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Journal of Bone and Soft Tissue Tumors (JBST) is the official Journal of The Indian Musculo Skeletal Oncology Society
A Case Report of Solitary Bone Metastasis from Primary Angiosarcoma of the Bilateral Breasts – A Rare Diagnosis
Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 16-21 | Katrina Ysabel R Naraval, Daniela Kristina D. Carolino, Ma. Lilia Molina P. Jose. DOI: 10.13107/jbst.2021.v07i01.43
Author: Katrina Ysabel R Naraval[1], Daniela Kristina D. Carolino[1], Ma. Lilia Molina P. Jose[1], [2]
[1]Institute of Orthopaedics and Sports Medicine, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Blvd., Quezon city 1112, Philippines,
[2]Orthopaedic Oncology section, Department of Orthopaedics, The Medical City Clark, Pampanga, Philippines.
Address of Correspondence
Dr. Katrina Ysabel R Naraval,
Institute of Orthopaedics and Sports Medicine, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Blvd., Quezon city 1112, Philippines.
E-mail: khayanaraval@gmail.com
Abstract
Introduction: Primary angiosarcoma of the breast is an uncommon subtype of soft-tissue sarcoma known to be aggressive and is associated with distant metastasis and poor prognosis. Solitary bone metastases occurring in these cases are even more rare with the available limited literature based from small retrospective case series.
Case Report: We present a case of a 24-year-old Filipino female previously diagnosed with primary angiosarcoma of the bilateral breasts, initially presenting with a 3-month history of the right hip pain and consulted due to a pathologic fracture of the right proximal femur. Diagnostic tests done confirmed solitary skeletal metastasis to this area, for which she underwent wide resection and application of a proximal femoral endoprosthesis. Postoperatively, the patient was able to independently ambulate, with follow-up radiographs showing stable implant fixation. Further imaging showed that lesion-free bones, however, noted development of distant recurrence manifesting with pulmonary metastases and hemorrhagic subcutaneous lesions 3 months after. Adequate tumor resection and radiotherapy are reported to successfully treat isolated skeletal metastasis in the proximal femur. The presence of the pathologic fracture before definitive treatment may have contributed to its distant recurrence, in addition to an already aggressive nature of the primary malignancy.
Conclusion: In the background of primary breast angiosarcoma, although rare, high suspicion for isolated skeletal metastasis in a symptomatic patient prevents delay in definitive management, which avoids progression to a poorer prognosis.
Keywords: Solitary bone metastasis, angiosarcoma, proximal femur, pathologic fracture.
References:
1. Bordoni D, Bolletta E, Falco G, Cadenelli P, Rocco N, Tessone A, et al. Primary angiosarcoma of the breast. Int J Surg Case Rep 2016;20:12-5.
2. An I, Harman M, Ibiloglu I. Topical ciclopirox olamine 1%: Revisiting a unique antifungal. Indian Dermatol Online J 2017;10:481-5.
3. Kunkiel M, Maczkiewicz M, Jagiełło-Gruszfeld A, Nowecki Z. Primary angiosarcoma of the breast-series of 11 consecutive cases-a single-centre experience. Curr Oncol 2018;25:e50-3.
4. Bhosale SJ, Kshirsagar AY, Patil MV, Wader JV, Nangare N, Patil PP. Primary angiosarcoma of breast: A case report. Int J Surg Case Rep 2013;4:362-4.
5. Zahir ST, Sefidrokh Sharahjin N, Rahmani K. Primary breast angiosarcoma: Pathological and radiological diagnosis. Malays J Med Sci 2014;21:66-70.
6. Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, et al. Angiosarcoma: Clinical and imaging features from head to toe. Br J Radiol 2017;90:20170039.
7. Wang L, Lao IW, Yu L, Wang J. Clinicopathological features and prognostic factors in angiosarcoma: A retrospective analysis of 200 patients from a single Chinese medical institute. Oncol Lett 2017;14:5370-8.
8. Hosaka S, Katagiri H, Honda Y, Wasa J, Murata H, Takahashi M. Clinical outcome for patients of solitary bone only metastasis. J Orthop Sci 2016;21:226-9.
