Diagnosis Of Bone Tumors Research Articles

A Comprehensive Clinico-Pathological Analysis of Osseous Neoplasms: An Observational Study in a Tertiary Care Facility.

Bone neoplasms represent a diverse group of malignancies that significantly impact morbidity and mortality. These tumors primarily affect the appendicular skeleton and, while less common than other malignancies, are particularly notable due to their prevalence in adolescents and young adults. Given their potential for rapid growth and high metastatic potential, these neoplasms can be life-threatening. This study aims to explore the relative frequencies, age, and sex distributions, as well as the anatomical and clinico-pathological characteristics of bone tumors in a tertiary care hospital. This retrospective cross-sectional study was conducted in the histopathology section of the Department of Pathology at a tertiary care medical college in Western India over 18 months (January 2023 to June 2024). All histopathologically confirmed cases of bone tumors, both benign and malignant, were analyzed based on the WHO's recent fifth-edition classification. Clinical data, including age, sex, and anatomical site, along with radiological investigations, were also reviewed for final diagnosis. A total of 63 patients, ranging from three months to 66 years old, with a mean age of 25.8 years, were included in the study. Of these, 34 (53.9%) were male and 29 (46.03%) were female, resulting in a male-to-female ratio of 1.17:1. The highest incidence of primary bone tumors occurred in the 11-20 years age group. Benign tumors accounted for 36 cases (57.11%), while 27 cases (42.85%) were malignant. Giant cell tumors (GCTs) were the most common, with 12 cases (19.04%), followed by osteochondroma with 11 cases (17.46%). Among malignant tumors, osteosarcoma was the most frequent, with 11 cases (17.46%), followed by Ewing's sarcoma with 10 cases (15.87%). The majority of tumors in this cohort were benign, with a slight male predominance, particularly among young adults. The diagnosis of bone tumors requires a comprehensive approach, including clinical evaluation, radiological correlation, and histopathological examination (HPE). In certain cases, immunohistochemistry is essential for an accurate diagnosis, staging, and the development of an effective treatment plan.

-AI-assisted diagnostic potential of CT in bone oncology and its impact on clinical decision-making for intensive care

ObjectiveThis study evaluates the AI-assisted diagnostic potential of computed tomography (CT) for bone cancer and its influence on patient care during the pre- and post-treatment phases. It compares patient management approaches based on CT severity levels and identifies distinct CT phenotypes linked to disease severity. MethodologyWe retrospectively examined 50 patients diagnosed with bone cancer between December 2022 and June 2023. The CT scans were analyzed according to the Radiological Society of North America (RSNA) guidelines. This study was performed using the deep convolutional neutral network (DCNN) model to assist doctors in diagnosing bone tumors through CT scanning. Patients’ management approaches were compared based on the severity levels indicated by CT scans. ResultsFifty patients participated in this study, with a median age of 67.2 years, ranging from 32 to 89 years. Of them, 38 % were female and 62 % were male. In 2022, 19 individuals (13 males and 6 females, ages 32 to 84) were assessed, with a mean age of 59.9 years. In 2023, 31 individuals, aged 54 to 89 with a mean age of 71.6 years, were assessed; among them were 18 men and 13 women. SPECT scans revealed the following key diagnostic features: 85.9 % of patients exhibited bone lesions with ground-glass opacities, 88 % had multipolar involvement, 92.8 % had bilateral involvement, and 92.8 % showed peripheral involvement. The severity scores based on CT scans were significantly higher in patients requiring intensive care, with scores above 14 being more common in this group. ConclusionDistinct CT findings during the AI-assisted diagnosis and treatment of bone cancer provided prompt and sensitive examination capabilities. Notably, two CT phenotypes emerged, associated with large consolidation patterns and high severity scores, offering crucial insights into disease severity and aiding in clinical decision-making for intensive care requirements. The study underscores the importance of CT in the effective monitoring and management of bone cancer pre- and post-treatment.

