Editorial May – August 2020

Editorial | Volume 6 | Issue 2 | JBST May – August 2020 | Page 1 | Yogesh Panchwagh, Ashish Gulia, Ashok Shyam. 10.13107/jbst.2020.v06.i02.20

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

In the last 4 months, we have seen the real impact of Covid-19 pandemic in India with multiple lockdowns implemented nationwide. With all offices and businesses, barring the healthcare sector and allied units, coming to a standstill or switching to work-from-home format, there have been major changes to the ways in which we used to accomplish things.

Certain branches of medicine and especially some hospital units saw tremendous surge in work pressure given the intense demand of workforce required to handle the pandemic. Many others faced challenges in form of reduced patient load affecting the economics and had to fight daunting circumstances to stay afloat. Everyone had to adapt to face the situation and emerge out less scathed if not unscathed.

However, the situation presented a unique opportunity to all. It ranged from data accrual and documentation pertaining to the various aspects of pandemic in case of some, while for others who had free time, it helped in analysis and manuscript writing of pending publication work. Everyone had an opportunity to contribute to research and hence we have seen a surge in manuscript submissions and publications. Thankfully, the review process for almost all remained mostly unaffected and hence the turnaround times for article publication were not affected significantly.

Adaptability remains the key for the human race. We need to look for the brighter aspects through the ongoing mayhem, fight the doubtful thoughts lurking around, take advantage of whatever situation we may be forced into and focus on the work that needs to be done.

JBST team is proud and happy to present this issue on time despite multiple challenges. Kudos to all the contributors who have shown grit and a strong will to fight on.

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 May-August 2020; 6(2):1

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The Baby Bump and Malignant Lump: A Case Report of a Pregnant Patient with Pelvic Sarcoma

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 25-27 | Daniela Kristina D. Carolino, Mary Rose C. Gonzales, Richard S. Rotor. DOI: 10.13107/jbst.2020.v06i02.28

Author: Daniela Kristina D. Carolino[1], Mary Rose C. Gonzales[1], Richard S. Rotor[2]

[1]Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Metro Manila, Philippines.
[2]Department of Musculoskeletal tumors, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Metro Manila, Philippines.

Address of Correspondence
Dr. Daniela Kristina D. Carolino, 279 E. Rodriguez Sr. Ave, Quezon City 1112 Metro Manila.
E-mail: dkdcarolino@gmail.com


Purpose: The occurrence of a malignancy during the course of pregnancy is uncommon but devastating. Due to the relative rarity of the condition, guidelines for management are largely based on small retrospective studies or case series with limited follow-up. With this case, we aim to discuss the options of management and rationalize the decisions, in which the course of treatment of this patient has proceeded.
Materials and Methods: We describe the clinical presentation of the patient as well as the radiological findings, diagnostic tests, and management during the course of the disease.
Results: A 26-year-old (gravida 2, para 1) Filipino female presented initially with a limp and gradual enlargement of a mass on the right hip while with a single intrauterine pregnancy of 8–9 weeks age of gestation. As the growth the mass continued, the patient sought consult at our institution at 22 weeks gestation and was presented with options for management. The patient opted for conservative treatment with chemotherapy over hemipelvectomy. The neonate was eventually delivered at 35 weeks of gestation and the demise of the patient ensued 2 months postpartum.
Conclusion: The treatment of malignancy in the pregnant patient should be individualized and largely dependent on the decision of the mother, once full disclosure of all options of management, possible risks, and prognosis has been discussed.

1. Zagouri F, Dimitrakakis C, Marinopoulos S, Tsigginou A, Dimopoulos MA. Cancer in pregnancy: Disentangling treatment modalities. ESMO Open 2016;1:e000016.
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3. Postl LK, Gradl G, von Eisenhart-Rothe R, Toepfer A, Pohlig F, Burgkart R, et al. Management of musculoskeletal tumors during pregnancy: A retrospective study. BMC Womens Health 2015;15:48.
4. Zarkavelis G, Petrakis D, Fotopoulos G, Mitrou S, Pavlidisa N. Bone and soft tissue sarcomas during pregnancy: A narrative review of the literature. J Adv Res 2016;7:581-7.
5. Figueiro-Filho EA, Al-Sum H, Parrish J, Wunder JS, Maxwell C. Maternal and fetal outcomes in pregnancies affected by bone and soft tissue tumors. AJP Rep 2018;8:e343-8.
6. Rimawi BH, Green V, Lindsay M. Fetal implications of diagnostic radiation exposure during pregnancy: Evidence-based recommendations. Clin Obstet Gynecol 2016;59:412-8.
7. Kal HB, Struikmans H. Radiotherapy during pregnancy: Fact and fiction. Lancet Oncol 2005;6:328-33.
8. Azim HA, Peccatori FA, Pavlidis N. Treatment of the pregnant mother with cancer: A systemic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part I: Solid tumors. Cancer Treat Rev 2010;36:101-9.