9. Vincenzi B, Santini D, Schiavon G, Frezza AM, Dileo P, Silletta M, et al. Bone metastases in soft tissue sarcoma patients: A survey of natural, prognostic value, and treatment. J Clin Oncol 2012;30 Suppl 15:10063.
10. Guzik G. Oncological and functional results after surgical treatment of bone metastases at the proximal femur. BMC Surg 2018;18:2-9.
11. Li N, Cusidó MT, Navarro B, Tresserra F, Baulies S, Ara C, et al. Breast sarcoma. A case report and review of literature. Int J Surg Case Rep 2016;24:203-5.
12. Saimura M, Mitsuyama S, Anan K, Koga K, Ono M, Toyoshima S. A rare case of rapidly progressing angiosarcoma of the breast with multiple metastases to the bone, liver, ovary, and gingiva. Int Cancer Conf J 2012;1:159-63.
13. Soeharno H, Povegliano L, Choong PF. Multimodal treatment of bone metastasis-a surgical perspective. Front Endocrinol (Lausanne) 2018;9:518.
14. Khattak MJ, Ashraf U, Nawaz Z, Noordin S, Umer M. Surgical management of metastatic lesions of proximal femur and the hip. Ann Med Surg (Lond) 2018;36:90-5.
15. Pramanik R, Gogia A, Malik PS, Gogi R. Metastatic primary angiosarcoma of the breast: Can we tame it the metronomic way. Indian J Med Paediatr Oncol 2017;38:228-31.
16. Apice G, Pizzolorusso A, di Maio M, Grignani G, Gebbia V, Buonadonna A, et al. Confirmed activity and tolerability of weekly paclitaxel in the treatment of advanced angiosarcoma. Sarcoma 2016;2016:6862090.
17. Yu Z, Xiong Y, Shi R, Min L, Zhang W, Liu H, et al. Surgical management of metastatic lesions of the proximal femur with pathological fractures using intramedullary nailing or endoprosthetic replacement. Mol Clin Oncol 2017;8:107-14.
18. Sarahrudi K, Hora K, Heinz T, Millington S, Vécsei V. Treatment results of pathological fractures of the long bones: A retrospective analysis of 88 patients. Int Orthop 2006;30:519-24.
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Treatment of GCT of Distal Radius Bone with Pre-operative Denosumab Plus Replacement by Distal Ulna and Ulnocarpal Arthrodesis: A Case Report
Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 9-11 | Francisco de Assis Serra Baima Filho. DOI: 10.13107/jbst.2021.v07i01.42
Author: Francisco de Assis Serra Baima Filho[1]
[1]Department of Orthopedics, Aldenora Bello Maranhao Institute of Oncology (IMOAB), São Luís, Brazil.
Address of Correspondence
Dr. Francisco de Assis Serra Baima Filho,
Department of Orthopedics, Aldenora Bello Maranhao Institute of Oncology (IMOAB), São Luís, Brazil.
E-mail: assisbaima@gmail.com
Introduction: Giant-cell tumor (GCT) of bone is a benign tumor, however locally aggressive with a tendency for local recurrence and potential for metastasis. The distal radio is the third most frequent location, after the distal femur and proximal tibia. In Campanacci grade Grade III tumors, multiple reconstruction techniques after resection of the distal radius have been described, such as bone graft plus wrist arthrodesis. The use of the drug denosumab in the pre-operative period helps a surgery with less comorbidity, and limb preservation and reduces the chance of function loss. The objective is to report a case of a patient who underwent treatment of Campanacci grade Grade III distal radius bone GCT, with pre-operative denosumab application and resection surgery, replacement by bone graft (distal ulna), and ulnocarpal arthrodesis.
Methodology: Quantitative, descriptive, retrospective study by analyzing the medical record of a case report, plus literature study.
Conclusion: The use of pre-operative denosumab favors surgery with less comorbidity, ; however, more studies are needed in order to define the ideal dosage. Ulnar translocation with ulnar carpal arthrodesis has also proved to be a successful technique and further studies are needed to evaluate its effectiveness.
