Journal of Bone and Soft Tissue Tumors (JBST) License
Journal of Bone and Soft Tissue Tumors (JBST) by http://jbstjournal.com/ is licensed under https://creativecommons.org/licenses/by-nc-sa/4.0/
Based on a work at http://jbstjournal.com/.
Permissions beyond the scope of this license may be available at editor.jbst@gmail.com
Journal of Bone and Soft Tissue Tumors (JBST) is the official Journal of The Indian Musculo Skeletal Oncology Society
A rare case of Rosai-Dorfman disease presenting as solitary lesion of distal femur: A case report
Cases Series | Volume 8 | Issue 1 | JBST January – June 2022 | Page 07-10 |Ebin Rahman, Subin Sugath, Nita John.
DOI: 10.13107/jbst.2021.v08i01.67
Author: Ebin Rahman [1], Subin Sugath [1], Nita John [1]
[1] Department of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India
Address of Correspondence
Dr. Ebin Rahman,
Senior Specialist, Department of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com
Abstract
Introduction: Rosai-dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a rare histiocytic proliferative disorder of unknown etiology first identified and characterized by Rosai and Dorfman in 1969. The disease is characterized by painless cervical lymphadenopathy, fever, leukocytosis, elevated erythrocyte sedimentation rate, and hypergammaglobulinemia. <500 patients have been reported worldwide. Osseous involvement without lymphadenopathy occurs in <10% of patients and is usually multifocal. Extranodal solitary osseous lesions are just 4% of this subpopulation, no more than 50 such cases have been described in the literature. Here, we report a rare case of RDD presenting as solitary lesion of the distal femur without any evidence of lymphadenopathy and normal laboratory work up.
Case Report: We report the case of a 29-year-old female who presented with pain and swelling of distal femur of 2-month duration without any evidence of lymphadenopathy, with a normal laboratory workup. Radiographical evaluation showed an epiphyseal, osteolytic, and well-defined lesion with cortical break over the medial femoral condyle and soft-tissue extension into the medial patellar recess abutting the medial patellar retinaculum. Whole body positron emission tomography did not show any other sites of abnormal increased uptake. Intralesional extended curettage, bone grafting, bone cementing, and pinning were done. Histologically, the biopsied lesion demonstrated the classic histiocyte proliferation which exhibited emperipolesis (engulfment of lymphocyte or plasma cells by large histiocyte) which are CD-68, S-100 positive, and CD-1a negative on immunohistochemistry. At 2-year follow-up, the patient is symptom free, without any new osseous/extranodal/nodal lesions.
Conclusion: RDD rarely affects bone as a primary or even secondary form of the disease. It has relatively non-specific radiological appearance causing diagnostic challenges and may lead to erroneous diagnosis of a malignancy. Biopsy and histological examination by an experienced pathologist is mandatory for the final diagnosis. The ideal treatment ranges from wait and see policy to surgery, chemotherapy, and radiotherapy.
Keywords: Rosai-Dorfman disease, Extranodal, Osseous, Histiocytosis, Emperipolesis
Reference:
1. Rosai J, Dorfman RF. Sinus histiocytosis with massive lymphadenopathy: A newly recognized benign clinicopathological entity. Arch Pathol 1969;87:63-70.
2. Pulsoni A, Anghel G, Falcucci P, Matera R, Pescarmona E, Ribersani M, et al. Treatment of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): Report of a case and literature review. Am J Hematol 2002;69:67-71.
3. Demicco EG, Rosenberg AE, Bjornsson J, Rybak LD, Unni KK, Nielsen GP. Primary Rosai-Dorfman disease of bone: A clinicopathologic study of 15 cases. Am J Surg Pathol 2010;34:1324-33.
4. Foucar E, Rosai J, Dorfman R. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): Review of the entity. Semin Diagn Pathol 1990;7:19-73.
5. Bhandari A, Patel PR, Patel MP. Extranodal Rosai-Dorfman disease with multiple spinal lesions: Arare presentation. Surg Neurol 2006;65:308-11.