How to Cite this article: Carolino DKD, Gonzales MRC, Rotor RS | The Baby Bump and Malignant Lump: A Case Report of a Pregnant Patient with Pelvic Sarcoma | Journal of  Bone and Soft Tissue Tumors | May-August 2020; 6(2): 25-27.

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A Clinicopathological Study of Ewing’s Sarcoma/PNET experience from a Tertiary Cancer Centre in North East India

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 21-24 | Jagannath Dev Sharma, Argha Baruah, Anupam Sarma, Lopa Mudra Kakoti, Nizara Baishya, Shiraj Ahmed. DOI: 10.13107/jbst.2020.v06i02.27

Author: Jagannath Dev Sharma[1], Argha Baruah[1], Anupam Sarma[1], Lopa Mudra Kakoti[1], Nizara Baishya[1], [2], Shiraj Ahmed[1]

[1]Department of Pathology, Dr.B.Borooah Cancer Institute, Guwahati, Assam, India.
[2]Department of Hospital based Cancer registry, Dr.B. Borooah Cancer Institute, Guwahati, Assam.

Address of Correspondence
Dr. Argha Baruah,
Department of Pathology, Dr.B.Borooah Cancer Institute,Guwahati-781028, Assam, India.
E-mail: argha20@gmail.com


Introduction: Ewing sarcoma (ES)/PNET is an aggressive malignant tumor with small round cell morphology affecting mainly children and adolescents. The aim of this study was to study the clinicopathological parameters and immunohistochemical panel of skeletal and extraskeletal ES and to correlate with overall survival.
Case Report: Medical files of 70 patients with ES treated at our center between 2009 and 2015 were retrospectively evaluated. The clinico pathological parameters were extracted and statistically correlated with overall survival(OS). Among 70cases of ES ,41 cases were males and 29 cases were females. Most common age group was 10–20 years. Skeletal involvement was seen in 45 cases(64.2%) and 25cases (35.8%) were extraskeletal. The most common skeletal sites of involvement was lower extremity involving  the Femur (24%) and the most common extraskeletal site involved in our study was sinonasal area(5.7%), followed by chestwall, thigh, orbital, calf, gluteal, kidney, and vulva. Two cases showed involvement of the central nervous system(CNS) involving pineal gland and the ventricle. Two cases showed multiple sites of involvement both including chest wall and thigh. Twenty-nine cases(41.4%) showed metastasized disease. The most common site of metastasis was lung followed by bone and brain. Recurrence was seen in 14 cases(20%). Overall 5-year survival was 24%. There was statistically significant correlation found between tumor size (≥8cm) and 5year survival. Furthermore, significant correlation was found between metastasis and 5-year survival.
Conclusion: ES is an aggressive tumor involving skeletal and extraskeletal sites affecting commonly young people, with a poor prognosis for patients with maximum diameter ≥8cm. Metastasisis common in ES and is also a poor prognostic factor.
Keywords: Ewing’sarcoma, skeletal, extraskeletal, survival, metastasis.

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8. Lee JA, Kim DH, Lim JS, Koh JS, Kim MS, Kong CB, et al. Soft-tissue Ewing sarcoma in a low-incidence population: Comparison to skeletal Ewing sarcoma for clinical characteristics and treatment outcome. Jpn J Clin Oncol 2010;40:1060-7.
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11. Folpe AL, Hill CE, Parham DM, O’Shea PA, Weiss SW. Immunohistochemical detection of FLI-1 protein expression: A study of 132 round cell tumors with emphasis on CD99-positive mimics of Ewing’s sarcoma/primitive neuroectodermal tumor. Am J Surg Pathol 2000;24:1657-62.
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20. El Weshi A, Allam A, Ajarim D, Al Dayel F, Pant R, Bazarbashi S, et al. Extraskeletal Ewing’s sarcoma family of tumours in adults: Analysis of 57 patients from a single institution. Clin Oncol 2010;22:374-81.
21. Pradhan A, Grimer RJ, Spooner D, Peake D, Carter SR, Tillman RM, et al. Oncological outcomes of patients with Ewing’s sarcoma: Is there a difference between skeletal and extra-skeletal Ewing’s sarcoma? J Bone Joint Surg Br 2011;93:531-6.
22. Bosma SE, Ayu O, Dijkstra PD, Fiocco M, Gelderblom H. Prognostic factors for survival in Ewing sarcoma: A systematic review. Surg Oncol 2018;27:603-10.