Not every knee tumour is a ganglion - retrospective analysis of benign and malign tumour entities around the knee.

Due to a lack of routine, there is often uncertainty regarding diagnostics of tumours around the knee joint. This study aimed to provide knowledge about the frequency, distribution and diagnostic algorithm of different bone and soft tissue tumour entities of the knee at a large referral university hospital in Germany. Retrospective, longitudinal, single-centre study that reviewed adult patients from 2010 until 2020 with a suspected tumours diagnosis around the knee at a university cancer centre. Inclusion criteria were adults with true bone or soft-tissue tumours in the knee joint and in its adjacent compartments. Suspected diagnosis, histological tumour entity, localization and its surgical treatment by biopsy, resection, osteosynthesis or tumour endoprosthesis were investigated. A total number of 310 adult patients were included with a mean age of 54.2 ± 18.8 years. In total 160 (51.6%) soft-tissue tumours (69/43.1% benign; 74/46.2% malignant; 17/10.6% intermediate), 92 (29.6%) primary bone tumours (46/50% benign; 39/42.3% malignant; 7/7.6% intermediate), 36 (11.6%) metastases and 22 (7.1%) lymphomas were detected. 171 (55.1%) tumours were classified as malignant. Suspected diagnosis was matched with histology in 74.5% (231/310) of all cases. In 6 cases a primarily suspected benign diagnosis turned out to be malignant. The majority of primary bone tumours was cartilage derived (63.1%;58/92) and located in the distal 2/3 of the femur, whereas intracapsular tumours of the knee joint were rare (13.0%). Soft-tissue tumours were located primarily in the middle third of the thigh (36.8%). The MRI was the diagnostic tool of choice in 98.1% of soft tissue tumours and 82.6% bone tumours. Awareness is crucial for detecting rare and malignant tumours around the knee, with adipocytic tumours being the most common soft tissue tumour and chondrogenic tumours as the most prevalent malignant bone tumour. Accurate diagnosis of bone tumours necessitates radiographs and frequently an additional MRI scan, while soft tissue tumours require mandatory MRI scans. Incorrectly diagnosing a tumour can have severe consequences, emphasizing the need for histological confirmation in all cases. Additionally, malignant tumours within joint capsules in adults are infrequent.

Epidemiology of bone tumors in children and adolescents: a retrospective study of 266 patients in the south of Tunisia.

Although bone tumors (BT) are relatively uncommon among the human neoplasm, they constitute the most frequent tumors in children and adolescents (CAA). Little information is available about the epidemiologic features of BT in CAA. We aimed to present and discuss epidemiological characteristics of BT in CAA in southern Tunisia, regarding the different histological types. This is a retrospective study including cases of BT in CAA collected in the pathology department at the Habib Bourguiba university hospital over a period of 15 years (2006- 2020). A total of 266 BT was diagnosed in our institution (42,7% among all BT in Southern Tunisia) divided into 200 benign bone tumors (BBT) (75,2%) and 66 malignant bone tumors (MBT) (24,8%). The mean age for all BT was 14,2 years (3-20 years) with male predominance (sex ratio: 1,48). The most common tumor was osteochondroma (42.2%) followed by osteosarcoma (14.6%) and Ewing sarcoma (6.4%). For BBT, the most affected age group was the 16 to 20 year - old - group (50,7%) with a male predominance (59.8%) and a predilection for lower limb (66.8%) then the upper limb (16,8%). Osteochondroma was the most common histological type (56.5%) followed by aneuvrysmal cyst (8,5%) and osteoid osteoma (6,5%). For MBT, the mean age was 12,5 years (5-20 years) and the most affected age group was the 11 to 15 year -old -group (59%). Boys were more affected (60.6%), with a preference for the lower limb (57%) followed by the pelvis (15,6%). Osteosarcoma was the most common MBT (60%) followed by Ewing sarcoma (24%). Given their rarity and heterogeneity, the diagnosis of BT is particular in CAA and requires a multidisciplinary approach. The reporting of epidemiological studies remains essential in order to expand our knowledge regarding these uncommon tumors.