6. George J, Stacy G, Peabody T, Montag A. Rosai-Dorfman disease manifesting as a solitary lesion of the radius in a 41-year-old woman. Skeletal Radiol 2003;32:236-9.
7. Bachmann KR, Dragoescu EA, Foster WC. Extranodal Rosai-Dorfman disease presenting as incidental bone tumor: A case report. Am J Orthop (Belle Mead NJ) 2010;39:E123-5.
8. Abou-Zeid AH, Herwadkar A, du Plessis D, Gnanalingham KK. Isolated extradural Rosai-Dorfman disease of the thoracic spine: A rare cause of spinal cord compression: Case report. Neurosurgery 2010;67:E514-5.
9. Duijsens HM, Vanhoenacker FM, ter Braak BP, Hogendoorn PC, Kroon HM. Primary intraosseous manifestation of Rosai-Dorfman disease: 2 cases and review of literature. JBR-BTR 2014;97:84-9.
10. Mehraein Y, Wagner M, Remberger K, Füzesi L, Middel P, Kaptur S, et al. Parvovirus B19 detected in Rosai-Dorfman disease in nodal and extranodal manifestations. J Clin Pathol 2006;59:1320-6.
11. Lin J, Lazarus M, Wilbur A. Sinus histiocytosis with massive lymphadenopathy: MRI findings of osseous lesions. Skeletal Radiol 1996;25:279-82.
12. Ruggiero A, Attinà G, Maurizi P, Mulè A, Tarquini E, Barone G, et al. Rosai-Dorfman disease: Two case reports and diagnostic role of fineneedle aspiration cytology. J Pediatr Hematol Oncol 2006;28:103-6.
13. Walker PD, Rosai J, Dorfman RF. The osseous manifestations of sinus histiocytosis with massive lymphadenopathy. Am J Clin Pathol 1981;75:131-9.
[Full Text HTML] [Full Text PDF] [XML]
Like this:
Malignant Transformation Of Solitary Phalangeal Enchondroma To High Grade Chondrosarcoma- A Case Report
Cases Series | Volume 8 | Issue 1 | JBST January – June 2022 | Page 03-06 |Ebin Rahman, Subin Sugath, Nanda Kachare.
DOI: 10.13107/jbst.2021.v08i01.65
Author: Ebin Rahman [1], Subin Sugath [1], Nanda Kachare [2]
[1] Department of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India
[2] Department of Pathology, Aster Medcity, Kochi, Kerala, India.
Address of Correspondence
Dr. Ebin Rahman,
Department of Orthopaedic Oncology, Aster Medcity, Kochi, Kerala, India.
E-mail: rahmanebin@gmail.com
Abstract
Introduction: Chondrosarcoma (CS) is a malignant neoplasm of mesenchymal origin characterized by the formation of cartilaginous matrix by neoplastic cells. It may arise as a primary lesion or occur secondarily at the site of a previous benign lesion such as enchondroma. Primary CS is rare in the hand with a frequency of <0.5–3.2% of all CS. Malignant transformation of a benign solitary enchondroma to secondary CS, especially in the hand, is extremely rare. This transformation is seen more often in multiple enchondromatosis than in solitary lesions, but even this event is rare in the hands. Here, we report a case of solitary enchondroma of proximal phalanx of middle finger initially treated with intralesional curettage and bone grafting, later recurring to high grade (Grade 3) CS.
Case Report: We report the case of 44-year-old lady presenting with pain and progressive fusiform swelling of the entire right middle finger of 4 months duration. She had a similar history 5 years back for which she had underwent intralesional curettage and bone graft substitute application. Curetted specimen was reported as enchondroma. Radiographical evaluation showed an expansile, intramedullary, and lytic lesion severe cortical destruction over proximal phalanx of the right middle finger. Magnetic resonance imaging detailed the soft-tissue component. She underwent a core needle biopsy which reported as low-grade CS arising from enchondroma. Resection of middle ray including distal 2/3 of 3rd metacarpal was performed. Excised specimen was reported as high-grade CS (Grade 3) with tumor free margins. At 2-year follow-up, she is symptom free without any local recurrence or distant lesions.
