Aggressive Benign Tumors Research Articles

Multidisciplinary Management of Primary Sacral Tumors: A Tertiary Care Center's Experience and Literature Review.

Sacral tumors are rare and can be benign or malignant. Their management is multifactorial and is based on the pathology, extent, and local and distant spread. Managing sacral tumors is challenging due to their proximity to visceral and neural structures. Surgical wide excision has been the standard of care for aggressive benign and malignant tumors. Our purpose was to evaluate the outcomes of a multimodal approach to managing primary sacral tumors in Sakra World Hospital, a tertiary spine care center in Bengaluru, India and perform a literature review to determine a workflow pathway. Our study was a retrospective review of patient records and included 15 patients with primary sacral tumors. Eleven surgically treated patients were evaluated clinically and radiologically and underwent biopsy before surgical excision by an all-posterior approach. A multidisciplinary approach that included intraoperative neural monitoring, plastic reconstruction, adjuvant chemotherapy, and radiotherapy was implemented whenever necessary. Sacral root preservation was attempted whenever feasible. Functional outcomes (based on the Visual Analog Scale [VAS] and Biagini scoring system) were analyzed along with disease control, with a minimum of 2 years of follow-up. The mean follow-up was 29±9.8 months. The mean VAS score significantly improved from 7.8±2.6 to 3.7±3.8 (p=0.026). Bowel function showed statistically significant improvement, from a mean score of 0.81±0.47 to 0.63±0.52 (p=0.026) at 2 years of follow-up. The mean pretreatment motor and bladder function scores were 0.53±0.31 and 0.74±0.44, respectively, improving to 0.48±0.33 and 0.68±0.56 at follow-up but without statistical significance. There was no significant loss of function, which is expected in radical sacral resections. In conclusion, primary sacral tumors require a multidisciplinary approach and management for optimal outcomes. A stand-alone posterior approach can be employed to treat most sacral lesions. En-bloc wide resection is the optimal treatment for primary malignant and aggressive benign tumors. Preservation of at least one functional S2 nerve root is imperative to preserve bowel and bladder function.

Prognostic significance of SOX2 and GPC3 in Ameloblastoma and its malignant counterpart (Ameloblastic Carcinoma)

Background: Ameloblastoma is a common benign aggressive odontogenic tumor with a tendency for high recurrence rate. Ameloblastic Carcinoma is the malignant counterpart of Ameloblastoma. However, they are usually difficult to be distinguished from one another. Therefore, using Immunohistochemical markers might be beneficial for diagnosing them accurately.Objective: Evaluation of SOX2 and GPC3 expressions as well as evaluating their roles in the tumorigenesis and the biological behavior of Ameloblastoma and Ameloblastic Carcinoma.Methods: Tissue samples are composed of 34 archived histopathologically confirmed cases of (19 Conventional Ameloblastomas, and 15 Ameloblatic Carcinomas). Sections were subjected to Immunohistochemical staining according to a standard protocol by applying antibodies to SOX2, and GPC3.Results: SOX2 and GPC3 expressions in recurrent Ameloblastoma were significantly higher than non- recurrent cases. Ameloblastic Carcinoma showed the highest immune-reactivity to SOX2 and GPC3 compared to the Conventional Ameloblastoma. Desmoplastic Ameloblastoma showed the highest scores of SOX2 and GPC3 compared to the other subtypes.Conclusions: SOX2 and GPC3 can be used as a panel for diagnosing the aggressive and the malignant odontogenic tumors accurately. Desmoplastic Ameloblastoma behaves more aggressively than other Conventional Ameloblastoma subtypes.

Outcome of Surgical Resection of Primary Malignant and Aggressive Benign Metacarpal Bone Tumors.