Osteosarcoma Arising as a Secondary Malignancy following Treatment for Hematologic Cancer: A Report of 33 Affected Patients from the Cooperative Osteosarcoma Study Group (COSS).

Osteosarcoma may arise as a secondary cancer following leukemias or lymphomas. We intended to increase the knowledge about such rare events. We searched the Cooperative Osteosarcoma Study Group's database for individuals who developed their osteosarcoma following a previous hematological malignancy. The presentation and treatment of both malignancies was investigated, and additional neoplasms were noted. Outcomes after osteosarcoma were analyzed and potential prognostic factors were searched for. A total of 33 eligible patients were identified (male: 23, female: 10; median age: 12.9 years at diagnosis of hematological cancer; 20 lymphomas, 13 leukemias). A cancer predisposition syndrome was evident in one patient only. The hematological cancers had been treated by radiotherapy in 28 (1 unknown) and chemotherapy in 26 cases, including bone-marrow transplantation in 9. The secondary bone sarcomas (high-grade central 27, periosteal 2, extra-osseous 2, undifferentiated pleomorphic sarcoma of bone 2) arose after a median lag-time of 9.4 years, when patients were a median of 19.1 years old. Tumors were considered radiation-related in 26 cases (1 unknown). Osteosarcoma-sites were in the extremities (19), trunk (12), or head and neck (2). Metastases at diagnosis affected eight patients. Information on osteosarcoma therapy was available for 31 cases. All of these received chemotherapy. Local therapy involved surgery in 27 patients, with a good response reported for 9/18 eligible patients. Local radiotherapy was given to three patients. The median follow-up was 3.9 (0.3-12.0) years after bone tumor diagnosis. During this period, 21 patients had developed events as defined, and 15 had died, resulting in 5-year event-free and overall survival rates of 40% (standard error: 9%) and 56% (10%), respectively. There were multiple instances of additional neoplasms. Several factors were found to be of prognostic value (p < 0.05) for event-free (osteosarcoma site in the extremities) or overall (achievement of a surgical osteosarcoma-remission, receiving chemotherapy for the hematologic malignancy) survival. We were able to prove radiation therapy for hematological malignancies to be the predominant risk factor for later osteosarcomas. A resulting overrepresentation of axial and a tendency towards additional neoplasms affects prognosis. Still, selected patients may become long-term survivors with appropriate therapies, which is an argument against therapeutic negligence.

Enhanced accuracy and reduced delay in diagnosing bone tumors within an expert sarcoma network: A nationwide study

IntroductionPrimary bone tumors encompass a range of rare and diverse lesions. Pathological diagnosis poses significant challenges, with histological discrepancies extensively studied in soft tissue sarcomas but lacking specific investigation in bone lesions. This study aimed to determine the rate of major diagnostic discrepancies in primary bone tumors, assessing whether initial histological analysis within an expert referral center network reduces this rate and final diagnostic delay. Additionally, we examined the impact of mandatory systematic re-reading by expert pathologists on diagnostic variation and readjustment. MethodsOur study cohort comprised patients with primary bone tumors, drawn from the national prospective French sarcoma network database. A total of 1075 patients were included from 2018 to 2019. ResultsThe cohort exhibited a major discrepancy rate of 24%. Within the expert referral centers network, 49 cases (7%) showed major diagnostic discrepancies in the initial analysis, compared to 207 cases (57%) outside the network (p < 0.001). Regarding the final diagnostic delay, a mean of 2.8 weeks (±4.9) was observed within the network, contrasting with 6.5 weeks (±9.1) outside the network (p < 0.001). Systematic re-reading by an expert pathologist facilitated diagnosis readjustment in 75% of the 256 cases, with 68% of all diagnostic variations occurring preoperatively. ConclusionEarly management within the expert network significantly reduced major diagnostic discrepancies and shortened the diagnosis delay by approximately a month. Expert pathologist systematic re-readings were responsible for diagnosis readjustments in three-quarters of cases, with two-thirds of all diagnostic variations occurring preoperatively, thereby mitigating the consequences of mistreatment.

