Unicameral Bone Cyst

Vol 5 | Issue 3 | September – December 2019 | page: 8-12| Vineet Kurisunkal, Manish Pruthi, Ashish Gulia. 10.13107/jbst.2019.v05i03.017

Author: Vineet Kurisunkal[1], Manish Pruthi[2], Ashish Gulia[3]
[1]M.S. Ortho, Fellowship in Musculoskeletal Oncology (HBNI)
Senior Clinical Fellow, Royal Orthopaedic Hospital, Birmingham, United Kingdom
[2]M.S. Ortho, DNB Ortho, Fellowship in Musculoskeletal Oncology (HBNI)
Consultant Orthopaedic Oncology, Rajiv Gandhi Cancer Institute, New Delhi
[3]M.S. Ortho, McH Surgical Oncology
Professor, Orthopaedic Oncology, Dept. Of Surgical Oncology
Tata Memorial Hospital, HBNI, Mumbai

Address of Correspondence
Dr. Ashish Gulia
Tata Memorial Centre, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai – 400 012, India. 


Unicameral bone cyst (UBC) is a benign cystic lesion of the bone also known as simple bone cyst or solitary bone cyst. It was first recognized by Virchow in 1876. (1) Although exact incidence is not known, UBC’s accounts for 3% of all bone tumors with a male to female ratio of 2:1(2). Proximal humerus and proximal femur are the two most common sites for occurrence and accounts for approximately 80% of cases. Most of the UBC’s are recognized in age between 9 to 13 years, and the lesions usually heal by skeletal maturity. They are unilocular, serous or sero-sanguineous fluid filled bone cavity usually seen in metaphyseal region of long bones. It was originally recognized by Virchow in 1876 and subsequently studied in detail by Jaffe and Lichtenstein in 1942 (1)

The etiopathogenesis of UBC is still very unsure, several theories have been postulated namely (3)
1. Virchow’s theory: Hypothesized the occurrence due to abnormalities in the local circulation of the affected area of bone.
2. Jaffe and Lichtenstein theory: Cystic cavity develops secondary to a traumatic insult leading to change in local circulation.
3. Mirra theory: On electron microscopy lesions appeared like intraosseous synovial cysts
4. Cohen’s theory: Hypothesized that the cyst forms as a response to venous occlusion in the intramedullary space.
5. Histopathologically: The lining of cavity contains synovial cells. On further evaluation of the cyst fluid high levels of oxygen free radicals and prostaglandins (prostaglandin E2, interleukin-1 and proteolytic enzymes) were found which have inherent ability to increase bone resorption hence create a cystic intramedullary cavity.
Epidemiology & Clinical features:
UBCs are lesions which arise in first two decades of life (85%) with 50% of lesions being detected in first decade itself and are rare to occur beyond age of 20 years. These Lesions show strong male predominance with male to female ratio of 2:1. (2) About 90% of cases occur in the proximal humerus, proximal femur and proximal tibia out of which most common location is the humerus (55% cases). Other less common sites are the ilium, distal humerus, tibia, calcaneum, talus, radius, ulna, and ribs. (4)
Patients are usually asymptomatic. Most lesions are picked up incidentally on plain radiographs when the patient presents following a history of fall or trauma or sport related injury. Few children present with pain after strenuous work or sports injury. (5)

Radiological Description:
UBC appears as a large, localized lytic lesion in the epimetaphyseal region of long bones. It appears expansile with a narrow zone of transition and a clear matrix. The adjacent matrix appears thinned with a well contained lesion. (6) A loculated appearance is due to the presence of ridges over the inner surface of the cyst rather than bony partitions, but following the healing of a fracture fibro osseous septa may actually form. Occasionally, a fragment of the fractured cyst wall is found in the fluid cavity which gives appearance to the pathognomic ‘fallen leaf sign”. (7) The cystic cavity may appear partially ossified or have septations after fracture or treatment. Mixed lytic sclerotic areas may be present in relapse cases.
Rarely magnetic resonance imaging may be warranted which reveals a single well contained lytic lesion with central fluid collection in primary cases. In the presence of previous healed pathological fractures across the cyst leads to formation of fibroosseous septations giving the appearance of an aneursymal bone cyst showing multiple fluid fluid levels. (8)

