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International Journal of Computer... Apr 2021Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the...
PURPOSE
Several technologies have been implemented in orthopedic surgery to improve surgical outcomes, usually focusing on more accurate execution of a surgical plan, but the development of the plan itself is also of great importance. The purpose of this study is to examine whether the use of preoperative computer planning platforms can improve the surgical plan?
METHODS
Eight surgeons created a preoperative surgical plan to resect a distal femur parosteal osteosarcoma in two settings: (1) Using a 2-D and 3-D CT scan only (current standard); and (2) using a computer-assisted planning platform. The plans were thereafter virtually executed using a novel surgical navigation system and a Sawbones model. This simulated model was derived from, and identical to, an actual patient scenario. The outcomes of interest were the number of positive margin cuts, and the volume of the resected specimen.
RESULTS
Using the surgical plan developed with computer assistance, there were 4 positive margin cuts made by 2 surgeons. In comparison, using standard planning, there were 14 positive margin cuts made by all 8 surgeons (p = 0.02). The resection volume was larger in the computer-assisted plans (96 ± 10 mm) than in the standard plans (88 ± 7 mm) (p = 0.055).
CONCLUSIONS
Computer-assisted planning significantly decreased the risk of a positive margin resection in this Sawbones tumor model used to simulate resection of a primary bone sarcoma. This proof of concept study highlights the importance of advanced surgical planning and sets the ground for developing beneficial surgical planning systems.
Topics: Algorithms; Bone Neoplasms; Computer Simulation; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Margins of Excision; Orthopedic Procedures; Reproducibility of Results; Sarcoma; Surgery, Computer-Assisted; Tomography, X-Ray Computed
PubMed: 33725339
DOI: 10.1007/s11548-021-02337-w -
Skeletal Radiology Sep 2021We report the peculiar case of a parosteal osteosarcoma arising beneath the periosteum in a 12-year-old boy. He complained of difficulty in left knee flexion. Plain...
We report the peculiar case of a parosteal osteosarcoma arising beneath the periosteum in a 12-year-old boy. He complained of difficulty in left knee flexion. Plain radiography showed a uniformly dense mineralized mass in the bone cortex and parosteal ossified nodules at the metaphysis and diaphysis of the left distal femur. Periosteal reaction was not evident. Uniquely, plain radiography had a smooth outline and revealed gradually thickening mass toward the center. Histologically, the tumor showed a proliferation of spindle-shaped cells with parallel-oriented dense bone trabeculae and hyaline cartilaginous tissue disclosing mild atypia. The periosteum was inverted along the polypoid mass, but there was no periosteum at the top. Immunohistochemically, the spindle cells, including those at the top of the polypoid mass, and cartilaginous cells were positive for MDM2 and CDK4. MDM2 gene amplification was detected in these cells by fluorescence in situ hybridization. Despite the peculiar feature of plain radiography, the lesion was diagnosed as parosteal osteosarcoma. This case report presents a case of parosteal osteosarcoma arising beneath the periosteum, although it is postulated to arise in the outer layer of the periosteum. The unique radiographic findings in this case suggest an association of parosteal osteosarcoma with vigorous bone growth before closure of the growth plate.
Topics: Bone Neoplasms; Child; Humans; In Situ Hybridization, Fluorescence; Male; Osteosarcoma; Periosteum; Radiography
PubMed: 33704522
DOI: 10.1007/s00256-021-03747-2 -
Oral Oncology Jun 2021Gnathic osteosarcoma is a rare malignant mesenchymal neoplasm showing evidence of osteoid matrix formation. Clinical behaviour and radiological appearances overlap with...
Gnathic osteosarcoma is a rare malignant mesenchymal neoplasm showing evidence of osteoid matrix formation. Clinical behaviour and radiological appearances overlap with benign osseous lesions and are prone to misdiagnosis. Early diagnosis of osteosarcoma plays a crucial role in the treatment plan and prognosis. Herein a rare case of parosteal osteosarcoma of fibroblastic histologic subtype affecting the angle of the mandible in a 12-year-old female is presented.
Topics: Bone Neoplasms; Child; Female; Humans; Mandible; Osteosarcoma, Juxtacortical
PubMed: 33579634
DOI: 10.1016/j.oraloncology.2021.105193 -
The Pan African Medical Journal 2020
PubMed: 33425168
DOI: 10.11604/pamj.2020.37.135.22667 -
Indian Journal of Surgical Oncology Sep 2020We present an atypical case of histopathology suggesting hemangioendothelioma and immunohistochemistry-proven Ewing's sarcoma in a 39-year-old lady who presented with...
We present an atypical case of histopathology suggesting hemangioendothelioma and immunohistochemistry-proven Ewing's sarcoma in a 39-year-old lady who presented with multiple stony hard swellings involving the occipital region of the scalp, right cervical lymph node, right scapular region, left infraclavicular region of the chest, right anterior abdominal wall swelling, and inner aspect of right thigh. She underwent left-sided below-knee amputation for parosteal osteosarcoma in the left distal tibia 3 years back. Palliative radiotherapy with dose of 30 Gy in 10 fractions over 2 weeks was administered to the right neck and right upper back following which she attained moderate pain relief but no reduction in swellings as was expected had it been a case of hemangioendothelioma or Ewing's sarcoma..