Primary bone tumors of the hand are relatively rare. Different treatment options have been described in case reports. In this study, the authors present the diagnostic methods and treatment strategies that they used. The goal of this study is to present the oncologic and functional outcomes of surgical resection of primary malignant and aggressive benign metacarpal bone tumors. This retrospective study included 7 patients with primary malignant and aggressive benign bone tumors of the metacarpals who underwent surgical resection with or without metacarpal reconstruction between 2000 and 2017, with a minimum follow-up of 2 years. Clinical and radiologic evaluations were reviewed, and functional evaluation was performed with the Musculoskeletal Tumor Society scoring system. Seven patients (6 female; 1 male), with a mean age of 30.9±11.3 years, were included in the study. Six tumors were de novo, whereas 1 was recurrent. After resection, 5 patients had metacarpal reconstruction. Nonvascularized fibula was used for 3 patients, extracorporeal freezing of the metacarpal using liquid nitrogen was used for 1 patient, and metacarpal shift was used for 1 patient. Mean follow-up was 52.6±26.7 months. At the final follow-up, mean Musculoskeletal Tumor Society score was 27.4±1.6, and no local recurrence was documented. One patient had chest metastasis after 8 years of follow-up. The results show that surgical resection of primary malignant and aggressive benign tumors of the metacarpal bones can achieve satisfactory functional and oncologic outcomes. [Orthopedics. 2021;44(5):e633-e638.].

PROSPECTIVE INTERVENTIONAL STUDY OF ASSESS FUNCTIONAL OUTCOME OF GIANT CELL TUMOUR OF DISTAL END RADIUS TREATED BY EN BLOE RESECTION AND RECONSTRUCTION BY ULNAR TRANSLOCATION

Background: Giant cell tumour (GCT) of bone is a relatively rare, locally aggressive benign neoplasm associated with a wide pathological spectrum, ranging from latent benign to highly recurrent and, occasionally, malignant metastatic potential.
 Methods: This retrospective study was conducted on 30 hospitalized patients for surgery in in Jaipur. We followed up all patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score.
 Results: Mean follow-up period was 52.36 months, mean resected length of the radius was 7.11±2.31 cm. One patient had tumor recurrence in the soft tissues after 16.32±2.31 months (recurrence rate 10.00 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4 weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.6° of dorsiflexion, 29.8° of volar flexion, 46.2° of supination, and 37.8° of pronation. Mean grip strength was 70 % (41–84 %). Overall revised MSTS score averaged 81.36 % with one being excellent, five good, and five satisfactory.
 Conclusion: The optimal treatment for GCTs arising around the knee remains controversial. Despite the trend towards better oncological control of this tumour after wide resections, the recurrence rates achieved through a more conservative procedure such as the curettage-based interventions seem to be acceptable. Additionally, curettage and local adjuvants allow for overall better function of the knee, in particular with proximal tibia GCTs.
 Keywords: GCT, MSTS, ROM

Pediatric Aggressive Benign Mandibular Tumors: Clinical Features and Management.

Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics. To review the clinical features and management of lower jaw pediatric aggressive benign tumor. Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019. Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%). Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.

Juvenile nasopharyngeal angiofibroma: National practice patterns and resource utilization via HCUP KID

BackgroundJuvenile nasopharyngeal angiofibroma (JNA) is a locally aggressive benign vascular tumor that typically afflicts young adolescent males. Historically removed via open approaches, these tumors are now being removed endoscopically. As the modern healthcare setting emphasizes value, efficient utilization of resources may lead to decreased cost while maintaining or improving patient outcomes. ObjectiveThe objective of this study was to investigate how perioperative management of juvenile nasopharyngeal angiofibromas (JNAs) influence overall cost. We specifically investigate the effect of approach type (open, endoscopic, or combined) with regards to cost and length of stay. We also delineated practice patterns, analyzed safety profiles, and characterize clinical outcomes. MethodsThe 2016 Healthcare Cost and Utilization Project Kids’ Inpatient Database (HCUP-KID) was queried to identify males aged <21 years with an ICD-10-CM diagnosis code of D10.6 (benign neoplasm of nasopharynx) and ICD-10-PCS codes to determine whether an open, endoscopic or combined approach was performed. Univariate statistical analysis and multivariable logistic regression were performed to examine the effects of demographics, patient characteristics, procedure type, and complications on length of stay (LOS) and cost. ResultsA total of 89 male patients were analyzed with a mean age of 14.8 years (range 8–20 years). Mean LOS was 3.4 days. Mean total charges were $128,780. Comparing open (n = 16), endoscopic (n = 65), and combined (n = 8) approaches, there was a significant difference in the need for fresh frozen plasma (p = 0.02) and packed red blood cell (pRBC) (p = 0.03) transfusion but no difference in preoperative embolization (p > 0.05) between approach types. LOS was associated with age (p = 0.02), pRBC transfusion (p = 0.04) and septal deviation (p = 0.03). Charges varied with LOS (p < 0.001) on linear regression analysis but not with other variables in this dataset. ConclusionApproach type for JNA appears to be unrelated to LOS or charges in this multi-site, population-based analysis. However, septal deviation, pRBC transfusion, and young age are associated with increased LOS in patients undergoing JNA resection.

