Malignant Bone Lesions Research Articles

The Role of Diffusion-Weighted MRI in Correlation with Contrast-Enhanced MRI and Histopathology in the Evaluation of Focal Liver Lesions.

Accurate diagnosis of focal liver lesions is of utmost importance for theinitiation ofappropriate treatment. This study aims to assess the effectiveness of diffusion-weighted imaging (DWI) in diagnosing focal liver lesions, specifically focusing on differentiating between benign and malignant lesions, distinguishing metastases from primary liver tumors, and identifying various types of both benign and malignant lesions.. The study design is that of a prospective observational study done on 28 cases withfocal liver lesions detected on ultrasound. DWI was done followed by contrast-enhanced MRI (CE-MRI). Identification of the lesion on DWI and apparent diffusion coefficient (ADC) map was madeby using the CE-MRI images as a guide. The signal intensity of the lesion on DWI is determined as either diffusion restriction or no restriction. ADC measurementswere made quantitatively over various regions of interest (ROIs) of the focal liver lesion. All the lesions were confirmed by histopathological examination (HPE) except few benign lesions like simple cysts and few hemangiomas, which were followed up by ultrasonography after six months. Our study included 28 patients with 44 focal liver lesions. Out of 28 patients in this study group (n=28), there were a total of 17 male and 11 female patients. The mean age of the sample population was 50.89±13.40 years. The lesions were more commonly seen is the age group of 41-60 years (57.14%). Out of 44 lesions(n),24 (54.5%) lesionswere benign , 20 (45.45%) were malignant. There were 17 hemangiomas (38.6%), 2 hematomas (4.5%), 2 simple cysts (4.5%), 1 hydatid cyst (2.27%), 2 hepatic adenomas (4.5%), 16 hepatocellular carcinoma (HCC) (36.36%), 3 cholangiocarcinoma (6.8%), and 1 hepatoblastoma (2.27%). DWI has 85% sensitivity and 84.7% specificity for the differentiation of benign from malignant lesions. The mean ADC value of benign lesions was 1.83x10-3mm2/s and the mean ADC of malignant liver lesions was 0.96x10-3mm2/s. In the present study, the average cut off of mean ADC to differentiate benign and malignant bone lesions is 1.3x10-3 mm2/s, with statistically significant p value of 0.001, sensitivity of 95% and specificity of 83.3%. DWI is a valuable imaging technique in the evaluation of focal liver lesions. The ability to differentiate between benign and malignant liver lesions without the need for contrast is a significant benefit, particularly in challenging cases involving uncooperative patients or when contrast administration is contraindicated.

Implementation of a New Classification and Stratification System for Solitary Bone Tumor: Osseous Tumor Radiological and Interpretation and Management System (OT-RIMS)

Abstract Objectives To propose a histological-grades-based Osseous Tumor Radiological Interpretation and Management System (OT-RIMS) that would simplify the radiological evaluation of bone tumors, categorize key radiological features into severity levels, and inform corresponding patient management actions. Methods This retrospective study between January 2015 and August 2022 evaluated patients with solitary bone tumors confirmed by pathology and imaging follow-up received two or three imaging modalities of radiographs, CT, or MRI. Three radiologists independently assessed radiological features, categorized bone lesions based on OT-RIMS criteria, and reached a consensus. Kappa statistics and observed agreement were calculated. Results A total of 341 patients (mean age, 26.0 years; 159 women) were included, with 102 malignant, 177 benign, and 62 intermediate or low-grade malignant bone lesions. Sensitivity and specificity of readers 1, 2, and 3, respectively, in the identification of malignant tumors into OT-RIMS 4 were 93.1% (95 of 102) and 93.3% (223 of 239), 96.1% (98 of 102) and 91.6% (219 of 239), 92.2% (94 of 102) and 89.5% (214 of 239). Inter-reader agreement of OT-RIMS category for three readers was considered excellent (Kendall’s W = 0.924, p < 0.001) with a kappa value of reproducibility in categories 1&2, 3, and 4 of 0.764, 0.528, and 0.930, respectively. Conclusion The OT-RIMS category demonstrated excellent reproducibility despite the reader’s expertise level in categorizing the risk stratification of bone tumors and informing patient management, with histological grades used as the reference standard. Advances in knowledge The OT-RIMS category reliably stratifies bone tumors into four categories corresponding to histological grades and standardized patient management.