Keywords: Giant -cell tumors of bone (MeSH ID: D018212), denosumab (MeSH ID: D000069448), arthrodesis (MeSH ID: D001174), case report (MeSH ID: D002363).
Reference:
1. Qi DW, Wang P, Ye ZM, Yu XC, Hu YC, Zhang GC, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg 2016;8:196-204.
2. Yang YF, Wang JW, Huang P, Xu ZH. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord 2016;17:1-6.
3. Barik S, Jain A, Ahmad S, Singh V. Functional outcome in giant cell tumor of distal radius treated with excision and fibular arthroplasty: A case series. Eur J Orthop Surg Traumatol 2020;30:1109-17.
4. Meena DK. Re: Wrist fusion through centralisation of the ulna for recurrent giant cell tumour of the distal radius. J Orthop Surg 2016;24:280.
5. McCarthy CL, Gibbons CL, Bradley KM, Hassan AB, Giele H, Athanasou NA. Giant cell tumour of the distal radius/ulna: Response to pre-operative treatment with short-term denosumab. Clin Sarcoma Res 2017;7:1-11.
6. Gulia A, Puri A, Prajapati A, Kurisunkal V. Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma 2019;10:1033-7.
7. Bianchi G, Sambri A, Marini E, Piana R, Campanacci DA, Donati DM. Wrist arthrodesis and osteoarticular reconstruction in giant cell tumor of the distal radius. J Hand Surg Am 2020;2020:1-6.
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Schwannoma in the Bifurcation of the Sciatic Nerve: A Case Report and Literature Review
Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 4-8 | Daniela Kristina D. Carolino, Ai E. Gamboa, Edwin Joseph R. Guerzon. DOI: 10.13107/jbst.2021.v07i01.41
Author: Daniela Kristina D. Carolino[1], Ai E. Gamboa[1], Edwin Joseph R. Guerzon[1]
[1]Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Philippines.
Address of Correspondence
Dr. Daniela Kristina D. Carolino,
Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Philippines.
E-mail: dkdcarolino@gmail.com
Abstract
Purpose: The schwannoma is a benign tumor and is known to be the most common type of tumor of the peripheral nerve sheath. They are known to arise from the nerves of the head and neck; however, outside this region, it is found more often in the upper extremity, and if occurring in the lower extremity, is likely found in the posterior tibial nerve. Schwannoma of the sciatic nerve is considered a very rare entity, accounting for only 1% of all schwannomas, with an estimated incidence of about 6 cases per million individuals.
Methods: In our literature search, it is noted that they are more likely to arise from the proximal aspect of the nerve, as it exits the sciatic notch, presenting as a mass in the proximal thigh. This case reports tackles an even more unusual presentation of this tumor, occurring adjacent to the bifurcation of the sciatic nerve.
Results: A 46-year- old male presented with sharp, shooting pain from the back of his thigh to the plantar aspect of his left foot of 2 years duration. Patient was initially diagnosed as a case of plantar fasciitis and hamstring tightness that was managed conservatively. However, due to persistence as well as appearance of a small mass on the posterior thigh and positive Tinel’s sign over the mass, patient underwent work-up and subsequent surgery.
Conclusion: Due to its presentation that closely mimics sciatica of a lumbosacral discal pathology and other musculoskeletal disorders, these are often diagnosed and managed late. Despite its rarity, it should be suspected in patients with history of radicular pain without any neurologic deficits, which is poorly controlled by analgesics and supportive therapy, with physical examination pointing to a localized neural pathology.
Keywords: Schwannoma, sciatic nerve, bifurcation.
References:
1. Omezzine SJ, Zaara B, Ali MB, Abid F, Sassi N, Hamza HA. A rare cause of non discal sciatica: Schwannoma of the sciatic nerve. Orthop Traumatol Surg Res 2009;95:543-6.
2. Rhanim A, El Zanati R, Mahfoud M, Berrada MS, El Yaacoubi M. A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve. J Clin Orthop Trauma 2013;4:89-92.
