Adjacent Bone Research Articles

Ultrasonography as an alternative to radiographs in assessing fracture healing

To determine whether ultrasound can assess healing of bone and check the development of callus prior to conventional radiograph thereby enabling early diagnosis of delayed union or confirmation of union. Fracture healing was evaluated with ultrasonography and radiography on specific intervals until healing was complete; in 20 fracture sites. Based on the findings of ultrasonographic and radiographic scores were assigned to classify healing.18 out of 20 fracture sites had completely healed with mature callus formation at the end of 3 months while only 2 fracture sites showed delayed healing. In patients with normal healing, colour doppler ultrasound showed neovascularisation in the 1 month of healing. With time it was noticed that the depth and width of the fractured site was reducing and becoming more isoechoic with the adjacent normal bone sites. Assessment of these parameters being more evident on the USG were statistically significant when compared with OPG. Ultrasound can be considered as a useful guide in assessing fracture healing as a replacement to conventional imaging modalities such as the OPG, particularly in the early prediction of impaired fracture healing.

Possible pathogenetic features of the development and progression of osteoarthritis in the metabolic syndrome (diabetes mellitus, obesity, arterial hypertension)


 The paper emphasizes the pathogenetic features of osteoarthritis in the metabolic syndrome (type 2 diabetes, obesity, and arterial hypertension), such as the violation of the structure of the bone and cartilage tissue of the joints. Attention is paid to such mechanisms as oxidative stress, low-grade chronic systemic inflammation, and participation of the cartilage extracellular matrix, where matriline-3 protein plays an important role. It is involved in cartilage development and possible pathological mechanisms contributing to the onset and progression of osteoarthritis/osteoarthritis.
 The significance of abnormal levels of reactogenic forms of oxygen, superoxide anion, and nitrogen monoxide, which provide an increase in the level of peroxynitrite, hydrogen peroxide, myeloperoxidase, and hypochlorous acid, is discussed in detail. It is indicated that in the presence of iron and hydrogen peroxide, chondrocytes release hydroxyl radicals that react with unsaturated fatty acids of membranes and start a chain reaction, producing radicals with a long lifetime. This causes degradation of both the cellular and intercellular components of the cartilage. In addition, intra-articular connections are formed, and the vascular wall is restructured, leading to impaired microcirculation in bone and cartilage tissue due to damage to the vascular endothelium, vasospasm, increased blood clotting, the formation of microemboli, and venous occlusion. As a result, ischemia of the subchondral bone develops, along with damage to the cartilage tissue and a local disturbance of microcirculation. The thickness of the subchondral bone decreases due to angiogenesis at the junction of the articular hyaline cartilage and adjacent subchondral bone in patients with osteoarthritis. This process enhances degenerative-inflammatory changes in the structure of the cartilage due to a violation of metabolic processes in it.
 The importance of lipid and protein peroxidation in the regulation of intracellular calcium homeostasis and the ability of smooth muscles to undergo persistent contractions, which cause muscle pain, are emphasized. Pathogenetically, an important role in this process is played by the inhibition of calcium-ATPase in the sarcoplasmic reticulum, the activation of calcium flow through calcium channels, and an increase in intracellular calcium. Hypocalcemia and hypercalciuria in patients with metabolic syndrome contribute to the progression of not only osteoarthritis but other components of the syndrome.
 Attention is drawn to the significance of the cytokine link as an important mechanism for the onset and progression of osteoarthritis/osteoarthritis. The features of the reaction of chronic systemic inflammation with the participation of IL-18 and IL-10 in the structure of the extracellular matrix of cartilage, where matrilin-3 protein plays an important role since it is involved both in the development of cartilage and in the progression of osteoarthrosis, depending on multimorbidity with other components of metabolic syndrome, are highlighted.

