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Journal of Bone and Soft Tissue Tumors (JBST) is the official Journal of The Indian Musculo Skeletal Oncology Society
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
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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:
1. Scoccianti G, Rigacci L, Puccini B, Campanacci DA, Simontacchi G, Bosi A, et al. Primary lymphoma of bone: outcome and role of surgery. Int Orthop 2013;37:2437-42.
2. Tsoucalas G, Papaioannou TG, Mainta I, Thomaidis V, Fiska A. A rare case of a non-Hodgkin’s lymphoma presented as a single bone lesion. Biomed J Sci Tech Res 2018;3:1-3.
3. Singh T, Satheesh CT, Lakshmaiah KC, Suresh TM, Babu GK, Lokanatha D, et al. Primary bone lymphoma: A report of two cases and review of the literature. J Can Res Ther 2010;6:296-8.
4. Coley BL, Higginbotham NL, Groesbeck HP. Primary reticulum cell sarcoma of bone; summary of 37 cases. Radiology 1950;55:641-58.
5. Jacobs AJ, Michels R, Stein J, Levin AS. Socioeconomic and demographic factors contributing to outcomes in patients with primary lymphoma of bone. J Bone Oncol 2015;4:32-6.
6. Jawad MU. Primary lymphoma of bone in adult patients. Cancer 2010;116:871-9.
7. Kitsoulis P, Vlychou M, Papoudou-Bai A, Karatzias G, Charchanti A, Agnantis NJ, et al. Primary lymphomas of bone. Anticancer Res 2006;26:325-38.
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.
9. Messina C, Christie D, Zucca E, Gospodarowicz M, Ferreri AJ. Primary and secondary bone lymphomas. Cancer Treatment Rev 2015;41:235-46.
10. Bhagavathi S, Fu K. Primary lymphoma of bone: Areview. Semin Diagn Pathol 2014;31:48-52.
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.
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Analysis of X-ray Patterns in Infection and Tumor
Cases Series | Volume 7 | Issue 2 | JBST May – August 2021 | Page 5-8 | Dominic Puthoor. DOI:10.13107/jbst.2021.v07i02.47
Author: Dominic Puthoor[1]
[1]Department of Orthopaedic Oncologist, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
Address of Correspondence
Dr. Dominic Puthoori,
Department of Orthopaedic Oncologist, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
E-mail: dkputhur@gmail.com
Abstract
Introduction: In diagnosis of bone tumor, X-ray is as important, if not more important than pathology report. However, X-ray had specific disadvantage. Tumor mimics especially infection can have same appearance as tumor in the X-ray. In this article, author analyzes the different patterns of X-ray changes common to tumor and infection and points outs that X-ray depicts the aggressiveness of the condition rather than a specific diagnosis.
Keywords: X-ray, Bone tumor, Tumor mimics.
References:
1. Mandal AK, Chaudhary S. Text Book of Pathology. Synapse Books. 1st ed. New Delhi, India: Avichal Publishing Company; 2010. p. 51, 113.
2. Kumar V, Abbas AK, Fausto N, Aster JC. Robbins and Cotran Pathological Basis of Diseases. Amsterdam, Netherlands: Elsevier; 2010. p. 1205-35.
3. Enneking WF, Bertoni F, The staging system for benign and malignant tumours of the musculoskeletal system. In: Nadarajan M, editors. Article Written in Principles of Orthopedic Oncology; 1997. p. 112-20.
4. Shimose S, Sugita T, Kubo T, Matsuo T, Nobuto H, Ochi M. Differential diagnosis between osteomyelitis and bone tumors. Acta Radiol 2008;49:928-33.