3. Nahar S, Goyal A. A large schwannoma of sciatic nerve-a case report. J Peripher Nerve Surg 2018;2:86-9.
4. Godkin O, Ellanti P, O’Toole G. Large schwannoma of the sciatic nerve. BMJ Case Rep 2016;2016:bcr201617717.
5. As-Sultany M, Ben-Ghashir N, Mistry A, Chandrasekar C. Giant schwannomas of the sciatic nerve. BMJ Case Rep 2017;2017:bcr2016218466.
6. Wu WT, Chang KV, Hsu YC, Yang YC, Hsu PC. Ultrasound imaging for a rare cause of sciatica: A schwannoma of the sciatic nerve. Cureus 2020;12:e8214.
7. Maes R, Ledoux P. A rare cause of sciatica: Sciatic nerve schwannoma-report of one case with long subclinical course and misleading presentation. SICOT J 2020;6:16.
8. Naik H, Velho V. Sciatic nerve schwannoma: A rare case. Neurol India 2019;67:151-3.
9. Rosario MS, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Inatani H, et al. A case of infected schwannoma mimicking malignant tumor. World J Surg Oncol 2016;14:302.
10. Eroglu U, Bozkurt M, Ozates O, Akturk S, Tuna H. Sciatic nerve schwannoma: Case report. Turk Neurosurg 2014;24:120-2.
11. Cavalcante JB, Cembraneli PN, Cavalcante RB, Valente VF, Cavalcante JE. Unusual presentation of giant schwannoma in the sciatic nerve. Case Rep Int 2020;9:100081Z06JC2020.
12. Haspolat Y, Ozkan FU, Turkmen I, Kemah B, Turhan Y, Sarar S, et al. Sciatica due to schwannoma at the sciatic notch. Case Rep Orthop 2013;2013:510901.
13. Gorgan M, Sandu AM, Bucur N, Neacsu A, Pruna V, Voina A, et al. Sciatic nerve schwannoma: A case report. Rom Neurosurg 2008;15:27-31.
14. Rekha A, Ravi A. Sciatic nerve schwannoma. Int J Low Extrem Wounds 2004;3:165-7.
15. Hamdi MF, Aloui I, Ennouri K. Sciatica secondary to sciatic nerve schwannoma. Neurol India 2009;57:685-6.
16. Mansukhani SA, Butala RR, Shetty SH, Khedekar RG. Sciatic nerve schwannoma: A case report. J Orthop Surg (Hong Kong) 2015;23:259-61.
17. Kumar S, Ralli M, Sharma J, Sansanwal P, Singh G. Sciatic schwannoma: A rare entity. Clin Cancer Investig J 2015;4:720-2.
18. Munakomi S, Shrestha P. Case report: Sciatic nerve schwannoma-a rare cause of sciatica. F1000Res 2017;6:267.
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A Giant Gluteal Mass in a One1-Year-Old: A Case Report on Pediatric Lipoblastoma
Case Report | Volume 7 | Issue 1 | JBST January-April 2021 | Page 1-2 | Abigail Rivera Tud, Albert Jerome C Quintos. DOI: 10.13107/jbst.2021.v07i01.40
Author: Abigail Rivera Tud[1], Albert Jerome C Quintos[1]
[1]Department of Orthopedics, The Medical City, Pasig City, Philippines.
Address of Correspondence
Dr. Abigail Rivera Tud,
Department of Orthopedics, The Medical City, Pasig City, Philippines.
E-mail: abitud@gmail.com
Abstract
Introduction: Lipoblastomas are a rare type of benign neoplasm arising from embryonal fat, found primarily among young children. Predominantly small tumors of the head and neck, trunk, and extremities, less than twenty 20 cases of gluteal lipoblastoma have been reported in the English literature. Complete surgical resection is recommended, with recurrence rates at 14–-46%.