Histopathological Description:
Gross examination:
Fusiform expansion of the bone is noted with a classical description of being “egg shell” thin, semi translucent, bluish, and easily penetrable. (5) The cavity is a single lined cavity containing yellow fluid often appearing serosanguinous to hemorrhagic if there is associated history of trauma. Following a healed fracture, the cavity may become divided by fibro osseous septa. A thin layer of grey connective tissue lines the inner surface of the cyst wall, which displays multiple scroll like ridges that account for the pseudoloculated appearance on roentgenograms. (8)

The cortical wall is composed of loosely trabeculated osseous tissue, and many thin walled vessels. The connective tissue is composed of layers of flattened cells (fibroblasts) lying on vascular collagenous or myxomatous tissue containing multinucleated giant cells, foam cells containing hemosiderin and lipids. (9) Following a fracture, periosteal new bone apposition may be evident. Recent literature reviews have revealed a number of new markers and histone mutations for differentiating benign from malignant tumours ie: Histone 3 mutations like H3F3A which is specific for giant cell tumours and H3F3B which is specific for chondroblastomas, these mutations help in differentiating from other giant cell containing tumours. (10)

Differential Diagnosis for UBC:
Varied benign and inflammatory bone lesion often lead to a misdiagnosis of unicameral bone cyst (5, 6) e.g.: Aneurysmal Bone Cyst (ABC), Fibrous Dysplasia with cystic changes, Enchondroma, Eosinphilic granuloma
ABC’s are eccentrically located lesions occurring near the metadiaphysis. Radiologically ABC’s show a significant expansion of the cortex, unlike the mild concentric expansion was seen in UBCs and show multiple fluid fluid levels which is pathognomic for ABC’s
Fibrous dysplasias are centrally located in the metadiaphyseal area occurring within the same age distribution. Radiographically lesion is usually “ground-glass” density.
An enchondroma has less sclerotic margins than the unicameral bone cyst and often contains a chondroid matrix and are usually located in the short tubular bones of the hands and feet.
Eosinphilic granuloma frequently involves axial skeleton than appendicular skeleton. Spinal Colum involvement is mostly seen in children. These are most destructive lytic lesion with associated soft tissue component and vertebral fracture or vertebra plana.

Treatment of UBC:
UBC’s are treated based on their stage at diagnosis. UBC’s could be latent or active, if a UBC has been diagnosed during its latent stage its most likely to be an incidental pick up which can be observed closely and should be followed up clinico – radiologically till healing. If during the observation phase there is an increase in the size or symptoms, it implies that lesion should be in the active stage of the disease and this should be intervened and treated. (6)
Treatment approach depends on the stage of UBC at presentation. Goal of treatment in UBC is to regain cortical thickness, bone strength and achieve healing of cyst. (3,11) If a lesion presents with a pathological fracture through the upper limb and is minimally displaced should be splinted and closely observed, there are studies which show cases spontaneously heal without any surgical intervention, the remaining cases have to be surgically stabilized. (4)
In lower limb defects, the treatment approach aims at aggressive surgical intervention so as to prevent any untoward event like occurrence of a pathological fracture. In a meta-analysis of 3217 cysts, healing after conservative treatment was 65% (27-100%). (3) In another study by Traub et al, healing after a conservative treatment was 70%. (12) However, in the study by Neer et al, healing of cysts after a conservative treatment was very low (4%) and was statistically low from healing after surgical procedures (77%) (p<0.001). (13) Also, subsequent fractures, growth disturbances and deformity were more common in the conservative treatment group.
In the meta-analysis of 62 studies (3217 cysts) mentioned earlier, the pool estimate of bone marrow injections was similar to steroid injections, 77.9% (65.9-89.9%). (3) The healing rates were improved when demineralized bone matrix was added. Healing rates after curettage were 90% while treatment with Intramedullary nails had almost 100% healing rates for UBC’s of long bones.
Based on the published literature, various treatment options have been suggested for the treatment of UBC’s. These can be broadly divided into 2 categories – (4, 8, 11, and 14)
a) Percutaneous interventions:
i. Percutaneous aspiration of the cyst fluid and steroid injection – When a corticosteroid is injected into a unicameral bone cyst, the cyst will heal in most cases by new bone formation.