Sinonasal (Schneiderian) Tumors in the Temporal Bone: Case Series and Systematic Review.

Neoplasms derived from the sinonasal epithelium are a rare finding in the temporal bone, and their origins are controversial. To review the characteristics of sinonasal epithelial (previously known as Schneiderian) tumors occurring in the temporal bone. This was a 2-center case series and systematic review of MEDLINE, EMBASE, and the Web of Science through May 2021. Patients with clinicopathologic evidence of temporal bone involvement by neoplasms of sinonasal epithelial origin were selected, with or without a history of prior primary sinonasal epithelial tumors. Clinical, radiologic, and pathologic data were extracted. The systematic review included 56 studies and our 8 unpublished cases, totaling 76 cases of papillomas or squamous cell carcinomas in the temporal bone. Of these, 51% occurred secondary to sinonasal tumors, and 49% occurred primarily. Secondary tumors were usually metachronous (77%), with a median delay of 1 year from sinonasal-to-temporal bone tumor diagnosis. Most cases were unilateral (90%); bilateral temporal bone involvement occurred only as secondary ("trilateral") tumors. Unilateral secondary tumors had ipsilateral (81%) or bilateral (19%) sinonasal counterparts. Secondary tumors were more likely to be malignant (OR, 6.7, P < .001). The review was based on case reports and small case series, which are subject to reporting bias. The observed tumor patterns support the hypothesis that the Eustachian tube facilitates the spread of sinonasal epithelium-derived neoplasms from the sinonasal cavity to the temporal bone. Transtubal spread of sinonasal epithelium-derived neoplasms should be considered among the rare causes of middle ear masses.

Diffusion weighted imaging of extremity bone tumors-inter-reader analysis and incremental value over conventional MR imaging.

To determine whether the addition of diffusion-weighted imaging (DWI) to conventional MRI improves diagnostic accuracy of bone tumor characterization with the hypothesis that the DWI has incremental value in the diagnosis of osseous tumors. In this multireader cross-sectional validation study, four musculoskeletal radiologists evaluated osseous tumors blinded to final diagnosis in two rounds-first without DWI or apparent diffusion coefficient (ADC) maps, then months later with these available. Each reader recorded a binary result as to whether the lesion is benign or malignant. Intraclass correlation (ICC) and Conger's κ were used. Diagnostic performance measures including area under the receiver operating curve (AUC) were reported. 133 osseous tumors of the extremities (76 benign, 57 malignant) were tested. Blinded to DWI, average reader sensitivity, specificity, positive-predictive value, and negative-predictive value were 0.83, 0.92, 0.94, and 0.82, respectively. With DWI, the values were 0.85, 0.92, 0.94, and 0.83, respectively. Interreader agreement was good for both rounds (0.67 and 0.71, respectively, p-value > 0.05). Average reader confidence was 4.1 and 4.4, respectively (p-value < 0.001). ADC values and DWI/ADC ratios showed significant differences between benign and malignant tumors. DWI and ADC show statistically significantly different values of benign from malignant osseous tumors and mildly increased radiologist confidence with similar interreader reliability. However, given similar diagnostic accuracy, conventional MR imaging is adequate for bone tumor characterization and incremental value of DWI is limited. This paper is the first of its kind to report the use of DWI/ADC ratio for the diagnosis of bone tumors.