Intraosseous hibernoma mimicking sclerotic bone metastasis-a case report.

Intraosseous hibernoma is an uncommon presentation of brown adipose tissue benign tumors. Imaging differential diagnoses include bone island, sclerotic metastasis, lymphoma, hemangioma, and sclerotic myeloma. In this report, a 72-year-old patient presented with right hip pain following a fall injury, leading to an extensive diagnostic workup. Initial CT of the pelvis without contrast suggested potential sclerotic metastatic disease. MRI findings could not be definitive. Further assessment with CT-guided biopsy and S-100 immunohistochemical staining confirmed a rare diagnosis of intraosseous hibernoma. This case describes multimodality imaging characteristics of a rare intraosseous hibernoma with discussion of imaging features of differential diagnostic considerations of related benign and malignant bone lesions.

Correlation between the maximum standard uptake value and mean Hounsfield unit on single-photon emission computed tomography-computed tomography to discriminate benign and metastatic lesions among patients with breast cancer.

Retrospective study. To compare and correlate technetium-99m methylene diphosphonate uptake between benign and metastatic bone lesions using semiquantitative analysis of maximum standard uptake value (SUVmax) and mean Hounsfield unit (HU) in single-photon emission computed tomography-computed tomography (SPECT-CT). Qualitative interpretation of metastatic bone lesions in breast cancer on bone scintigraphy is often complicated by coexisting benign lesions. In total, 185 lesions were identified on bone and SPECT-CT scans from 32 patients. Lesions were classified as metastatic (109 sclerotic lesions) and benign (76 lesions) morphologically on low-dose CT. Semiquantitative analysis using SUVmax and mean HU was performed on the lesions and compared. To discriminate benign and metastatic lesions, the correlation between SUVmax and mean HU was determined using the intraclass correlation coefficients. The SUVmax was higher in metastatic lesions (20.66±14.36) but lower in benign lesions (10.18±12.79) (p<0.001). The mean HU was lower in metastatic lesions (166.62±202.02) but higher in benign lesions (517.65±192.8) (p<0.001). A weak negative correlation was found between the SUVmax and the mean HU for benign lesions, and a weak positive correlation was noted between the SUVmax and the mean HU on malignant lesions with no statistical significance (p=0.394 and 0.312, respectively). The cutoff values obtained were 10.8 for SUVmax (82.6% sensitivity and 84.2% specificity) and 240.86 for the mean HU (98.7% sensitivity and 88.1% specificity) in differentiating benign from malignant bone lesions. Semiquantitative assessment using SUVmax and HU can complement qualitative analysis. Metastatic lesions had higher SUVmax but lower mean HU than benign lesions, whereas benign lesions demonstrated higher mean HU but lower SUVmax. A weak correlation was found between the SUVmax and the mean HU on malignant and benign lesions. Cutoff values of 10.8 for the SUVmax and 240.86 for the mean HU may differentiate bone metastases from benign lesions.

Quantitative Analysis of 99mTc-MDP SPECT-CT Data in Diagnosing Bone Metastases in Breast Cancer Patients

Background: In patients with advanced breast cancer (BC), distant metastases happen mainly in the skeleton. This study aimed to investigate the role of 99mTc-MDP SPECT/CT in the differential diagnosis of malignant bone lesions from degenerative benign bone diseases in female BC patients. Methods and Results: The study included 39 female BC patients who underwent a baseline 99mTc-MDP SPECT/CT bone scans. After lesion detection, a quantitative radiotracer uptake analysis was conducted, and the standardized uptake value (SUVmax) was identified in each patient, and the data were then statistically analyzed. SUVmax values were significantly higher in BC patients with malignant metastasis than in patients with degenerative changes (33.04±15.3 vs. 13.25±5.46 g/mL, P&lt;0.05). The SUVmax cut-off value of 22.75 g/mL (25th percentile) obtained through box plot analysis can help to discriminate metastatic from degenerative lesions. The logistic regression analysis indicated that the SUVmax was a significant predictor of metastatic BL (P&lt;0.001, OR = 159.90, B=5.07). Conclusion: Our results suggested that quantitative analysis of the 99mTc-MDP SPECT-CT data can improve diagnostic accuracy in differentiating malignant metastatic bone lesions from degenerative bone lesions in high-risk BC patients.