How to Cite this article: Sharma JD, Baruah A, Sarma A, Kakoti LM, Baishya N, Ahmed S | A Clinicopathological Study of Ewing’s Sarcoma/PNET experience from a Tertiary Cancer Centre in North East India | Journal of  Bone and Soft Tissue Tumors | May-August 2020; 6(2): 21-24.

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Osteosarcoma of the Rib: A Case Report

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 17-20 | Kanu Priya Bhatia, Sameer Rastogi, Ekta Dhamija, Adarsh Barwad, Nishant Bhatia, Jyoutishman Saika. DOI: 10.13107/jbst.2020.v06i02.26

Author: Kanu Priya Bhatia[1], Sameer Rastogi[1], Ekta Dhamija[2], Adarsh Barwad[3], Nishant Bhatia[4], Jyoutishman Saika[5]

[1]Department of Medical Oncology, Dr. B.R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
[2]Department of Radiodiagnosis, Dr. B.R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
[3]Department of Pathology, All India Institute of Medical Sciences, New Delhi, India,
[4]Department of Orthopaedics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India,
[5]Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India.

Address of Correspondence
Dr. Kanu Priya Bhatia,
Department of Medical Oncology, Dr. B.R Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
E-mail: bhatiakanu13@gmail.com


Introduction: Osteosarcoma (OS) is the most common primary malignancy of bone in children and adolescents. OS has a predilection for the metaphyseal region of the long bones. The most common site of involvement is the distal femur followed by proximal tibia, proximal humerus, middle and proximal femur, and other bones. Primary OS of chest wall is a very rare entity.
Case Report: We, here, describe a case of a 14-year-old boy who presented to our center with a chest wall swelling and pleural effusion, which was subsequently diagnosed as chest wall OS originating from the rib. We treated him with neoadjuvant chemotherapy (Ifosfamide, Adriamycin, and Carboplatin). He showed an excellent transient response to the chemotherapy, after which he underwent an en bloc resection of the tumor. He was then started on adjuvant chemotherapy, but unfortunately, he relapsed soon after the last cycle and later on succumbed to the disease.
Conclusion: Chest wall OS is an infrequent malignancy. Pathological diagnosis is difficult and requires a high index of suspicion. Data regarding the prognostic factors are scarce, and no concrete guidelines are available for the management of such patients.
Keywords: Chest wall, osteosarcoma, rib.

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9. Ikeda H, Takeo M, Kayata H, Mikami R, Nakamoto Y, Yamamoto M. A case of rapidly growing osteosarcoma of the rib. Ann Thorac Cardiovasc Surg 2014;20:521-4.
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13. Masoud S. Scapula osteosarcoma. Biomed J Sci Tech Res 2017;1:739-42.
14. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: An analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002;20:776-90.

How to Cite this article: Bhatia KP, Rastogi S, Dhamija E, Barwad A, Bhatia N, Saika J | Osteosarcoma of the Rib: A Case Report | Journal of Bone and Soft Tissue Tumors | May-August 2020; 6(2): 17-20.