Galectin-3 in the blood serum of patients with bone tumors

Background. Due to diversity of cancer, the functional role of galectin-3 is rather controversial; however, for many types of neoplasms, the marker acts as a tumor growth promoter.Aim. To perform a comparative analysis of galectin-3 levels in the blood serum of healthy individuals and patients with benign, borderline, and malignant bone tumors divided into two age groups (under and over 18 years of age) based on the main clinical and morphological characteristics of the disease and prognosis.Materials and methods. The study included 201 patients with benign, borderline (giant cell tumors, locally aggressive tumors), and malignant bone tumors and 31 healthy donors. The galectin-3 level was determined in the blood serum before treatment with Human Galectin-3 ELISA kit (R&amp;D, USA).Results. The level of galectin-3 in the blood serum of patients with benign and malignant bone tumors was statistically significantly higher than that in the control group of patients both under and over 18 years. In patients with borderline bone tumors, a trend toward an increase in the galectin-3 concentration compared with the controls was revealed. The ROC analysis for galectin-3 in patients with bone sarcomas showed that the area under the curve (AUC) comprised 0.795 (р &lt; 0.0001) in the group of patients over 18 years and 0.868 (р = 0.0008) in the individuals under 18 years. For malignant bone tumors in patients over 18 years, the sensitivity of this method was 71.3%, and specificity was 71.43% (optimal cut-off level was 8.09 ng / ml; р &lt; 0.0001), while in patients under 18 years, the sensitivity of the method was 80%, and specificity was 90% (optimal cut-off level was 5.49 ng / ml; р &lt; 0.001). No significant associations between the serum galectin-3 level and the clinical and morphological characteristics of bone neoplasms were found both in patients under and over 18 years of age. However, it could be noted that the highest concentration of the marker was found in chordomas and at earlier stages of the disease. In patients over 18 years with chondrosarcoma and osteosarcoma, no correlation between the marker and the disease prognosis was found.Conclusion. An increase in the galectin-3 level in the blood serum was observed in all age groups of patients with both benign and malignant bone tumors. However, the sensitivity and specificity of the method assessed by the ROC analysis do not allow to apply this marker for the diagnosis of bone tumors.

Biomaterial-assisted tumor therapy: A brief review of hydroxyapatite nanoparticles and its composites used in bone tumors therapy.

Malignant bone tumors can inflict significant damage to affected bones, leaving patients to contend with issues like residual tumor cells, bone defects, and bacterial infections post-surgery. However, hydroxyapatite nanoparticles (nHAp), the principal inorganic constituent of natural bone, possess numerous advantages such as high biocompatibility, bone conduction ability, and a large surface area. Moreover, nHAp's nanoscale particle size enables it to impede the growth of various tumor cells via diverse pathways. This article presents a comprehensive review of relevant literature spanning the past 2decades concerning nHAp and bone tumors. The primary goal is to explore the mechanisms responsible for nHAp's ability to hinder tumor initiation and progression, as well as to investigate the potential of integrating other drugs and components for bone tumor diagnosis and treatment. Lastly, the article discusses future prospects for the development of hydroxyapatite materials as a promising modality for tumor therapy.

Imaging Recommendations for Diagnosis, Staging, and Management of Bone Tumors

AbstractPrimary bone sarcomas account for less than 1% of diagnosed cancers each year. In this era of multiplanar and functional imaging, the approach to the radiographic diagnosis of bone cancers goes much beyond traditional radiography. Radiographs are still the most pertinent part of the initial diagnosis of bone tumors. Multimodal imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), can help with issues such as complex anatomy, marrow assessment, soft assessment, and better local staging. The emerging imaging modality such as positron emission tomography (PET)-CT/PET-MRI has further transformed the imaging of bone malignancies. Radiologist plays an important role in the workup, staging, and management of bone tumors. The purpose of this article is to review imaging recommendations for better diagnosis, staging, and management of bone tumors.