5. Stacy GS, Kapur A. Mimics of bone and soft tissue neoplasms. Radiol Clin North Am 2011;49:1261-86.
6. Dorman HD, Czerniak B. Bone Tumors. 1st ed. United States: Mosby; 1998. p. 22.
7. Puthur D. X-ray patterns common to infection and tumours. Kerala J Orthop 2014;27:73-7.
8. Malawer MM, Sugarbaker PH. Musculoskeletal Cancer Surgery: Treatment of Sarcomas and Allied Diseases. Berlin, Germany: Springer; 2001. p. 59, 60.
9. Sutton D. Text Book of Radiology and Imaging. 7th ed. United Kingdom: Churchill Livingstone; 2003. p. 1153-60.
10. Miwa S, Otsuka T. Practical use of imaging technique for management of bone and soft tissue tumors. J Orthop Sci 2017;22:391-400.
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Malignant Transformation of Monostotic Fibrous Dysplasia after Surgery: A Case Report
Case Report | Volume 7 | Issue 2 | JBST May- August 2021 | Page 1-4 | Abigail R. Tud, Cesar D. Dimayuga.
DOI:10.13107/jbst.2021.v07i02.46
Author: Abigail R. Tud[1], Cesar D. Dimayuga[1]
[1]Department of Orthopedics, The Medical City, Ortigas Avenue, Pasig City, Philippines 1605.
Address of Correspondence
Dr. Abigail R. Tud,
Musculoskeletal Tumor Unit, Philippine Orthopedic Center, Banawe corner Maria Clara Streets, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1114.
E-mail: abitud@gmail.com
Abstract
Introduction: Fibrous dysplasia (FD) is a benign lesion characterized by replacement of normal bone with abnormal connective tissue. It occurs in monostotic or polyostotic forms, with a rare but proven potential for malignant transformation. Symptoms of acute pain, rapid swelling, or an enlarging mass should increase suspicion for possible sarcomatous change. Complete surgical resection is the mainstay of treatment, and chemotherapy is recommended to improve survival.
Case Report: A 52-year-old male presented with a painful, enlarging mass on the right proximal thigh 2 years after undergoing plate fixation of the distal femur for a pathologic fracture secondary to monostotic FD. Diagnostic imaging revealed signs of recurrence, and core needle biopsy revealed aggressive features suggestive of malignant transformation. Following surgical resection and chemotherapy, the outcome has been uneventful without evidence of recurrence or metastasis at 4-year post-operation.
Conclusion: Malignant transformation in monostotic FD is rare. Symptom exacerbation should increase the suspicion for sarcomatous change and prompt the need for diagnostic imaging as well as histologic confirmation.
Keywords: Fibrosarcoma, fibrous dysplasia, malignant transformation, secondary sarcoma.
References:
1. Picci P, Sieberova G, Alberghini M, Balladelli A, Vanel D, Hogendoorn PC, et al. Late sarcoma development after curettage and bone grafting of benign bone tumors. Eur J Radiol 2011;77:19-25.
2. Muthusamy S, Conway SA, Subhaeong TY, Temple HT. Locally aggressive fibrous dysplasia mimicking malignancy: A report of four cases and review of the literature. Clin Orthop Relat Res 2015;473:742-50.
3. Qu N, Yao W, Cui X, Zhang H. Malignant transformation in monostotic fibrous dysplasia: Clinical features, imaging features, outcomes in 10 patients, and review. Medicine (Baltimore) 2015;94:e369.
4. Mardekian SK, Tuluc M. Malignant sarcomatous transformation of fibrous dysplasia. Head Neck Pathol 2015;9:100-3.
5. Riddle ND, Bui MM. Fibrous dysplasia. Arch Pathol Lab Med 2013;137:8-21.
6. Ruggieri P, Sim FH, Bond JR, Unni KK. Malignancies in fibrous dysplasia. Cancer 1994;73:1411-24.
7. Chapurlat RD, Gensburger D, Jimenez-Andrade JM, Ghilardi JR, Kelly M, Mantyh P. Pathophysiology and medical treatment of pain in fibrous dysplasia of bone. Orphanet J Rare Dis 2012;7:S3.
