Osseous Involvement Research Articles

Multiple hepatic and osseous focal lesions without splenomegaly and/or lymph nodes enlargement

BackgroundHepatic involvement is a common extranodal manifestation of common and some rare hematologic malignancies. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Imaging has an important role in the diagnosis of hepatic focal lesions.Case presentationA case presented with isolated multiple hepatic focal lesions without nodal or spleen enlargement diagnosed only by immunohistochemical study and turned out to be primary hepatic lymphoma (PHL). PHL is rare with roughly 100 described cases and accounts for less than 1% of all non-Hodgkin lymphomas. Osseous involvement adds more challenge to the diagnosis.ConclusionHepatologists must be aware of PHL as it may be confused with more common hepatic diseases, mainly multifocal HCC and/or hepatic metastasis.

Prognostic factors in endometrial cancer patients with bone metastasis.

This study aims to examine the pattern and prognosis of osseous involvement and the role of orthopedic surgery in patients with endometrial cancer (EC) and to evaluate the quality of life, local tumor control, and survival of patients. Between January 2011 and December 2018, a total of 14 patients (median age: 60.5 years; range, 55 to 73 years) who were surgically treated for osseous metastasis of EC and followed for minimum 12 months were retrospectively analyzed. All patients were evaluated for their primary malignancy, characteristics of bone metastasis, and type of treatment related to musculoskeletal involvement. For evaluating the functional outcomes, the Visual Analog Scale (VAS) for pain and Eastern Cooperative Oncology Group (ECOG) performance status scale were used in the pre- and postoperative period. The median follow-up was 34.5 (range, 9 to 89) months. All patients had advanced-stage disease (FIGO Stage III-IV). Four patients had solitary and 10 patients had multiple bone metastases. The mean VAS score and ECOG performance status grades improved (p<0.001 and p<0.05, respectively). The median survival after detection of bone metastasis was 61 (range, 41 to 82) months. Endometrial cancer patients with musculoskeletal pain should be investigated for the possibility of bone metastasis to tailor a prompt treatment and to achieve a better prognosis. Appropriate surgical treatment of bone metastasis may improve both pain and performance status in carefully selected patients.

Thrombocytopenia As a Risk Factor for Developing Febrile Neutropenia in Patients with DLBCL Receiving R-CHOP Chemotherapy

Background: Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is currently the standard of care for diffuse large B-cell lymphoma (DLBCL). Although heterogeneous, approximately 60 % of patients are cured while 10% of patient's refractory to initial chemotherapy. These outcomes are highly dependent on the dose intensity of chemotherapy received with poor outcomes associated with reduced dose intensity. Febrile neutropenia is one of the most common adverse events experienced leading to dose delays and interruptions. Therefore, we planned to evaluate the incidence of febrile neutropenia, its influence on delaying chemotherapy doses, and the need for subsequent growth factor support. We also planned to identify risk factors for the development of febrile neutropenia after the initiation of chemotherapy. Methods: We conducted a single-center retrospective study including adults with newly diagnosed DLBCL initiating R-CHOP-21 chemotherapy without growth factor support between dates January 2016 to February 2021 at the University of Alabama at Birmingham. We extracted baseline clinical and demographic variables (age, sex, race, stage, bulky disease > 7.5 cm, number of extranodal sites, osseous or bone marrow involvement, presence of B-symptoms, ECOG score, height, weight) and laboratory variables (absolute lymphocyte count, absolute neutrophil count, absolute monocyte count, platelets, lactate dehydrogenase, albumin, and creatinine) within 7 days of initiating treatment. The outcome variable was the development of febrile neutropenia during treatment. We used a multivariate regression model to identify risk factors for the development of febrile neutropenia adjusted for demographic and laboratory covariates listed above. Collinearity amongst variables was evaluated and highly correlated variables were excluded. The hypothesis testing was two-sided, and the level of significance was chosen as 0.05. Results: Of the 257 patients with a diagnosis of DLBCL, 149 patients met the inclusion criteria and were included in our cohort. The median age at diagnosis was 60 yrs (IQR 50 - 68) with 61% male and 77% white. Stage I/II was present in 33% of patients with bulky disease in 32% pts and 17% with involvement of the bone or bone marrow at diagnosis. The ECOG PS was less than 2 in 82% of patients with only 17% of patients endorsing B symptoms prior to treatment. Delays in treatment by more than 3 days were seen in 49 pts (32%) and 32 pts(21%) had delays of more than 7 days. Treatment discontinuation due to toxicity or death was seen in 19 pts (13%). Febrile neutropenia was experienced by 17 pts (11%) requiring subsequent growth factor support in 8 pts and leading to subsequent delays in treatment in all but one patient. Increasing platelet count (Odds Ratio, OR 0.91; 95%CI 0.84 - 0.98; p value 0.02) was associated with a decreased risk of developing febrile neutropenia during treatment. Conclusions: R-CHOP chemotherapy is generally well-tolerated, however, febrile neutropenia remains the most-common toxicity occurring in approximately 11% of patients and leads to associated treatment delays. Lower platelet count prior to initiation of chemotherapy was identified as a risk factor for developing febrile neutropenia adjusted for other known variables of bone marrow function. Therefore, future predictive models of febrile neutropenia in DLBCL should include baseline platelet count as a feature. Affiliations: 1. The Joe R. and Teresa Lozano Long School of Medicine, San Antonio, TX 2. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 3. Mays Cancer Center, UT San Antonio, San Antonio, TX 4. Division of Hematology and Oncology, Department of Medicine, O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Primary Epithelioid Pulmonary Angiosarcoma with WAIHA and Thrombocytopenia: A Rare Association

