition, an old compression fracture in the same vertebra was observed. ACT-guided biopsy specimen suggested schwannoma. The tumor was successfully excised, and afterward, remission of the symptoms was observed. A definitive diagnosis of intraosseous schwannoma was made. There has been no recurrence in the 6 years following surgery.
Conclusion: We have presented the radiological and histopathological findings as well as the clinical outcomes of an unusual case of intraosseous schwannoma of the posterior element of the 12th thoracic spine. Pre-operative CT-guided biopsy was useful in making a diagnosis and planning a surgical strategy.

Keywords: Schwannoma, Thoracic spine, Bone.

References:

1. Mirra JM. Neurilemoma (Schwannoma). In: Mirra JM, editor. Bone Tumors. Philadelphia, PA, London: Lea & Febiger; 1989. p. 834-43.
2. Czerniak B. Intraosseous schwannoma. In: Czerniak B, editor. Dorfman and Czerniak’s Bone Tumors. 2nd ed. Philadelphia, PA: Elsevier; 2016. p. 1008-17.
3. Ida CM, Scheithauer BW, Yapicier Ö, Carney JA, Wenger DE, Inwards CY, et al. Primary schwannoma of the bone: A clinicopathologic and radiologic study of 17 cases. Am J Surg Pathol 2011;35:989-97.
4. BXu ZQ, Zhang P, Zhong ZH, Zhou W, Yu HT. Spinal intraosseous schwannoma without spinal canal and neuroforamina involvement: A case report. World J Clin Cases 2020;8:1271-7.
5. Nooraie H, Taghipour M, Arasteh MM, Daneshbod K, Erfanie MA. Intraosseous schwannoma of T12 with burst fracture of L1. Arch Orthop Trauma Surg 1997;116:440-2.
6. Ramasamy P, Shackleford I, Al Jaferari M. Schwannoma of T12 vertebra: Case report and review and review of literature. Sarcoma 2000;4:185-90.
7. Inaoka T, Takahashi K, Hanaoka H, Aburano T, Tokuhashi Y, Matsuno T, et al. Paravertebral neurinoma associated with aggressive intravertebral extension. Skeletal Radiol 2001;30:286-9.
8. Choudry Q, Younis F, Smith RB. Intraosseous schwannoma of D12 thoracic vertebra: Diagnosis and surgical management with 5-year follow-up. Eur Spine 2007;16 Suppl 3:283-6.
9. Cetinkal A, Atabey C, Kaya S, Colak A, Topuz AK. Intraosseous schwannoma of thoracic 12 vertebra without spinal canal involvement. Eur Spine J 2009;18 Suppl 2:236-9.
10. Kojima M, Seichi A, Yamamuro K, Inoue H, Kimura A, Hoshino Y. Intraosseous schwannoma originating from the posterior column of the thoracic spine. Eur Spine J 2011;20 Suppl 2:S153-6.
11. Kojima M, Seichi A, Yamamuro K, Inoue H, Kimura A, Hoshino Y. Intraosseous schwannoma originating from the posterior column of the thoracic spine. Eur Spine J 2011;20 Suppl 2:S153-6.
12. Jia S, Zheng W, Ruan J, Chen T, Huang Y, Guan J. Mobile thoracic schwannoma combined with intraosseous schwannomas. A case report. Medicine (Baltimore) 2019;98:e14153.
13. Rimondi E, Staals EL, Errani C, Bianchi G, Casadei R, Alberghini M, et al. Percutaneous CT-guided biopsy of the spine: Results of 430 biopsies. Eur Spine J 2008;17:975-81.

How to Cite this article: Kudawara I, Aono H | Intraosseous schwannoma of the thoracic spine: A case report. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 2-4.

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Editorial September- December 2021

Editorial | Volume 7 | Issue 3 | JBST Sep – Dec 2021 | Page 1 | Yogesh Panchwagh, Ashish Gulia, Ashok Shyam. DOI: 10.13107/jbst.2021.v07i03.51

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, India.
[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

Unlocking …the new normal.

The pandemic has entered its third year. Countries around the world witnessed the third wave, characterized by a rapid rise in number of cases and a dramatic fall in those numbers as well.  As the history of any pandemic goes, one would expect further reduction in severity and mortality worldwide.

One striking feature of this Covid 19 pandemic has been the quick development of vaccines and its largescale deployment in most countries of the world. Keeping the initial hesitancy and availability issues aside, there is ample evidence that the vaccines have altered the course of the pandemic which otherwise would have seen worse outcomes.