How to distinguish a benign from a malignant tumour in children and when should a biopsy be done and by whom.

Bone tumours are frequent in children but most of them are benign. Moreover, the incidence and type of tumours differ from those of adults. As an orthopaedic surgeon, we will likely encounter a bone lesion in a child and we must be able to distinguish if it is a benign lesion or has malignant characteristics and it is necessary to refer it to a centre specialized in tumours. We will discuss the key points we would have to ask in the medical history, look at the physical examination and the radiological characteristics that will allow us to distinguish between a benign and a malignant bone lesion in a child. When there are doubts about the malignancy of a bone lesion or if the diagnosis is not clear, a biopsy should be performed following certain rules in a specialized centre.

Assessment of the dalargin effect on the level of vitamin D and melatonin in blood serum in patients with malignant bone tumors and polymorbidity

Background. Involved in many cascades of biological regulatory reactions, calcium, vitamin D and melatonin create a single metabolic pattern, maintaining the dynamic balance of bone tissue homeostasis. Nevertheless, these regulatory molecules, as structural and functional elements of bone tissue, play a crucial role in various cellular processes associated with oncogenesis and tumor progression. Synthetic peptide dalargin has wound healing, reparative, anti-inflammatory, antioxidant, immunomodulatory, anticarcinogenic, antitumor, and antimetastatic effects. The purpose of the study was to investigate the synthetic neuropeptide dalargin influence on the dynamics of vitamin D and melatonin blood serum le­vels as part of the treatment algorithm of patients with bone malignant tumors of the lower extremities and pelvis with polymorbidity and endoprosthetics. Materials and methods. The study inclu­ded a control (first) group and a main (second) group of clinical observation of patients with malignant bone lesions. The serum melatonin content was measured by enzyme immunoassay using reagent kits (No. RE54021) from IBL-Hamburg GmbH (Germany). Serum levels of 25-hydroxycalciferol (25(OH)D) were determined by the immunochemiluminescent method on an ARCHITECT 25-OH Vitamin D Controls automatic analyzer. Results. In patients who received dalargin, more pronounced positive dynamics were established in the normalization of 25(ОН)D and melatonin levels, and there was no exacerbation of concomitant diseases. In contrast to the data of patients who did not receive dalargin, in the group where it was used, there were no relapses or metastases of the tumor du­ring 14 months. A comparison of the 25(ОН)D and melatonin le­vels in patients 6–7 months and 12–14 months after treatment shows a tendency to recovery of indicators only in patients who were additionally treated with dalargin (p &lt; 0.01). Conclusions. The study showed the possibility of using the neuropeptide dalargin to increase the effectiveness of the treatment of patients with primary malignant tumors with the burden of polymorbidity by influencing the levels of vitamin D and melatonin in the blood serum.

Does the presence of macroscopic intralesional fat exclude malignancy? An analysis of 613 histologically proven malignant bone lesions.