Osteological correlates of evolutionary transitions in cetacean feeding and related oropharyngeal functions

Teeth are often the first structures that anatomists and paleontologists examine to understand the ecology and morphology of feeding, both because teeth are highly specialized structures that provide precise information, and because they are among the best and most commonly preserved fossils. Unfortunately, many fragmentary fossil and recent specimens lack teeth, and some come from edentulous individuals and taxa, as in mysticete (baleen) whales. In our broad comparative review, we survey non-dental osteological features that, due to size, shape, arrangement, and surface features reflecting muscle attachments, provide useful clues to general or specific aspects of prey capture, intraoral transport, processing, or swallowing. We focus on hyoid, palatal, and pterygoid bones, mandibular symphyses and processes such as the coronoid, and the temporal fossa and zygomatic arch, as well as adjacent cranial bones relating to oral and pharyngeal anatomy. These bones relate to muscles of five general locations especially indicative of feeding: mandibular, hyoid, tongue, pharyngeal, and facial regions. Together these bones and muscles affect feeding and related activities including suckling and breathing. We discuss osteological correlates that provide special relevance to key transitions in cetacean evolutionary history, such as the shift from predominantly terrestrial to aquatic feeding, the shift from typical mammalian mastication to swallowing prey entirely or nearly whole, and the separation of respiratory and digestive passages. We also point to examples of modern specialists in these anatomical optima for different modes of prey capture, intraoral transport, processing, and swallowing. Although we focus on cetaceans, our approach is broadly relevant to all vertebrates, notably other marine tetrapods.

Clinical Features and Radiographic Aspects of Squamous Cell Carcinoma in the Gnathic Bones

This integrative review aimed to discuss the clinical features and imaging aspects of squamous cell carcinoma in the gnathic bones on panoramic radiographs and cone-beam computed tomography. The electronic search was conducted in PubMed, Embase, and Scopus using the keywords cone-beam computed tomography, panoramic radiography, dentomaxillofacial complex, and oral squamous cell carcinoma. Studies between 2012 and 2022, report imaging aspects of the oral squamous cell carcinoma in panoramic radiography and cone-beam computed tomography were selected. The initial search found 375 articles, leaving 171 after excluding duplicates. Eighteen studies met the inclusion criteria, bringing together a total of twenty cases. Swelling and pain are common clinical features. In most cases, the squamous cell carcinoma was in the mandible; the borders were poorly defined with invasive aspects; the internal structure was radiolucent/hypodense and some cases, had radiopaque flecks. The lesion causes structures destroyed like the adjacent bone, the alveolar process, border of the mandibular canal, ramus of the mandible. The image aspects raised in this review: as large areas of osteolysis interspersed with an irregular pattern of radiopaque/hyperdense flakes, with imprecise limits and invasive borders, causing significant destruction of adjacent structures, squamous cell carcinoma can be a diagnostic hypothesis. In these cases, we recommend urgency in completing the diagnosis. The panoramic radiography can provide information that leads to the suspicion of a malignant lesion, but cone-beam computed tomography provides the real dimension and repercussion of the lesion.

Hemophilic Pseudotumor of the Distal Phalanx

Introduction: Haemophilia is one of the hereditary recessive diseases linked to sex-induced coagulation disorder and is characterized by bleeding episodes. This report presents a rare involvement of the distal phalanx hemophilic pseudotumor. Case Presentation: A 21-year-old man was crushed by a closing door 18 months before. The distal phalanx was fractured, and a large hematoma developed under the nail plate, which separated the nail plate from its bed. Eighteen months after the injury, plain radiographs demonstrated an expansile lesion with extensive destruction of the distal phalanx. Regarding the patient’s history and abnormal clotting tests, the development of a hemophilic pseudotumor was considered at the distal phalanx due to the enlarging nature of the coagulum, which induced compression and pressure necrosis on the adjacent bone and structures. Conclusions: Hemophilic pseudotumors in the small bones are rarely reported. After a minor traumatic injury in hand, exact management and coagulopathy control are important to prevent further complications.

A case report: An unusual presentation of adenoid cystic carcinoma of the lacrimal gland.