Abstract Introduction/Objective Angiosarcomas accounts for approximately 1%-2% of sarcomas, particularly involving the deep soft tissue. As a subtype, primary epithelioid angiosarcoma is an extremely rare neoplasm. Herein, we present an unusual primary epithelioid angiosarcoma of the right upper lung lobe with multiple nodal and bony metastases and associated severe form of autoimmune hemolytic anemia (WAIHA) and thrombocytopenia. Methods/Case Report Our case is a 79-year-old female with a recent onset of warm type autoimmune hemolytic anemia with positive coombs test and thrombocytopenia. The patient serum was also positive for EBV (IgG and IgM). On chest CT scan, a right upper lobe, metabolically active lung mass with mediastinal lymphadenopathy was found. Metabolically active bilateral osseous lesions identified within thoracic spine, ribs, bilateral humeri and femurs. A transbronchial core biopsy of the lung mass revealed poorly differentiated epithelioid hemorrhagic neoplasm with extensive necrosis and vascular background. The tumor cells are positive for AE1/AE3, CK7, FLI-1, BRG1 (SMARCA4, retained), and vimentin; and faint weak focal membranous staining for CD31, Factor VIII, and ERG. They are negative for CK20, TTF-1, Napsin-A, p63, p40, SMA, Melan-A, HMB45, GATA3, PAX-8, CDX-2, HepPar, synaptophysin, calretinin, CAMTA1, EBER (EBV) and S100 (Figure-1-A-D, H&amp;E, 10X, CK AE2/AE3, FLI-1, CD31). This immunoprofile and histologic features favor epithelioid angiosarcoma. Results (if a Case Study enter NA) NA. Conclusion Comprehensive morphological and immunohistochemical findings supported the diagnosis of epithelioid angiosarcoma. The importance of reporting this case was the unusual pulmonary primary presentation, associated nodal and osseous secondary involvement, together with the unique systemic presentation with warm autoimmune hemolytic anemia and thrombocytopenia in a patient with active EBV infection.

Classic cytomorphological features of Langerhans cell histiocytosis with osseous involvement.

Classic cytomorphological features of Langerhans cell histiocytosis with osseous involvement.

Cystic lesions of the humeral head on magnetic resonance imaging: a pictorial review.

Cystic lesions of the humeral head are commonly encountered on routine shoulder magnetic resonance imaging (MRI). Differential diagnoses include degenerative lesions, calcific tendinitis with osseous involvement, perianchor cysts, abscesses and less often, tumours. Degenerative lesions, including subcortical and subchondral cysts, are the most commonly encountered. These may be associated with rotator cuff disease and degenerative joint diseases or considered part of ageing depending on the location of the cystic lesions. For instance, cysts of the bare area of the humeral head are considered benign age-related entities, whereas cysts of the greater or lesser tuberosity may herald rotator cuff disease. Infectious lesions, particularly osteomyelitis and intraosseous (Brodie’s) abscesses, are intramedullary in location and should be suspected in the context of clinical features such as fever and radiological features such as the penumbra sign. Perianchor cysts are postoperative lesions associated with the use of suture anchors in surgeries such as rotator cuff tear repairs. They generally self-resolve over 18 to 24 months. On MRI, the distribution, morphology, and signal characteristics can help point towards a specific diagnosis. The patient’s demographic, clinical presentation, and past surgical history can be discriminatory. Knowledge of different cystic lesions in the humeral head and underlying aetiology can be useful in helping the radiologist develop a more thorough search pattern for associated conditions. Determining the underlying cause of cysts can have important implications on management, such as when differentiating perianchor cysts from infection. This pictorial review outlines the differential diagnoses of humeral head cysts on MRI and provides a diagnostic approach for the radiologist.