To determine if macroscopic intralesional fat detected in bone lesions on CT by Hounsfield unit (HU) measurement and on MRI by macroscopic assessment excludes malignancy. All consecutive CT-guided core needle biopsies (CNB) of non-spinal bone lesions performed at a tertiary center between December 2005 and September 2021 were reviewed. Demographic and histopathology data were recorded. All cases with malignant histopathology were selected, and imaging studies were reviewed. Two independent readers performed CT HU measurements on all bone lesions using a circular region of interest (ROI) to quantitate intralesional fat density (mean HU < -30). MRI images were reviewed to qualitatively assess for macroscopic intralesional fat signal in a subset of patients. Inter-reader agreement was assessed with Cronbach's alpha and intraclass correlation coefficient. In 613 patients (mean age 62.9 years (range 19-95 years), 47.6% female), CT scans from the CNB of 613 malignant bone lesions were reviewed, and 212 cases had additional MRI images. Only 3 cases (0.5%) demonstrated macroscopic intralesional fat on either CT or MRI. One case demonstrated macroscopic intralesional fat density on CT in a case of metastatic prostate cancer. Two cases demonstrated macroscopic intralesional fat signal on MRI in cases of chondrosarcoma and osteosarcoma. Inter-reader agreement was excellent (Cronbach's alpha, 0.95-0.98; intraclass correlation coefficient, 0.90-0.97). Malignant lesions rarely contain macroscopic intralesional fat on CT or MRI. While CT is effective in detecting macroscopic intralesional fat in primarily lytic lesions, MRI may be better for the assessment of heterogenous and infiltrative lesions with mixed lytic and sclerotic components. Macroscopic intralesional fat is rarely seen in malignant bone tumors and its presence can help to guide the diagnostic workup of bone lesions. • Presence of macroscopic intralesional fat in bone lesions has been widely theorized as a sign of benignity, but there is limited supporting evidence in the literature. • CT and MRI are effective in evaluating for macroscopic intralesional fat in malignant bone lesions with excellent inter-reader agreement. • Macroscopic intralesional fat is rarely seen in malignant bone lesions.

Évaluation de la modalité de reconstruction xSPECT bone dans la détection de lésions osseuses secondaires en scintigraphie osseuse

IntroductionThe xSPECT Bone® (xB) algorithm modifies the distribution of scintigraphic information using CT combined with SPECT in order to improve spatial resolution. It could help to detect bone lesions, especially malignant ones. We evaluated its ability to highlight malignant bone lesions compared with conventional reconstruction, and studies the discrepancies between the two reconstruction modalities. MethodForty-seven patients who underwent SPECT-CT for oncology purpose were retrospectively included. Images (Symbia Intevo T6 camera; Siemens) were reconstructed with xB and a conventional iterative algorithm (F3D), and interpreted by two nuclear medicine physicians. Bone lesions and malignant ones were identified (with a diagnostic reference established by consensus after rereading of doubtful lesions and analysis of the patients’ records). ResultsF3D allowed to detect more lesions than xB. In a per-lesion analysis, F3D showed better interobserver agreement than xB (p = 0.02) but overall diagnostic performance was equivalent. More malignant lesions were detected with F3D only, than with xB only (p<0.01), and these discordances did not involve any particular bone segment. Enhancement of healthy bone structures or decrease in contrast related to xSPECT reconstruction (OSCGM) could decrease contrast in xB. ConclusionMore lesions were detected with F3D than with xB, but overall diagnostic performance seems equivalent.

Brodie's Abscess of the Ankle Presenting as a Tumor: A Summary of Five Cases.

A Brodie's abscess is a form of subacute osteomyelitis that is often considered in the differential diagnosis of other benign and malignant bone lesions. The authors summarize the findings of five cases of Brodie's abscesses in the distal tibia initially thought to be tumors by the referring physicians. All five cases were presented to the referring physicians with a chief complaint of ankle pain. All patients complained of chronic ankle pain and swelling that was aggravated by activity without constitutional symptoms. On physical examination, all patients presented with point tenderness over the distal tibia/malleolar regions. Three out of the five cases had a full range of ankle motion; the other two had limited dorsiflexion secondary to pain. All inflammatory laboratory values were within normal limits or only slightly elevated. All initial radiographs of the cases described demonstrated a well-defined radiolucent lesion within the distal tibia. In all cases, patients were treated with curetting, with or without bone graft. Bacterial and fungal cultures were negative in all five patients and no long-term post-operative antibiotics were administered. In this report, we discuss the clinical, radiographic, and pathologic features of this relatively rare condition in the distal tibia. The distinct clinicopathologic features of the disease process are presented to distinguish Brodie's abscess from a bone tumor.