The world has realized that it is futile to expect a completely covid free world. Many have accepted the reality that humanity will coexist in future with the virus and its various mutations. The strict lockdowns and restrictions imposed in the earlier days have lost their significance particularly in the post vaccine world. As a result, the process of unlocking has already started in a few countries and probably would be the norm very soon in others.

It’s certainly a relief for certain sections of society. The now empty school corridors would again witness kids resuming uninterrupted schooling and other activities along with their peers. Patients with other life threatening diseases, including cancer would continue getting treated and operated without having to worry about interruption in care or best practices. Travel would become easier with fewer restrictions. It would be possible to expect a life reasonably similar to pre-covid world in a few months. The medical fraternity has garnered enough experience and is geared to adapt, evolve and manage challenging situations. It would continue to do so until any unforeseen catastrophic event throws the world out of gear again.

The patient care, peer interactions, research and publication in the various specialities hopefully should be back on track very soon. Unlocking, hopefully, would be the new normal this year.

Dr. Yogesh Panchwagh
Dr. Ashish Gulia
Dr. Ashok Shyam

How to Cite this article: Panchwagh Y, Gulia A, Shyam A. Editorial.|  Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3):1.

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Pathologic Fractures Secondary to Primary Non-Hodgkin’s Lymphoma of Bone: A Report of Two Cases Treated with Surgery

Case Report | Volume 7 | Issue 3 | JBST September – December 2021 | Page 16-19 | Abigail R Tud, Celestine Marie G Trinidad. DOI:0.13107/jbst.2021.v07i03.61

Author: Abigail R Tud [1], Celestine Marie G Trinidad [2]

[1] Musculoskeletal Tumor Unit, Philippine Orthopedic Center, Quezon City, Manila, Philippines.

[2] Department of Pathology, Philippine Orthopedic Center, Quezon City, Manila, Philippines.

Address of Correspondence
Dr. Abigail R Tud,
Musculoskeletal Tumor Unit, Philippine Orthopedic Center, Quezon City, Manila, Philippines.
E-mail: abitud.pocmtu@gmail.com

Abstract

Background: Primary lymphoma of bone (PLB) is a rare condition accounting for <2% of lymphomas among adults. Diagnosis is confirmed through clinical features, radiologic findings, and immunohistochemical studies. Treatment consists primarily of chemotherapy and radiotherapy. A lack of consensus remains, however, regarding the role of surgery on prognosis. Interventions with potential to improve quality of life therefore warrant further investigation. The authors report two cases of PLB treated with surgery, with favorable outcomes.
Case Presentation 1: A 21-year-old female presented with the left knee pain unaccompanied by constitutional symptoms. Imaging studies showed an isolated pathologic fracture of the left proximal tibia. Histopathology showed an atypical proliferation of large round cells, which stained diffusely and strongly positive for CD20. 90% of the cells also stained positive for the proliferation marker Ki-67. These findings were consistent with a high-grade B-Cell non-Hodgkin’s lymphoma (NHL). The tibial lesion was managed with direct fracture reduction and knee arthrodesis. Six cycles of chemotherapy were completed. Current Musculoskeletal Tumor Society (MSTS) score is 28/30, without evidence of recurrence 3 years post-surgery.
Case Presentation 2: A 69-year-old male sustained a pathologic subtrochanteric fracture after falling on his left hip. Diagnostic imaging revealed no other osseous lesions. Biopsy specimens showed a proliferation of atypical lymphoid cells, and on immunohistochemistry, these were diffusely and strongly positive for lymphocyte common antigen (CD45) and CD20. This was consistent with a high-grade B-Cell NHL. After proximal femoral nailing was performed, no further treatment was given. The patient is currently 2 years post-surgery with MSTS score of 28/30, and no signs of recurrence or metastases.

Conclusion: Current approach to treatment of PLB is multi-modal, but guidelines for surgical intervention are unavailable. Few reports have been made on outcomes after surgery. Pathologic fracture fixation is an option among select patients, affording satisfactory functional outcomes while minimizing morbidity.

Keywords: Knee resection arthrodesis, Non-Hodgkin’s lymphoma of bone, pathologic fracture, primary lymphoma of bone.

References:

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8. Mavrogenis AF, Angelini A, Pala E, Zinzani P, Ruggieri P. The role of surgery for haematologic neoplasms of bone. Acta Orthop Belg 2012;78:382-92.
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11. Bhagavathi S, Micale MA, Les K, Wilson JD, Wiggins ML, Fu K. Primary bone diffuse large B-cell lymphoma. Am J Surg Pathol 2009;33:1463-9.

 

How to Cite this article: Tud AR, Trinidad CMG | Pathologic fractures secondary to primary non-Hodgkin’s lymphoma of bone: A report of two cases treated with surgery. | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2021; 7(3): 16-19.

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