Bone Tissue Tumors Research Articles

Prevalence of Psychological Distress and Its Risk Factors in Patients with Primary Bone and Soft Tissue Tumors.

Psychological distress is common in patients with soft tissue and bone tumors. We first investigated its frequency and the associated risk factors in patients with pre-operative bone and soft tissue tumors. Participants included 298 patients with bone and soft tissue tumors who underwent surgery in our institution between 2015 and 2020. Psychological distress was evaluated by the Distress and Impact Thermometer (DIT) that consists of two types of questions (questions about the severity of the patient’s distress (DIT-D) and its impact (DIT-I)). We used a cut-off point of 4 on the DIT-D and 3 on the DIT-I for screening patients with psychological distress. We therefore investigated: (1) the prevalence of psychological distress as assessed with DIT or distress thermometer (DT), which can be decided by DIT-D ≥ 4, (2) what are the risk factors for the prevalence of psychological distress, and (3) what is the number of patients who consulted a psychiatrist for psychological distress in patients with pre-operative bone and soft tissue tumors. With DIT and DT, we identified 64 patients (21%) and 95 patients (32%), respectively, with psychological distress. Multivariate logistic regression revealed that older age, sex (female), malignancy (malignant or intermediate tumor), a lower Barthel Index, and higher numeric rating scale were risk factors for psychological distress. Two patients (3%) consulted a psychiatrist after surgery. In conclusion, careful attention to psychological distress is needed, especially for female patients, older patients, and those with malignant soft or bone tissue tumors who have more than moderate pain.

СРАВНИТЕЛЬНАЯ ХАРАКТЕРИСТИКА КОМПЬЮТЕРНОЙ И МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ ПРИ ДИАГНОСТИКЕ СПИНАЛЬНЫХ НОВООБРАЗОВАНИЙ У МЕЛКИХ ДОМАШНИХ ЖИВОТНЫХ

Currently, spinal neoplasms account for approximately 10 % of all neurological pathologies associated with the spinal cord and spinal column. For their diagnosis, such modern methods of vis-ual diagnostics as CT and MRI are used. Studies were conducted to compare the diagnostic capabilities of CT and MRI in spinal neoplasms in small pets. It was established that the CT method is suitable for the diagnosis of bone tissue neo-plasms, and with the intravenous administration of an X-ray contrast substance - for the diagnosis of neoplasms of paraspinal soft tissues and roots of the spinal nerves. The MRI method is equally well suited for the diagnosis of both bone and soft tissue neoplasms, but it is longer and requires deeper anesthesia, which increases the anesthetic risks.

Progress on Treatment of Bone and Soft Tissue Tumors

Progress on Treatment of Bone and Soft Tissue Tumors

Sechenov First Moscow State Medical University (Sechenov University)

This article is devoted to the most common bone tissue tumor among children — Ewing's sarcoma. The epidemiological data, most frequent afflicted zones of bones, clinical signs, diagnostics and treatment methods are analysed. The main focus is on the molecular genetic mechanisms of carcinogenesis initiation.

The diagnostic value of serum human neutrophilic apolipoprotein in infectious diseases of orthopedics

Objective To study the serum human neutrophilic apolipoprotein (HNL), white blood cell (WBC) and neutrophil counts, procalcitonin (PCT), ESR and C-reactive protein (CRP) levels in orthopaedic diseases, and to explore the significance of HNL levels in the identification of infectious diseases in orthopaedic diseases. Methods Orthopaedic diseases were selected from Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, including 185 non-infectious cases (spinal and joint degenerative disease, closed fractures, bone and soft tissue tumor), and 60 infectious cases (osteomyelitis, various postoperative infection and chronic ulcer). Serum HNL level, WBC and neutrophil counts, PCT, ESR and CRP levels were determined, and statistically analyzed. The diagnostic efficacy of HNL, WBC and neutrophil counts, PCT, ESR and CRP levels in orthopedic infectious diseases was evaluated by ROC curves. Results Levels of HNL: non-infected group 141.28±63.11 and the infected group 229.96±107.62, the difference was statistically significant (t=-7.819, P AUCESR (0.752) >AUCCRP (0.676) >AUCPCT (0.534) >AUCNBC (0.528) >AUCWBC (0.481). The HNL cut-off value for the diagnosis of bone infectious diseases was 120.1 μg/L. Conclusion HNL can be used as a reference index to distinguish infection from non-infection in orthopaedic diseases, and its efficacy is better than the traditional white blood cell and neutrophil count, ESR, CRP and PCT. Key words: Orthopaedic; Infection disease; Human neutrophil apolipoprotein