PubMed: 33364700
DOI: 10.1007/s13193-020-01126-2 -
Pathology Aug 2021
Topics: Bone Neoplasms; Humans; Osteosarcoma
PubMed: 33272695
DOI: 10.1016/j.pathol.2020.08.018 -
Clinical Imaging Jan 2021Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, is a rare benign surface-based bone lesion most commonly involving the tubular bones of hands... (Review)
Review
Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, is a rare benign surface-based bone lesion most commonly involving the tubular bones of hands and feet. We report an unusual case of BPOP affecting the distal ulna in a 22-year-old man who presented with a painless wrist mass following injury and was successfully treated with surgical resection. We focus on multi-modality imaging, histopathology, and differential diagnosis (including osteochondroma, florid reactive periostitis, myositis ossificans, and surface-type osteosarcoma), as well as a review of the literature regarding recent concepts on etiology and evolution, spectrum of imaging characteristics and diagnostic overlap, histopathology, as well as treatment options.
Topics: Adult; Bone Neoplasms; Cell Proliferation; Humans; Male; Osteochondroma; Ulna; Wrist Joint; Young Adult
PubMed: 32977195
DOI: 10.1016/j.clinimag.2020.08.019 -
Skeletal Radiology Feb 2021To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence.
OBJECTIVE
To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence.
MATERIALS AND METHODS
Retrospective review of patients across two institutions with histological confirmation of POS diagnosed between January 2007 and March 2020. Data collected included age, sex, skeletal location, results of chest CT and whole-body bone scintigraphy (WB-BSc) or whole-body MRI (WB-MRI) obtained at initial diagnosis. The histological tumour grade based on surgical resection specimens was classified as low-grade POS (LG-POS) and dedifferentiated POS (DD-POS). Findings of chest CT and skeletal staging were correlated with tumour grade. Follow-up chest CT and MRI studies were reviewed to determine the rate of late lung metastases and local recurrence.
RESULTS
There were 27 males and 44 females, mean age 33 years (range 12-79 years). The femur (n = 43) and tibia (n = 14) were the most commonly involved bones. From surgical resection histology, 42 (59.2%) were LG-POS and 29 (40.8%) were DD-POS. WB-BSc/WB-MRI showed no skeletal metastases, while 1 case of DD-POS presented with bilateral calcified lung metastases. At follow-up, 7 patients (9.9%) developed lung metastases (mean of 18.9 months, range 10-48 months) from initial presentation, of which all were DD-POS. All but 1 patient who developed subsequent lung metastases had a local recurrence.
CONCLUSIONS
Skeletal staging is unlikely to be of value in POS. Staging chest CT is very unlikely to demonstrate lung metastases in LG-POS and could be limited to DD-POS, particularly at the time of local recurrence.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Osteosarcoma, Juxtacortical; Retrospective Studies; Whole Body Imaging; Young Adult
PubMed: 32705301
DOI: 10.1007/s00256-020-03557-y -
Skeletal Radiology Jan 2021Surface lesions of bone are uncommon. Although their imaging features generally mirror those of their intramedullary counterparts, surface lesions may demonstrate... (Review)
Review
Surface lesions of bone are uncommon. Although their imaging features generally mirror those of their intramedullary counterparts, surface lesions may demonstrate distinct characteristics which along with their unusual location present a diagnostic challenge. Surface sarcomas are usually of a lower grade compared with intramedullary variants, leading to differences in management. Osteosarcoma arising from the cortical surface of the bone is termed juxtacortical or surface osteosarcoma and includes three distinct entities: parosteal, periosteal, and high-grade surface osteosarcoma. We also review the features intracortical osteosarcoma, which some authors include under the umbrella term surface osteosarcoma. These lesions exhibit biologic features distinct from those of conventional intramedullary osteosarcoma, which underlines the importance of accurate imaging diagnosis. Periosteal chondrosarcoma and periosteal Ewing sarcoma also have distinctive imaging appearances. The purpose of this article is to review surface sarcomas of bone with regard to their clinical and radiological features and to discuss the differential diagnosis for each condition.
Topics: Bone Neoplasms; Bone and Bones; Chondrosarcoma; Humans; Osteosarcoma; Soft Tissue Neoplasms
PubMed: 32681279
DOI: 10.1007/s00256-020-03546-1 -
Medicine Jul 2020Fibro-osseous pseudotumor of the digit is a rare benign lesion of subcutaneous tissue that typically arises in the parabone site of the proximal phalanx in young adult...
INTRODUCTION
Fibro-osseous pseudotumor of the digit is a rare benign lesion of subcutaneous tissue that typically arises in the parabone site of the proximal phalanx in young adult females. The lesion is histopathologically characterized by fibroblastic proliferation and osteoid formation. Good prognosis following complete surgical excision of the tumor has been reported, with a very low recurrence rate and no reports of malignant transformation. Despite its benign clinical behavior, the lesion can be mistaken for a malignant neoplasm, such as an extraskeletal or parosteal osteosarcoma, in case of rapid growth, thereby rendering the diagnosis challenging.
PATIENT CONCERNS
We report the case of a 30-year-old right-handed male who presented to our hospital with a rapidly growing mass on the dorsal aspect of the right little finger.
DIAGNOSIS
The patient was suspected to have soft tissue tumor of the little finger. The lesion could be considered a malignant tumor on the basis of clinical findings.
INTERVENTIONS
The patient underwent surgery for exploration and excision of the mass.
OUTCOMES
The excised mass was diagnosed to be fibro-osseous pseudotumor of the digit upon histological assessment. Postoperatively, the wound healed without complications. At postoperative 6 months, there were no signs or symptoms of recurrence, and the patient returned to his premorbid functional status.
CONCLUSION
Following the detection of a soft tissue mass with clinicopathological features of pseudomalignancy in the digit, clinicians should consider fibro-osseous pseudotumor of the digit as a possible diagnosis, thereby avoiding unnecessary aggressive surgery.
Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Fibroma, Ossifying; Fibrous Dysplasia of Bone; Fingers; Humans; Magnetic Resonance Imaging; Male; Soft Tissue Neoplasms; Tomography, X-Ray Computed
PubMed: 32664136
DOI: 10.1097/MD.0000000000021116