Method: This is done by two needle method. Needles are introduced into the cavity to allow free escape of cystic fluid. Removal of fluid should be thorough so that the injected suspension of prednisolone acetate crystals can cover the whole cyst wall cavity. Up to 200 mg can be injected depending up on the size of the cavity. Generally, repeat injections are required. The injection does not appear to impair the growth of the epiphyseal plate, and no biochemical disturbances have been noted. Commercially available bone substitute material can be injected in to the cavity to provide osteogenic potential and rapid healing.

ii. Percutaneous aspiration of the cyst fluid and autogenous bone-marrow injection.
iii. Percutaneous aspiration of the cyst fluid and demineralized bone matrix injection
iv. Percutaneous aspiration of the cyst fluid and demineralized bone matrix combined with bone-
marrow injection.
v. Percutaneous drilling and Kirschner wires, Cannulated screws, or flexible intramedullary nails insertion to provide continuous decompression of the cyst.

b) Surgical procedures:
Principles of surgical intervention in a case of UBC’s:
i. The fracture should be allowed to heal with splinting if required maintaining limb length
ii. Adequate sized bone window should be made for curettage
iii. The reduce recurrence cyst wall cavity should be completely excised
iv. Avoid damaging the growth plate in order to avoid angular deformities
v. Cavity may be filled with bone grafts or bone graft substitutes
vi. Periosteum should be preserved for inducing osteogenesis
vii. Recurrent lesions may require subperiosteal resection

Described surgical techniques are:
i. Limited Curettage and bone grafting: This is the classical method of curettage where a small bony window is made and curettage is attempted through this cavity. This method is associated with a high rate of local recurrence due to inadequate disease clearance
ii. Extended intralesional curettage and bone grafting: Extended curettage is done by making an adequately sized bony window and post curettage all intervening bony septae and cyst membrane are broken down using a high-speed burr. The residual cavity is reconstructed using auto or allografts.
iii. Partial Resection and Bone Grafts: Subtotal excision of the cavity is done leaving only a small longitudinal portion of host bone to maintain length and stability. A strut of auto/allograft or in combination with morsellized bone graft can be used to fill the defect. The preserved periosteum is closed over the grafts.

• Immediate Complications:
i. Pathological Fractures
ii. Angular Deformities
iii. Limb Length Discrepancy
• They are also associated with increased chance of local recurrence which ranges from 10 to as high as 80 percent


1) Sung AD, Anderson ME, Zurakowski D, Hornicek FJ, Gebhardt MC. Unicameral bone cyst: a retrospective study of three surgical treatments. Clin Orthop Relat Res. 2008;466(10):2519-26.
2) Kaelin, Andre & D. MacEwen, G. (1989). Unicameral bone cysts. International Orthopaedics. 13. 275-282. 10.1007/BF00268511.
3) Kadhim, M., Thacker, M., Kadhim, A., & Holmes, L. (2014). Treatment of unicameral bone cyst: systematic review and meta analysis. Journal of children’s orthopaedics, 8(2), 171-91.
4) Ulici, A., Balanescu, R., Topor, L., & Barbu, M. (2012). The modern treatment of the simple bone cysts. Journal of medicine and life, 5(4), 469-73.
5) Evans J, Blake J. Unicameral Bone Cyst. [Updated 2019 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470587/
6) Noordin, S., Allana, S., Umer, M., Jamil, M., Hilal, K., & Uddin, N. (2018). Unicameral bone cysts: Current concepts. Annals of medicine and surgery (2012), 34, 43-49. doi:10.1016/j.amsu.2018.06.005
7) S. Struhl, M.D., C. Edelson, M.D., H. Pritzker, M.D., L.P. Seimon, M.D., and H.D. Dorfman, M.D. Solitary (unicameral) bone cyst The fallen fragment sign revisited. Skeletal Radiology (1989) 18:261-265
8) Donaldson, S., Chundamala, J., Yandow, S., & Wright, J. G. (2010). Treatment for unicameral bone cysts in long bones: an evidence based review. Orthopedic reviews, 2(1), e13.
9) Aiba, Hisaki & Kobayashi, Masaaki & Waguri-Nagaya, Yuko & Goto, Hideyuki & Mizutani, Jun & Yamada, Satoshi & Okamoto, Hideki & Nozaki, Masahiro & Mitsui, Hiroto & Miwa, Shinji & Kobayashi, Makoto & Endo, Kojiro & Saito, Shiro & Goto, Taeko & Otsuka, Takanobu. (2018). Treatment of aneurysmal bone cysts using endoscopic curettage. BMC Musculoskeletal Disorders. 19. 10.1186/s12891-018-2176-6.
10) Cleven, Arjen & Höcker, Saskia & Bruijn, Inge & Szuhai, Karoly & Cleton-Jansen, Anne-Marie & Bovee, Judith. (2015). Mutation Analysis of H3F3A and H3F3B as a Diagnostic Tool for Giant Cell Tumor of Bone and Chondroblastoma. The American journal of surgical pathology. 39. 1576-1583. 10.1097/PAS.0000000000000512.
11) Kadhim, Muayad & Sethi, Samir & M. Thacker, Mihir. (2016). Unicameral Bone Cysts in the Humerus: Treatment Outcomes. Journal of Pediatric Orthopaedics. 36. 392-399.
12) Traub, Frank & Eberhardt, Oliver & F. Fernandez, Fransico & Wirth, Thomas. (2016). Solitary bone cyst: A comparison of treatment options with special reference to their long-term outcome. BMC Musculoskeletal Disorders. 17. 10.1186/s12891-016-1012-0.
13) Alshryda, Sattar & Wright, James. (2017). Evidence-Based Treatment of Simple Bone Cyst. 10.1007/978-3-319-41142-2_43.
14) Fauzi Kamal, A., A. Ajiantoro, and Y. Prabowo. “Simple Bone Cyst Treated With Percutaneous Steroid Injection”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, no. 5, May 2018, pp. 186-90, doi:10.22159/ajpcr.2018.v11i5.21775.