SPORADIC AND HEREDITARY FORMS OF MULTIPLE PRIMARY MALIGNANT TUMORS IN CHILDREN

The article presents the features of the clinical manifestation of multiple primary sporadic and heritable malignant tumors in 104 children who observed at Pediatric Oncology and Hematology Research Institute of «NN Blokhin's National Medical Research Center of Oncology» from 1998 to 2012. The age of patients at the time of occurrence of the second malignant tumor ranged from 2.8 to 28 years and averaged 15.6 years. The second neoplasia occurred significantly more frequently in the group of primary hemoblastosis, compared with the group of solid tumors - 8.7% versus 3.4%, respectively (p <0.0001). In children with multiple primaries, were found tumors that occur in common the most frequency. Retinoblastoma patients have an increased risk of developing sarcoma. Patients with Hodgkin's lymphoma have an increased risk of developing leukemia. In surviving children after treatment of the first neoplasia the thyroid, bone tissue and breast have a specific risk for the development of metachronous cancer and are target organs for control. Children with new hematopoietic tumors may be candidates for metachronous development of leukemia and bone tissue tumors. The using methods Next Generation Sequencing (NGS) and Multiplex Ligation-dependent Probe Amplification (MLPA) revealed germinal mutations in 12 children with of multiple primary tumors. The mutations in the TP53, RB1, CHEK2, FANCN/PALB2, MLH1, PMS2 genes identified in patients were associated with hereditary syndromes and an increased risk of developing second tumors, among which: sarcomas, brain tumors, hematopoietic tumors were the most frequent. It was shown that the second tumors can appear at the any age. Children who survived the treatment of the first tumor in later life should be monitored annually. Clinical management of children with multiple primary tumors requires a multidisciplinary approach.

Shoulder Girdle Resection, Modification in the Surgical Techniques and Introduction of a New Classification System

Background: Surgical techniques for resection of tumors at proximal humerus and scapula has been described in literature along with different classification systems, however , these techniques have not been revised for a while and the classification systems didn’t respect the difference between bone and soft tissue tumors, or humerus vs. scapula locations. Material and methods: The author operated on 32 patients with shoulder girdle tumors, all are bone tumors, Ewings sarcoma (n=12), Osteosarcoma (n=7), Metastatic tumors (n=7), GCT (n=3), Chondrosarcoma (n=3). We assigned two separate classifications to humerus and scapula resection, since surgical techniques, mechanics and reconstruction is totally different for the both sites. Resection of the humerus classified into: Type I to Type IV, A: is added to the type when the majority of Deltoid is preserved, and B: when it is sacrificed. Type I: Intra articular proximal humerus resection Type II: Extra articular proximal humerus resection Type III: Intra articular total humerurs resection Type IV: Extra articular total humerus resection And we classify the scapula resection into: Type I to Type III Type I: Partial Scapular Resection Type II: Intra articular Total Scapular Resection Type III: Extra articular Scapular Resection In extra articular humerus resection, we found that sacrificing the acromion and coracoid process is not needed as a routine part of the extra articular resection of the proximal humerus and preservation of these structures can improve the cosmetic outcome of the shoulder., and for all tumors with no huge medial component, in our techniques there is no need to detach the muscle attachment from the coracoid process and so post operatively elbow extension as tolerated can be started immediately. Endoprosthesis was used in 23 patients for reconstruction, osteoarticular allograft was used in 3 patients, and Tichoff Lindberg technique for 3 patients. Results: At 30 month mean follow up period, 2 patients developed local recurrence (osteosarcoma n=1, Ewing Sarcoma n=1), and 2 patients infection, one patient stem loosening, the average MSTS functional score for all patient was 83%. Conclusion: The modification of surgical techniques saved structures which were unnecessarily resected, and kept the integrity of more muscular tissue and attachments which were detached in previous described techniques with no obvious advantage leading to less restriction during the rehabilitation process. The new classification system is realistic, easy to be recalled and applicable to all patients.

