Benign Bone Tumors Research Articles

Enchondroma Detection from Hand Radiographs with an Interactive Deep Learning Segmentation Tool-A Feasibility Study.

Enchondromas are common benign bone tumors, usually presenting in the hand. They can cause symptoms such as swelling and pain but often go un-noticed. If the tumor expands, it can diminish the bone cortices and predispose the bone to fracture. Diagnosis is based on clinical investigation and radiographic imaging. Despite their typical appearance on radiographs, they can primarily be misdiagnosed or go totally unrecognized in the acute trauma setting. Earlier applications of deep learning models to image classification and pattern recognition suggest that this technique may also be utilized in detecting enchondroma in hand radiographs. We trained a deep learning model with 414 enchondroma radiographs to detect enchondroma from hand radiographs. A separate test set of 131 radiographs (47% with an enchondroma) was used to assess the performance of the trained deep learning model. Enchondroma annotation by three clinical experts served as our ground truth in assessing the deep learning model's performance. Our deep learning model detected 56 enchondromas from the 62 enchondroma radiographs. The area under receiver operator curve was 0.95. The F1 score for area statistical overlapping was 69.5%. Our deep learning model may be a useful tool for radiograph screening and raising suspicion of enchondroma.

La diagnosi differenziale del dolore osseo in età pediatrica: quando preoccuparsi

Bone pain is a common cause of admission to the Paediatric Emergency Department. Although in most cases it is associated with benign processes, this symptom should be investigated thoroughly when anamnestic and clinical features suggest the possible presence of an underlying malignant process. This article describes the case of an adolescent presenting with persistent musculoskeletal pain, initially treated as an infectious bone disease that later turned out to be a malignant neoplasm. Based on clinical, laboratory and imaging data the differential diagnosis of paediatric bone pain can sometimes be challenging and includes nonneoplastic diseases, benign bone tumours and malignant bone tumours. Moreover, this article indicates the medical history data to be investigated, the signs and symptoms to be evaluated and the laboratory and imaging investigations to be performed in a paediatric patient with bone pain. In addition, the epidemiological, clinical and radiographic characteristics of the most frequent causes of paediatric bone pain are summarized in a final table.

Rheumatoid arthritis increases the risk of malignant neoplasm of bone and articular cartilage: a two-sample bidirectional mendelian randomization study

ObjectivePrior research has revealed a heightened prevalence of neoplasms in individuals diagnosed with rheumatoid arthritis (RA). The primary objective of this study is to delve into the causal association between RA and two distinct types of neoplasms: benign neoplasm of bone and articular cartilage (BNBAC) and malignant neoplasm of bone and articular cartilage (MNBAC).MethodsWe employed summary data from genome-wide association analyses (GWAS) to investigate the causal relationship between RA and two neoplasms, BNBAC and MNBAC, using a two-sample bidirectional Mendelian randomization (MR) study design. The IEU OpenGWAS database provided the GWAS summary data for RA, while the Finnish consortium supplied the GWAS summary data for BNBAC and MNBAC. Our analysis involved the utilization of eight distinct MR methods, namely random-effects inverse variance weighted (IVW), MR Egger, weighted median, simple mode, weighted mode, maximum likelihood, penalized weighted median, and fixed effects IVW. Subsequently, we conducted assessments to evaluate heterogeneity, horizontal pleiotropy, outliers, the impact of a single-nucleotide polymorphism (SNP), and adherence to the assumption of normal distribution in the MR analysis.ResultsThe results from the MR analysis revealed that there was no significant genetic association between RA and BNBAC (P = 0.427, odds ratio [OR] 95% confidence interval [CI] = 0.971 [0.904–1.044]). However, a positive genetic association was observed between RA and MNBAC (P = 0.001, OR 95% CI = 1.413 [1.144–1.745]). Conducting a reverse MR analysis, we found no evidence to support a genetic causality between BNBAC (P = 0.088, OR 95% CI = 1.041 [0.994–1.091]) or MNBAC (P = 0.168, OR 95% CI = 1.013 [0.995–1.031]) and RA. Our MR analysis demonstrated the absence of heterogeneity, horizontal pleiotropy, and outliers and confirmed that the effect was not driven by a single SNP. Additionally, the data exhibited a normal distribution.ConclusionThe findings of this study demonstrate that RA constitutes a significant risk factor for MNBAC. In the context of clinical application, it is advisable to conduct MNBAC screening in RA patients and remain vigilant regarding its potential manifestation. Importantly, the outcomes of this investigation introduce a fresh vantage point into the understanding of the tumorigenesis associated with RA.