8. Doqanavsarqil B, Argin M, Kececi B, Sezak M, Sanli UA, Oztop F. Secondary osteosarcoma arising in fibrous dysplasia, case report. Arch Orthop Trauma Surg 2009;129:439-44.
9. Stanton RP, Ippolito E, Springfield D, Lindaman L, Wientroub S, Leet A. The surgical management of fibrous dysplasia of bone. Orphanet J Rare Dis 2012;7 Suppl 1:S1.
10. Hatano H, Morita T, Arllzumi T, Kawashima H, Ogose A. Malignant transformation of fibrous dysplasia: A case report. Oncol Lett 2014;8:384-6.
11. National Comprehensive Cancer Network (NCCN). Bone Cancer, NCCN Guidelines; 2013. Available from: http://www.nccn.org. [Last accessed on 2016 Mar 16].
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Distal Ulnar Translocation with Partial Wrist Arthrodesis for Grade III Campanacci Giant Cell Tumors of the Distal Radius – A Case Series
Cases Series | Volume 7 | Issue 1 | JBST January – April 2021 | Page 12-15 | Sivakumar Raju, Prahalad Kumar Singhi, M. Chidambaram, V. Somashekar. DOI: 10.13107/jbst.2021.v0701.43
Author: Sivakumar Raju[1], Prahalad Kumar Singhi[1], M. Chidambaram[1], V. Somashekar[1]
[1]Department of Orthopaedic, Preethi Hospitals Pvt. Ltd., 50 Melur Main Road, Uthangudi, Madurai, Tamil Nadu, India.
Address of Correspondence
Dr. Prahalad Kumar Singhi,
Consultant Arthroscopy and Trauma Surgeon, Preethi Hospitals Pvt. Ltd., Madurai – 625 107, Tamil Nadu, India.
E-mail: docpsin2001@yahoo.co.in
Abstract
Introduction: Campanacci Grade III giant cell tumor of distal radius is an uncommon condition with limited treatments options and ulnar translocation is one.
Materials and Methods: We retrospectively analyzed five cases of Campanacci Grade III tumor in which three were recurrent cases, four female and one male all operated under regional anesthesia (supraclavicular brachial plexus block) with en bloc resection and reconstruction using ulnar translocation with fusion only with proximal carpal row from 2012 to 2018 at our institute. The mean length of tumor resected was 6.74 cm and average follow-up of 60 months. Average union time at radioulnar junction was 4–5 months and ulnocarpal joint was 3–4 months.
Results: Functional outcome was assessed using musculoskeletal tumor society scoring system, 80% had excellent and good outcome, and one patient had extensive recurrence and ended up in below-elbow amputation.
Conclusion: Ulnar translocation with partial wrist arthrodesis is a simple, valid, option with acceptable appearance of forearm, useful wrist function, no donor site morbidity nor need for a microvascular procedure, and no need to achieve complete wrist arthrodesis as compared to other options for reconstruction.
Keywords: Distal radius giant cell tumor, Campanacci Grade III tumor, modified ulnar translocation, partial wrist arthrodesis.
Reference:
1. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. JBone Joint Surg [Am] 1987;69-A:106-14.
2. Vander Griend RA, Funderburk CH. The treatment of giant-cell tumors of the distal part of the radius. J Bone Joint Surg [Am] 1993;75-A:899-908.
3. Sheth DS, Healey JH, Sobel M, Lane JM, Marcove RC. Giant cell tumor of the distal radius. J Hand Surg [Am] 1995;20:432-40.
4. Khan MT, Gray JM, Carter SR, Grimer RJ, Tillman RM. Management of the giant-cell tumours of the distal radius. Ann R Coll Surg Engl 2004;86:18-24.