Reflection on improving the quality of the standardized training of resident in orthopaedics rotary training

We carry out the tutorial system in the standardized training of residents, promote students to grasp the clinical skills and clinical research and thinking, and promote teachers' professional theoretical level and teaching ability. In the orthopedic rotation we define the teaching focus to the trainees of different seniority: for junior trainees, the training of medical records writing and basic clinical skills should be focused, and for senior trainees, the emphasis of training is to improve their clinical capacity of diagnosis and treatment. In teaching, the teaching methods of a combination of Multidisciplinary team(MDT)of bone and soft tissue tumors and problem based learning(PBL)have been actively tried to improve students' learning enthusiasm and initiative, which helps the trainees fully grasp the diagnosis and treatment of certain diseases. Key words: Standardized training of resident; Orthopaedics; Tutorial system; Problem-based learning(PBL)

Aneurysmal bone cyst of the mandible: Report of a case with a review of the literature

Aneurysmal bone cyst (ABC), is a rare benign osteolytic bone neoplasm of bone tissue characterized by several sponge-like blood or serum filled, generally non-endothelialized spaces of various diameters that can contain osteoid tissue and osteoclast-like giant cells. In this article, we describe a case of ABC in the mandibular corpus region with clinical, radiological and pathological findings and review the literature concerning the case. A 23-year-old male patient attended to our clinic with the complaint of a mild-pain on the left posterior lower jaw since two months. The superior margin of the lesion was extending between the apical third parts of the roots of the teeth 35-38. Cone beam computed tomography (CBCT) was performed. CBCT Slices revealed an expansile lesion with hydraulic-appearing outer margins above the mandibular canal. Excisional surgical treatment was performed after raising a mucoperiosteal flap and finalized with curette of lesion under local anesthesia. Diagnosis of aneurysmal bone cyst was confirmed by histopathological evaluation. The patient was pain free after six months follow-up, and panoramic radiography showed no evidence of recurrence. The ABC is most common in those regions of the skeleton where there is a relatively high venous pressure and high marrow content. Clinical presentation of the ABC varies from a small, indolent, asymptomatic lesion to rapidly growing, expansile, destructive lesion causing pain, swelling, deformity, neurologic symptoms, pathologic fracture, and perforation of the cortex. As the radiologic and clinical presentation of ABC is extremely variable, histopathologic examination is placed a great emphasis on for the diagnosis.

Tumors and tumor-like lesions of the foot and ankle: 170 cases treated in a tertiary referral center

