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Veterinary Surgery : VS Nov 2022To describe the surgical application of a 3D-printing-based, patient-specific, biocompatible polycaprolactone/beta-tricalcium phosphate (PCL/β-TCP) scaffold to...
OBJECTIVE
To describe the surgical application of a 3D-printing-based, patient-specific, biocompatible polycaprolactone/beta-tricalcium phosphate (PCL/β-TCP) scaffold to reconstruct the zygomatic arch after tumor resection in a dog.
ANIMAL
A 13 year old female spayed Maltese.
STUDY DESIGN
Case report METHODS: The dog's presenting complaint was swelling ventral to her right eye. A round mass arising from the caudal aspect of the right zygomatic arch was identified by computed tomography (CT). The histopathologic diagnosis was a low-grade spindle-cell tumor. Surgical resection was planned to achieve 5 mm margins. A patient-specific osteotomy guide and polycaprolactone/beta-tricalcium phosphate (PCL/β-TCP) scaffold were produced. Osteotomy, including 30% of total zygomatic arch length, was performed using an oscillating saw aligned with the guide. The scaffold was placed in the defect. Parosteal osteosarcoma was diagnosed based on histopathological examination. Excision was complete, with the closest margin measuring 0.3 mm.
RESULTS
Mild epiphora, due to surgical site swelling, subsided after 20 days. Tissue formation within and around the porous scaffold was noted on CT 10 months postoperatively, with no evidence of metastasis or local recurrence. Facial conformation appeared symmetrical, and no complications were noted 16 months postoperatively.
CONCLUSION
The use of a 3D-printing-based, patient-specific, biocompatible PCL/β-TCP scaffold successfully restored the structure and function of the zygomatic arch without complications, even following wide zygomectomy for complete tumor removal.
Topics: Female; Dogs; Animals; Zygoma; Tissue Scaffolds; Osteosarcoma; Dog Diseases
PubMed: 36168884
DOI: 10.1111/vsu.13895 -
Dedifferentiation in low-grade osteosarcoma: a Japanese Musculoskeletal Oncology Group (JMOG) study.International Journal of Clinical... Nov 2022Low-grade osteosarcomas, namely parosteal osteosarcoma (POS) and low-grade central osteosarcoma (LGCOS), occasionally dedifferentiate into high-grade malignancy,...
BACKGROUND
Low-grade osteosarcomas, namely parosteal osteosarcoma (POS) and low-grade central osteosarcoma (LGCOS), occasionally dedifferentiate into high-grade malignancy, referred to as dedifferentiation in low-grade osteosarcoma (DLOS). This study aimed to elucidate the clinicopathologic features of DLOS, which are poorly described to date due to the extreme rarity of the disease.
METHODS
A total of 33 patients with DLOS were included. Clinical characteristics, including the diagnostic accuracy of tumor biopsy, multimodal treatments, and clinical course, were retrospectively reviewed. Univariate analysis was performed to identify prognostic factors associated with overall survival (OS) and metastasis-free survival (MFS).
RESULTS
The tumor subtypes comprised 10 cases (30.3%) of LGCOS and 23 cases (69.7%) of POS. The timing of dedifferentiation was synchronous in 25 (75.8%) and metachronous in 8 (24.2%) patients. The rates of preoperative diagnosis of DLOS were 40.0% and 65.4% for core needle biopsy and incisional biopsy, respectively. All patients underwent surgery and 25 patients received perioperative chemotherapy. Of the 13 patients who received neoadjuvant chemotherapy, 11 exhibited a poor histological response. The 5-year OS and MFS rates were 88.1% and 77.7%, respectively. Univariate analysis revealed that local recurrence was associated with poor OS (P < 0.01) and MFS (P < 0.01). Perioperative chemotherapy did not affect OS or MFS.
CONCLUSIONS
The diagnostic accuracy of tumor biopsy for DLOS was lower than that for bone sarcomas, as reported previously. In contrast to conventional osteosarcomas with high chemosensitivity, both histological responses and survival analysis revealed low efficacy of chemotherapy for DLOS.
Topics: Humans; Bone Neoplasms; Retrospective Studies; Japan; Osteosarcoma; Neoadjuvant Therapy; Prognosis
PubMed: 35932377
DOI: 10.1007/s10147-022-02223-8 -
Sarcoma 2022Parosteal osteosarcoma (PAOS) is a surface osteosarcoma. Treatment options include wide excision and endoprosthetic or allograft. However, due to the low local...
BACKGROUND
Parosteal osteosarcoma (PAOS) is a surface osteosarcoma. Treatment options include wide excision and endoprosthetic or allograft. However, due to the low local recurrence and metastasis rate, when it appears in the posterior surface of the distal femur, the lesion can be managed with hemicortical wide resection and biological reconstruction with hemicortical allograft. The purpose of this study is to evaluate the oncological and functional outcomes of patients with parosteal osteosarcoma (PAOS) of the posterior cortex of the distal femur who underwent biological reconstruction after hemicortical resection.