Interventional Palliation of Painful Extraspinal Musculoskeletal Metastases.

The musculoskeletal system is commonly involved by metastases, and skeletal-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a result of nerve compression often adversely affect patient's quality of life. There have been substantial advances in percutaneous minimally invasive musculoskeletal oncologic interventions for the management of patients with musculoskeletal metastases including thermal ablations, cementation with or without osseous reinforcement via implants, osteosynthesis, neurolysis, and palliative injections which are progressively incorporated in clinical practice. These interventions are performed, in conjunction with or supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesics, to achieve durable pain palliation, local tumor control, or cure. This article reviews minimally invasive percutaneous image-guided musculoskeletal oncologic interventions for the management of patients with extraspinal musculoskeletal metastases.

Isolated Sacral Sarcoidosis a Hidden Cause of Sciatica: Case Report and Brief Review of the Literature

Bone involvement in sarcoidosis is rare; its estimated prevalence ranges between 3 and 13%. Osseous lesions usually occur in the phalanges of the hands and feet. Involvement of the axial skeleton is more uncommon. Osseous involvement may be asymptomatic. It is often incidentally discovered on imaging modalities. Radiological techniques can reveal sclerotic and/or destructive lesions. We present a case of a 61-year-old woman in whom osseous sarcoidosis of the sacrum was revealed by back pain and sciatica. To our knowledge, only one isolated case of sacral sarcoidosis has been reported in the literature. Sarcoid bone lesions can be present at disease onset without pulmonary involvement. A biopsy is often required in order to eliminate other conditions, especially malignancy. Treatment is not specific and also not needed in a significant number of cases.

MRI enhancement patterns in 28 cases of clival chordomas

Clival chordomas are classically thought of as locally aggressive tumors of the skull base and differentiate themselves from their benign counterparts by demonstrating moderate to marked contrast enhancement, reported as 95–100% in prior studies. The purpose of this review was to evaluate the imaging characteristics of lesions from a single institution classified as clival chordomas with an emphasis of highlighting lesions that do not follow the prevalent current description for chordoma. We searched our institutional databases for all patients with pathologically proven clival chordomas from 1997 to 2017 who had pre-operative imaging available. The images were evaluated for degree of contrast enhancement, MRI signal characteristics, osseous involvement, location, aggressiveness of appearance, and presence of calcifications. 28 cases were identified that had preoperative imaging available for review. Over half of the patients demonstrated either no/minimal (11/28, 39%) or mild enhancement (7/28, 25%). The remaining cases demonstrated moderate (4/28, 14%) and marked enhancement (6/28, 21%). The 4 lesions measuring less than 20 mm all had mild to minimal/no enhancement and lacked aggressive features on CT. Our experience finds that over half (64%) of clival chordomas will demonstrate mild or no enhancement at all. These findings suggest that the lack of MRI contrast enhancement should not be synonymous with a benign clival mass.

ISOLATED PRIMARY TUBERCULOSIS OF VASTUS LATERALIS MUSCLE IN SEVERE OSTEOARTHRITIS PATIENT: A CASE REPORT

Extra pulmonary Tuberculosis involving soft tissues and affecting the joints and surrounding structures (tuberculous arthritis) is well known. However, Tubercular myositis is a rare condition with skeletal muscle involvement without underlying osseous or extra osseous involvement in extremely rare presentation. Due to atypical presentation the diagnosis is often delayed. We report and present a case of isolated tubercular myositis of Vastus lateralis muscle in severe osteo arthritis knee patient without evidence of any primary focus.

Adult Langerhans Cell Histiocytosis and the Skeleton.