How to Cite this article: Shetty N, Hegde P, Singh H, Gulia A. Aneurysmal Bone Cyst – Review. Journal of Bone and Soft Tissue Tumors Sep-Dec;5(3): 8-12.

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Editorial September – December 2019

Original Article | Volume 6 | Issue 1 | JBST September – December 2019 | Page 21 | Yogesh Panchwagh, Ashish Gulia, Ashok Shyam. 10.13107/jbst.2019.v05i03.014

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

JBST has completed 5 years of publication. At present, JBST is indexed with Index Copernicus, ETH Bibliothek and Google scholar while the process of Pubmed indexation is in pipeline. Being the official journal of the Indian Musculoskeletal Oncology Society (IMSOS), most of the contributions to the journal have come from the members of IMSOS. There have been respectable international contributions too, mostly in form of review articles. We have noticed that the original research articles which JBST would like to emphasize on currently, are far and few to be submitted. We feel one of the main reason for this could be the pending pubmed indexation.
The awareness about need of publications is already there in the subcontinent. We believe that there is tremendous clinical work ongoing. The data analysis and writing of the manuscripts, which earlier was in the backseat, also is on the rise currently. Most of the educational institutes now look at the research done and published by the faculty to decide on multitude of factors like enhancing financial aid, giving additional manpower and deciding on appraisals and promotions. This boosts the need of doing more research and publishing it.
When an author thinks of sending his or her original research work to a journal, the main thing that plays a role is the indexation. It simply is a reflection on how the journal is valued, how much of a difference it’s making in the concerned field and whether the processes followed are up to a certain standard. This in turn gives a certain credibility to the journal. However, there were certain branches, orthopaedic oncology being one, where there was dearth of a journal dedicated to the field. JBST aimed at filling the void and giving an option to the researchers to publish their hard work which otherwise takes a long time to find its way to the online or print version of journals dedicated to a broader speciality. Our focus was and always will be quick turnaround time, good quality and being clinician and researcher friendly. Considering that most clinicians and students would have limited budget allocation, we have kept the publishing fees to the bare minimum. In fact, for the life members of the affiliated societies of the journal, JBST is happy to waive off the publishing fees.
As we continue to walk the path that we had set our feet on, we would like to thank all our authors, reviewers, editorial board members and readers for the pivotal role that they have played over the years in shaping JBST. With continued help and support by the abovementioned, we hope to continue improving and getting better.

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 September-December; 5(3):1.

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Primary Leiomyosarcoma of the Hip Bone: A Case Report and Literature Review

Vol 5 | Issue 3 | September – December 2019 | page: 5-7 | Dr. Francisco de Assis Serra Baima Filho.

Author: Francisco de Assis Serra Baima Filho [1].