Purpose To investigate epidemiology and clinical features of tumors and tumor-like lesions of the foot and ankle,as well as prognosis of malignant tumors.Methods A total of 170 patients,surgically treated for bone and soft tissue tumors of the feet and ankle between 1984 and 2009 in a tertiary referral center specializing in orthopedic oncology,were enrolled in this retrospective study.The age,gender,clinical feature,tumor types,anatomical sites,the correlation between tumor size and tumor types,and the prognosis of malignant tumor were analyzed.Results There were 91 males and 79 females,aged from 7months to 76 years (average,33.1 years).There were 51 cases of bone tumor and 119 cases of soft tissue tumor.Benign tumors commonly occurred in the second and third decades of life,with an average age of 29.54years,while most malignant tumors occurred in patients aged between 40 and 59 years,with an average age of 43.73 years.Skin lesion was a symptom implying malignance.Soft tissue tumor and benign tumor were the most common types in the foot and ankle.Giant cell tumor of the tendon sheath was the most common type among benign soft tissue tumors; subungual exostosis and enchondroma were the most common types among benign osseous tumors; while melanoma and synovial sarcoma were the most common types among malignant soft tissue lesions.Both primary and metastatic bone tumors were very rare.Forefoot was the most common site where foot and ankle tumors happened.There was no correlation between tumor size and types of soft tissue tumor,while there was a high correlation between tumor size and types of bone tumor.Among 44 patients with malignant tumor,16 patients underwent limb salvage surgery,while 28 patients underwent amputation.The mean duration of follow-up was 32.4 months.Six patients survived with no evidence of disease.The 5-year survival rate was 16.13％.Conclusion Benign and soft tissue tumors are the most common tumors in the foot and ankle.Most malignant tumors occur in patients over 40 years of age.Skin lesion is a useful symptom in diagnosing malignant tumor.Forefoot is the most common site where tumor happened.There is a high correlation between tumor size and tumor types.The prognosis of malignant tumor is very poor. Key words: Foot; Ankle; Neoplasms; Retrospective studies

Experiences with total femur replacement for malignant bone and soft tissue tumors

Background: Reasonable function can be restored after total femur replacement after massive resection of bone and soft tissue sarcomas of the thigh. The type of femoral prosthesis and surgical approach are tailored to the clinical characteristics of individual patients and to tumor anatomy. Though the complication rate is high, total femur replacement offers the patient limb salvage and a chance at functional ambulation. Objective: We described the function and complications of total femur replacement performed at the institution as well as relevant literature reviews. Methods: Seven patients underwent total femur replacement for the treatment of malignant bone and soft tissue tumors of the lower extremities between 1992 and 2010 at our institute. Ages ranged from 12 to 68 (mean=34) years. The tumor was pathologically diagnosed as osteosarcoma in two patients, Ewing’s sarcoma in two, chondrosarcoma (grade 3) in one, soft tissue malignant fibrous histiocytoma in one, and bone metastasis from renal cancer in one. Follow-up periods ranged from 1 to 17 years (mean = six years three months). All patients underwent wide resection, using the Howmedica Modular and Reconstruction System in five cases and the Kyocera Limb Salvage System in two cases. Function, complications and outcomes were evaluated in these patients, and the usefulness of the operative procedures is discussed herein. Results: The mean functional score was 60%. X-ray examination revealed migration in only one case. Complications were infection (n=2), bipolar head dislocation (n=1) and patellar fracture (n=2). The outcomes were DOD (died of disease) in three cases, NED (no evidence of disease) in two, AWD (alive with disease) in one, and CDF (continuous disease free) in one. Conclusion: The results suggest that total femur replacement is useful as a means of reconstructing affected limbs in patients with malignant bone and soft tissue tumors, but that latissimus dorsi muscle transplantation, as well as other procedures, must also be considered in cases requiring extensive soft tissue resection to prevent infection. Furthermore, early one-stage revision is advisable in cases showing signs of infection. Keywords: Femoral prosthesis, functional outcomes, malignant tumors, total femur replacement

Giant-cell tumor of the patella.

We report a 38-year old man with a giant-cell tumor in a rare site, the patella. Primary patellar neoplasms are highly unusual. According to a survey by the Bone and Soft Tissue Tumor Committee of the Japanese Orthopaedic Association, of more than 2,126 giant-cell tumors of bone reported since 1972, only 22 were primary patellar neoplasms. We present a case of this rare entity along with its clinical and radiographic features. The first clinical symptom was anterior knee pain. Though anterior knee pain has numerous and varied causes, it is necessary to consider patellar bone tumors in the differential diagnosis.