Is higher body mass index associated with secondary osteoarthritis in patients treated with bone cement for benign aggressive bone tumors? Long-term evaluation of 43 patients

BackgroundThis study was designed to investigate the secondary osteoarthritis rate in patients with benign aggressive bone tumors treated with curettage and cementing at long-term follow up. MethodsPatients diagnosed with benign aggressive bone tumor (giant cell or aneurysmal bone cyst), treated with extended curettage and cementation with polymethylmethacrylate, who had a minimum of 60 months of follow up after surgery were included in this study. After definitive diagnoses were confirmed by a histopathologist, we decided to perform standard surgical management. Osteoarthritis was staged radiologically using the Kellgren–Lawrence scoring system, and the contralateral knees of the patients were used as the control group. Based on the Kellgren–Lawrence classification system, stages 3 and 4 were accepted as the existence of osteoarthritis. Body mass index, the distance to the subchondral joint line, tumor mass volume, the location of the tumor (i.e., femur, tibia, medial condyle, or lateral condyle), age, and sex were also investigated, all of which are factors that can affect the occurrence of osteoarthritis. ResultsForty-three patients, 24 male (56%) and 19 female (44%), were included in the study. The mean age of the patients was 29.5 ± 10 years, and mean follow up duration was 128.7 months. Tumor localization was the distal femur in 20 patients (46.5%) and the proximal tibia in 23 patients (53.5%). The mean tumor mass volume was 77.84 cm3 and the distance to the knee joint subchondral line was 3.2 ± 2 mm. According to this scoring system, 14 patients were at stage 0, 10 patients were at stage 1, 10 patients were at stage 2, four patients were at stage 3, and five patients were at stage 4. When we compared osteoarthritis development, the affected knee had a significantly higher rate of osteoarthritis development than the contralateral knee. A univariate analysis demonstrated that age (P = 0.002) and body mass index (P = 0.045) were associated with secondary osteoarthritis. Moreover, multivariate analysis demonstrated that none of the variables were independently associated with secondary osteoarthritis. ConclusionPatients with contralateral osteoarthritis had bilateral knee osteoarthritis, indicating that primary osteoarthritis progressed in both knees. Seven of the 43 patients (16.2%) showed secondary osteoarthritis. Although age and body mass index were associated with secondary osteoarthritis in univariate analysis, none of the variables were independently associated with secondary osteoarthritis in the multivariate analysis.

Giant Cell Tumor: Pathogenesis and Clinical Manifestation

A giant cell tumor of bone (GCTB) as known as a benign bone tumor (neoplasm) is aggressive locally and frequently recurs, and it is characterized by the growth of mononuclear stromal cells and datia cells that resemble osteoclasts. GCTB has varying incidence rates and has been shown to have high mortality. GCTB patients have several treatment options, but the majority of patients still experience recurrence and even metastasis to other organs. This literature review aims to explain more deeply about Giant Cell Tumor (GCT) starting from the definition, etiology, epidemiology, pathogenesis, clinical manifestations and treatment options so that patients get a better prognosis. This literature review was conducted using the keywords "Giant Cell Tumor AND pathogenesis AND clinical manifestation" from PubMed dan Google Scholar. The results of the literature review carried out are that the molecular and biological pathogenesis of GCTB consists of 4 processes, namely tumorigenesis of neoplastic mononuclear stromal cells, generation of reactive multinucleated giant cells, bone resorption/migration, and bone matrix remodeling for angiogenesis, invasiveness, and metastasis. Besides, the histological picture of GCTB contains "reactive" osteoclasts such as multinucleated giant cells (Giant Cells/GC), round cells such as macrophages and spindle stromal cells such as "neoplastic" fibroblasts (mononuclear stromal cells/SC) which are important findings in establishing the diagnosis. In conclusion, staging and management are very important to produce a better prognosis and reduce recurrence rates in GCTB patients.