[1] Department of Orthopedic Oncology, Aldenora Bello Oncology Institute of Maranhao, Brazil.

Address of Correspondence
Dr. Francisco de Assis Serra Baima Filho,
Department of Orthopedic Oncology, Aldenora Bello Orthopedic Oncology Institute of Maranhao (IMOAB), Brazil.
E-mail: assisbaima@gmail.com


Introduction: Leiomyosarcoma is a rare smooth muscle mesenchymal neoplasm. The primary bone form is the rarest subtype. It mainly affects middle aged and female people. The most common complaint is the presence of a mass accompanied by pain. Diagnostic imaging and biopsy are required. The gold standard treatment is resection with oncologic margin.
Case Report: A 20-year-old female had a history of tumor mass and left hip pain beginning in September 2018.The patient showed the radiographic examination, osteolytic lesion of the left hip, and computed tomography scan of the abdomen with a solid expansive process measuring 15.8 cm left hip destruction and absence of organ damage. Biopsy and immunohistochemical result of leiomyosarcoma. Neoadjuvant chemotherapy was not effective. Thus, we opted for tumor resection with internal hemipelvectomy Type I.
Conclusion: Primary bone leiomyosarcoma is a rare malignant neoplasm which only shows tumoral resection with oncological margins as a curative treatment, thus the need for early diagnosis to allow adequate resection and lower patient morbidity.
Keywords: Leiomyosarcoma, case reports, rare diseases, literature review.


1. Gordon RW, Tirumani SH, Kurra V, Shinagare AB, Jagannathan JP, Hornick JL, et al. MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: Experience in 47 patients. Skeletal Radiol2014;43:615- 22.
2. Tahara K, Yamashita K, Hiwatashi A, Togao O, Kikuchi K, Endo M, et al. MR imaging findings of a leiomyosarcoma of the thoracic spine: A case report. Clin Neuroradiol 2016;26:229-33.
3. Mori T, Nakayama R, Endo M, Hiraga H, Tomita M, Fukase N, et al. Fortyeight cases of leiomyosarcoma of bone in Japan: A multicenter study from
the Japanese musculoskeletal oncology group. J Surg Oncol 2016;114:495-500.
4. Rekhi B, Kaur A, Puri A, Desai S, Jambhekar NA. Primary leiomyosarcoma of bone–a clinicopathologic study of 8 uncommon cases
with immunohistochemical analysis and clinical outcomes. Ann Diagn Pathol2011;15:147-56.
5. Potsi M, Stavrinou P, Patsinakidis N, Hatzibougias D, Foroglou N, Karayanopoulou G, et al. Primary osseous leiomyosarcoma of the spine: A
rare entity–case report and review of the literature. J Neurol Surg A Cent Eur Neurosurg2012;73:238-42.
6. Yang Y, Ma L, Li L, Liu H. Primary leiomyosarcoma of the spine: A case report and literature review. Medicine (Baltimore) 2017;96:e6227.
7. Zumárraga JP, Arouca MM, Baptista AM, Caiero MT, Rubio DE, Camargo OP. Primary leiomyosarcoma of bone: Clinicopathologic and
prognostic factors analysis in a single institution. Acta Ortopédica Bras 2019;27:152-5.
8. Recine F, Bongiovanni A, Casadei R, Pieri F, Riva N, De Vita A, et al. Primary leiomyosarcoma of the bone: A case report and a review of the literature. Medicine (Baltimore) 2017;96:e8545.

How to Cite this article:  De Assis Serra Baima Filho F | Primary Leiomyosarcoma of the Hip Bone: A Case Report and Literature Review | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2019;5(3): 5-7.

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Osteoid Osteoma Radiofrequency Ablation Treatment using a Kirschner Wireguided with a Scope: A Case Report and Literature Review

Vol 5 | Issue 3 | September – December 2019 | page: 2-4 | Dr. Francisco de Assis Serra Baima Filho.

Author: Francisco de Assis Serra Baima Filho [1].

[1] Department of Orthopedic Oncology, Aldenora Bello Oncology Institute of Maranhao, Brazil.