Application of Machine Learning for Differentiating Bone Malignancy on Imaging: A Systematic Review

An accurate diagnosis of bone tumours on imaging is crucial for appropriate and successful treatment. The advent of Artificial intelligence (AI) and machine learning methods to characterize and assess bone tumours on various imaging modalities may assist in the diagnostic workflow. The purpose of this review article is to summarise the most recent evidence for AI techniques using imaging for differentiating benign from malignant lesions, the characterization of various malignant bone lesions, and their potential clinical application. A systematic search through electronic databases (PubMed, MEDLINE, Web of Science, and clinicaltrials.gov) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 34 articles were retrieved from the databases and the key findings were compiled and summarised. A total of 34 articles reported the use of AI techniques to distinguish between benign vs. malignant bone lesions, of which 12 (35.3%) focused on radiographs, 12 (35.3%) on MRI, 5 (14.7%) on CT and 5 (14.7%) on PET/CT. The overall reported accuracy, sensitivity, and specificity of AI in distinguishing between benign vs. malignant bone lesions ranges from 0.44-0.99, 0.63-1.00, and 0.73-0.96, respectively, with AUCs of 0.73-0.96. In conclusion, the use of AI to discriminate bone lesions on imaging has achieved a relatively good performance in various imaging modalities, with high sensitivity, specificity, and accuracy for distinguishing between benign vs. malignant lesions in several cohort studies. However, further research is necessary to test the clinical performance of these algorithms before they can be facilitated and integrated into routine clinical practice.

Utility of Magnetic Resonance Imaging in the Assessment of Primary Bone Tumors

Background: These radiographic features, coupled with clinical information, help to define whether the lesion is neoplastic or non-neoplastic, primary or metastatic, and will help to direct the subsequent work-up further. MRI is the best modality to assess the focal extent and local staging. Aims and Objectives: To assess the Utility of magnetic resonance imaging in assessing primary bone tumors. Materials and Methods: Present cross-sectional study was performed on 50 patients undergoing magnetic resonance imaging with clinical suspicion of primary bone tumors at the Department of Radiodiagnosis. A detailed socio-demographic, in addition to routine MR pulse sequences, was recorded. Results: In our study, 31 cases (62 %) had a wide zone of transition, in which 25 cases were benign, and the remaining 6 cases were malignant, while 19 cases (38 %) had an arrow zone of transition and all 19 cases (38%) were malignant. This difference was found to be statistically significant. (χ2 value = 30.645 , p value= 0.0001. Sixteen patients (32%) were in the age group of 11-20 years of age. The majority of the primary bone tumors (72%) were observed in the appendicular skeleton; the most commonly involved bones were the femur, tibia, and humerus in 19, 8, and 5 cases, respectively. Conclusion: MR imaging is an excellent modality to delineate the extent of the tumor, and soft tissue involvement, localize the lesion, and determine its aggressiveness. The findings of this population study are consistent with other studies in this field. So we have sufficient evidence to conclude that MRI is highly accurate in diagnosing bone tumors.

Tumor Microenvironment, Clinical Features, and Advances in Therapy for Bone Metastasis in Gastric Cancer.

Simple SummaryBone metastasis in gastric cancer (GC-BM) has received little attention because of its rarity, but the increased pain and shortened survival of patients due to the bone destruction and skeletal-related events (SREs) caused by tumors cannot be ignored. Immune cells and molecules such as RANK-L and GFs in complicated bone microenvironments create suitable conditions for tumor cells to proliferate and break the balance of bone circulation, which leads to osteolysis and osteogenesis. Bone radionuclide scans now are the most sensitive examination for diagnosing bone tumors, and bone-related alkaline phosphatase (ALP) also shows a certain significance in the diagnosis of bone tumors. Combined application of chemotherapeutic drugs, targeted drugs, and immune drugs are the main treatments of GC-BM. This review paper intends to discuss the clinical status of GC-BM, as well as its possible molecular pathogenesis pathways and therapeutic options.Gastric cancer (GC) is one of the most malignant neoplasms worldwide, accounting for about 770,000 deaths in 2020. The incidence of gastric cancer bone metastasis (GC-BM) is low, about 0.9–13.4%, and GC patients develop GC-BM because of a suitable bone microenvironment. Osteoblasts, osteoclasts, and tumor cells interact with each other, secreting cytokines such as PTHrP, RANK-L, IL-6, and other growth factors that disrupt the normal bone balance and promote tumor growth. The functions and numbers of immune cells in the bone microenvironment are continuously inhibited, resulting in bone balance disorder due to the cytokines released from destroyed bone and growing tumor cells. Patients with GC-BM are generally younger than 65 years old and they often present with a later stage of the disease, as well as more aggressive tumors. They usually have shorter overall survival (OS) because of the occurrence of skeletal-related events (SREs) and undetected bone destruction due to the untimely bone inspection. Current treatments of GC-BM focus mainly on gastric cancer and SRE-related treatment. This article reviews the clinical features, possible molecular pathogeneses, and the most commonly used diagnostic methods and treatments of bone metastasis in gastric cancer.

