Tumour-like Lesions—- Are We Over Treating Them?

Vol 5 | Issue 1 | Jan-April 2019 | page: 3-8 | Dominic Puthoor, Dijoe Davis


Authors: Dominic Puthoor [1], Dijoe Davis [1].

[1] Department of Orthopedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.

Address of Correspondence
Dr. Dominic Puthoor,
Orthopedic Oncologist, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
E-mail: dkputhur@gmail.com


Abstract

Introduction: Tumour-like lesions of the bone is area frequently used term but has have not yet been clearly defined. There are no definite guidelines available for their management. The present study was aimed to evaluate the tumour-like lesions and their management.
Case Report: A total of 164 cases of tumour-like lesions managed by the senior author in a Cancer Institute during the past three decades were systematically analyzed. By and large non-aggressive and non-operative treatment was given in all conditions. Outcome of conservative management of tumour-like lesions was very encouraging on long-term follow-up .
Conclusions: Most of the cases with lesser interventions produced better results. They need to be treated only if they are symptomatic or likely to produce a pathological fracture. Even in such situations, one need not take a radical approach.
Keywords: Tumour-like lesions, Cystic lesions, Fibrous lesions.


References

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20. Dicprio M, Enneking W. Current concept review of fibrous dyplasia pathophysiology evolution and treatment. J Bone Joint Surg 2005;87:1848-63.
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How to Cite this article: Puthoor D, Davis D. Tumour-like Lesions—- Are We Over Ttreating Them?. Journal of Bone and Soft Tissue Tumors Jan-Apr 2019;5(1): 3-8.


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Preliminary Results of Curettage and Cementation in the Treatment of Fibrous Dysplasia of the Proximal Radius

Vol 5 | Issue 1 | Jan-April 2019 | page: 13-16 | Ismail Tawfeek Badr, Sanjiv Rampal Ahmed Shahin


Authors: Ismail Tawfeek Badr [1], Sanjiv Rampal [2], Ahmed Shahin [1]

[1] Department of Orthopaedic, Faculty of Medicine, Menoufia University, Faculty of Medicine, Egypt.
[2] Department of Orthopeaedic Department, Faculty of Medicine, Putra University, Faculty of Medicine, Malaysia.

Address of Correspondence

Dr. Ismail Tawfeek Badr,
Department of Orthopaedic, Faculty of Medicine, Menoufia University, Egypt.
E-mail: ismail.tawfeek@yahoo.com


Abstract

Introduction: Fibrous dysplasia (FD)is a benign pathological condition usually observed in the first three decades of life. A single bone may be involved either wholly or partially, or multiple bones may be affected, we aimed to use curettage and cementation as a control method of FDfibrous dysplasia of the proximal radius.
Methods: We describe our finding with the treatment of FDfibrous dysplasia of the proximal radius in five patients(four females and, one male), the mean age of 28.6 years (22 to –39 years). The lesions were in the metaphysis extending to the diaphysis. Persistent pain and pain after pathological fracture were the indications for surgical intervention. We used an extensile approach to expose the lesion then extended curettage using a high-speed burr and filling the cavity with bone cement. Functional outcome and radiological findings were monitored on follow-up visits.
Results: The mean follow-up period was 3.2 years (ranged from 2 years to 5 years).There waswereno recurrences and no patient sustained a fracture at the end of the filling cement. At the time of the last follow-up, all patients have excellent score(mean 27 points) according to the musculoskeletal tumor society scoring system.
Conclusion: Extended curettage and cementation provide a safe and reliable alternative for control of FDfibrous dysplasia of the proximal radius with little morbidity with little risk of recurrence and low incidence of complications.
Keywords: Fibrous dysplasia, Curettage, Cement.