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Retrospective Study of Seven Patients with Tumoral Calcinosis

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 12-16 | Kshitij Manerikar, Abhijeet Salunke, Jaymin V. Shah, Mayur Kamani, Shashank Pandya. DOI: 10.13107/jbst.2020.v06i02.25

Author: Kshitij Manerikar[1], Abhijeet Salunke[1], Jaymin V. Shah[1], Mayur Kamani[1], Shashank Pandya[1]

[1]Department of Surgical Oncology, Gujarat Cancer Research and Institute, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Kshitij Manerikar,
A-302, Divyadeep, Ram Mandir Road, TPS-3, Borivali West, Mumbai – 400 092, Maharashtra, India.
E-mail: drkshitijmanerikar@gmail.com


Introduction: Calcium deposition in the skin has been termed as calcinosis cutis. Tumoral calcinosis is idiopathic form of calcinosis cutis. Etiology of idiopathic calcinosis cutis is unknown. It is characterized by periarticular deposition of amorphous calcium salts around large joints. Our diligent search through literature could not find any consensus on the etiopathogenesis and treatment modalities for tumoral calcinosis.
Materials and Methods: A retrospective study of seven patients of tumoral calcinosis treated with complete surgical excision over a period of 1 year was done. Demographic details were compiled. Routine blood investigations were performed. All patients underwent radiographs and magnetic resonance imaging (MRI) scans of involved part. We did not perform computed tomography (CT) or bone scan in any of our patients. All seven patients underwent surgery and were followed up till 2 years.
Results: In our study, five were female and two were male patients ranging from 31 to 76 years. Size of swelling varied from 2 to 15 cm. Most common location was hip. Serum calcium, phosphorus, and alkaline phosphatase were normal in all patients. Radiographs showed well-outlined periarticular cluster of calcifications in the soft tissues around joint. MRI revealed round to oval multiple cystic lesions around the affected region, but not involving the joint.
Conclusion: Tumoral calcinosis is always the diagnosis of exclusion. It can be normophosphatemic or hypophosphatemic subtype. Large joints are more commonly affected. One can rely on radiographs for diagnosis. MRI for knowing exact location of lesion, its relationship with adjacent structures and planning of surgery is advocated. Complete surgical excision is the only optimum treatment of tumoral calcinosis.
Keywords: Amorphous calcium phosphate, hyperphosphatemia, X-ray film, hip joint, calcinosis, magnetic resonance imaging.

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How to Cite this article: Manerikar K, Salunke A, Shah JV, Kamani M, Pandya S | Retrospective Study of Seven Patients with Tumoral Calcinosis | Journal of  Bone and Soft Tissue Tumors | May-August 2020; 6(2): 12-16.

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

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 9-11 | Adam Goldman, Matthew Doscher, Neil Lancaster, Paul Lamberti. DOI: 10.13107/jbst.2020.v06i02.24

Author: Adam Goldman[1], Matthew Doscher[1], Neil Lancaster[2], Paul Lamberti[1]

[1]Department of Orthopaedics, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA,
[2]Department of Orthopaedics, Franciscan Health- Olympia Fields, Illinois, USA.

Address of Correspondence
Dr. Adam Goldman,
Orthopedic Surgery Resident, Franciscan Health Olympia Fields
20201 S. Crawford Ave, Olympia Fields, IL 60461.
E-mail: adamgoldman91@gmail.com


Introduction: Synovial sarcomas of the hand are extremely rare, high grade, slow growing, malignant soft-tissue neoplasms. They represent only a fraction of soft-tissue sarcomas, are usually found in the lower extremities around tendon sheaths, bursae, and joint capsules, and carry a significant risk for recurrence and eventual metastasis to the lymph nodes and lungs. There are limited reports of synovial sarcomas of the hand.
Case Report: A 67-year-old male presented with a slow-growing soft-tissue mass of the proximal right long finger over the course of one year. Initial excision was performed, which provided a diagnosis of monophasic synovial cell sarcoma. Subsequently, the patient underwent further staging with an eventual ray resection of the right long finger and an index ray transfer.
Conclusion: There are unique approaches to a patient with a highly malignant neoplasm in the hand. By performing a ray resection and index ray transfer, the patient was spared the potential side effects of radiation therapy and provided a quality functional and cosmetic outcome. The patient returned to work 4 weeks postoperatively. To the best of our knowledge, this treatment has not been used for a synovial sarcoma of the hand.
Keywords: Hand, synovial sarcoma, soft-tissue sarcoma, soft-tissue neoplasms

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9. Italiano A, Penel N, Robin YM, Bui B, Le Cesne A, Piperno-Neumann S, et al. Neo/adjuvant chemotherapy does not improve outcome in resected primary synovial sarcoma: A study of the French sarcoma group. Ann Oncol 2009;20:425-30.
10. Maia DC, Menezes CK, Bastos TC, de Lima Ferreira LC, Francesconi F. Poorly differentiated synovial sarcoma in the wrist: Case report. An Bras Dermatol 2014;89:816-18.
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How to Cite this article: Goldman A, Doscher M, Lancaster N, Lamberti P | Clear Cell Sarcoma: A Rare Aggressive Tumor with Potential Diagnostic Challenge | Journal of Bone and Soft Tissue Tumors | May-August 2020; 6(2): 9-11.