X-ray and MRI Correlation of Bone Tumors Using Histopathology As Gold Standard.

IntroductionBone tumors are a common pathology of the musculoskeletal system being frequently encountered by clinicians. Radiological workup is a mainstay in the diagnostic workup of bone tumors. This study aimed to highlight the importance of plain radiography and MRI in the diagnosis of bone tumors keeping histopathology as a gold standard. It is a descriptive validation study conducted in the Radiology Department of Pakistan Institute of Medical Sciences Islamabad.MethodologyThe study included 92 patients with suspected bone lesions. After taking a complete history and receiving informed written consent. X-rays radiographs and magnetic resonance imaging were performed. X-ray radiograph and magnetic resonance imaging parameters were recorded and compared with the histopathology of lesions as a standard.ResultsThe mean age of patients was 30.50 ± 8.95 years. Of 92 patients examined on X-ray, 51 (55.4%) had lytic lesions, 34 (37.0%) had sclerotic lesions, and seven (7.6 %) had mixed lesions. MRI revealed the location of the lesion. There were 25 (27.2%) bone lesions in diaphysis, 19 (20.7%) in metaphysis, nine (9.8%) at meta-diaphysis, and 32 (34.8 %) in the meta-epiphyseal region. These findings were later on confirmed with histopathological results.ConclusionMRI can differentiate soft-tissue components and periosteal reactions. An X-ray radiograph can provide information about bony matrix and calcifications within tumors. After analysis of imaging findings and histopathological results, it is concluded that these modalities can be used to diagnose bone tumors with high diagnostic accuracy.

Talar metastasis of mucinous lung adenocarcinoma with fluid-fluid levels: a rare presentation mimicking a benign tumor.

The differential diagnosis of bone tumors in the talus is broad and includes both benign and malignant conditions. Metastases, although very rare, are one of these conditions. The typical nonspecific clinical and radiological presentations of metastases are a diagnostic challenge, and a high level of suspicion is needed in order to perform an adequate diagnostic approach. Moreover, they can present with features which have classically been associated with benign conditions such as fluid-fluid levels. We present a rare case of talar metastasis of a mucinous pulmonary adenocarcinoma that presented with fluid-fluid levels and was initially misdiagnosed as a giant-cell tumor with areas of secondary aneurysmal bone cyst transformation.

Added values of diffusion weighted imaging, Dynamic contrast enhancement and opposed phase MRI in evaluation of bony lesions around the knee &amp; ankle joints

Background: Magnetic resonance imaging (MRI) represents the most advanced imaging technique in diagnosis of bone tumors being more sensitive in assessing bone marrow changes and extent of tumors compared to CT and plain X-ray. The distinction between malignant and benign neoplasms is mandatory for appropriate therapeutic choices and planning. MRI has the upper hand in the assessment of such tumors due to its brilliant soft tissue discrimination. The use of multiparametric MRI techniques increase accuracy of discrimination between malignant and benign lesions. Results: This prospective study included 34 patients; 16 males and 18 females with musculoskeletal complaint around the knee &amp; ankle joints. Their age ranged from 10 to 65 years (mean age was 26.65 ± 17.23 years). The cut off value of ADC for bony lesions (by ROC curve) was ≤ 1 to be considered malignant. At this cut off point; the sensitivity of ADC to detect malignant and to exclude benign lesions was 83.3 % and the specificity was 86.4 %. The cut off value for SIR for bony lesions (by ROC curve) was ≥ 0.89 to be considered malignant.