Osteoid osteoma total resection at frontal bone. case report

Frontal osteomas are benign neoformations, which often remain asymptomatic throughout a patient’s life or develop a cosmetic disfigurement. Diagnosis is usually by chance, and can result from various stimuli, such as accidental or surgical trauma, acne scars, and skin tumors, however in the absence of currently known triggering factors. Case report: 85 years female patient who reports the onset of the current disease 20 years prior to the first medical consult, characterized by a progressive frontal tumor growth that was self-detected, with an aesthetical awkwardness and progressive headache. At the frontal region she had an impressive increase in volume is evidence emerging from the external cortical of the frontal bone, non-mobile consistency, adhered to deep planes. For this reason, a simple tomographic study was performed and shows a probable osteoid osteoma. The patient was taken to the operation room, performed a transverse incision in the line of implantation of the scalp, division through planes and soft tissues until reaching a bone lesion at the expense of the external table of the left frontal region, and was completely resected. The histological results of the biopsy reports an osteoid osteoma. Discussion: despite the increasing use of endoscopic procedures, open approach via coronal incision remains the gold standard for frontal sinus osteoma with lower recurrence rates. Conclusion: Osteoid osteomas are a relatively frequent benign bone tumors that have a slow growth and are usually asymptomatic, however with the past of the years can develop headache and cosmetic uncomforted.

Giant Cell Tumor in the Proximal Femur of an Eight-Year-Old Boy: A Case Report

Background: Giant cell tumor (GCT) is a benign aggressive bone tumor that occurs mostly in young adult patients after puberty. The most common location is around the knee joint. Occurrence in pre-puberty pediatric patients is very rare and accounts for 1.8% to 10% of all known GCTs.
 Case Report: Here, we report an eight-year-old boy who complained of pain and loss of range of motion (ROM) in the right hip. Radiological and pathological studies revealed GCT of the femoral head with joint expansion. We treated the patient by wide resection and osteochondral allograft reconstruction.
 Conclusion: We believe this is the first reported case of GCT in the proximal femoral bone of pediatric patients, which is proven by pathology. Studying the current case may help tumor surgeons to become aware of this possibility.

Partial sternectomy with reconstruction of a giant cell tumor of the sternum, a case report, Saudi, Arabia

BackgroundGiant cell tumor (GCT) is a relatively common and locally aggressive benign bone tumor that rarely affects the sternum.Case presentationWe report a case of giant cell tumor of the sternum in a 28-year-old Saudi with painful swelling at the lower part of the sternum. Subtotal sternectomy and reconstruction with a neosternum using two layers of proline mesh, a methyl methacrylate prosthesis, and bilateral pectoralis muscle advancement flaps were performed.ConclusionsGiant cell tumor of the sternum is a rare diagnosis. Surgical resection with negative margins is the ideal management. To avoid defects or instability of the chest wall, reconstruction of the chest wall with neosternum should be considered.

Long-term effectiveness of uncemented allograft-prosthesis composite for reconstruction of bone defects after proximal femur tumor resection