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Fracture Prosthesis in Giant Cell Tumor of Distal Radius: Precautions and Management

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 5-8 | Mahesh Kulkarni, Sourab Shetty, Monappa Naik, Sandeep Vijayan. DOI: 10.13107/jbst.2020.v06i02.23

Author: Mahesh Kulkarni[1], Sourab Shetty[1], Monappa Naik[1], Sandeep Vijayan[1]

[1]Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India.

Address of Correspondence
Dr. Sourab Shetty,
Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal – 576 104, Udupi, Karnataka, India.
E-mail: sourab.shetty.ss@gmail.com


Introduction: Distal radius is one of the common locations for giant cell tumor (GCT) in the second to the fourth decade of life. Based on the extent of the tumor, various treatment options are available such as curettage and bone grafting or use of bone cement, various ablation techniques, excision, and vascularized or non-vascularized fibular graft. However, when subchondral bone and articular surface are involved and the patient is not ready for the fibular grafting, one of the methods described is excision and use of custom-made acrylic prosthesis, of which fracture prosthesis is a complication. Here, we are reporting a case who presented with a fractured prosthesis,  the way we managed it and the precautions that can be taken while use of the prosthesis.
Case Report: We are presenting a case of a 42-year-old male who came back after 2 years of implantation with a fractured prosthesis, which happened during a routine activity. There was no evidence of recurrence of the tumor. A discussion about the cause, the management done, precautions to be taken while implanting acrylic prosthesis, and a follow-up of the patient for 3 years is also done.
Conclusion: Acrylic can be used as a cost-efficient material for a prosthesis in both primary excision and revisions in distal radius GCT with good functional results if specific precautions are taken preoperatively and intraoperatively.
Keywords: Acrylic prosthesis, broken prosthesis, fractured prosthesis, radius giant cell tumor.

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How to Cite this article: Kulkarni M, Shetty S, Naik M, Vijayan S | Fracture Prosthesis in Giant Cell Tumor of Distal Radius: Precautions and Management | Journal of Bone and Soft Tissue Tumors | May-August 2020; 6(2): 5-8.

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Resection and Reconstruction of Calcaneal Tumors – A Review

Original Article | Volume 6 | Issue 2 | JBST May-August 2020 | Page 2-4 | Subbiah Shanmugam, Sujay Susikar, Murali Kannan. DOI: 10.13107/jbst.2020.v06i02.22

Author: Subbiah Shanmugam[1], Sujay Susikar[1], Murali Kannan[1]

[1]Department of Surgical Oncology, Associate Professor, Centre for Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu, India.

Address of Correspondence
Dr. Sujay Susikar,
Department of Oncology, Centre for Oncology, Government Royapettah Hospital, Chennai, Tamil Nadu, India.
E-mail: sujaysusikar@gmail.com


Introduction: Calcaneum is a rare site for Ewing’s sarcoma. The treatment includes neoadjuvant systemic therapy followed by surgical resection and adjuvant systemic therapy. The reconstruction options in this era of limb salvage for bone tumors are not much established in calcaneal tumors in view of limited reporting. Various other reconstruction options available are allograft, iliac crest autograft, and custom-made prosthesis.
Case Report: We have reported a 13-year-old female patient with Ewing’s sarcoma of calcaneum diagnosed by imaging and biopsy. The patient underwent neoadjuvant chemotherapy and then had undergone total calcanectomy with allograft reconstruction. The post-operative outcomes are fair, and the patient is on adjuvant chemotherapy at present.
Conclusion: Biological reconstruction in the form of allograft is a reliable option with regard to the functional outcomes for calcaneal resections.
Keywords: Calcaneum, Ewing sarcoma, total calcanectomy, allograft.

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How to Cite this article: Shanmugam S, Susikar S, Kannan M | Resection and Reconstruction of Calcaneal Tumors – A Review | Journal of Bone and Soft Tissue Tumors | May-August 2020; 6(2): 2-4.

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