References

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8. Guille JT, Kumar SJ, MacEwen GD. Fibrous dysplasia of the proximal part of the femur. Long-term results of curettage and bone-grafting and mechanical realignment. J Bone Joint Surg Am 1998;80:648-58.
9. Leet AI, Boyce AM, Ibrahim KA, Wientroub S, Kushner H, Collins MT, et al. Bone-grafting in polyostotic fibrous dysplasia. J Bone Joint Surg Am 2016;98:211-9.
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13. Leet AI, Magur E, Lee JS, Wientroub S, Robey PG, Collins MT, et al. Fibrous dysplasia in the spine: Prevalence of lesions and association with scoliosis. J Bone Joint Surg Am 2004;86-A:531-7.
14. Kumta SM, Leung PC, Griffith JF, Kew J, Chow LT. Vascularised bone grafting for fibrous dysplasia of the upper limb. J Bone Joint Surg Br 2000;82:409-12.
15. Plotkin H, Rauch F, Zeitlin L, Munns C, Travers R, Glorieux FH, et al. Effect of pamidronate treatment in children with polyostotic fibrous dysplasia of bone. J Clin Endocrinol Metab 2003;88:4569-75.
16. Leet AI, Collins MT. Current approach to fibrous dysplasia of bone and mcCune-albright syndrome. J Child Orthop 2007;1:3-17.
17. Adetayo OA, Salcedo SE, Borad V, Richards SS, Workman AD, Ray AO, et al. Fibrous dysplasia: An overview of disease process, indications for surgical management, and a case report. Eplasty 2015;15:e6.
18. Keijser LC, Van Tienen TG, Schreuder HW, Lemmens JA, Pruszczynski M, Veth RP, et al. Fibrous dysplasia of bone: Management and outcome of 20 cases. J Surg Oncol 2001;76:157-66.
19. 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:S1.
20. Bryant DD 3rd, Grant RE, Tang D. Fibular strut grafting for fibrous dysplasia of the femoral neck. J Natl Med Assoc 1992;84:893-7.
21. Shih HN, Chen YJ, Huang TJ, Hsu KY, Hsu RW. Treatment of fibrous dysplasia involving the proximal femur. Orthopedics 1998;21:1263-6.
22. Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Experience with 41 cases. Clin Orthop Relat Res 1983;174:87-95.
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24. 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;75:1648-55.
25. Keçeci B, Küçük L, Isayev A, Sabah D. Effect of adjuvant therapies on recurrence in aneurysmal bone cysts. Acta Orthop Traumatol Turc 2014;48:500-6.
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29. Rosario MS, Hayashi K, Yamamoto N, Takeuchi A, Miwa S, Taniguchi Y, et al. Functional and radiological outcomes of a minimally invasive surgical approach to monostotic fibrous dysplasia. World J Surg Oncol 2017;15:1..


How to Cite this article: Badr I T, Rampal S, Shahin A. Preliminary Results of Curettage and Cementation in the Treatment of Fibrous Dysplasia of the Proximal Radius. Journal of Bone and Soft Tissue Tumors Jan-Apr 2019;5(1): 13-16.


                  


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Unusual presentation of Chordoma in distal radius

Vol 4 | Issue 2 | July-Dec 2018 | Page 33-35 | Subin Sugath, Jayashree, Shrijith MB.


Authors: Subin Sugath [1], Jayashree [1], Shrijith MB [1].

[1] Dept of Regional Cancer Centre , Trivandrum.

Address of Correspondence
Dr. Subin Sugath
Dept of Regional Cancer Centre , Trivandrum,
Email:bhaskarsubin@gmail.com


Abstract

Chordoma is rarely seen in appendicular skeleton. Here we describe a rare case of chordoma occuring in distal radius. Radiograph showed ill defined lytic distal radius, meta diaphyseal lesion. IHC marker for Chordoma Brachyury was done (TMH , Mumbai), which came diffuse strongly positive- confirming the pre op diagnosis of Extra Axial Chordoma. He was treated with Wide resection of the distal radius and one bone forearm wrist arthrodesis
Keywords: Chordoma, extraxial, radius


References

1. Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012 Feb;13(2):e69-76.

2. Nielsen GP, Mangham DC, Grimer RJ, Rosenberg AE. Chordoma periphericum: a case report. Am J Surg Pathol 2001;25:263–7.
3. O’donnell P, Tirabosco R, Vujovic S, Bartlett W, Briggs TW, Henderson S, et al. Diagnosing an extraaxial chordoma of the proximal tibia with the help of brachyury, a molecule required for notochordal differentiation. Skeletal Radiol 2007;36:59–65.
4. Tirabosco R, Mangham DC, Rosenberg AE, Vujovic S, Bousdras K, Pizzolitto S, et al. Brachyury expression in extra-axial skeletal and soft tissue chordomas: a marker that distinguishes chordoma from mixed tumour/myoepithelioma/parachordoma in soft tissue. Am J Surg Pathol 2008;32:572–80.
5. van Akkooi AC, van Geel AN, Bessems JH, den Bakker MA. Extra-axial chordoma. J Bone Joint Surg Br 2006;88:1232–4.
6. DiFrancesco LM, Davanzo Castillo CA, Temple WJ. Extra-axial chordoma. Arch Pathol Lab Med 2006; 130:1871–4.
7. Lantos JE, Agaram NP, Healey JH, Hwang S. Recurrent skeletal extra-axial chordoma confirmed with brachyury: imaging features and review of the literature. Skeletal Radiol 2013;42:1451–9
8. Rekhi B. Primary, large extra-axial chordoma in proximal tibia: a rare case report with literature review and diagnostic implications. APMIS. 2016
Mar;124(3):238-42


How to Cite this article: Sugath S, Jayashree, Shrijith MB. Unusual presentation of Chordoma in distal radius. Journal of Bone and Soft Tissue Tumors July-Dec 2018;4(2): 33-35.


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Clear Cell Sarcoma: A Rare Aggressive Tumor with Potential Diagnostic Challenge

Vol 4 | Issue 2 | July-Dec 2018 | Page 30-32 | Yash B Rabari, Nikhil Suri, D.V. Prasad, Siddharth Shah.


Authors: Yash B Rabari [1], Nikhil Suri [1], D.V. Prasad [1], Siddharth Shah [1].

[1] Department of Orthopaedics, Rural Medical Collage, LoniBk, Maharashtra, India.

Address of Correspondence
Dr. Yash B. Rabari.
107, NRI Hostel, PMT Campus, LoniBk, Tal.-Rahta, Dist.- Ahmadnagar Maharastra 413736
Email: dryash.rabari@gmail.com


Abstract

Clear cell sarcoma (CCS) is an exceedingly rare tumor of young adults with melanocytic differentiation. The exact incidence is largely unknown, although occasional case series mention CCS comprising less than 1% of all soft tissue sarcoma. CCS is a deep-seated tumor, typically involving tendons and aponeuroses. It has a predilection for lower extremities, particularly around the foot and ankle region, accounting for nearly 40% of cases. A primary dermal origin is rarer. We report a case of primary cutaneous CCS of 42 year old female located on the left popliteal fossa. Complete excision led to relief of symptoms
Keywords: Clear cell Sarcoma, Tumor, CCS


References

1. Dim DC, Cooley LD, Miranda RN. Clear cell sarcoma of tendons and aponeuroses: A review. Arch Pathol Lab Med. 2007;131:152–6.
2. Deenik W, Mooi WJ, Rutgers EJ, Peterse JL, Hart AA, Kroon BB. Clear cell sarcoma (malignant melanoma) of soft parts: A clinicopathological study of 30 cases. Cancer. 1999;86:969–75.
3. Kazakos CJ, Galanis VG, Giatromanolaki A, Verettas DA, Sivridis E. Clear cell sarcoma of the scapula. A case report and review of literature. World J SurgOncol. 2006;4:48–53. [PMC free article]
4. Hantschke M, Mentzel T, Rutten A, Palmedo G, Calonje E, Lazar AJ, et al. Cutaneous clear cell sarcoma: A clinicopathological, immunohistochemical, and molecular analysis of 12 cases emphasizing its distinction form dermal melanoma. Am J SurgPathol. 2010;34:216–22.
5. Hisaoka M, Ishida T, Kuo TT, Matsuyama A, Imamura T, Nishida K, et al. Clear cell sarcoma of soft tissue: A clinicopathological, immunohistochemical, and molecular analysis of 33 cases. Am J SurgPathol. 2008;32:452–60.
6. Patel RM, Downs-Kelly E, Weiss SW, Folpe AL, Tubbs RR, Tuthill RJ, et al. Dual-color, break-apart fluorescence in situ hybridization for EWS gene rearrangement distinguishes clear cell sarcoma of soft tissue from malignant melanoma. Mod Pathol. 2005;18:1585–90.
7. Rodriguez-Martin M, Saez- Rodriguez M, Esquivel B, Gonzalez RS, Cabrera AN, Herrera AM. Clear cell sarcoma: A case mimicking primary cutaneous malignant melanoma. Indian J Dermatol. 2009;54:168–72.
8. Enzinger FM. Clear cell sarcoma of tendons and aponeuroses: An analysis of 21 cases. Cancer. 1965;18:1163–74.
9. Chung EB, Enzinger FM. Malignant melanoma of soft parts.A reassessment of clear cell sarcoma. Am J SurgPathol. 1983;7:405–13.


How to Cite this article: Rabari YB, Suri N, Prasad D.V, Shah S. Clear Cell Sarcoma: A Rare Aggressive Tumor with Potential Diagnostic Challenge . Journal of Bone and Soft Tissue Tumors July-Dec 2018;4(2): 30-32.


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Inter-Osseous Epidermoid Inclusion Cyst Of The Sacrum: A Case Report

Vol 4 | Issue 2 | July-Dec 2018 | Page 27-29 | Mike Parry, Anish Patel, Rajesh Botchu, Vaiyapuri S, Desai, Jeys Lee.


Authors: Mike Parry [1], Anish Patel [2], Rajesh Botchu [2], Vaiyapuri S [3], Desai [4], Jeys Lee [1].