OP82 Positron Emission Tomography Combined With Computed Tomography Using 18F-Sodium Fluoride

IntroductionPositron emission tomography combined with computed tomography (PET/CT) using 18F-sodium fluoride (18F-NaF) is used for functional imaging in diseases to detect abnormally altered osteogenic activity, such as benign and malignant bone diseases and inflammatory or traumatic changes in skeletal bones.MethodsA systematic search of literature using keywords in the MEDLINE database was conducted to identify literature on the clinical and cost effectiveness of using PET/CT with 18F-NaF-based radiopharmaceuticals in the diagnosis of bone and cartilage cancer. The search retrieved 323 publications. The analysis included 11 publications that met the selection criteria, including one meta-analysis and ten literature reviews.ResultsThe pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve of 18F-NaF-based PET/CT for the detection of bone metastases were 0.98 (95% confidence interval [CI]: 0.95, 0.99), 0.90 (95% CI: 0.86, 0.93), 123.2, and 0.97, respectively. 18F-NaF-based PET/CT was highly effective in detecting bone metastases during staging and restaging of patients with high-risk prostate cancer. The effectiveness of 18F-NaF-based PET/CT was superior to bone scintigraphy with technetium-99m and single-photon emission computed tomography (SPECT) and was comparable to diffusion-weighted imaging.ConclusionsPET/CT with 18F-NaF is a more accurate method of localizing and characterizing malignant bone lesions than SPECT. This method has improved clinical accuracy and provides greater convenience for patients and referring physicians. PET/CT with 18F-NaF in malignant neoplasms is a more specific, sensitive study than 18F-fluorodeoxyglucose PET/CT. These results were submitted to the Ministry of Health for a decision on the inclusion of 18F-NaF-based PET/CT in the state reimbursement system.

The diagnostic value of quantitative bone SPECT/CT in solitary undetermined bone lesions.

To investigate the diagnostic value of the maximum standard uptake value (SUVmax) of quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) in solitary undetermined bone lesions. In Part I, retrospective study, 167 untreated patients with extra-skeletal malignant tumors by pathology were consecutively enrolled for staging with Tc-99m methyl-diphosphonate (99mTc-MDP) whole-body bone scan (WBS) and quantitative SPECT/CT, and a total of 396 bone lesions with abnormal radioactivity concentration in 167 patients were included from April 2019 to September 2020. The differences in SUVmax among the benign bone lesions, malignant bone lesions, and normal vertebrae were analyzed. The receiver operating characteristic (ROC) curve and cutoff value of SUVmax were obtained. Part II, prospective study, 49 solitary undetermined bone lesions in SPECT/CT in 49 untreated patients with extra-skeletal malignant tumors were enrolled from October 2020 to August 2022. The diagnostic efficacy of SUVmax in solitary undetermined bone lesions was assessed. The final diagnosis was based on follow-up imaging (CT, MRI, or 2-deoxy-2-[18F]fluoro-D-glucose-positron emission tomography/computed tomography) for at least 12 months. In Part I, a total of 156 malignant and 240 benign bone lesions was determined; the SUVmax of malignant lesions (26.49 ± 12.63) was significantly higher than those of benign lesions (13.92 ± 7.16) and normal vertebrae (6.97 ± 1.52) (P = 0.00). The diagnostic efficiency of the SUVmax of quantitative SPECT/CT revealed a sensitivity of 75.00% and a specificity of 81.70% at a cutoff value of 18.07. In Part II, 17 malignant and 32 benign lesions were determined. Using SUVmax ≥18.07 as a diagnostic criterion of malignancy, it has a sensitivity of 82.35%, a specificity of 93.75%, and an accuracy of 89.80%. The SUVmax of quantitative SPECT/CT is valuable in evaluating solitary undetermined bone lesions. Using a cutoff SUVmax value of 18.07, quantitative SPECT/CT demonstrated high sensitivity, specificity, and accuracy in differentiating malignant from benign bone lesions.

Relative fat fraction of malignant bone lesions from breast cancer, prostate cancer and myeloma are significantly lower than normal bone marrow and shows excellent interobserver agreement.

