Abstract
BackgroundMalignant tumors in the proximal fibula are rare but life-threatening; however, biopsy is not routine due to the high risk of peroneal nerve injury. Our aim was to determine preoperative clinical indicators of malignancy.MethodsBetween 2004 and 2016, 52 consecutive patients with proximal fibular tumors were retrospectively reviewed. Details of the clinicopathological characteristics including age, gender, location of tumors, the presenting symptoms, the duration of symptoms, and pathological diagnosis were collected. Descriptive statistics were calculated, and univariate and multivariate regression were performed.ResultsOf these 52 patients, 84.6% had benign tumors and 15.4% malignant tumors. The most common benign tumors were osteochondromas (46.2%), followed by enchondromas (13.5%) and giant cell tumors (13.5%). The most common malignancy was osteosarcomas (11.5%). The most common presenting symptoms were a palpable mass (52.0%) and pain (46.2%). Pain was the most sensitive (100%) and fourth specific (64%); both high skin temperature and peroneal nerve compression had the highest specificity (98%) and third sensitivity (64%); change in symptoms had the second highest specificity (89%) while 50% sensitivity. Using multivariate regression, palpable pain, high skin temperature, and peroneal nerve compression symptoms were predictors of malignancy.ConclusionsMost tumors in the proximal fibula are benign, and the malignancy is rare. Palpable pain, peroneal nerve compression symptoms, and high skin temperature were specific in predicting malignancy.
Highlights
Malignant tumors in the proximal fibula are rare but life-threatening; biopsy is not routine due to the high risk of peroneal nerve injury
The proximal fibula is the most common area of the fibula to be affected by tumors, and osteosarcoma, giant cell tumors, chondrosarcoma, and aneurysmal bone cysts are the most common type of tumor to develop at this location [2]
Intralesional or marginal excision was often performed in benign tumors, while en bloc resection is recommended to be performed in aggressive benign tumors and malignant tumors [3,4,5]
Summary
Malignant tumors in the proximal fibula are rare but life-threatening; biopsy is not routine due to the high risk of peroneal nerve injury. The primary fibular tumor is rare with only 2.5% of all primary bone tumors occurring in this anatomical location [1]. Most proximal fibular tumors are benign; malignant tumors account for a significant amount of morbidity and. Most patients with symptomatic benign tumors or malignant tumors in the proximal fibula require surgical management. The preoperative chemotherapy is based on biopsy results and plays an important role in prognosis of malignant bone tumors, especially osteosarcoma [6]. Given the sensitive anatomy in this location, biopsy is not considered unless malignancy is highly suspected. It is necessary, to obtain more information of symptoms and signs in predicting benign or malignant proximal fibular tumors
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