Conclusion: Diagnosis of CS in the hand can pose problems to clinicians and pathologists alike. To definitely set a diagnosis of CS in the hand, comparison of histological and radiological finding is paramount. CS are malignancies resistant to both radiation and chemotherapy. CS of the hand is characterized by local recurrence and very low metastatic potential. Hence, wide excision is the recommended approach.
Keywords: Phalanx, Enchondroma, Chondrosarcoma, High grade, Amputation.
Reference:
1. Rieger H, Neuber M, Joosten U, Grunert J, Brug E, Strobel M. Therapy and prognosis of enchondroma of the hand. Chirurg 2000;71:1152-5.
2. Bertoni F, Bacchini P, Hogendoorn PC. Chondrosarcoma. In: Pathology and Genetics of Tumours of Soft Tissue and Bon. France: IARC Press, Lyon; 2002. p. 247-248..
3. Bovee JV, van der Heul RO, Taminiau AH, Hogendoorn PC. Chondrosarcoma of the phalanx: A locally aggressive lesion with minimal metastatic potential: A report of 35 cases and a review of the literature. Cancer 1999;86:1635-7.
4. Fechner RE, Mills SE. Atlas of Tumour Pathology. Tumours of the Bones and Joints, Fascicle 8, Third Series. Washington, DC: Armed Forces Institute of Pathology; 1993. p. 86-128.
5. Nelson DL, Abdul-Karim FW, Carter JR, Makley JT. Chondrosarcoma of small bones of the hand arising from enchondroma. J Hand Surg 1990;15A:655-9.
6. Dahlin DC, Salvador AH. Chondrosarcomas of bones of the hands and feet-a study of 30 cases. Cancer 1974;34:755-60.
7. Mankin HJ. Chondrosarcoma of digits. Are they really malignant? Cancer 1999;86:1635-7.
8. Nigrisoli M, Ferraro A, De Cristofaro R, Picci P. Chondrosarcoma of the hand and foot. Chir Organi Mov 1990;75:315-23.
9. Unni KK. Chondrosarcoma (primary, secondary, dedifferentiated, and clear cell). In: Dahlin’s Bone Tumors. General Aspects and Data on 11,087 Cases. 5th ed. Philadelphia, PA: Lippincott-Raven; 1996. p. 71-108.
10. Thanigai S, Douraiswami B. Chondrosarcoma of metacarpal – A rare presentation. J Clin Orthop Trauma 2013;4:85-8.
11. Patil S, de Silva MV, Crossan J, Reid R. Chondrosarcoma of small bones of the hand. J Hand Surg Br 2003;28:602-8.
12. Eriksson AI, Schiller A, Mankin HJ. The management of chondrosarcoma of bone. Clin Orthop Relat Res 1980;153:44-66.
13. Dempsey S, Mark CG, Michael HM. Chondrosarcoma: Areview. J Bone Joint Surg 1996;78:644-9.
14. Demireli P, Cavdar DK, Vural S, Ovali Y, Ozalp T. Secondary chondrosarcoma arising from a solitary enchondroma at the index finger of the right hand-a case report. Turk J Pathol 2006;22:53-6.
[Full Text HTML] [Full Text PDF] [XML]
Like this:
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:
1. Zils K, Bielack S, Wilhelm M, Werner M, Schwarz R, Windhager R, et al. Osteosarcoma of the mobile spine. Ann Oncol 2013;24:2190-5.
2. World Health Organization Classification of Tumours Editorial Board. Soft Tissue and Bone Tumours. WHO Classification of Tumours Series. 5th ed., Vol. 3. Lyon France: International Agency for Research on Cancer; 2020. p. 404-5.
3. Ozaki T, Flege S, Liljenqvist U, Hillmann A, Delling G, Salzer-Kuntschik M, et al. Osteosarcoma of the spine: Experience of the cooperative osteosarcoma study group. Cancer 2002;94:1069-77.
4. Green R, Saifuddin A, Cannon S. Pictorial review: Imaging of primary osteosarcoma of the spine. Clin Radiol 1996;51:325-9.