Giant cell tumour of bone around the knee: a systematic review of the functional and oncological outcomes.

Giant cell tumour of bone (GCT) is a relatively rare, locally aggressive benign neoplasm observed in the long bone epiphyseal-metaphyseal regions of young adults.The optimal treatment strategy for these tumours remains controversial, and a huge amount of contradictory data regarding the functional and oncological outcomes can be found. Therefore, we performed a systematic review intended to investigate the functional and oncological outcomes after surgical treatment of GCTs arising around the knee, namely in the distal femur and proximal tibia.A trend towards better oncological control was found using wide resections, nonetheless, curettage-based techniques achieve a highly acceptable recurrence rate with overall better knee function. A slight advantage favouring proximal tibia GCTs regarding the Musculoskeletal Tumor Society (MSTS) score was also observed.Prospective studies comparing groups of more homogeneous patients, tumours, and treatment options should be developed to obtain more conclusive and definitive results regarding the optimal strategy for treating GCTs. Cite this article: EFORT Open Rev 2021;6:641-650. DOI: 10.1302/2058-5241.6.200154

Calcaneal Reconstruction With Free Deep Circumflex Iliac Artery Osseocutaneous Flap Following Aggressive Benign Bone Tumor Resection.

Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors. We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case. The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either. Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes. Level IV, case series.

Straightplasty, a Limb Salvage Procedure in Malignant and Aggressive Bone Tumors of Lower Extremities: A Retrospective Analysis.

IntroductionThe management of malignant bone tumors of lower extremities involves various modalities, which depend not only on local and systemic affection but are also affected by psychosocial factors. The purpose of this study was to evaluate functional and psychosocial outcomes in patients with non-salvageable lower limbs having malignant or aggressive benign bone tumors of distal thighs, who were treated with a technique called straightplasty.Material and methodsWe enrolled 20 patients of non-salvageable primary malignant or aggressive benign bone tumors around the knee. Out of these, 15 patients were followed and evaluated in view of functional and clinical outcomes having a minimum of 22 months of final follow-up.ResultsA total of 15 patients (8 males, 7 females) having a non-salvageable lower limb with a mean age of 20.53 years (range, 12 to 45 years), who were managed with straightplasty and followed for a mean duration of 31.73 months (range 22 to 72 months) were evaluated clinico-radiologically, and the functional outcomes were measured by Enneking’ s method. The surgical procedure is simple and better in terms of functional outcomes than other procedures described in the literature, while it is observed as psychosocially more acceptable in developing nations, especially in the Indian context. Most of the parameters are comparable to rotationplasty and above-knee amputation, whereas it is less technically demanding and satisfying due to the straight limb rather than the rotated leg in rotationplasty.ConclusionWe recommend straightplasty as an alternative to rotationplasty or above-knee amputation in patients having malignant or aggressive benign tumors around the knee joint and where limb salvage procedures are not feasible.

Perioperative complications of total en bloc spondylectomy for spinal tumours.