Changes of 3-tesla 31P-MR spectroscopy of bone and soft tissue tumors

To study the characteristic changes of 31P-MR spectroscopy of bone and soft tissue tumors. 41 patients were examined by phosphorus surface coil of 3 tesla MR machine, including 18 benign tumor foci and 28 malignant foci, and adjacent normal muscles. The areas under the peaks of various metabolites in the spectra were measured, including phosphomonoester (PME), inorganic phosphours (Pi), phosphodiester (PDE), phosphocreatine (Pcr), adenosine triphosphate (ATP) gamma, alpha, beta. The ratios of the metabolites to beta-ATP, NTP and Pcr were calculated. Intracellular pH was calculated according to the chemical shift change of Pi relative to Pcr. The ratios of Pcr/PME and PME/NTP in benign and malignant tumor groups were significantly different from those of the normal group (P<0.05). Between benign and malignant tumor groups, the ratios of PME/beta-ATP and PME/NTP were significantly different (P<0.05). Pcr/PME and PME/NTP are potential diagnostic indexes of bone and soft tissue tumors. PME/beta-ATP and PME/NTP are potential indexes of differential diagnosis of bone and soft tissue tumors.

Clinical Usefulness of [18F]FDG-PET for Diagnosis of Bone and Soft Tissue Tumors—An Analysis Based on Multi-center Questionnaire Survey—

骨軟部腫瘍を対象にFDG-PETによる診断成績について全国アンケート調査を行い,7施設から20疾患75症例のデータが寄せられた。骨肉腫,ユーイング肉腫(原始神経外胚葉腫瘍を含む),脂肪肉腫,平滑筋肉腫,血管肉腫,横紋筋肉腫,骨巨細胞腫,神経鞘腫,悪性線維性組織球症,軟骨肉腫,胞巣状軟部肉腫,類上皮肉腫,内膜間質肉腫,Hibernoma,線維肉腫,多発性骨軟骨腫,仙骨脊索腫,ランゲルハンス細胞組織球症,神経線維腫症についてのデータを分析した結果,上記の疾患すべてについて,FDG-PETは有用性が高いと考えられた。

Atelocollagen‐Mediated Systemic DDS for Nucleic Acid Medicines

The goal of our research is to provide a practical platform for drug delivery in oligonucleotide therapy. We report here the efficacy of an atelocollagen-mediated oligonucleotide delivery system applied to systemic siRNA and antisense oligonucleotide treatments in animal disease models. Atelocollagen and oligonucleotides formed a complex of nanosized particles, which was highly stable against nucleases. The complex allowed oligonucleotides to be delivered efficiently into several organs and tissues via intravenous administration. In a tumor metastasis model, the complex successfully delivered siRNA to metastasized tumors in bone tissue and inhibited their growth. We also demonstrated that a single intravenous treatment of the antisense oligodeoxynucleotide complex suppressed ear dermatitis in a contact hypersensitivity model. These results indicate the strong potential of the atelocollagen-mediated drug delivery system for practical therapeutic technology.

The value of MRI and 31PMRS in differential diagnosis of bone and soft tissue tumors