Langerhans cell histiocytosis (LCH) is a rare inflammatory neoplasia in which somatic mutations in components of the MAPK/ERK pathway have been identified. Osseous involvement is evident in approximately 80% of all patients and may present as a single osteolytic lesion, as a multi-ostotic single system disease or as part of multisystem disease. Both exogenous, such as treatment with glucocorticoids, and endogenous parameters, such as anterior pituitary hormone deficiencies and inflammatory cytokines, may severely affect bone metabolism in LCH. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually required to precisely assess the degree of bone involvement; 18F-fluorodeoxyglucose (FDG) positron emission tomography—CT can both detect otherwise undetectable LCH lesions and differentiate metabolically active from inactive or resolved disease, while concomitantly being useful in the assessment of treatment response. Treatment of skeletal involvement may vary depending on location, extent, size, and symptoms of the disease from close observation and follow-up in unifocal single-system disease to chemotherapy and gene-targeted treatment in cases with multisystem involvement. In any case of osseous involvement, bisphosphonates might be considered as a treatment option especially if pain relief is urgently needed. Finally, a patient-specific approach is suggested to avoid unnecessary extensive surgical interventions and/or medical overtreatment.

Adult Pulmonary Langerhans Cell Histiocytosis with Osseous Involvement: understanding this rare mimic of malignancy

Langerhans cells are dendritic cells that form the antigenic barrier of the human body. They occur in nearly any tissue but are most prevalent in the skin, submucosa of the bronchial tree, and other mucosae. Langerhans Cell Histiocytosis (LCH) develops when these cells damage the tissues in which they reside through a combination of inflammatory and monoclonal stimulation. The pulmonary variant of LCH involves the lung parenchyma and creates a wide variety of disturbances: pulmonary hypertension and both obstructive and restrictive lung disease. Osseous involvement, in addition to the pulmonary variant, presents with pulmonary masses and lytic bone lesions, which sparks suspicion for malignancy. Early recognition of this rare pathology is important as early treatment is clinically beneficial. The following explores a case of adult Pulmonary Langerhans Cell Histiocytosis with osseous involvement.

A Study of Temporomandibular Joint Osteoarthritis and Rheumatoid Arthritis using Computed Tomographic Imaging

Context: Computed tomography (CT) and magnetic resonance imaging are widely used tools for imaging the temporomandibular joints (TMJs) in patients with temporomandibular disorders, in particular, for assessing degenerative bony changes, disc position and configuration, and presence of effusion in joint spaces and bone marrow edema. Aim: The present study was undertaken to evaluate osseous changes in TMJs secondary to osteoarthritis (OA) and rheumatoid arthritis (RA) using CT. Settings and Design: The present study included 40 patients including 20 patients each with OA and RA, wherein the patients were selected from the outpatient department with known history of OA and RA. Materials and Methods: Twenty patients each with OA and RA were subjected to a detailed examination, routine radiography, and CT imaging of the TMJs, while images were evaluated for presence of osteophytes, flattening of articular surfaces, sclerosis, and narrowing of joint space. Statistical Analysis Used: Statistical analysis was done using Statistical Product and Service Solutions (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA) while Mann–Whitney U test and Wilcoxon signed–rank test were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Flattening and narrowing of joint space were seen in both types of arthritides; however, a relatively higher percentage of such patients were seen in the RA group. Similarly, osteophytes, though, seen in both types of arthritides, were predominantly seen in patients with OA. Conclusions: OA and RA in TMJs are two most commonly seen conditions which can impair functional capacity of entire masticatory system. Their in-depth clinical and radiological evaluation is a must to assess disease activity. Similarly, CT is a valuable tool in assessing osseous abnormalities and should be used in cases wherein osseous involvement of TMJs is suspected.

Sidebar: Community-driven Approaches to Preventing Overdoses Among American Indians.

### BACKGROUND AND PURPOSE: Spinal instrumentation plays a key role in the treatment of spinal instability in patients with metastatic tumors. Poor bone quality, radiation, and diffuse osseous tumor involvement present significant challenges to spinal stabilization with instrumentation and occasionally result in postinstrumentation compression fractures. Vertebral cement augmentation has been effective in the treatment of painful tumor-related compression fractures. Our objective was to describe cement augmentation options in the treatment of vertebral compression fractures associated with spinal instrumentation in patients with metastatic tumors. ### MATERIALS AND METHODS: Patients who underwent percutaneous vertebral cement augmentation in the treatment of instrumentation-associated vertebral compression fractures between 2005 and 2011 were included in the analysis. Only fractures that occurred within the construct or at an adjacent level were included. The change in Visual Analog Scale and need for further surgery were analyzed. ### RESULTS: Eleven patients met the inclusion criteria, with 8 tumors located in the thoracic spine and 3 tumors in the lumbar spine. The median time between instrumented surgery and vertebral augmentation was 5 months (1--48 months) and the median follow-up after cement augmentation was 24 months (4--59 months). A total of 22 vertebrae that were either within or immediately adjacent to the surgical instrumentation underwent vertebral augmentation. All patients reported a decrease in their pain scores (mean decrease: 6 Visual Analog Scale points; *P* \< .003). One patient required reoperation after cement augmentation. None of the patients experienced vertebral cement augmentation--related complications. ### CONCLUSIONS: Vertebral cement augmentation represents a safe and effective treatment option in patients with recurrent or progressive back pain and instrumentation-associated vertebral compression fractures.