To investigate the long-term effectiveness of uncemented allograft-prosthesis composite (APC) for reconstruction of bone defects after proximal femur tumor resection. Between June 2007 and March 2014, 21 patients who underwent uncemented APC reconstruction of proximal femur after tumor resection were retrospectively evaluated. There were 9 males and 12 females with an average age of 33.2 years (range, 19-54 years). There were 9 cases of giant cell tumor of bone, 5 cases of osteosarcoma, 4 cases of osteoblastic osteosarcoma, 2 cases of chondrosarcoma, and 1 case of undifferentiated pleomorphic sarcoma. Thirteen cases of benign bone tumors were all classified as stage 3 by Enneking staging; and 8 cases of malignant bone tumors were classified as grade ⅡB in 7 cases and grade ⅡA in 1 case according to the American Joint Committee on Cancer (AJCC) staging system. Among them, 7 patients underwent reoperation after recurrence, and the rest were primary operations; 8 patients presented with pathological fractures. The preoperative Harris hip score (HHS) and American Musculoskeletal Tumor Society (MSTS) score was 40 (30, 49) and 9.1±3.5, respectively. The length of osteotomy was 80-154 mm, with an average of 110 mm. At 1 year after operation and last follow-up, HHS and MSTS scores were utilized to evaluate the function of hip joint; the gluteus medius strength score was used to evaluation of the hip abduction function. Image examinations were taken at 1, 3, 6, 9, and 12 months after operation and every year thereafter to assess the union of allograft-host bone interfaces. Intra- and post-operative complications were also recorded. All patients were followed up 84-163 months (mean, 123.5 months). At 1 year after operation and last follow-up, the HHS and MSTS scores significantly improved when compared with the preoperative scores ( P<0.05). However, there was no significant difference in the HHS score, MSTS score, and gluteus medius strength score between the two time points after operation ( P>0.05). Image examination showed that all allograft-host bone interfaces achieved union after 5-10 months (mean, 7.6 months). At last follow-up, all patients had bone resorption, including 11 severe cases, 4 moderate cases, and 6 mild cases; the bone resorption sites included Gruen 1, 2, and 7 regions. Complications included 10 fractures and 1 prosthetic fracture. Local recurrence occurred in 3 patients and pulmonary metastasis in 3 patients. Uncemented APC is a reliable method for the reconstruction of bone defects after proximal femur tumor resection. It has the good long-term effectiveness and possesses obvious advantages in the union at the bone-bone surface.

Intensity Modulated Radiotherapy For Recurrent Spine Aneurysmal Bone Cyst In Adolescence-Case Report And Review of Literature

Aneurysmal bone cysts are rarely diagnosed aggressive benign bone tumors that require CT and MRI imaging and strict histopathological analysis. This clinically and histologically benign tumor is mainly diagnosed in children and adolescents in the long bones of the limbs, but in 12%-30% it is localized in the spine. Since the value of external beam radiotherapy (EBRT) for aneurysmal bone cyst (ABC) has not been well defined, we present our observations and treatment outcome after the realization of intensity modulated radiotherapy (IMRT) up to total dose 30 Gy for recurrent spine aneurysmal bone cyst in adolescent age. In this article, for the first time in the world medical literature, an MRI imaging finding after performed IMRT in recurrent ABC is presented. Our observations lead to the conclusion, that radiation therapy is an effective treatment method for relapsed or inoperable disease, achieving not only a symptomatic pain-relieving effect, but also a significant tumor reduction and restoration of the bone structure.

Evaluation of Scientific Publications on Osteoblastoma Published between 2000 and 2022

Objective: The aim of this bibliometric study was to review the scientific outputs published between 2000 and 2022 on osteoblastoma, a benign aggressive bone tumor.&#x0D; Methods: Scientific research articles on osteoblastoma published between 2000 and 2022 were targeted and data were obtained from the Web of Science database. The data obtained were analyzed and visualized using bibliometric programs.&#x0D; Results: A total of 679 articles about osteoblastoma published between 2000-2022 met our inclusion criteria. Most of the articles on osteoblastoma (n=48) were published in 2020. There was no noteworthy peak in the trend of the number of publications between 2000 and 2022. These articles cited 10366 times in total and 15.27 times per article. At least 62 various countries and regions took part in osteoblastoma publishing research over the past 22 years. The United States (192) was the largest contributor to osteoblastoma publications followed by China (60), India (51), Italy (50), and Turkey (46). The United States was the country that published the most publications in all years between 2000 and 2022. Especially China's publications increased in 2022. The United States was also the country with the highest level of publication collaboration (such as citation and co-authorship) among countries.&#x0D; Conclusion: The number of published articles is well below the expected level. Although the number of scientific publications from China has increased in recent years, the United States still ranks first.

Nonossifying Fibroma Involving Epiphysis of Long Bone-Case Report and Review of the Literature.