Adenoid cystic carcinoma (ACC) is the most common malignant epithelial tumor of the lacrimal gland with the highest malignant degree. ACC of the lacrimal gland is characterized by symptoms of <1 years duration. We present a 38-year-old male patient who complained of an enlarging mass in the left lacrimal fossa for almost 10 years previous to the diagnosis of ACC. A 38-year-old male patient visited our ophthalmology clinic with a chief complaint of a mass in his left upper lid, which had enlarged significantly over the previous months. Magnetic resonance imaging with intravenous Gadobutrol showed moderate and homogenous mass enhancement. Bone destruction is found. The periosteum is not eroded. The magnetic resonance imaging finding was supportive for malignancy. Histopathological examination of the specimen revealed solid tumor showing a cribriform pattern mixed small amount of basaloid cell proliferation. Therefore, the final diagnose was Adenoid cystic carcinoma of the lacrimal gland. The treatment included en bloc resection of the mass and adjacent bone and radiotherapy. In 1 year follow-up after operation, there is no recurrence. Visual acuity is 30/30. The left eye shows limitation on abduction. The present case demonstrates an unusual progression of ACC of the Lacrimal Gland.

The effects of material and structural properties of the periodontal ligament in mechanical function of tooth-PDL-bone complex in dental trauma: A sensitivity study using finiteelement analysis

Periodontal ligament (PDL) plays a crucial role in transferring load from tooth to its adjacent bone, and its role is more pronounced in case of trauma, due to its shock-absorbing character, which has not been fully understood yet. Different constitutive models have correlated mechanical function of PDL with its anisotropic, inhomogeneous, non-linear elastic nature, and it was variably modeled using Finite Element (FE) simulations of dental trauma. Furthermore, since capturing accurate dimension of PDL is difficult, various thicknesses were considered for PDL in FE reconstruction process. In this study, the sensitivity of FE analyses to variation in mechanical properties, including a large range of elastic properties for a linear elastic model, also a hyper-elastic material model, and various thicknesses of PDL was investigated by developing a CT-based FE model of tooth-PDL-bone complex. Results of this study highlighted the crucial role of PDL in absorption and dissipation of energy, as well as in stress distribution within alveolar bone during dental trauma. It was observed that as Young's modulus of PDL decreases and its thickness increases, its shock-absorbing capacity would be escalated. Moreover, it was found that inclusion of PDL reduces the maximum von Mises stress exerted on the alveolar bone by about 60% in some areas, compared to the case in which the PDL is absent. Results of this work underscore the need of presenting comprehensive constitutive models to describe mechanical behavior of PDL, with the goal of understanding the behavior of a tooth-PDL-bone complex in pathological conditions, such as trauma.

Fleas and lesions in armadillo osteoderms.

Armadillos are bitten by several species of flea. Females of the genus Tunga penetrate the epidermis and when in place are fertilised by males, after which the abdomen swells enormously to form a 'neosome'. Within the penetrans group, T. perforans, makes lesions that perforate the osteoderms within the integument to form ~3 mm diameter cavities occupied by a discoid neosome. We examined these lesions in carapace material from animals which had died in the wild to see whether we could recruit evidence as to how they may be generated, either by the insect or by the host. We studied one species without such lesions, the nine-banded armadillo Dasypus novemcinctus, and two species with, the greater hairy armadillo Chaetophractus villosus and the southern three-banded armadillo Tolypeutes matacus, both showing the characteristic 'flea bite' holes in the external surfaces of the osteoderms. Samples were studied by three-dimensional backscattered electron mode scanning electron microscopy and X-ray microtomography. Both methods showed resorption pit complexes in the external surfaces of the osteoderms characteristic of those made by osteoclasts in active bone resorption. Lesions involved both the syndesmoses (sutures) between adjacent bones and the central regions of the osteoderms. Many lesions showed extensive repair by infilling with new bone. We conclude that the T. perforans neosome creates a local host response which causes bone resorption, creating the space in which it can grow.

Regional differences in bone mineral density biomechanically induce a higher risk of adjacent vertebral fracture after percutaneous vertebroplasty: a case-comparative study.

Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compressive fracture. Biomechanical deterioration initially induces a higher risk of AVF. Studies demonstrated that the aggravation of regional differences in the elastic modulus of different components might deteriorate the local biomechanical environment and increase the risk of structural failure. Considering the existence of intravertebral regional differences in bone mineral density (BMD) (i.e. elastic modulus), it was hypothesized in the present study that higher intravertebral BMD differences may induce a higher risk of AVF biomechanically. The radiographic and demographic data of osteoporotic vertebral compressive fracture patients treated using PVP were reviewed in the present study. The patients were divided into two groups: those with AVF and those without AVF. The Hounsfield unit (HU) values of transverse planes from the superior to the inferior bony endplate were measured, and the differences between the highest and lowest HU values of these planes were considered the regional differences of the HU value. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. PVP with different grades of regional differences in the elastic modulus of the adjacent vertebral body was simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to AVF were computed and recorded in surgical models. Clinical data on 103 patients were collected in this study (with an average follow-up period of 24.1 months). The radiographic review revealed that AVF patients present a significantly higher regional difference in the HU value and that the increase in the regional difference of the HU value was an independent risk factor for AVF. In addition, numerical mechanical simulations recorded a stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral cancellous bone, with a stepwise aggravation of the adjacent cancellous bony regional stiffness differences. The aggravation of regional BMD differences induces a higher risk of AVF after PVP surgery through a deterioration of the local biomechanical environment. The maximum differences in the HU value of the adjacent cancellous bone should, therefore, be measured routinely to better predict the risk of AVF. Patients with noticeable regional BMD differences should be considered at high risk for AVF, and greater attention must be paid to these patients to reduce the risk of AVF. Level III b.

Primary synovial sarcoma of the shoulder: Case report of the “triple sign” on proton density magnetic resonance imaging

The first case of synovial sarcoma was published in 1893. The disease is a type of primary malignancy of the soft tissues. It is a rare and aggressive neoplasm of unknown tissue origin, characterized by strong metastatic potential and poor prognosis. The present case of a 64-year-old male patient with pain and swelling in his right shoulder and progressive loss of movement demonstrates an uncommon location for the neoplasm. Magnetic resonance proton-density fat-suppressed turbo spin-echo sequences show a heterogeneous mass in the right shoulder. The lack of homogeneity in the signal has been described in medical literature as the "triple sign" and is represented by low, intermediate, and high signal intensity areas through the neoplasm. Visible serpentine vessels spread through the tumor. There was a visible metastatic disease in the regional lymph nodes and metastatic foci in the adjacent bones. Pathological analysis of the tumor confirmed the diagnosis of biphasic synovial sarcoma. An oncological committee advised chemotherapy and radiotherapy. More prominent magnetic resonance imaging findings in synovial sarcoma that may facilitate the diagnostic process are the inhomogeneity and "triple sign" in proton density and T2 sequences, multilobulated tumors, septa, irregular borders, serpentine vascular channels, engagement of the adjacent bones and bone marrow, and involvement of the joint synovia.

Unusual presentation of an aneurysmal bone cyst: A case report and literature review

Aneurysmal bone cysts (ABCs) are non-neoplastic primary bone tumors, typically involving the long bones and vertebrae in the first 2 decades of life. ABCs require prompt diagnosis and intervention due to their rapidly expansile nature and ability to destroy the adjacent normal bone. ABCs rarely affect the rib. We report a case of a 51-year-old female presenting with chronic dry cough and right upper back pain. A chest X-ray and computed tomography scan revealed an expansile, lytic mass affecting the posterior aspect of the third right rib. The third right rib was resected using a posterolateral, Shaw-Paulson approach. Histopathology of the resected mass confirmed the diagnosis of ABC. There were no intra- or perioperative complications, and follow-up X-ray was normal.

Melanotic Neuroectodermal Tumour of Infancy.

Melanotic neuroectodermal tumour of infancy (MNTI) is a locally aggressive neoplasm of neural crest origin. It is primarily a paediatric tumour, and 95% of the cases occur in children below 1 year. The tumour mainly affects the head and neck region. It shows a predilection for the craniofacial sites and the most common site affected is anterior maxilla. Microscopically, it is characterized by a biphasic population of neuroblastic cells and pigmented epithelial cells. Although generally considered as a benign tumour, it can invade the adjacent muscle and bone, causing destruction of the involved site. The rapidity in growth and the aggressive clinical behaviour of the tumour can be deceptive and hence lack of familiarity with the clinical characteristics of the tumour may often lead to an erroneous diagnosis of malignancy. The treatment of choice for MNTI is excision, and it is usually curative. Extensive surgery in a child may interfere with the normal growth and development of the facial structures and reconstruction can be very challenging in infants. Hence, early diagnosis is critical for the effective management. Clinical findings, histopathological features, and differential diagnosis of a classic case of melanotic neuroectodermal tumour of infancy are discussed.