Case Report: A one1-year-old female presented with a large, painless gluteal mass of one 1 year. Growth was consistent since shortly after birth, with no history of manipulation, constitutional symptoms or trauma. Magnetic resonance imaging showed a heterogenous, encapsulated, lobulated mass without bone or vascular invasion, and marginal excision was completed without need for soft soft-tissue reconstruction. At five 5 years post-surgery, the outcome has been uneventful, without evidence of recurrence.
Conclusion: Lipoblastomas present with characteristic features on clinical examination, diagnostic imaging, and histology. While benign, they may share features with more aggressive soft tissue tumors, emphasizing the need for careful assessment prior to before surgery.
Keywords: Gluteal, lipoblastoma, pediatric.
Reference:
1. Coffin CM. Adipose and myxoid tumors. In: Pediatric Soft Tissue Tumors: A Clinical, Pathological, and Therapeutic Approach. Ch. 8. New Salt Lake City, Utah. JA Majors Company; 1997. p. 254-76.
2. Bruyeer, E, Lemmerling M, Poorten VV, Sciot R, Hermans R. Paediatric lipoblastoma in the head and neck: Three cases and review of literature. Cancer Imaging 2012;12:484-7.
3. Gisselsson, D, Hibbard MK, Dal Cin P, Sciot R, His BL, Kozakewich HP, et al. PLAG1 alterations in lipoblastoma: Involvement in varied mesenchymal cell types and evidence for alternative oncogenic mechanisms. J Pathol 2001;159:955-62.
4. Hicks J, Dilley A, Patel D, Barrish J. Lipoblastoma and lipoblastomatosis in infancy and childhood: Histopathologic, ultrastructural, and cytogenetic features. Ultrastruct Pathol 2009;25:321-33.
5. Jung SH, Chang PY, Luo CC, Huang CS, Lai JY, Hsueh C. Lipoblastoma/ lipoblastomatosis: A clinicopathologic study of 16 cases in Taiwan. Pediatr Surg Int 2005;21:809-12.
6. Kok KY, Telishinghe PU. Lipoblastoma: Clinical features, treatment, and outcome. World J Surg 2010;34:1517-22.
7. Nakib GL, Calcaterra V, Avolio L, Guazzotti M, Goruppi I, Viglio A, et al. Intrascrotal lipoblastoma in a ten-year-old: Case report and review of literature. Rare Tumors 2013;5:e11.
8. Kerkeni Y, Sahnoun L, Ksia A, Hidouri S, Chahed J, Krichen I, et al. Lipoblastoma in childhood: About 10 cases. Afr J Paediatr Surg 2014;11:32-4.
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Watch HD Movies With Cinemax Online With 30-Day Trail
Cinemax is a cable and TV network which is owned by Home Box Office, Inc. They televise theatre feature movies, documentaries, behind-the-scenes, and their very own original series. Cinemax offers a free trial to new users that last for 7 days. Their name was coined from cinema and maximum. As of 2011, they had up to 16.7 million subscribers in the United States.
Cinemax provides content that is action-packed and up to date in today’s entertainment. In addition to that, they also offer original programs to their users. You can watch Cinemax on your television or download it as an application on your Smartphone. Continue reading to know how you can Sign up for Cinemax Free – 30 Days Trial and start streaming content.
Users can redeem this free trial through to the 31st of August. You can do this by going into YouTube TV settings. Then head to the membership section and under add-ons enable Cinemax access. Normally, Cinemax only offers a 7-day free trial so users are getting a reasonably good deal here. However, it is worth noting that there is a catch with this deal.
Unlike other free trials, this one will not end automatically. After your 30-day period is over you will need to manually cancel. This is something to keep in mind and perhaps set a reminder for the end of the month if you are likely to forget.
If you do not cancel then you will end up paying an extra $9.99 a month on top of your YouTube TV subscription fee. In the promotional statement surrounding the deal, YouTube TV does recognize this slight catch. They are not trying to hide it in fairness to them but it is still a little bit sneaky.
Before you reach your 30-day trial end you will also receive an email letting you know so you have the opportunity to cancel then. Overall, this seems like a nice little perk for YouTube TV’s customers. Given how much they are paying it is good to see they are getting something decent in return. Just remember to cancel the trial to make sure you do not get charged after your month is over.