To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection. In total, 307 patients who underwent TES in a single centre were reviewed retrospectively. There were 164 male and 143 female patients with a mean age at the time of surgery of 52.9 years (SD 13.3). A total of 225 patients were operated on for spinal metastases, 34 for a malignant primary tumour, 41 for an aggressive benign tumour, and seven with a primary of unknown origin. The main lesion was located in the thoracic spine in 213, and in the lumbar spine in 94 patients. There were 97 patients who underwent TES for more than two consecutive vertebrae. Major and minor perioperative complications were observed in 122 (39.7%) and 84 (27.4%) patients respectively. The breakdown of complications was as follows: bleeding more than 2,000 ml in 60 (19.5%) patients, hardware failure in 82 (26.7%), neurological in 46 (15.0%), surgical site infection in 23 (7.5%), wound dehiscence in 16 (5.2%), cerebrospinal fluid leakage in 45 (14.7%), respiratory in 52 (16.9%), cardiovascular in 11 (3.6%), digestive in 19 (6.2%)/ The mortality within two months of surgery was four (1.3%). The total number of complications per operation were 1.01 (SD 1.0) in the single vertebral resection group and 1.56 (SD 1.2) in the group with more than two vertebral resections. Cardiovascular and respiratory complications, along with hardware failure were statistically higher in the group who had more than two vertebrae resected. Also, in this group the amount of bleeding in patients with a lumbar lesion or respiratory complication in patients with a thoracic lesion, were statistically higher. Multivariate analysis showed that using a combined anterior and posterior approach, when more than two vertebral resections were significant independent factors. The characteristics of perioperative complications after TES were different depending on the extent and level of the tumour resection. In addition to preoperative clinical and pathological factors, it is therefore important to consider these factors in patients who undergo en bloc resection for spinal tumours. Cite this article: Bone Joint J2021;103-B(5):976-983.

DISTAL TIBIAL RECONSTRUCTION WITH INTRAMEDULLARY NAIL COMBINED WITH T-PLATE FOLLOWING EN-BLOC-EXCISION OF GIANT CELL TUMOR OF DISTAL TIBIA: CASE-REPORT

Background: Giant cell tumor is locally aggressive benign tumor that occur more common in distal femur, proximal tibia, and distal radius, and has tendency for recurrence and has capability for metastatize. Giant cell tumor in foot ankle are rare, and comprise less than four percent of giant cell tumor of the bone.Case Report: A 33 years old man presented with complains of pain and swelling in right ankle since 6 months ago with no history of trauma. Physical examination revealed increasing swelling over the distal-posteromedial aspect of lower leg and limitation ankle movements due to pain. Routine blood investigations showed slight increase of alkaline phosphatase. X-ray and Magnetic Resonance Imaging showed the lesion with morphology suggestive of giant cell tumor. Histopathology examination showed multinucleated giant cells and spindle shaped of mononuclear cells suggestive of giant cell tumor. The patient was treated with en-bloc-excision followed with distal tibial reconstruction using reverse intramedullary tibial nail combined with T-plate (tibio-talar arthodesis).Discussion: The main treatment of giant cell tumor of the bone is surgical removal to achieve tumor-free by eradication of the tumor, with various surgical techniques for reconstructing the cavity left. In this case we performed distal tibial reconstruction using reverse intramedullary tibial nail combined with T-plate.Conclusion: The patient at 12-month follow up is doing well, walking comfortably without any pain, has no limitation in range of motion with no signs of recurrence and good MSTS score (90).

Synchronous presentation of two dentigerous cysts and ameloblastoma: Eight-years follow-up

Dentigerous cysts are benign lesions mainly related to the crown of a tooth, early diagnosis is essential (which is almost always done radiographically and sometimes clinically) these not usually causing symptoms unless these are large and generate compression on nerve structures, the possibility of transformation or the evolution of these lesions to ameloblastomas has been described in the literature, possibly due to cellular and protein changes, among others, which are still under study. Ameloblastomas, on the other hand, are aggressive benign tumors and their possible formation from a dentigerous cyst has been described. It is important to have a good histopathological diagnosis since sometimes similarities can be observed and these can generate controversy or confusion between them. The present clinical case is representative because it involves both lesions in the same site, the importance lies in the fact that conservative treatment was provided through enucleation and curettage of the lesions performed at the Maxillofacial Surgery at "La Raza" National Medical Center. And then the patient was kept under control, showing clinical and radiographic results at eight years of follow-up, without recurrences, with adequate evolution and a good prognosis.