METHODS
Eleven patients who underwent wide tumor resection and defect reconstruction of the posterior surface of the distal femur using hemicortical allograft were retrospectively studied. Local recurrence, metastasis, complications, and the functional outcome using the Musculoskeletal Tumor Society (MSTS) scoring system were evaluated.
RESULTS
The average postoperative follow-up period was 53.64 months (range, 30 to 84 months). At the latest follow-up, all patients had no evidence of disease without metastases. One patient with local recurrence underwent revision surgery with fibula autograft reconstruction. The mean MSTS score was 93.45 ± 3.56.
CONCLUSIONS
Treatment of patients with PAOS of the posterior aspect of the distal femur with hemicortical resection and allograft reconstruction has satisfactory oncological and functional outcome and low complication rates.
PubMed: 35692235
DOI: 10.1155/2022/5153924 -
Cureus Apr 2022Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion is a rare, benign, but locally aggressive tumor. We present a case of a 45-year-old patient...
Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion is a rare, benign, but locally aggressive tumor. We present a case of a 45-year-old patient with progressive swelling of his toe for four years, pain, and difficulty with shoe wear. The lesion was excised after adequate evaluation and the resection histopathology was compatible with Nora's lesion. There was no local recurrence at 24 months of follow-up. Nora's lesion can be effectively treated by complete surgical excision or en bloc resection. Though rare, Nora's lesion should be considered in the differential diagnoses of osteogenic and/or chondrogenic overgrowths in the bones of feet such as subungual exocytosis, osteochondroma, chondrosarcoma, periosteal chondroma/chondrosarcoma, and parosteal osteosarcoma.
PubMed: 35602798
DOI: 10.7759/cureus.24197 -
Cureus May 2022Background/Aim Oral epithelia demonstrate a broad spectrum of pre-cancerous, cancerous, and benign lesions. The aim of this study was to record and analyze the...
Background/Aim Oral epithelia demonstrate a broad spectrum of pre-cancerous, cancerous, and benign lesions. The aim of this study was to record and analyze the prevalence of various oral and intraosseous lesions, highlighting malignancies that are hard to clinically identify as such too. Materials and methods A series of 536 oral lesions were collected covering a period of 8.5 years. Epidemiological and clinico-histopathological data were stratified and analyzed retrospectively. Results According to extensive differential analysis, the male to female ratio for oral squamous cell carcinoma was estimated at 1:1, for pre-cancerous lesions at 1:2, and for lichen planus at 1:5. The prevalent diagnostic category were cysts (n = 223, 41.6%). The biological behavior of lesions differed among anatomic sites (P<0.001). Concordance between clinical suspicion of pre-cancerous or malignant lesions and histological verification was 96.4% (P<0.001). Conclusions Primary intraosseous squamous cell carcinoma, acinic cell carcinoma, clear cell myoepithelial carcinoma, aggressive osteoblastoma/parosteal osteosarcoma, and undifferentiated carcinoma raised no clinical suspicion of malignancy reflecting the importance of training in oral biopsy taking.
PubMed: 35572462
DOI: 10.7759/cureus.24956 -
Discover Oncology Apr 2022Osteosarcomas are the most common primary malignant bone tumors and are classified by the WHO into several intramedullary and surface subtypes. One of these is the rare...
Osteosarcomas are the most common primary malignant bone tumors and are classified by the WHO into several intramedullary and surface subtypes. One of these is the rare parosteal osteosarcoma. Liposarcomas are the second most common soft tissue sarcoma and are classified into several types ranging from intermediate to high grade tumors. In one of our recent patients we found an unusual combination of a parosteal osteosarcoma and a large fatty component, which fluorescence-in-situ-hybridization revealed as liposarcoma. Radiologists, pathologists, and surgeons should consider the possibility of bone and soft tissue malignancies consisting of different components, as this may be of paramount importance for oncologically complete resection.
PubMed: 35384584
DOI: 10.1007/s12672-022-00484-3 -
Orthopaedics & Traumatology, Surgery &... Jun 2022Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether...
BACKGROUND
Proximity of tumor to the neurovascular bundle (NVB) makes achieving a wide margin difficult. In low-grade parosteal osteosarcoma (POS), it is not clear whether adherence of tumor to NVB increases the rate of local recurrence (LR). In this study, we evaluated whether tumor adherence to the NVB increases the risk of LR in low-grade POS of the distal femur?
HYPOTHESIS
We hypothesized that if the thin neurovascular barrier (the adventitia of the vessels and the epineurium of the nerve) prevents tumor penetration, the rate of LR should be comparable between the lesions with and without a continuous layer of healthy fatty tissue between the tumor and NVB.