Nonossifying fibroma (NOF) is a common benign bone neoplasm and is usually observed in the first 2 decades of life. Most NOFs occur in the metaphysis of long bones of the lower extremities and migrate toward the diaphysis during skeletal maturation. Epiphyseal involvement by NOF has been rarely reported, with only one case found in the English literature. The authors report the second case of NOF involving the epiphysis of a long bone, the proximal tibia of a 21-year-old woman. Clinicians and pathologists should be aware of the rare possibility of epiphyseal involvement of long bones by this condition. Pathologists should select appropriate immunohistochemistry markers to rule out alternative diagnoses.

Post radiofrequency ablation management of complications of osteoid osteoma with Ayurveda

Osteoid osteoma is a benign bone tumour that usually develops in the long bones of the body such as femur &amp; tibia. It causes continuous, deep and severe pain at night, Swelling, joint stiffness. Modalities of management in modern medicine are limited and many patients suffer from post RFA complication like pain, general debility, gait disorder etc. Hence, there is a need of more efficient methods to treat this. Our present study comprises of one such way of dealing post radiofrequency management of Osteoid Osteoma through Ayurveda. A single case study of 18 year old male patient, diagnosed with Osteoid Osteoma of right hip joint who underwent RFA for same but did not get relief. Patient came to us with the complaint of severe pain in right hip joint with muscle lag associated with difficulty in doing daily activities such as walking, cross leg sitting, squatting &amp; Gait disorder from last two years.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts: A single-center experience.

Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol. To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC. Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo. All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed. Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.

Giant cell tumor of distal femur with pathological fracture: A case report

Giant cell tumor of bone (GCTB) is a mostly benign bone tumor which can occasionally progress to malignancy, usually in chronic cases. It is a common benign and aggressive bone tumor that affects patients aged 20-45 years. A case of giant cell tumor (GCT) of the distal femur is reported here with an intraoperative complication. A 37-year female presented with a 1-month history of painful swelling over her left knee. On clinical examination, the patient had tenderness and swelling on the anterolateral aspect of the knee extending from the distal part of the femur towards the lateral aspect of the knee. Swelling was well-defined, smooth, firm, and uniform in consistency with dimensions of about 12cm x 8 cm. Knee movement was restricted. An X-ray of the affected knee revealed a soft tissue mass arising from the distal femur on its lateral aspect. MRI revealed a soft tissue mass with the cortical breach. In this case, we planned for curettage with bone grafting and bone cementing using a sandwich technique, but while handling the limb, an medial cortical breach occurred, which was then fixed with the help of a distal femur lateral locking plate and cement in the second setting due to unavailability of distal femur plates during the initial surgery. Following surgery, a sample was sent for histopathology, which s/o high-grade giant cell tumor. Because of the high risk of recurrence, the tumor should be completely removed. Finally, the Knee function recreated to minimize the loss. Another options were enblock excision with arthrodesis of the affected joint but that causes joint stiffness other is arthroplasty of the affecting joint with the help of custom-made prostheses but this procedure is too costly thus we opted for the extended curettage with bone cement with bone grafting (Sandwich technique) with plating.

Long-term results of periprosthetic infection prevention and treatment in oncoorthopedics