Management of benign bone tumours

Benign bone tumours are rare, occurring most commonly in skeletally immature patients, usually arising from cartilage or bone. The commonest locations are the distal femur, proximal tibia and proximal humerus. They present with pain, swelling, pathological fracture or as incidental findings. Diagnosis is by a combination of radiography, MRI, CT and core needle biopsy if indicated. More aggressive benign tumours may appear radiologically similar to malignant tumours. Management depends upon anatomical location, symptoms, morbidity of treatment and the natural history of the tumour. In most cases it involves either simple excision or curettage, although occasionally it is necessary to perform a complete excision using similar principles as for malignant tumours.

Cross-cultural adaptation and validation of the Turkish version of the Musculoskeletal Tumor Society scoring system in patients with musculoskeletal tumors.

This study aimed to translate and cross-culturally adapt the musculoskeletal tumor society (MSTS) scoring system into Turkish and to determine the reliability and validity of the translated version for the functional evaluation of patients with musculoskeletal tumors. A total of 36 patients (16 women, 20 men; mean age=36.6; age range=13-75 years) who underwent limb-salvage surgery owing to benign aggressive or malignant musculoskeletal tumors were included in the study. Translation and back translations of the MSTS were performed according to the published guidelines. Short form (SF) 36 physical component, Western Ontario and McMaster Universities Arthritis Index (WOMAC), disabilities of the arm, shoulder, and hand (DASH), and range of motion scale (ROMS) that were previously analyzed for Turkish validation were used for validity. Reliability of MSTS Turkish version was evaluated by calculating test-retest reliability and internal consistency. Intraclass correlation coefficient (ICC) was used to evaluate the inter-observer consistency and test-retest reliability. Alpha coefficient (Cronbach's alpha) was used to evaluate the internal consistency. It was observed that total MSTS score has a strong negative correlation with DASH (r=-0.689; p<0.001) and WOMAC scores (r=-0.634; p<0.001) and moderate correlation with the ROMS score (r=0.521; p<0.001). Total MSTS score also had a statistically significant strong correlation with SF-36 scores (r values ranging from 0.425 to 0.609, p<0.001). Inter and intra-observer reliability of the MSTS scale was found to be excellent (Cronbach's α=0.97 p<0.001; ICC: 0.97 (0.96-0.99; p<0.001). Unlike other subscales, statistical correlation between dexterity and hand-positioning subscales of MSTS with DASH scores was found to be insignificant (r=-0.533, p =0.061 and r=-0.336, p=0.261, respectively). The Turkish version of the MSTS scoring system seems to be a valid and reliable scale that measures the correct and desired values in the evaluation of health-related quality of life in orthopedic oncology. Reliability coefficients of the Turkish version of MSTS were determined to be strong. Level II, Diagnostic Study.

Giant Cell Tumor of Bone: An Update.

To highlight the new developments in the management of advanced giant cell tumor of bone, a rare locally aggressive benign tumor, which was traditionally managed with surgery alone by either curettage and local adjuvant therapy, wide resection, or marginal excision. Here, we review the current role of systemic therapy for management of locally advanced or metastatic giant cell tumor of bone (GCTB). The elucidation of the pathophysiology of giant cell tumor of bone, especially with regards to the role of nuclear factor kappa B ligand (RANKL), has led to the Food and Drug Administration (FDA) approval of denosumab in the management of locally advanced or metastatic GCTB. For advanced giant cell tumor where surgical resection alone can cause severe morbidity, the paradigm has shifted from local treatment alone to multidisciplinary management with the consideration of use of denosumab.

Prognostic significance of CTNNB1 mutation in recurrence of sporadic desmoid tumors.

Aim: Desmoid tumor (DT) is a rare, locally aggressive benign neoplasm withahigh recurrence rate. The majority of sporadic DTsare associated withmutations in CTNNB1, butwhether CTNNB1 mutations areassociated with the risk of DT recurrence remains unclear. The goal of this meta-analysis was to evaluate the association between CTNNB1 mutation and recurrence in surgically treated DT patients. Methods: PubMed, Embase and Cochrane library were systematically searched. The outcome of interest was the risk of recurrence. The number of patients with CTNNB1 mutation and the number of recurrences they developed were recorded and compared. The quality of these studies wasassessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratiosand variances were calculated and pooled. Results: A total of eight studies were identifiedincluding637 patients. S45F-mutated DTs were more likely to recur compared with wildtype, T41A and other mutated DTs. However, there were no statistically significant differences in the rate of recurrence between wildtype and T41A mutationor other mutation. Conclusions: Among CTNNB1 mutations, the mutationS45F is a high-risk factor for recurrence of DT and may be a predictive marker for the recurrence of sporadic DT.