5. Ilaslan H, Sundaram M, Unni KK, Shives TC. Primary vertebral osteosarcoma: Imaging findings. Radiology 2004;230:697-702.
6. Egea-Gamez RM, Ponz-Lueza V, Cendrero-Torrado A, Martínez-Gonzalez C, Certucha-Barragan JA, Gonzalez-Díaz R. Spinal osteosarcoma in the paediatric age group: Case series and literature review. Rev Esp Cir Ortop Traumatol 2019;63:122-31.
7. Yalniz E, Özcan M, Copuroglu C, Memisoglu S, Yalçin O. Osteosarcoma of the lumbar vertebra: Case report and a review of the literature. Arch Orthop Trauma Surg 2009;129:1701.
8. Sansur CA, Pouratian N, Dumont AS, Schiff D, Shaffrey CI, Shaffrey ME. Part II: Spinal-cord neoplasms-primary tumours of the bony spine and adjacent soft tissues. Lancet Oncol 2007;8:137-47.
9. Murphey MD, Andrews CL, Flemming DJ, Temple HT, Smith WS, Smirniotopoulos JG, et al. From the archives of the AFIP. Primary tumors of the spine: Radiologic pathologic correlation. Radiographics 1996;16:1131-58.
10. Deyrup AT. Skeletal metastases. Surg Pathol 2012;5:287-300.
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.
[Full Text HTML] [Full Text PDF] [XML]
Like this:
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:
1. Karpik M. Giant cell tumor (tumor gigantocellularis, osteoclastoma)-epidemiology, diagnosis, treatment. Ortop Traumatol Rehabil 2010;12:207-15.
2. Trieb K, Bitzan P, Lang S, Domikus M, Kotz R. Recurrence of curetted and bone grafted giant-cell tumors with and without adjuvant phenol therapy. Eur J Surg Oncol 2001;27:200-2.
3. Boons HW, Keijser LC, Schreuder HW, Pruszczynski M, Lemmens JA, Veth RP. Oncologic and functional results after treatment of giant cell tumors of bone. Arch Orthop Trauma Surg 2002;122:17-23.
4. Blake SM, Gie GA. Large pelvic giant cell tumor-a case report and a review of current treatment modalities. J Arthroplasty 2004;19:1050-4.
5. Reid R, Banerjee SS, Sciot R. Giant cell tumour. In: Fletcher CD, Unni KK, Mertens F, editors. Pathology and Genetics of Tumors of Soft Tissue and Bone. Lyon, France: IARC Press; 2002. p. 309-13.
6. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg Am 1978;60:731-46.
7. Sanjay BK, Frassica FJ, Frassica DA, Unni KK, McLeod RA, Sim FH. Treatment of Giant cell tumor of the pelvis. J Bone Joint Surg Am 1993;75:1466-75.
8. Moore AT. The Moore self-locking vitallium prosthesis in fresh femoral neck fractures: A new low posterior approach (the southern exposure). In: American Academy of Orthopaedic Surgeons: Instructional Course Lectures. Vol. 16. St. Louis: CV Mosby; 1959.
9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty. An end‐result study using a new method of result evaluation. J Bone Joint Surg Am 1969;51:737-55.
10. Sung HW, Kuo DP, Shu WP, Chai YB, Liu CC, Li SM. Giant cell tumor of bone: Analysis of two hundred and eight cases in Chinese patients. J Bone Joint Surg 1982;64A:755-61.
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.
14. Agarwal S, Agarwal T, Agarwal R, Agarwal PK, Jain UK. Fine needle aspiration of bone tumors. Cancer Detect Prev 2000;24:602-9.
15. Goto T, Lijima T, Kawano H, Yamamoto A, Arai M, Matsuda K, et al. Serum acid phosphatase as a tumour marker in giant cell tumuor of bone. Arch Orthop Trauma Surg 2001;121:411-3.
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.
[Full Text HTML] [Full Text PDF] [XML]
Like this:
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.
[Full Text HTML] [Full Text PDF] [XML]
Like this:
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.
[Full Text HTML] [Full Text PDF] [XML]
Like this: