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Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report

September 10, 2020

Original Article | Volume 6 | Issue 3 | JBST September – December 2020 | Page 9-12 | V.R.Ganesan, T.C.Prem Kumar, Sanjay.C, Roopesh Kumar.S DOI: 10.13107/jbst.2020.v06i03.32 Author: V.R.Ganesan[1], T.C.Prem Kumar[1], Sanjay.C[1], Roopesh Kumar.S[1] [1]Department of Orthopaedic Surgery & Traumatology, Madurai Medical College & GRH, Madurai, Tamilnadu. India. Address of Correspondence Dr. V R Ganesan, Department […]

Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma

September 10, 2020

Original Article | Volume 6 | Issue 3 | JBST September – December 2020 | Page 5-8 | Abigail R Tud, Jose Bayani O Aliling, Carlo Emmanuel J SumpaicoDOI: 10.13107/jbst.2020.v06i03.31 Author: Abigail R Tud[1], Jose Bayani O Aliling[1], Carlo Emmanuel J Sumpaico[1] [1]Department of Orthopedics, The Medical City, Ortigas Avenue, Pasig City, Metro Manila 1605, […]

Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report

September 10, 2020

Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma

September 10, 2020

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Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report

September 10, 2020

Author: V.R.Ganesan[1], T.C.Prem Kumar[1], Sanjay.C[1], Roopesh Kumar.S[1]

[1]Department of Orthopaedic Surgery & Traumatology,
Madurai Medical College & GRH, Madurai, Tamilnadu. India.

Address of Correspondence
Dr. V R Ganesan,
Department of Orthopaedic Surgery & Traumatology,
Madurai Medical College & GRH , Madurai, Tamilnadu. India.
E-mail: sphospital@hotmail.com

Introduction: Osteosarcoma (OS), the most common primary bone tumor, is known to be relatively a radioresistant tumor. Pathological fracture in OS denotes its aggressive biological response and so it was considered a contraindication to limb salvage in earlier days. Radiotherapy has its role only in cases that are inoperable or have poor prognostic factors. In recent years, there have been major advances in the management of pathological fractures in high-grade OS (HGOS). This case report is about the effect of combination chemotherapy and radiotherapy in the management of pathological fracture in HGOS with limb salvage procedure.
Case Report: A 19-year-old male with pain and swelling in his right lower third of thigh and inability to walk for 3 months was diagnosed as a case of OS right distal femur with a pathological fracture. Open biopsy was done which confirmed the diagnosis as HGOS, staged Enneking IIb. He was treated with a combination of chemotherapy, external beam radiotherapy, tumor resection, and modular resection prosthesis.
Results: There were no immediate, early, and late complications. At the end of 1½ years, his functional recovery is good and he has reached more than 70% of the right knee functions. He has no signs of recurrence at present. He has got a better quality of life and functional activity with the prosthesis compared to what an amputated limb can produce.
Conclusion: Pathological fracture in OS is not a contraindication to limb salvage. Radiotherapy can be used in combination with chemotherapy and limb salvage surgery in HGOS with a pathological fracture. This combination treatment helps in increasing the chances of limb sparing surgery with good local control and tumor necrosis rate. The new knowledge that radiotherapy can be effective when used with chemotherapy has shown good result in our case.
Keywords: Osteosarcoma, pathological fracture, external beam radiotherapy, limb salvage, custom modular prosthesis.

Reference:
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How to Cite this article: Ganesan VR, Kumar TCP, Sanjay C, Kumar SR| Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report | Journal of Bone and Soft Tissue Tumors | September-December 2020; 6(3): 9-12.

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Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma

September 10, 2020

Author: Abigail R Tud[1], Jose Bayani O Aliling[1], Carlo Emmanuel J Sumpaico[1]

[1]Department of Orthopedics, The Medical City, Ortigas Avenue, Pasig City, Metro Manila 1605, Philippines.

Address of Correspondence
Dr. Abigail R Tud,
Unit 5F Tower 1, Sonata Private Residences, Lourdes corner St. Francis Avenues, East Wack Wack, Mandaluyong City, Metro Manila 1505, Philippines.
E-mail address: abitud@gmail.com

Introduction: Langerhans cell histiocytosis (LCH) comprises a rare spectrum of disorders characterized by abnormal proliferation of histiocytes. Lesions may be limited to a single system, or present as disseminated disease, with subsequent worse prognosis. Radiologic findings for spinal LCH are non-specific however and must be carefully differentiated from Pott’s disease (spinal tuberculosis, or [TB]) in endemic countries.
Case Report: An 8-year-old female was brought for consult due to back pain and compression deformity on plain radiographs, unaccompanied by constitutional symptoms. Computed tomography (CT) scan of the thoracic spine was done, which showed osteolysis of the T11 vertebra and paravertebral soft-tissue extension. Findings were deemed suggestive of tuberculous spondylitis, and CT-guided biopsy was performed for confirmation. Acid-fast Bacilli smears as well as Gram stains were negative. While waiting for definitive results, the patient was started on an empiric treatment regimen for TB. Final tissue and fluid cultures were negative for Mycobacterium tuberculosis, as were Gene Xpert and TB polymerase chain reaction studies. Histopathologic analysis showed atypical mononuclear histiocytes surrounded by inflammatory cells, suggestive of LCH. At present, the patient is 2 years post-biopsy, with stable lesions and no evidence of multi-system involvement.
Conclusion: In the setting of a spinal lesion in a child with a benign clinical history and no other pertinent laboratory findings, histopathologic analysis constitutes the gold standard in differentiating non-specific features of LCH from spinal TB. Both conditions necessitate long-term follow-up, due to the risk of progression, deformities, and neurologic sequelae.
Keywords: Langerhans cell histiocytosis, pediatric spine, Pott’s disease, tuberculosis, vertebra plana.

Reference:
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How to Cite this article: Tud AR, Aliling JBO, Sumpaico CEJ | Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma. | Journal of Bone and Soft Tissue Tumors | September-December 2020; 6(3): 5-8.

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Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report

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Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma

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Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report

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Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma

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Effect of Combination Chemotherapy and Radiotherapy in the Management of a Pathological Fracture in High-grade Osteosarcoma with Limb Salvage Procedure – A Case Report

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Langerhans Cell Histiocytosis of the Spine in a Child: A Rare Case and a Diagnostic Dilemma

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