BACKGROUND: Endoprosthesis after bone and joint resection is the treatment of choice for patients with malignant bone tumors, especially in case of a favorable oncological prognosis. Endoprosthesis bone site infection and relapse associated with the underlying disease are important complications that are difficult to treat. The development of periprosthetic infection leads to the loss of functional potential after the end of this complication treatment and worsens oncologic prognosis.&#x0D; AIM: To study and improve the long-term results of treatment in patients with diagnosed periprosthetic infection who underwent oncologic endoprosthesis, to develop a preventive complex of measures aimed at reducing periprosthetic infection.&#x0D; MATERIAL AND METHODS: The study included 1292 patients with primary bone sarcomas, soft tissue sarcomas, metastatic and benign bone tumors who underwent 1671 primary and recurrent endoprosthetic replacements between January 1992 and January 2020. A total of 677 (52.4%) men and 615 (47.6%) women participated in the study. Patients ranged in age from 10 years to 81 years. Oncologic endoprosthetics were performed in 886 (68.6%) patients with primary malignancies, 144 (11.1%) with metastatic bone lesions, and 262 (20.3%) with benign neoplasms. The mean follow-up period after endoprosthetic replacement with various bone segments was 82.8 months (0-335.7 months).&#x0D; RESULTS: The incidence of periprosthetic infection during the entire follow-up period in primary endoprosthesis was 7.1%, and in repeat endoprosthesis 6.2%. The recurrence rate of endoprosthesis infection in primary endoprosthesis during the observation period was 83%, in repeat endoprosthesis 61.5%. The frequency of periprosthetic infection was reduced by changes in the endoprosthetic strategy. The prevalence of early (type IVA according to ISOLS 2013) infectious complications (15 and 11.9%) over late (type IVB) complications (5 and 4.4%, respectively) in both primary and repeat arthroplasty was higher. Staphylococcus aureus was most frequently identified after primary endoprosthetic replacement (38.1%) and Staphylococcus epidermidis was most commonly verified after repeat endoprosthetic replacement (53%). Two-stage reendoprosthesis was used most often to treat periprosthetic infection: after primary endoprosthesis in 58.3% of cases, after repeat endoprosthesis in 65.4%. The preventive measures developed in the study made it possible to reduce the incidence of the endoprosthesis site early infection by 15.3% in primary endoprosthesis and by 7.1% in repeat endoprosthesis.&#x0D; CONCLUSION: The perioperative antibiotic prevention regimen should provide a steady antibiotic concentration during the entire course of surgery and the time associated with the highest risk of endoprosthesis site early infection (extended antibiotic treatment up to 5 days), which allows to reduce the wound microbial contamination to a safe level. The findings suggest that two-stage reendoprosthetic replacement remains the main treatment option for periprosthetic infection.

Infantile Sinonasal Myxoma Is Clinically and Genetically Distinct From Other Myxomas of the Craniofacial Bones and From Desmoid Fibromatosis.

Sinonasal myxomas are rare benign tumors of the maxillary bone and sinus. There is published evidence that sinonasal myxomas occurring in children up to 3 years of age ("infantile sinonasal myxomas") are clinically distinctive and harbor Wnt signaling pathway alterations. Here, we characterized 16 infantile sinonasal myxomas and compared them to 19 maxillary myxomas and 11 mandibular myxomas in older patients. Clinical follow-up was available for 21 patients (46%) overall (median: 2.6y; range: 4mo to 21y), including 10 of 16 infantile sinonasal myxomas (62%). None of the 8 resected infantile sinonasal myxomas recurred, despite positive margins in 6 of them. One incompletely resected infantile sinonasal myxoma underwent partial regression without additional treatment. In contrast, 4 of the 11 other myxomas with follow-up recurred (36%), including one that recurred twice. Imaging studies demonstrated all infantile sinonasal myxomas to be expansile lesions arising from the anterior maxillary bone adjacent to the nasal aperture, with peripheral reactive bone formation. Histologically, infantile sinonasal myxomas showed short, intersecting fascicles of bland fibroblastic cells with prominent stromal vessels. Examples with collagenous stroma showed some morphologic overlap with desmoid fibromatosis, although none showed infiltrative growth into adjacent soft tissue. Immunohistochemistry demonstrated nuclear β-catenin expression in 14 of 15 infantile sinonasal myxomas (93%), in contrast to 4 of 26 other myxomas of craniofacial bones (15%). Smooth muscle actin was expressed in only 1 of 11 infantile sinonasal myxomas (9%). Next-generation sequencing was successfully performed on 10 infantile sinonasal myxomas and 7 other myxomas. Infantile sinonasal myxomas harbored CTNNB1 point mutations in 4 cases (D32Y, G34E, G34R, and I35S), and none harbored alterations to the phosphorylation sites T41 and S45 that are altered in 99% of CTNNB1 -mutant desmoid fibromatoses. Three tumors showed alterations consistent with biallelic APC inactivation. Three infantile sinonasal myxomas that showed strong nuclear β-catenin expression were negative for CTNNB1 and APC alterations. Sequencing was negative for CTNNB1 or APC alterations in all 7 myxomas of craniofacial bones in older patients. Four of these myxomas in older patients (57%) showed copy number alterations, and all lacked known driving alterations. These findings support the notion that infantile sinonasal myxomas are clinically and genetically distinctive, and we propose the use of the diagnostic term "infantile sinonasal myxoma" to distinguish this tumor type from other myxomas of the craniofacial bones. Infantile sinonasal myxoma should be distinguished from desmoid fibromatosis because of its unique clinical presentation, more indolent clinical behavior, different morphology, different immunohistochemical profile, and different genetics. Given its indolent behavior even when marginally excised, infantile sinonasal myxoma can be managed with conservative surgery.