The effectiveness of treadmill and swimming exercise in an animal model of osteoarthritis.

Introduction: Osteoarthritis (OA) is considered an inflammatory and degenerative joint disease, characterized by loss of hyaline joint cartilage and adjacent bone remodeling with the formation of osteophytes, accompanied by various degrees of functional limitation and reduction in the quality of life of individuals. The objective of this work was to investigate the effects of treatment with physical exercise on the treadmill and swimming in an animal model of osteoarthritis. Methods: Forty-eight male Wistar rats were divided (n=12 per group): Sham (S); Osteoarthritis (OA); Osteoarthritis + Treadmill (OA + T); Osteoarthritis + Swimming (OA + S). The mechanical model of OA was induced by median meniscectomy. Thirty days later, the animals started the physical exercise protocols. Both protocols were performed at moderate intensity. Forty-eight hours after the end of the exercise protocols, all animals were anesthetized and euthanized for histological, molecular, and biochemical parameters analysis. Results: Physical exercise performed on a treadmill was more effective in attenuating the action of pro-inflammatory cytokines (IFN-γ, TNF-α, IL1-β, and IL6) and positively regulating anti-inflammatories such as IL4, IL10, and TGF-β in relation to other groups. Discussion: In addition to maintaining a more balanced oxi-reductive environment within the joint, treadmill exercise provided a more satisfactory morphological outcome regarding the number of chondrocytes in the histological evaluation. As an outcome, better results were found in groups submitted to exercise, mostly treadmill exercise.

A Combined Surgical Approach for the Treatment of a Sino-Naso-Orbital Glomangiopericytoma

Glomangiopericytomas are a rare type of sinonasal tumors with high relapse rates. Endoscopic sinus surgery is the classical technique to remove such tumors. Here we report a case of sinonasal glomangiopericytoma with orbital extension, infrequently described in the literature. A 50 year-old woman was referred to our hospital because of a right paranasal painless swelling, which appeared 9 months ago and was slowly increasing in size since her first visit. A Magnetic Resonance Imaging (MRI) revealed a tumor (18 × 25 × 37 mm) centered on the right ethmoidal cells, with adjacent nasal bone erosion and a right orbital invasion. The tumor was removed with a combined surgical approach (endoscopic and trans-sinusal frontal approach) after pre-surgical embolization. Based on the results of the histopathological examination, the diagnosis of a glomangiopericytoma was confirmed. The patient was discharged after one week, and an uneventful long-term follow-up.

Transient depletion of macrophages alters local inflammatory response at the site of disc herniation in a transgenic mouse model

Macrophages are abundantly detected at sites of disc herniation, however, their function in the disease progression is unclear. We aim to investigate the functions of macrophages in acute disc herniation using a macrophage Fas-induced apoptosis (MaFIA) transgenic mouse strain. To transiently deplete macrophages, a dimerizer, AP20187, or vehicle solution was administered via intraperitoneal injection to MaFIA mice immediately, day 1 and 2 after annular puncture induced disc herniation. Local infiltrated tissues at disc hernia and DRGs at corresponding levels were harvested to analyze immune cells and neuroinflammation on postoperative day (POD) 6 by flow cytometry and/or immunostaining. Mouse spines were harvested to analyze structures of degenerated discs and adjacent vertebrae and to assess osteoclast activity by histology and tartrate-resistant acid phosphatase (TRAP) staining on POD 6, 13, and 20, respectively. On POD 6, abundant macrophages were confirmed at disc hernia sites. Compared to vehicle control, AP20187 significantly reduced GFP+ cells in blood, spleen, and local inflammatory tissue. At disc hernia sites, AP20187 markedly reduced macrophages (CD11b+, F4/80+, GFP+CD11b+, CD11b+F4/80+) while increasing neutrophils and B cells. Transient macrophage depletion decreased ectopic bone formation and osteoclast activity in herniated discs and adjacent cortical bones for up to 20 days post herniation. Disc herniation elevated expressions of TNF-α, IL-6, substance P, calcitonin gene-related peptide, accompanied by increasing GFP+, CD11b+ and F4/80+ macrophages. Macrophage depletion did not attenuate these markers of neuroinflammation. Transient depletion of macrophages altered local inflammatory response at the site of disc herniation.