Address of Correspondence
Dr. Francisco de Assis Serra Baima Filho,
Department of Orthopedic Oncology, Aldenora Bello Orthopedic Oncology Institute of Maranhao (IMOAB), Brazil.
E-mail: assisbaima@gmail.com


Introduction: Osteoid osteoma is a benign tumor and is the third most common bone tumor. It is <2cm and characterized by very intense clinical pain at night which lets up after taking two nonsteroid anti-inflammatory drugs. Conventionally, the surgical treatment performed was resection or curettage. At present, the recommended treatment is computed tomography (CT)-guided radio frequency due to the high efficacy rate and low comorbidity.
Case Report: A 29-year-old male patient diagnosed with an osteoid osteoma in a small right femoral trochanter. Due to the location of the tumor, we opted for a percutaneous treatment, but it was not possible to be submitted to CT-guided radio frequency due to the high costs. Thus, the scope-guided Kirschner wire radioablation technique was developed.
Discussion: At present, CT-guided radio frequency ablation is the most commonly used method due to its safety, high efficacy (over 90%), and minimally invasive. However, there are disadvantages: Problems with sterility of the radiological set, radiation, and high risk of thermal the skin and soft tissue necrosis. New treatment methods are under development, but they are even more costly.
Conclusion: Due to its high costs, many patients, especially from underdeveloped countries, donot undergo this treatment and are reserved to open surgical treatment with resection or curettage. Therefore, the development of low-cost minimally invasive percutaneous techniques is necessary.
Keywords: Osteoid osteoma (MeSH ID: D010017), case report (MeSH ID: D002363), rare diseases (MeSH ID: D035583), literature review (MeSH ID: D016454).


1. Göksel F, Aycan A, Ermutlu C, Gölge UH, Sarisözen B. Comparison of radiofrequency ablation and curettage in osteoid osteoma in children. Acta Ortop Bras 2019;27:100-3.
2. Gurkan V, Erdogan O. Foot and ankle osteoid osteomas. J Foot Ankle Surg 2018;57:826-32.
3. Rinzler ES, Shivaram GM, Shaw DW, Monroe EJ, Koo KS. Microwave ablation of osteoid osteoma: Initial experience and efficacy. Pediatr Radiol 2019;49:566-70.
4. Hage AN, Chick JF, Gemmete JJ, Grove JJ, Srinivasa RN. Percutaneous radiofrequency ablation for the treatment of osteoid osteoma in children and adults: A comparative analysis in 92 patients. Cardiovasc Intervent Radiol 2018;41:1384-90.
5. Santiago E, Pauly V, Brun G, Guenoun D, Champsaur P, Le Corroller T. Percutaneous cryoablation for the treatment of osteoid osteoma in the adult population. Eur Radiol 2018;28:2336-44.
6. Shields DW, Sohrabi S, Crane EO, Nicholas C, Mahendra A. Radiofrequency ablation for osteoid osteoma-recurrence rates and predictive factors. Surgeon 2018;16:156-62.
7. Cuesta HE, Villagran JM, Horcajadas AB, Kassarjian A, Caravaca GR. Percutaneous radiofrequency ablation in osteoid ostema: Tips and tricks in special scenarios. Eur J Radiol 2018;102:169-75.
8. Miyazaki M, Saito K, Yanagawa T, Chikuda H, Tsushima Y. Phase I clinical trial of percutaneous cryoablation for osteoid osteoma. Jpn J Radiol 2018;36:669-75.
9. Erdogan O, Gurkan V. Hand osteoid osteoma: Evaluation of diagnosis and treatment. Eur J Med Res 2019;24:1-5.
10. Doyle AJ, Graydon AJ, Hanlon MM, French JG. Radiofrequency ablation of osteoid osteoma: Aiming for excellent outcomes in an Australasian context. J Med Imaging Radiat Oncol 2018;62:789-93.

How to Cite this article:  de Assis Serra Baima Filho F | Osteoid Osteoma Radiofrequency Ablation Treatment using a Kirschner Wire-guided with a Scope: A Case Report and Literature Review | Journal of Bone and Soft Tissue Tumors | Sep-Dec 2019; 5(3): 2-4.