Outcomes With Local Therapy and Tyrosine Kinase Inhibition in Patients With ALK/ROS1/RET-Rearranged Lung Cancers

Local therapy (LTX) prolongs progression-free and overall survival (OS) in patients with oligometastatic non-small cell lung cancer. We previously reported substantial LTX benefit in time to progression or next therapy (TTP/TTNT) in patients with EGFR-mutant lung adenocarcinoma treated with tyrosine kinase inhibitors (TKI). Here, we investigate the role of LTX in patients who progressed on TKI for ALK/ROS1/RET-rearranged stage IV lung adenocarcinoma.This single-institution IRB-approved retrospective review included all patients with pathologically confirmed stage IV ALK/ROS1-rearranged or RET fusion-positive lung adenocarcinoma who underwent radiation therapy (RT), surgery, or percutaneous thermal ablation (PTA) from 2012 to 2020 for progressive disease (PD) while on an ALK, ROS1, or RET TKI and for whom TKI therapy was continued post LTX. Patients receiving consolidative LTX after initial response to TKI without PD were not included. PD was classified as solitary- (one site), oligo- (2-5 sites), or poly- (> 5 sites) PD. TTP and TTNT were measured from start of any LTX. OS was evaluated from start of first LTX and from diagnosis. Significance was assessed with the Kruskal-Wallis test and Cox Univariate Analysis.61 eligible patients (37 ALK, 12 ROS1, 12 RET; 37 female, median age 62 at LTX) were identified. Most common TKIs were alectinib (34), selpercatinib (17), and crizotinib (11). 92% of patients underwent RT (82 RT courses: median dose 27 Gy, 72% ≤5 fractions), 13% and 8% underwent surgery and PTA, respectively, with 13% undergoing > 1 LTX modality. In 87% of interventions, LTX addressed all sites of PD. PD prior to LTX was predominantly oligoPD (94%). Most frequent LTX sites were brain (41%), bone (28%), and lung (27%). Subsequent PD after LTX was also mostly oligoPD (81%; 38% solitary). In-field local failure occurred in 19%. Median follow-up post LTX was 18 mo. Median TTP and TTNT from LTX were 5.1 and 7.8 mo, respectively. TTP and TTNT were not significantly different in the sub-cohort in which all sites of PD were treated with LTX. Median OS was 51 mo from diagnosis and 19.4 mo from first LTX. TTP was significantly shorter for ≥3rd LTX course v. < 3rd LTX course (2.3 v. 6.0 mo; P = 0.006). TTNT was significantly longer for patients on first line TKI v. ≥2nd line (9.0 v. 5.2 mo, P = 0.04). Factors associated with shorter TTP were osseous disease prior to LTX (HR 1.7; P = 0.03) and ≥3rd LTX course (HR 5.1; P < 0.001). Factors associated with shorter TTNT were osseous (HR 1.7; P = 0.04) and leptomeningeal (HR 7.3; P = 0.003) involvement prior to LTX, and polyprogression prior to LTX (HR 2.7; P = 0.04).Local therapy for PD on ALK, ROS1 or RET TKIs was associated with clinically meaningful time on continued TKI therapy beyond progression.

A large femoral primary cutaneous Ewing's sarcoma in a 35-year-old woman: Case report.