5. Harness NG, Mankin HJ. Giant-cell tumor of the distal forearm. J Hand Surg Am. 2004; 29(2):188-193.Cheng CY, Shih HN, Hsu KY, Hsu RW. Treatment of giant cell tumor of the distal radius.Clin Orthop Relat Res. 2001; (383):221-228.
6. Gitelis S, Mallin BA, Piasecki P, Turner F. Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am. 1993; 75(11):1648-1655.
7. O’Donnell RJ, Springfield DS, Motwani HK, Ready JE, Gebhardt MC, Mankin HJ. Recurrence of giant-cell tumors of the long bones after curettage and packing with cement. J Bone Joint Surg Am. 1994: 76(12):1827-1833.
8. Kocher MS, Gebhardt MC, Mankin HJ. Reconstruction of the distal aspect of the radius with use of an osteoarticular allograft after excision of a skeletal tumor. J Bone Joint Surg Am. 1998; 80(3):407-419.
9. Szabo RM, Anderson KA, Chen JL. Functional outcome of en bloc excision and osteoarticular allograft replacement with the Sauve-Kapandji procedure for Campanacci grade 3 giant-cell tumor of the distal radius. J Hand Surg Am. 2006; 31(8):1340-1348.
10. Lalla RN, Bhupathi SC. Treatment of giant cell tumor of the distal radius by ulnar translocation. A case report and review of the literature. Orthopedics. 1987; 10(5):735-739.
11. Seradge H. Distal ulnar translocation in the treatment of giant-cell tumors of the distal end of the radius. J Bone Joint Surg Am. 1982; 64(1):67-73.
12. Bhan S, Biyani A. Ulnar translocation after excision of giant cell tumour of distal radius. J Hand Surg Br. 1990; 15(4):496-500.
13. Ono H, Yajima H, Mizumoto S, et al. Vascularized fibular graft for reconstruction of the wrist after excision of giant cell tumor. Plast Reconstr Surg 1997;99:1086-93.
14. Bhagat S, Bansal M, Jandhyala R, et al. Wide excision and ulno-carpal arthrodesis for primary aggressive and recurrent giant cell tumours. Int Orthop 2008;32:741-5.
15. Natarajan MV, Chandra Bose J, Viswanath J, Balasubramanian N, Sameer M. Custom prosthetic placement for distal radial tumours. Int Orthop 2009;33:1081-4.
16. Seradge H. Distal ulnar translocation in the treatment of giant-cell tumors of the distal end of the radius. J Bone Joint Surg [Am] 1982;64-A:67-73.
17. Chalidis BE, Dimitriou CG. Modified ulnar translocation technique for the reconstruction of giant cell tumour of the distal radius. Orthopedics 2008;31:608.
18. 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 Orthop 1993;286:241-6.
19. Asavamongkolkul A, Waikakul S, Phimolsarnti R, Kiatisevi P. Functional outcome following excision of a tumour and reconstruction of the distal radius. Int Orthop 2009;33:203
20. SK Saraf, SC Goel, Complications of resection and reconstruction in giant cell tumour of distal end of radius – An analysis, IJO, October 2005, Volume 39: Number 4: P.206-211
21. WILSON, P. D., and LANCE, E. M.: Surgical Reconstruction of the Skeleton following Segmental Resection for Bone Tumors. J. Bone and Joint Surg., 47-A: 1629-1656, Dee. 1965
22. A.Puri, Ulnar translocation after excision of a Campanacci grade III giant cell tumour of the distal radius, JBJS (br) 2010; 92-B-875-9
23. Turcotte RE, Wunder JS, Isler MH, et al. Giant cell tumor of long bone: a Canadian Sarcoma Group study. Clin Orthop Relat Res. 2002; (397):248-258.
24. Zou C, Lin T, Wang B, et al. Managements of giant cell tumor within the distal radius: A retrospective study of 58 cases from a single center. J Bone Oncol. 2018;14:100211. Published 2018 Dec 14. doi:10.1016/j.jbo.2018.100211.
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