MATERIALS AND METHODS
In a retrospective survey, 30 patients with low-grade POS of the posterior aspect of the distal femur were evaluated for the proximity of mass to NVB. Based on the proximal to distal T1 axial MRI sections, the tumors were divided into two groups including the tumors with an uninterrupted (group A) and interrupted (group B) rim of fatty tissue between the mass and NVB. The rate of LR was compared between the two study groups. The concordance of MRI in detecting NVB adherence was checked with pathology specimen.
RESULTS
Using MRI, we identified 16 cases in group A and 14 cases in group B. The MRI status of fatty rim was concordant with pathology specimen in 96.4% of cases. The mean follow-up period of the two groups was not statistically different (117±27.6 vs. 105.8±29.4 months, respectively, p=0.29). The other baseline characteristics of the two groups were statistically comparable, as well. The rate of LR was 12.5% (2 out of 16 patients) in group A and 14.3% (2 out of 14 patients) in group B (95% CI: 0.142-9.586, p=0.87). The 10-year recurrence-free survival was 87.5% for group A and 85.7% for group B (p=0.9).
DISCUSSION
The absence of a continuous rim of fatty tissue between the tumor and NVB in MRI does not increase the risk of LR in low-grade POS of the distal femur.
LEVEL OF EVIDENCE
IV.
Topics: Bone Neoplasms; Femur; Humans; Osteosarcoma; Osteosarcoma, Juxtacortical; Recurrence; Retrospective Studies
PubMed: 35093566
DOI: 10.1016/j.otsr.2022.103220 -
Hand Surgery & Rehabilitation Apr 2022Parosteal osteosarcoma (PO) is a rare malignant tumor arising from the surface of the bone. Locations in the hand are even more exceptional. This low-grade osteosarcoma... (Review)
Review
Parosteal osteosarcoma (PO) is a rare malignant tumor arising from the surface of the bone. Locations in the hand are even more exceptional. This low-grade osteosarcoma shows non-specific clinical and radiological presentation, making diagnosis challenging. Moreover, histologic examination is extremely difficult and can easily lead to misdiagnosis. We report the case of a 21-year-old woman who presented PO of the right thumb, initially diagnosed as a "benign exostosis" 9 years previously. En-bloc resection followed by reconstruction using a free corticocancellous iliac crest autograft provided good esthetic and functional outcome. No recurrence occurred at 2 years' follow-up. Our literature review confirmed the rarity of PO of the hand, with only 8 cases reported in the past 60 years. Amputation was the main treatment, but some authors reported limb-sparing surgery. The present result and those in the literature review support conservative surgery when feasible, with little recurrence and better functional and esthetic results. These rare tumors should not be misdiagnosed, and should be treated in specialized centers to optimize outcome.
Topics: Adult; Bone Neoplasms; Female; Humans; Ilium; Osteosarcoma; Osteosarcoma, Juxtacortical; Thumb; Young Adult
PubMed: 35091042
DOI: 10.1016/j.hansur.2022.01.005 -
Indian Journal of Thoracic and... Jan 2022Parosteal osteosarcoma represents a low-grade, well-differentiated type of cortical surface osteosarcoma with a relatively better prognosis. Systemic metastasis is rare...
Parosteal osteosarcoma represents a low-grade, well-differentiated type of cortical surface osteosarcoma with a relatively better prognosis. Systemic metastasis is rare overall and occurs in 10-15% of patients only. Delayed recurrences (>5 years) of parosteal osteosarcoma are even rarer and only few isolated case reports of local recurrence with systemic metastasis occurring beyond 10 years exist in the literature. We present here a case of femoral parosteal osteosarcoma, successfully treated previously, that recurred with high-grade transformation locally and with lung metastasis after 12 years. The patient was managed by lung wedge resection followed by type A1 rotationplasty. Histopathology report confirmed evidence of high-grade transformation (de-differentiation) both locally and at the metastatic site, in view of strong CDK4 and MDM2 nuclear immuno-expression. The present report highlights the importance of long-term follow-up, even for a seemingly less aggressive osteosarcoma variant with identification of a novel pattern of lung metastasis.
PubMed: 34898877
DOI: 10.1007/s12055-021-01214-0 -
Clinics in Shoulder and Elbow Dec 2021A large parosteal osteoma arising on the surface of the right clavicle of a 39-year-old male patient was suspected preoperatively as a parosteal osteosarcoma. The lesion...
A large parosteal osteoma arising on the surface of the right clavicle of a 39-year-old male patient was suspected preoperatively as a parosteal osteosarcoma. The lesion was treated with wide resection and allograft reconstruction. In this case report, we discuss the accurate diagnosis and appropriate surgical treatment for unusual clavicular tumors.
PubMed: 34823310
DOI: 10.5397/cise.2021.00465