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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.
E-mail: vishhal82@gmail.com

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.
2. Coleman RE. Metastatic bone disease: Clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001;27:165-76.
3. Koizumi M, Yoshimoto M, Kasumi F, Iwase T, Ogata E. Post-operative breast cancer patients diagnosed with skeletal metastasis without bone pain had fewer skeletal-related events and deaths than those with bone pain. BMC Cancer 2010;10:423.
4. Cramarossa G, Chow E, Zhang L, Bedard G, Zeng L, Sahgal A, et al. Predictive factors for overall quality of life in patients with advanced cancer. Support Care Cancer 2013;21:1709-16.
5. Lee SJ, Park S, Ahn HK, Yi JH, Cho EY, Sun JM, et al. Implications of bone-only metastases in breast cancer: Favorable preference with excellent outcomes of hormone receptor positive breast cancer. Cancer Res Treat 2011;43:89-95.
6. Ahn SG, Lee HM, Cho SH, Lee SA, Hwang SH, Jeong J, et al. Prognostic factors for patients with bone-only metastasis in breast cancer. Yonsei Med J 2013;54:1168-77.
7. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D, et al. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
8. Parkin DM. Cancer base No. 7. In: Cancer Incidence in Five Continents. Vol. 1-8. Lyon: IARC Press; 2005.
9. Brockton NT, Gill SJ, Laborge SL, Paterson AH, Cook LS, Vogel HJ, et al. The breast cancer to bone (B2B) metastases research program: A multi-disciplinary investigation of bone metastases from breast cancer. BMC Cancer 2015;15:512.
10. Pulido C, Vendrell I, Ferreira AR, Casimiro S, Mansinho A, Alho I, et al. Bone metastasis risk factors in breast cancer. Ecancermedicalscience2017;11:715.
11. Chen WZ, Shen JF, Zhou Y, Chen XY, Liu JM, Liu ZL, et al. Clinical characteristics and risk factors for developing bone metastases in patients with breast cancer. Sci Rep 2017;7:11325.
12. Colleoni M, O’Neill A, Goldhirsch A, Gelber RD, Bonetti M, Thürlimann B, et al. Identifying breast cancer patients at high risk for bone metastases. J Clin Oncol 2000;18:3925-35.
13. James JJ, Evans AJ, Pinder SE, Gutteridge E, Cheung KL, Chan S, et al. Bone metastases from breast carcinoma: Histopathological radiological correlations and prognostic features. Br J Cancer 2003;89:660-5.
14. Purushotham A, Shamil E, Cariati M, Agbaje O, Muhidin A, Gillett C, et al. Age at diagnosis and distant metastasis in breast cancera surprising inverse relationship. Eur J Cancer 2014;50:1697-705.
15. Xiao W, Zheng S, Yang A, Zhang X, Zou Y, Tang H, et al. Breast cancer subtypes and the risk of distant metastasis at initial diagnosis: A population-based study. Cancer Manag Res 2018;10:5329-38.
16. Diessner J, Wischnewsky M, Stüber T, Stein R, Krockenberger M, Häusler S, et al. Evaluation of clinical parameters influencing the development of bone metastasis in breast cancer. BMC Cancer 2016;16:307.
17. Irawan C, Hukom R, Prayogo N. Factors associated with bone metastasis in breast cancer: A preliminary study in an Indonesian population. Acta Med Indones2008;40:178-80.
18. Coleman RE, Rubens RD. The clinical course of bone metastases from breast cancer. Br J Cancer 1987;55:61-6.
19. Huszno J, Nowara E. Risk factors for disease progression in HER2-positive breast cancer patients based on the location of metastases. PrzMenopauzalny2015;14:173-7.
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.
E-mail: ms.satish@cancerinstitutewia.org

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.
2. Allison DC, Carney SC, Ahlmann ER, Hendifar A, Chawla S, Fedenko A, et al. A meta-analysis of osteosarcoma outcomes in the modern medical era. Sarcoma 2012;2012:704872.
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.
5. Davidson JH, Jones LE, Cornet J, Cittarelli T. Management of the multiple limb amputee. DisabilRehabil2002;24:688-99.
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.
10. Weddington WW Jr.,Segraves KB, Simon MA. Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol 1985;3:1393-9.
11. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am 1997;44:973-89.
12. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin OrthopRelat Res 1993;286:241-6.
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.
18. Davis AM, Devlin M, Griffin AM, Wunder JS, Bell RS. Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: A matched case-control study. Arch Phys Med Rehabil1999;80:615-8.
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.
20. Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 2000;73:198-205.
21. Ginsberg JP, Rai SN, Carlson CA, Meadows AT, Hinds PS, Spearing EM, et al. A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma. Pediatr Blood Cancer 2007;49:964-9.
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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