Neurogenic Аrthropathy, Сhronic Osteomyelitis, Diabetic Foot: Differential X-Ray and MSCT Diagnostics

X-ray and MSCT-differential diagnostics between neurogenic arthropathy, diabetic osteoneuroarthropathy (DONAP), complicated by osteomyelitis and chronic osteomyelitis, has not been studied enough.The purpose of the study was to study the MSCT semiotics of various variants of neurogenic arthropathy, DONAP complicated by osteomyelitis and chronic post-traumatic osteomyelitis in order to substantiate etiopathogenetic treatment. In 44 patients with neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis, the results of polypositional radiography, MSCT were studied before treatment for the purpose of differential diagnosis. Single center retrospective study. MSCT and x-ray revealed differential diagnostics differences between neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis. They are manifested by the localization of destructive processes, characteristic changes in the angles of the foot and a violation of the architectonics of the bones, concomitant changes in blood vessels and soft tissues. Neurogenic arthropathy is characterized by disorganization of the joints, bone resorption, giving the impression of surgical amputation, sharpening of the ends of the metatarsal bones, a symptom of «pestle in a mortar», a violation of the structure of spongy bones. DONAP is manifested by pronounced destructive changes in the midfoot, collapse of the tarsal bones with defects, fragmentation, vascular calcifications (Menckeberg), a «pathological» reference line, an increase in the Meary angle, a decrease in the angle of the calcaneus, and a «rocking foot», increased density of the calcaneus. Chronic osteomyelitis is characterized by an isolated lesion of one or more bones; the presence of a fistulous tract, focal disorders of the trabecular pattern, a decrease in the density of adjacent bones, the presence of isolated foci of sclerosis.

Optimization of thread configuration in dental implants through regulating the mechanical stimuli in neighboring bone

Background and objectiveThe threads, as the most critical component of dental implants, transfer the imposed occlusal loads to the adjacent bone. Moreover, regulation of the mechanical stimuli in the implant adjacent bone is crucial to maximize the bone-implant construct stability. An optimal thread design can be resulted when the distribution of mechanical stimuli within the bone, and at the implant-bone interface, lie in an advised confined range. In this work, with the goal of finding the optimal thread design, which can provide the maximum level of stability, the effects of thread parameters, namely, thread depth, thread width, and thread pitch, together with upper and lower thread angles, on maximum principal strain within the cortical and cancellous bone, and shear strain at the implant-bone interface, were investigated. MethodsIn this study, the response surface methodology (RSM), due to the central composite design (CCD), was employed to obtain a set of 53 experiments. Following that, they were numerically simulated using the finite element method (FEM). The polynomial regression model was then used to predict the response functions based on the magnitude of thread parameters. The effectiveness of each thread parameter was also evaluated through statistical tools. Moreover, the non-dominated sorting genetic algorithm (NSGA-II) was performed to find the optimum dimensions of the thread. ResultsThrough comparing the results obtained from analyzing initial and optimized configuration of threads, it was shown that the latter causes a reduction in the maximum principal strains in cancellous and cortical bones by about 25% and 30%, respectively, which is in favor of making a higher quality bone, and thus greater stability in dental implant-bone construct. Moreover, the maximum shear strains at the implant-bone interface in different planes were reduced by about 40%, in the optimized thread, compared with the initial design. ConclusionsThe optimized design found in this study is a buttress thread with a fine pitch, but deep thread, which keeps the mechanical stimuli in a safe range to grant an acceptable level of stability.

Periosteal chondrosarcoma of the rib: a case report

Periosteal chondrosarcomas, also known as juxtacortical chondrosarcomas, are a rare subtype of chondrosarcoma. They usually present with pain and swelling over the affected site, most often arising in the appendicular skeleton, with the metaphysis of the distal femur and humerus the most common sites. In this poster we present the case report of a periosteal chondrosarcoma arising on the internal surface of the right 8th rib, making this an unusual site for such a tumour. Periosteal chondrosarcomas differ macroscopically from the differential diagnosis of chondroma in both size, as periosteal chondrosarcomas are often greater than 5cm, and by showing invasion into the adjacent bone or surrounding soft tissue. Histologically they have a lobulated appearance with chondrocytes showing atypia and binucleation. They can be differentiated from osteosarcoma in that no malignant osteoid or bone formation can be seen. This case report presents a rare tumour at an unusual site and discusses the differential diagnoses to be considered when making a diagnosis of periosteal chondrosarcoma.