目的 探讨常规MRI与31 P MR波谱(MRS)对骨及软组织肿块的鉴别诊断价值.方法在1.5 T场强下,对16例健康志愿者及35例骨及软组织肿块患者分别行常规MRI与31 P MRS检查,测定波谱中各代谢产物的峰下面积,计算各代谢产物与β-三磷酸腺苷(β-ATP)的比值,以及根据无机磷(Pi)的化学位移相对于磷酸肌酸(PCr)的改变测定细胞内pH值.结果良恶性两组肿块在大小、信号均匀性、境界及对周围结构的侵犯等方面差异无统计学意义(P值均>0.05),其MRI特征有很大重叠性.对照组的磷酸单酯/β-三磷酸腺苷(PME/β-ATP)、磷酸二酯(PDE)/β-ATP、低能磷酸盐(LEP)/β-ATP、PCr/β-ATP、细胞内pH值分别为0.33±0.21、0.64±0.27、1.62±0.67、3.12±0.78、7.08±0.16,良性肿块组的PME/β-ATP、PDE/β-ATP、LEP/β-ATP、PCr/β-ATP、pH值分别为0.55±0.31、0.81±0.31、2.03±0.87、1.65±0.65、7.18±0.23,恶性肿块组的PME/β-ATP、PDE/β-ATP、低能磷酸盐(LEP)/β-ATP、PCr/β-ATP、pH值分别为1.73±0.40、1.73±0.45、4.31±1.18、1.44±0.54、7.32±0.29.与对照组比较,恶性肿块组的PME/β-ATP(P 0.05).与良性肿块组比较,恶性肿块组的PME/β-ATP、PDE/β-ATP、LEP/β-ATP升高,差异有统计学意义(P值均 0.05).以良性肿块的PME/β-ATP均值的1.8倍作为鉴别良恶性肿块的标准,则对肿块潜在恶性评估的敏感性为88.89%,特异性为94.12%.结论31P MRS对骨及软组织肿块的诊断及鉴别诊断具有重要价值,是1种简单、无创、有效的补充检查手段。

DNA image cytometry on sections compared with flow cytometry in human bone metastases

The DNA analysis of tumor cells discloses characteristic features from which their biological behavior with respect to both the intensity and regulation of growth can be deduced. The objective of this study was to comparatively assess the results of image cytometry (ICM) and flow cytometry (FCM) in human bone metastases as standard methods of DNA analysis and evaluate their possible importance. The nuclear DNA content of surgically removed tumors of bone tissue was determined using ICM and FCM, and the percentage of tumor cells in various cell cycle phases and ploidy status in each case were determined based on the DNA distribution pattern. Comparable results were determined by ICM and FCM with respect to the ploidy status in about 58% of examined tumor samples. When tissue samples from various regions of a tumor were examined, it was found that DNA-euploid and -aneuploid tumor areas were present within the tumors. The DNA aneuploidy was detected in 90% of these tumors with ICM. The percentage cell-cycle phase distribution varied widely with ICM and FCM. Based on our results, the use of ICM in addition to FCM is mandatory under certain conditions for the assessment of the DNA analysis of bone metastases and necessary for the critical assessment of the obtained findings.

Clinical Significance of Cytogenetic Findings in Solid Tumors

Chromosome analysis of solid tumors is becoming an increasingly useful tool to help establish a correct diagnosis and to provide prognostically important information. Characteristic karyotypic patterns in terms of degree of cytogenetic complexity and type of nonrandom abnormalities may help to distinguish neoplasia from a nonneoplastic lesion and to differentiate between a benign and a malignant tumor. More importantly, the presence of a specific or pathognomonic change may confirm or refute a suspected diagnosis, provide an alternative, unsuspected diagnosis, and trace the origin of a metastasis. Presently, specific cytogenetic abnormalities may be of substantial, and sometimes decisive, help in four groups of differential diagnostic dilemmas: (1) Benign vs. malignant epithelia tumors of the kidney. thyroid gland. salivary glands. And ovary; (2) Benign vs. malignant mesenchymal tumors of adipose and muscle tissue; (3) Differentiation between various malignant bone and soft tissue tumors; and (4) Diagnosis of undifferentiated small-cell and round-cell tumors. In addition to the diagnostic value, karyotypic findings may provide prognostic information. Thus, the presence of an abnormal clone and/or complex rearrangements is a poor prognostic sign in , e.g., carcinomas of the ovary, prostate, bladder, colon, and pancreas. Furthermore, characteristic cytogenetic aberrations are now known to be valuable prognostic parameters in malignant melanoma, malignant fibrous histiocytoma, germ cell tumors, neuroblastoma, and squamous cell carcinoma of the head and neck region. Many of the correlation analyses are preliminary, but they all point in the same direction, namely that cytogenetic studies will soon play the same essential role in the management of patients with solid tumors as they do today in hematologic oncology.