To compare relative fat fraction (rFF) of active bone lesions from breast, prostate and myeloma malignancies and normal bone marrow; to assess its inter-reader agreement. Patients with breast (n = 26), myeloma (n = 32) and prostate cancer (n = 52) were retrospectively evaluated. 110 baseline rFF maps from whole-body MRI were reviewed by two radiologists. Regions of interest for up to four focal active lesions in each patient were drawn on rFF maps, one each at the cervicothoracic spine, lumbosacral spine, pelvis and extremity. The mean and standard deviation of rFF were recorded. The rFF of normal marrow was measured in the pelvis for patients without diffuse bone disease (n = 88). We compared the rFF of malignant bone lesions and normal marrow using Mann-Whitney test. Interobserver agreement was assessed by interclass correlation coefficient. Malignant bone lesions showed significantly lower median rFF (13.87%) compared with normal marrow (89.76%) with little overlap (p < 0.0001). There was no significant difference in the median rFF of malignant lesions from breast (14.46%), myeloma (13.12%) and prostate cancer (13.67%) (p > 0.017, Bonferroni correction) and in the median rFF of bone disease according to their anatomical locations (p > 0.008, Bonferroni correction). There was excellent interobserver agreement (0.95). The low rFF of active bone lesions in breast, prostate and myeloma malignancies provides high image contrast relative to normal marrow that may be used to detect bone metastases. This study shows the importance of rFF towards detecting bone metastases.

Usefulness of Diffusion Weighted MRI in Differentiating Benign from Malignant Bone Lesions

Background Bone tumors represent a wide spectrum of disease in children &amp; adult ranging from benign lesions to an aggressive malignancy, so finding a noninvasive diagnostic tool was needed. Objective We aimed to differentiate between benign and malignant bone lesions and to limits the number of patient with benign lesion who undergo biopsy. Patients and Methods Our study was carried out on 32 patients were diagnosed with bone tumors (21 benign &amp; 11 malignant), at the MRI unit of the Radiology Department Ain Shams University, outpatient clinics and private centers after getting approval from each ethical committee. They were assessed with conventional &amp; diffusion MR images, DW EPI carried out using different b values including 0 s/ mm², 500 s/ mm², and 800 s/ mm². ADC map were automatically calculated. Results The mean ADC value for benign tumors was 1.6±0.4 x 10 -3 mm2/s. while malignant tumors were 1.2±0.3 x 10 -3 mm2/s. ROC analysis was used to define the best cut off mean ADC value for detecting malignancy which was &amp;lt;1.3, with sensitivity of 81.8% specificity of 81%. Conclusion The present study showed high specificity and sensitivity of DWI as a complementary sequence with conventional MRI and ADC value measurements in discrimination between benign and malignant bone tumors with significant cut-off value, making it a noninvasive tool for increasing the accuracy in identifying bone lesions.

Deep learning image segmentation approaches for malignant bone lesions: a systematic review and meta-analysis.

Image segmentation is an important process for quantifying characteristics of malignant bone lesions, but this task is challenging and laborious for radiologists. Deep learning has shown promise in automating image segmentation in radiology, including for malignant bone lesions. The purpose of this review is to investigate deep learning-based image segmentation methods for malignant bone lesions on Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron-Emission Tomography/CT (PET/CT). The literature search of deep learning-based image segmentation of malignant bony lesions on CT and MRI was conducted in PubMed, Embase, Web of Science, and Scopus electronic databases following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 41 original articles published between February 2017 and March 2023 were included in the review. The majority of papers studied MRI, followed by CT, PET/CT, and PET/MRI. There was relatively even distribution of papers studying primary vs. secondary malignancies, as well as utilizing 3-dimensional vs. 2-dimensional data. Many papers utilize custom built models as a modification or variation of U-Net. The most common metric for evaluation was the dice similarity coefficient (DSC). Most models achieved a DSC above 0.6, with medians for all imaging modalities between 0.85-0.9. Deep learning methods show promising ability to segment malignant osseous lesions on CT, MRI, and PET/CT. Some strategies which are commonly applied to help improve performance include data augmentation, utilization of large public datasets, preprocessing including denoising and cropping, and U-Net architecture modification. Future directions include overcoming dataset and annotation homogeneity and generalizing for clinical applicability.