A Novel Surgical Classification for Extremity and Pelvic Hemophilic Pseudotumors: The PUMCH Classification.

A hemophilic pseudotumor (HPT) is a rare and challenging complication of hemophilia for which there is no classification system that provides uniformity of descriptions or that can be used to guide management. We have developed such a classification based on anatomical site, HPT severity, and corresponding surgical treatment. The PUMCH (Peking Union Medical College Hospital) classification was developed on the basis of clinical manifestations and imaging features. Extremity and pelvic HPTs were divided into 4 types and 6 subtypes according to anatomical site and whether or not there was destruction of adjacent bone. Associations between the PUMCH classification and surgical treatment, preoperative comorbidities, operative time, intraoperative bleeding, and postoperative complication rates were analyzed. Forty-five patients with 53 HPTs that were treated at PUMCH between December 2005 and October 2021 were included. The mean age at the time of surgery was 35.4 ± 11.9 years, and the median follow-up duration was 60.3 months. Twenty-eight HPTs were classified as type I (13 IA, 7 IB, 8 IC); 3, as type II; 6, as type III; and 16, as type IV. All 20 type-IA and IB HPTs were treated with excision, and the 3 type-II HPTs were treated with curettage and bone grafting. Fourteen type-IV pelvic HPTs underwent excision, 2 of which needed concomitant pelvic reconstruction. Six type-IC HPTs and 1 type-III HPT underwent excision and osseous reconstruction. Amputation was required for 1 type-IC and 3 type-III HPTs. Type-IC HPTs had the longest mean operative time (194.3 ± 28.2 minutes) and the greatest intraoperative bleeding (2,000 mL [interquartile range, 1,100 to 3,000 mL]). Postoperative infection was more common in patients with type-III (50.0%) and type-IC (28.6%) HPTs, but not significantly so. The PUMCH classification is based on the anatomic pathology and surgical strategy for HPTs. The classification of HPTs corresponds to surgical outcomes, and may be helpful for decision-making regarding their surgical treatment. Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Cytogenetic and survival analysis in 315 multiple myeloma patients; five with orbital and eight with extramedullary disease

ABSTRACT Purpose To describe cytogenetic abnormalities in five patients with orbital involvement of multiple myeloma (MM) and to determine if high-risk cytogenetic abnormalities were more prevalent in patients with extramedullary disease (EMD). The final goal was to determine predictors of poor survival in the entire cohort. Methods Retrospective cohort study of 315 patients diagnosed with multiple myeloma over a 9-year period at a single institution. Results Males comprised 61% of the 315 patients and the majority (54.3%) were stage II at diagnosis of MM. Follow-up ranged 6 months to 18 years, mean 5.3 ± 3.7 years. Eight patients (2.5%), two of which had orbital involvement, developed EMD and an additional three patients had orbital involvement from adjacent bone disease. No genetic abnormality reached statistical significance between non-EMD and EMD groups. At the time of analysis 127 (41%) non-EMD patients and 6 (75%) EMD patients have died. The median survival time for the EMD group was 2 years, whereas for the non-EMD group it was 9 years (P-value of log rank test = .00015). Stage at time of MM diagnosis and age were associated with worse prognosis. Median survival for patients over 65 years of age was 7 years, compared to 12 years for patients 65 or younger (P-value for the log-ranked test <.001). Conclusions Cytogenetic abnormalities are described in five patients with orbital involvement of MM. No genetic abnormality reached statistical significance between non-EMD and EMD groups. EMD status, stage of MM at diagnosis and age are associated with poorer overall survival. Abbreviation: MM: Multiple Myeloma; EMD: Extramedullary disease; FISH: fluorescence in situ hybridization; B2M: beta-2 microglobulin; LDH: lactate dehydrogenase; OS: overall survival.