Thermal necrosis in orthopedic bone tumors: experimental research.

The extent of surgical resection in orthopedic oncology differs according to tumor biology. While malignant bone tumors are operatively managed with wide resection, benign bone tumors and metastatic carcinomas are often treated through intralesional excision and adjuvant modalities, including the elimination of residual neoplastic cells through thermal necrosis. This study investigates in vitro temperature thresholds for thermal necrosis in common orthopedic bone tumors. Eleven cell lines, including metastatic carcinomas to bone (A549, A498, FU-UR-1, PC3, MDA-MB-231, TT, MCF7, and K1), giant cell tumor of bone, osteosarcoma (HG-63), and control non-neoplastic cells (HEK293) were cultured. Cells were exposed to thermal stress at varying times and temperatures and evaluated for survival and viability with crystal violet and MTT assays. Both the MTT and crystal violet assay demonstrated statistically superior rates of viability and survival for A549 (lung carcinoma), FU-UR-1 (renal carcinoma), K1 (thyroid carcinoma), and MG-63 (osteosarcoma) cell lines compared to control (HEK293 cells) at 60°C. Additionally, the MTT assay demonstrated superior viability for PC3 (prostate carcinoma), MCF7 (breast carcinoma), and A498 (renal carcinoma) compared to control. All cell lines demonstrated significantly decreased survival and viability in temperatures more than 90°C. This study demonstrated in vitro thresholds for thermal necrosis for cell lines of common orthopedic tumors of bone. The A549 (lung carcinoma), K1 (thyroid carcinoma), and FU-UR-1 (renal carcinoma) cell lines demonstrated greater resistance to heat stress compared to non-neoplastic control cells. Temperatures in excess of 90°C are necessary to reliably reduce cell survival and viability to less than 10%.

Osteoma osteoide en cuarto metatarsiano: A propósito de un caso.

Osteoid osteoma (OO) is the third benign bone tumor most frequent. Its epidemiologic, clinical, and radiological characteristics are classically well described. Although its gold standard treatment is still radiofrequency-guided ablation, some new techniques have recently appeared. We present a case of a patient with an OO of atypical localization (the fourth metatarsal of the right foot), and we review the characteristics of this tumor.

Treatment trends of benign bone lesions in a suburban New York healthcare system.

The management of benign bone lesions is controversial as it is dependent on a multitude of factors such as age, anatomic location, comorbidities, lesion metabolic activity, surgeon preferences, and goals of care, among others. Thus far, many studies have attempted to report on these lesions; however, most are heterogeneous compilations of benign and malignant lesions with nearly all failing to report patient treatment and none of which have originated from a suburban area of the United States. The goal of this study was to establish a modern database dedicated solely to benign bone tumors to reflect current diagnosis and treatment trends in suburban New York. This was a multicenter retrospective observational study with inclusion criteria limited to benign bone lesions of all ages. Malignant lesions were excluded. Patients were drawn from both primary care provider and surgeon records, with documentation of their associated management. A total of 689 patients met inclusion criteria. The overall operative rate for this cohort was 71.6%. In agreement with current literature, aneurysmal bone cysts, giant cell tumors, and osteochondromas underwent surgery more frequently than enchondromas; older patients underwent surgery less frequently; benign bone lesions were more commonly found in younger males, and the distal femur and proximal tibia were the most common locations for lesions (P < .05 for all findings). This study demonstrates the management of a globally representative variety of benign bone lesions in a diverse suburban population of New York and should facilitate future research on how lesion type, location, management, and other factors relate to patient outcomes.