How to get 3 weeks of Cinemax free trials
Like several other premium networks, Cinemax is available through multiple platforms as a 3rd party. Most platforms will often offer you a free trial to each premium network with the hope that you keep the add-on.
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Skeletal Muscle Metastases Arising from Renal Cell Carcinoma in a 58-Year-Old Male: A Case Report
Original Article | Volume 6 | Issue 3 | JBST September – December 2020 | Page 20-25 | Sybill Sue M. Moser, Edwin Joseph R. Guerzon, John Christopher R. Ragasa DOI: 10.13107/jbst.2020.v06i03.035
Author: Sybill Sue M. Moser[1], Edwin Joseph R. Guerzon[1], John Christopher R. Ragasa[1]
[1]Department of Orthopedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center – Quezon City, Manila, Philippines.
Address of Correspondence:
Dr. Sybill Sue M. Moser
2632 Molave St. United Hills Village,
Parañaque City, Metro Manila, Philippines.
E-mail: sybillsuemoser@gmail.com
Introduction: Renal cell carcinoma (RCC) is the most common malignant kidney tumor, commonly metastasizing to the lung, lymph nodes, bones, and brain. Here, we present a rare case of renal cell skeletal muscle metastases (SMMs), accounting for only <1% of all RCC metastases.
Methods: This is a descriptive report on the clinical course, diagnostic investigations, and surgical treatment of a case of SMM in a patient previously diagnosed with RCC.
Results: This is a 58-year-old male who previously underwent radical nephrectomy for RCC, presenting with a 5-month history of a rapidly enlarging left gluteal mass. The mass was confirmed to be renal clear cell metastasis through percutaneous biopsy. On magnetic resonance imaging, two heterogeneously enhancing lesions in the left gluteal muscle and right paralumbar muscles at the level of L4 and L5 were noted. Positron emitted tomography scan confirmed no other metastases. He underwent wide excision of the right paraspinal mass and buttockectomy for the left gluteal mass.
Conclusion: SMM in RCC is rare, thus tissue diagnosis and imaging is deemed necessary to rule out any other primary sarcoma. In these cases, patients may benefit from metastasectomy. Regular follow-up and surveillance are recommended for these patients to rule out recurrence.
Keywords: Renal cell carcinoma, metastases, extraskeletal, buttockectomy.
Reference:
1. Graves A, Hessamodini H, Wong G, Lim WH. Metastatic renal cell carcinoma: Update on epidemiology, genetics, and therapeutic modalities. ImmunoTargets Ther 2013;2:73-90.
2. Sakamoto A, Yoshia T, Matsuura S, Tanaka K, Matsuda S, Oda Y, et al. Metastasis to the gluteus maximus muscle from renal cell carcinoma with special emphasis on MRI features. World J Surg Oncol 2007;5:88.
3. Surov A, Hainz M, Holzhausen HJ, Arnold D, Katzer M, Schmidt J, et al. Skeletal muscle metastases: Primary tumours, prevalence, and radiological features. Eur J Radiol 2010;20:649-58.
4. Sountoulides P, Metaxa L, Cindolo L. Atypical presentations and rare metastatic sites of renal cell carcinoma: A review of case reports. J Med Case Rep 2011;5:429.
5. Ramchandani P. Post-treatment surveillance of renal cancer renal cell. In: Patel U, editor. Carcinoma of the Kidney. 1st ed. Cambridge: Cambridge University Press; 2008. p. 185-202.
6. Goger Y, Piskin M, Balasar M, Kilinc M. Unusual Presentation of Renal Cell Carcinoma: Gluteal Metastasis. Case Reports in Urology; 2013.
7. Haygood TM, Sayyouh M, Wong J, Lin J, Matamoros A, Sandler C, et al. Skeletal muscle metastasis from renal cell carcinoma. Sultan Qaboos Univ Med J 2015;15:327-37.
8. Crispen PL, Blute ML. Role of cytoreductive nephrectomy in the era of targeted therapy for renal cell carcinoma. Curr Urol Rep 2012;13:38-46.
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