Case of Recurrence of 8 years back operated case of benign Giant Cell Tumor of the proximal Tibia with malignant fulminating mass over upper one third of leg

Giant cell tumor is a locally aggressive benign tumor of bone predominantly involving proximal tibia region. We are reporting Case of Recurrence of 8years back operated case of Giant Cell Tumor of the proximal Tibia previously treated with cementing and bone grafting now presented with malignant fulminating mass over upper one third of leg managed with amputation.

Desmoplastic fibroma of the ulna

Introduction: Desmoplastic fibroma is an extremely rare, locally aggressive, benign bone tumour with incidence of 0.1% of primary bone tumors. It is composed of spindle cells with minimal cytological atypia and abundant collagen. Diagnosis is made on radiology and histopathology. Case Summary: A 17yr female patient presented with pain and swelling in left forearm since 9yrs, slowly progressive in nature. Radiograph showed an osteolytic lesion of the proximal ulna. En-bloc excision was done. Grossly the tumor was 13x6x2.5cm, hard in consistency with grey-white mass on cut section. Microscopically it was composed of spindle shaped cells with elongated bland appearing nuclei arranged in whorled pattern and fascicles with abundant collagen present between spindle cells. No pleomorphism or mitoses were noted. Conclusion: Desmpoplastic fibroma is a very rare locally aggressive benign neoplasm of bone. The diagnosis and management are often difficult and requires a combined speciality approach. Keywords: Desmoplastic fibroma, Ulna, Bone tumor, Spindel cell, Collagen.

DESMOPLASTIC FIBROMA OF MAXILLA: A CASE REPORT

Desmoplastic fibroma (DF) is an extremely rare aggressive benign bone tumor, and it represents 0.1% of all primary bone tumors. We reported a case of a 53-year-old feoderm man. In the extraoral examination, a discrete volume increase was observed in the genic region that was painless under pressure; magnetic resonance imaging and cone beam computed tomography showed an expansive left maxillary sinus lesion with involvement of the homolateral zygomatic bone. The patient was submitted to previous incisional biopsy with histopathologic diagnosis of lipoma being referred for surgical removal. In the intraoperative period the noncompatibility with the aforementioned diagnosis was verified; thus, a new histopathologic examination of the specimens was requested that resulted in the diagnosis of DF. The subsequent control is performed annually with the help of cone beam computed tomography. Currently, the patient is healthy and asymptomatic.

Reorganization Tips from a Sarcoma Unit at Time of the COVID-19 Pandemic in Italy: Early Experience from a Regional Referral Oncologic Center.

Since the World Health Organization declared the novel coronavirus outbreak a global health emergency, Italy’s lockdown was declared on 9 March 2020. Elective orthopedic surgery was forced to stop to allow the healthcare system to face the emergency. However, many orthopedic oncology cases could not be postponed. The aim of this study was to report the experience in managing sarcoma patients and the reorganization of a cancer center in an attempt to maintain it free from COVID-19. A Coronavirus Crisis Unit was established by the health directorate coordination in order to adopt specific procedures. General rules of screening and social distancing were applied in different health settings (entrance check point, hospital inward, outpatient clinic, operative room). Regarding oncologic orthopedics, priority was given to bone and soft tissue sarcomas, metastases and aggressive benign tumors at risk of impending or pathologic fracture. Precise indications were followed to manage first outpatient visits, patients undergoing surgery and follow-up. Meticulous adherence to rules among patients and personnel and collaboration between leadership and medical staff in order to continue to perform multidisciplinary treatment protocols, maintain the availability of infrastructural spaces and source protective equipment, swabs and screening samples have been successful in the aim towards a safe cure for cancer patients.