Interdisciplinarity in Diagnostics of Bone Lesions.

Due to substantial advances in all medical disciplines, interdisciplinary cooperation is of major relevance in modern medicine. Given the rarity of benign and malignant bone tumours, diagnosis and therapy of these lesions is especially challenging. Focusing on typical cases, it is the aim of this article to illustrate the necessity of interdisciplinary cooperation. The scope of this article is to highlight the particular significance of interdisciplinarity in the diagnosis of bone tumours. To this end, we illustrate the interdisciplinary approach in typical clinical cases. The article demonstrates that a combined clinico-radiological approach is essential in the diagnosis of leave-me-alone lesions, and it underlines the essential role of an interdisciplinary correlation of clinical context, radiology and pathology in the interpretation of bone tumour biopsies. It documents the experience that all clinical aspects and diagnostic findings need to be synoptically integrated in a joint interdisciplinary tumour board to eventually find the correct diagnosis. It is generally accepted that the diagnosis of a bone tumour can often not be made by the pathologist alone but essentially requires interdisciplinary cooperation.

A Comprehensive Understanding of the Genomic Bone Tumor Landscape: A Multicenter Prospective Study.

Complexity and heterogeneity increases the difficulty of diagnosis and treatment of bone tumors. We aimed to identify the mutational characterization and potential biomarkers of bone tumors. In this study, a total of 357 bone tumor patients were recruited and the next generation sequencing (NGS)-based YuanSu450 panel, that includes both DNA and RNA sequencing, was performed for genomic alteration identification. The most common mutated genes in bone tumors included TP53, NCOR1, VEGFA, RB1, CCND3, CDKN2A, GID4, CCNE1, TERT, and MAP2K4. The amplification of genes such as NCOR1, VEGFA, and CCND3 mainly occurred in osteosarcoma. Germline mutation analysis reveal a high frequency of HRD related mutations (46.4%, 13/28) in this cohort. With the assistance of RNA sequencing, 16.8% (19/113) gene fusions were independently detected in 20% (16/79) of patients. Nearly 34.2% of patients harbored actionable targeted mutations, of which the most common mutation is CDKN2A deletion. The different mutational characterizations between juvenile patients and adult patients indicated the potential effect of age in bone tumor treatment. According to the genomic alterations, the diagnosis of 26 (7.28%) bone tumors were corrected. The most easily misdiagnosed bone tumor included malignant giant cell tumors of bone (2.8%, 10/357) and fibrous dysplasia of bone (1.7%, 6/357). Meanwhile, we found that the mutations of MUC16 may be a potential biomarker for the diagnosis of mesenchymal chondrosarcomas. Our results indicated that RNA sequencing effectively complements DNA sequencing and increased the detection rate of gene fusions, supporting that NGS technology can effectively assist the diagnosis of bone tumors.

The role of the clinician in the diagnosis of tumors of the musculoskeletal system

Diagnosis of musculoskeletal tumors is quite often difficult and for the accurate diagnosis close collaboration of specialist in orthopaedic oncology, morphologist as well as roentgenologist is required. The more precise diagnosis of bone tumors can be made at specialized Centers (but not centers for general oncology) where roentgenologists and morphologists are trained for musculoskeletal tumors. Leading role in the collaboration of orthopaedic surgeon, roentgenologist and morphologist belongs to the clinician. These theses are confirmed by adduced clinical observations. The causes of diagnostic mistakes are analysed.