IntroductionExtraskeletal Ewing's sarcoma is a rare malignant tumor of mesenchymal origin, which is histologically similar to primary osseous Ewing's sarcoma. It has been well described in deep soft tissues. However, location in cutaneous or subcutaneous tissue has rarely been reported. Being seen principally in children, it can be seen, rarely, in old men.Case presentationWe present a case of large primary cutaneous Ewing sarcoma within the left thigh of a 35-year-old woman, without osseous involvement. Physical examination. Histologically, it was a small round cell tumor that marked strongly for CD99. The diagnosis of cutaneous Ewing sarcoma was performed.DiscussionThe things that distinguish our case are that it is the first case in Syria, in addition to the size of the large tumor with diameters of 15 × 20 cm, and it is in a 35-year-old woman.ConclusionEwing sarcoma is a rare malignant small round cell tumor of the skin and subcutaneous tissue. It should be differentiated from other cutaneous neoplasms composed of small round cells.

Primary Ewing's sarcoma with orbit involvement: Survival and visual outcomes after eye‐sparing multidisciplinary management in eight patients

To describe the clinical presentation, treatment, and overall prognosis in eight patients with primary Ewing's sarcoma (ES) involving the orbit. A retrospective interventional study of all biopsy-proven cases of primary ES involving the orbit was done. There were seven males and one female with a median age of 14 years. Imaging showed osseous involvement in all eight cases with extraorbital extension in four. Complete tumor resection was done in four, partial resection in three, and biopsy followed by sinus surgery in one. EWSR1 gene rearrangement analysis was done to confirm diagnosis. All patients received multidrug systemic chemotherapy and seven patients received adjuvant radiotherapy. Eye salvage was achieved in all patients. At a mean follow-up duration of 52.63 months, seven patients were doing well with no evidence of disease. ES involving the orbit is sensitive to chemotherapy and radiation. Aggressive multimodality treatment can help salvage the globe and improve overall survival.

Who Needs Surgical Stabilization for Pyogenic Spondylodiscitis? Retrospective Analysis of Non-Surgically Treated Patients.

Retrospective case series analysis. To identify relevant clinical and radiographic markers for patients presenting with infectious spondylo-discitis associated with spinal instability directly related to the infectious process. We evaluated patients presenting with de-novo intervertebral discitis or vertebral osteomyelitis /discitis (VOD) who initiated non-surgical treatment. Patients who failed conservative treatment and required stabilization surgery within 90 days were defined as "failed treatment group" (FTG). Patients who experienced an uneventful course served as controls and were labeled as "nonsurgical group" (NSG). A wide array of baseline clinical and radiographic parameters was retrieved and compared between 2 groups. Overall 35 patients had initiated non-surgical treatment for VOD. 25 patients had an uneventful course (NSG), while 10 patients failed conservative treatment ("FTG") within 90 days. Factors found to be associated with poorer outcome were intra-venous drug abuse (IVDA) as well as the presence of fever upon initial presentation. Radiographically, involvement of the same-level facets and the extent of caudal and rostral VB involvement in both MRI and CT were found to be significantly associated with poorer clinical and radiographic outcome. We show that clinical factors such as IVDA status and fever as well as the extent of osseous and posterior element involvement may prove to be helpful in favoring surgical treatment early on in the management of spinal infections.

Bone Metastases: State of the Art in Minimally Invasive Interventional Oncology.

Bone is the third most common site involved by cancer metastases, and skeleton-related events such as intractable pain due to direct osseous tumor involvement, pathologic fracture, and neurologic deficits as a consequence of nerve or spinal cord compression often affect patients' functional independence and quality of life unfavorably. The annual medical-economic burden related to bone metastases is a substantial component of the total direct medical cost estimated by the National Institutes of Health. There have been substantial recent advances in percutaneous image-guided minimally invasive musculoskeletal oncologic interventions for the management of patients with osseous metastatic disease. These advances include thermal ablation, cementation with or without osseous reinforcement with implants, osteosynthesis, thermal and chemical neurolyses, and palliative injections, which are progressively incorporated into the management paradigm for such patients. These interventions are performed in conjunction with or are supplemented by adjuvant radiation therapy, systemic therapy, surgery, or analgesic agents to achieve durable pain palliation, local tumor control, or cure, and they provide a robust armamentarium for interventional radiologists to achieve safe and effective treatment in a multidisciplinary setting. In addition, these procedures are shifting the patient management paradigm in modern-era practice. The authors detail the state of the art in minimally invasive percutaneous image-guided musculoskeletal oncologic interventions and the role of radiologists in managing patients with skeletal metastases. ©RSNA, 2021.

Erdheim-Chester Disease with Pulmonary and Osseous Involvement.

Erdheim-Chester Disease with Pulmonary and Osseous Involvement.