Osteoma infiltrated by schwannoma in sinonasal region: radiologically masquerading as a malign tumor

Neoplasms in sinonasal cavity are dominated by epithelial type. Sinonasal osteomas are common, benign, slow-growing, often asymptomatic neoplasms occurring mainly in the frontal and ethmoid sinuses. Peripheral nevre sheath tumors are soft tissue neoplasms rarely encountered in the sinonasal region. Schwannoma is a benign peripheral nevre sheath tumor. Here, we presented co-occurence of osteoma and schwannoma. So far, osteoma infiltrated by schwannoma in sinonasal region is not reported in English literature. Additionally it was masquerading as malignant tumor radiologically. The pathologist should be aware of a second soft-tissue tumor that may accompanied the radiologically suspicious malignant bone lesions.

HIGH - GRADE OSTEOBLASTIC OSTEOSARCOMA OF THE MAXILLA: DIAGNOSIS, TREATMENT, AND BUCCOMAXILLOFACIAL REHABILITATION

Osteosarcoma is one of the most common malignant bone lesions; however, it comprises only 6%-8% of all osteosarcomas. It is a lesion commonly found between the third and fourth decade of life, in addition to having a similar proportion of appearing between the mandible and maxilla. This study aims to report the case of a 64-year-old Caucasian female patient, affected by a high-grade osteoblastic osteosarcoma. The patient presented an edema in the posterior region of the maxilla, paresthesia, and nasal obstruction. Panoramic radiography and CT scans, along with anatomopathological examination, were performed. Histopathologically, an intense volume of osteoid was found. Left radial maxillectomy was the chosen treatment. The patient was first rehabilitated with a provisional palatal obturator prosthesis in order to improve her nutritional status. Her rehabilitation was planned and accomplished with a mandibular removable partial denture and a maxillary removable partial obturator denture. Osteosarcoma is one of the most common malignant bone lesions; however, it comprises only 6%-8% of all osteosarcomas. It is a lesion commonly found between the third and fourth decade of life, in addition to having a similar proportion of appearing between the mandible and maxilla. This study aims to report the case of a 64-year-old Caucasian female patient, affected by a high-grade osteoblastic osteosarcoma. The patient presented an edema in the posterior region of the maxilla, paresthesia, and nasal obstruction. Panoramic radiography and CT scans, along with anatomopathological examination, were performed. Histopathologically, an intense volume of osteoid was found. Left radial maxillectomy was the chosen treatment. The patient was first rehabilitated with a provisional palatal obturator prosthesis in order to improve her nutritional status. Her rehabilitation was planned and accomplished with a mandibular removable partial denture and a maxillary removable partial obturator denture.

Orthopaedic applications of cold physical plasma.

Cold physical plasma (CPP) technology is of high promise for various medical applications. The interplay of specific components of physical plasma with living cells, tissues and organs on a structural and functional level is of paramount interest with the aim to induce therapeutic effects in a controlled and replicable fashion. In contrast to other medical disciplines such as dermatology and oromaxillofacial surgery, research reports on CPP application in orthopaedics are scarce. The present implementation of CPP in orthopaedics involves surface modifications of orthopaedic materials and biomaterials to optimize osseointegration. In addition, the influence of CPP on musculoskeletal cells and tissues is a focus of research, including possible adverse reactions and side effects. Its bactericidal aspects make CPP an attractive supplement to current treatment regimens in case of microbial inflammations such as periprosthetic joint infections. Attributed anticancerogenic and pro-apoptotic effects underline the clinical relevance of CPP as an additive in treating malignant bone lesions. The present review outlines ongoing research in orthopaedics involving CPP; it distinguishes considerations for safe application and the need for more evidence-based research to facilitate robust clinical implementation.

Malignant Bone and Soft Tissue Lesions of the Foot.

Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed by a properly performed biopsy, is thus mandatory to avoid these pitfalls. The present article reviews the most common malignant bone and soft tissue lesions of the foot region, discussing their clinicopathological presentation, imaging features, and current concepts in treatment.

Machine learning and magnetic resonance imaging: Differentiating benign from malignant osseous tumors.

Radiomics and machine learning applied to the isolated cartilaginous bone lesion on magnetic resonance imaging (MRI) is increasingly useful to distinguish malignant versus benign bone lesions, to determine whether repetitive imaging over time, to determine dynamic expansion, or immediate excisional biopsy are indicated.