[1] Department of Orthopedic Oncology.
[2] Department of Musculoskeletal Radiology,
[3] Department of pathology,The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
[4] Department of Surgery, The Queen Elizabeth Hospital, Birmingham, UK

Address of Correspondence
Dr. Rajesh Botchu
Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
Email: drbrajesh@yahoo.com


Abstract

Whilst common in subcutaneous locations, inclusion epidermoid cysts arising from the pelvic bones are extremely rare. We report the case of a patient presenting with coccydynia and altered bowel habit who, following investigation was found to have a large cystic lesion of the sacrum with extending anteriorly into the presacral tissue resulting in compression of the rectum. The lesion was treated by surgical resection, sacrificing the lower sacral nerve roots. Histology confirmed an epidermoid cyst. Whilst a rare presenting symptom, careful assessment of the patient presenting with coccydynia and altered bowel function must raise the suspicion of a sacral pathology that demands further investigation.
Keywords: sacral epidermoid cyst, rare presentation


References

1. Handa U, Kumar S, Mohan H. Aspiration cytology of epidermoid cyst of terminal phalanx. Diagn Cytopathol. 2002;26(4):266–7.
2. Adachi H, Yoshida H, Yumoto T, Naniwa S, Okuno M, Morimoto K, et al. Intraosseous epidermal cyst of the sacrum. A case report. Acta Pathol Jpn. 1988;38(12):1561–4.
3. Muellner T, Nicolic A, Lang S, Schabus R, Kwasny O. Epidermoid cyst after arthroscopic knee surgery. Arthroscopy. 1998;14(3):331–4.
4. Ettinger RL, Manderson RD. Implantation keratinizing epidermoid cysts. A review and case history. Oral Surg Oral Med Oral Pathol. 1973;36(2):225–30.
5. Musharrafieh RS, Tawil AN, Saghieh SS, Macari G, Atiyeh BS. Epidermoid cyst of the thumb. Orthopedics. 2002;25(8):862–3.
6. Zadek I, Cohen HG. Epidermoid cyst of the terminal phalanx of a finger; with a review of the literature. Am J Surg. 1953;85(6):771–4.
7. Vion-Dury J, Vincentelli F, Jiddane M, Van Bunnen Y, Rumeau C, Grisoli F, et al. MR imaging of epidermoid cysts. Neuroradiology. 1987;29(4):333–8.
8. Epstein WL, Kligman AM. Epithelial cysts in buried human skin. AMA Arch Derm. 1957;76(4):437–45.
9. Jaiswal A, Shetty AP, Rajasekaran S. Precoccygeal epidermal inclusion cyst presenting as coccygodynia. Singapore Med J. 2008;49(8):e212–4.


How to Cite this article: Parry M, Patel A, Botchu R, Vaiyapuri S, Desai, Jeys L. Interosseous Epidermoid Inclusion Cyst of the Sacrum: A Case Report. Journal of Bone and Soft Tissue Tumors July-Dec 2018;4(2): 27-29.


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Osseous Hydatid Disease: Mimicker of primary bone neoplasms.: Report of 2 cases

Vol 4 | Issue 2 | July-Dec 2018 | Page 25-26 | Sujit Joshi, Yogesh Panchwagh.


Authors: Sujit Joshi [1], Yogesh Panchwagh [2].

[1] Dept. of Pathology Deenanath Mangeshkar Hospital and Research Centre, Pune
[2] Orthopaedic Oncology Clinic, Pune, India.

Address of Correspondence
Dr. Sujit Joshi,
Dept. of Pathology Deenanath Mangeshkar Hospital and Research Centre, Pune
Email:sujitjoshi30@gmail.com


Abstract

Osseous hydatid disease is rare, and it is even rare to see it in extremities or pelvis. At times these lesions present as destructive lesions on radiographs and mimic neoplasm. Here we present two such cases, one arising in the lower end of femur mimicking chondrosarcoma and required excision and surgical stabilization. Second case presented as a cystic lesion in iliac bone suggestive of aneurysmal bone cyst. Both are quite unusual presentation and hydatid disease should always be kept in differential while dealing with such lesion
Keywords: Osseous hydatid disease, chondrosarcoma, aneurysmal bone cyst


References

1. International Journal of Research in Medical Sciences; Kumar R et al. Int J Res Med Sci. 2017 Mar;5(3):1126-1130.
2. M Laubscher et al SA Orthopedic Journal Winter 2018, Page 44-48.
3. Dahniya MH, Hanna RM, Ashebu S, Muhtaseb SA, el-Beltagi A, Badr S, et al. The imaging appearances of hydatid disease at some unusual sites. Br J Radiol. 2001;74:283-9.
4. Mattern CJ, Gardner MJ, Grose A, Helfet DL. Echinococcus disease of the bone presenting as a femoral shaft non-union. ClinOrthopRelat Res. 2007;458:220-5.


How to Cite this article: Joshi S, Panchwagh Y. Osseous Hydatid Disease: Mimicker of primary bone neoplasms.: Report of 2 cases. Journal of Bone and Soft Tissue Tumors July-Dec 2018;4(2): 25-26.


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