Osseous Tumors Research Articles

Intraosseous schwannoma of the proximal humerus with pathologic fracture

BackgroundIntraosseous schwannomas are extremely rare in the humerus, and less than five cases have been reported previously in the literature. This is the first report of its origin in the proximal humerus with pathologic fracture. We herein present this case to discuss the reason for its rarity and share our experience of management.Case presentationA 55-year-old female patient presented with pain in the right shoulder, which was caused by tripping and falling over a board. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) showed considerable tumor in proximal humerus, which connected with a fracture. For this suspected tumor, we performed two operations. Pathological examination demonstrated typical picture of a schwannoma, showing whorls and interlacing fascicles of schwannoma spindle cells. Immunohistochemistry, the tumor cells were diffusely positive for S-100 protein, SOX-10 and CD68, while they were completely negative for desmin, DOG-1, AE1/AE3 and P63. The Ki-67 index was about 10%. No mitoses or features of malignancy were identified. The final diagnosis of intraosseous schwannoma was made. The treatment for intraosseous schwannoma with pathologic fracture includes excisional biopsy, curettage, bone allograft, and fracture fixation. The patient recovered well. After the surgery, the patient gradually regained mobility and the pain subsided. There was no recurrence after 6 months of follow-up by X-ray.ConclusionsAlthough very rare, intraosseous schwannoma should be taken under consideration in the differential diagnosis of benign-appearing osseous tumor in the proximal humerus with pathologic fracture.

Osseous Tumor Reporting and Data System-Multireader Validation Study.

To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management. In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity. Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively. Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.

A STUDY OF FINE NEEDLE ASPIRATION CYTOLOGY SMEARS OF UPPER AND LOWER LIMB SOFT TISSUE LESIONS.

BACKGROUND: Soft tissue tumours constitute a large and heterogeneous group of neoplasms. Most soft tissue tumors in the upper extremity are benign, and soft tissue sarcomas are rare in the hand and wrist. Supercial soft-tissue masses are among the most common indications for imaging of the extremities. A broad array of benign and malignant processes may be manifested in palpable cutaneous or subcutaneous masses or nodules. In tertiary care set up both imaging and FNAC can play a vital role in preliminary diagnosis of soft tissue lesions of the extremities by differentiating them from cutaneous vs. non cutaneous, osseous vs. non osseous tumors. METHODS: A prospective study was conducted in the Department of Pathology, Government general hospital Nizamabad, Telangana ,during March 2017 to March 2019 that evaluated 50 patients with history of swelling in upper and lower limb had been evaluated . Detailed history, thorough clinical examination, Imaging, Fine needle aspiration cytology was performed in all the 50 Patients. Aspiration smears were stained with Hematoxylin and Eosin and microscopic examination done. RESULT: The patients aged from 10 to 75 years, average age at presentation was 41.2 yrs. Of total 50 cases 27 were upper limb (54%) and 23(46%) were lower limb lesions. Of both upper limb and lower limb lesions, Lipoma constituted most common lesion 20 cases(40%) with 16 cases of total 27 cases in upper limb (59%) making it most common benign soft tissue lesion in the upper limb. 4 cases(8%) out of 50 cases were diagnosed as spindle cell lesion undetermined/sarcoma and advised histo-pathological evaluation. CONCLUSION: A detailed evaluation of patients presenting with swelling in the upper and lower limb coupled with imaging and FNAC, in establishing the diagnosis required for further follow action was done. In most of the cases imaging coupled with FNAC gave better results but in some it required histo-pathological evaluation. FNAC was found to be an better modality for preliminary diagnosis along with radiology in decision making process for further surgical approach.

Extended Curettage for Giant Cell Tumors of Bone: A Surgeon's View.

The surgical procedure involves 4 essential components.(1) Surgical exposure and isolation of the soft tissues. The technique begins with a complete exposure that allows visualization of the entire tumor cavity. The initial part of the exposure involves getting to the bone and to the soft-tissue mass outside the bone, when present. The muscles are separated from the bone and retracted away from the soft-tissue component of the tumor. Soft tissue is adequately retracted to allow complete visualization of the tumor cavity. The tissues around the cavity are protected by placing hydrogen peroxide-soaked mops around the tumor cavity. The aim is to isolate the bone opening and avoid any contamination of soft tissue by the tumor, as hydrogen peroxide kills GCTB cells on contact1. The soft-tissue mass of the tumor is removed en bloc with a cover of normal tissue in order to prevent spillage into uninvolved tissues. Ward and Li advise the use of cautery for this part of the exposure in order to minimize contamination because high-temperature cautery kills the tumor2. The initial opening into the osseous tumor cavity is made smaller in order to control the tumor spillage, and then enlarged in order to gain complete visualization.(2) Curetting and burring for tumor clearance. The walls are curetted, using the sharp edges of the curet. Good visualization is the key to meticulous and complete curetting. We recommend the use of a surgical loupe and headlight for adequate visualization1. Tumor cavities often have overhanging osseous ridges with tumor hidden behind them. A curet may not be useful for breaking these hard osseous ridges; a burr is best utilized for this task. In addition to breaking the ridges, a high-speed burr helps to extend the curettage for a few millimeters beyond the grossly visible tumor margin3,4.(3) Use of adjuvants to achieve extended curettage. Various physical and chemical agents have been utilized to control the microscopic disease remaining in the walls following a thorough curettage. Liquid nitrogen, phenol, hydrogen peroxide, alcohol, electrocautery, bone cement, and argon plasma cautery have been utilized as adjuvants. Balke et al. showed that the rate of recurrence decreases with use of more adjuvants, with high-speed burring having the greatest effect on the rate of recurrence, likely as a result of the larger resection and the thermal effect of the burring5. We suggest a case-by-case use of specific adjuvants, but in our experience, a high-speed burr is always utilized, hydrogen peroxide is utilized commonly when safe, and argon-plasma cautery is utilized judiciously.(4) Reconstruction of the cavity. The defect may be filled with bone, cement, or a combination of both. We suggest an individual, case-by-case approach to the reconstruction. In cases in which >25% of the articular surface is undermined2, subchondral bone grafting is recommended prior to cementing (i.e., a sandwich procedure). GCTB requires tumor clearance for local control. One alternative to intralesional surgical treatment performed around the knee is resection of the tumor-affected segment of bone and reconstruction with an endoprosthesis. This is a joint-sacrificing alternative and, in our experience, should be reserved for patients with joint involvement, multiply recurrent disease, or insufficient remaining wall to curet. When adequate tumor clearance is possible, joint-salvaging intralesional surgical treatment remains the superior option to achieve physiological joint function6. Indications for this procedure include maintained or restorable joint congruity and construct stability allowing early mobilization. The rate of local recurrence following intralesional surgical treatment ranges from 16% to 25%1,7. The use of a high-speed burr is an essential part of the curettage5, and hydrogen peroxide is a safe choice for an adjuvant, if desired and when suitable, to provide greater local control8. Reconstruction with bone, cement, or both is acceptable, but we recommend building up a few millimeters of subchondral bone with bone graft before cement filling1,9. Illumination and magnification within the tumor cavity provide better visualization.Isolation of the soft tissue around the tumor with use of hydrogen peroxide-soaked mops can prevent seeding and contamination.Meticulous tumor clearance is more important to minimize recurrence than the use of adjuvants.Use of a C-arm helps to better guide extension of the curettage and avoid inadvertent joint penetration.Maintaining joint congruity is essential.

Resection of Benign Osseous Spine Tumors in Pediatric Patients by Minimally Invasive Techniques

Benign osseous tumors of the spine in children are a rare cause for surgery. The aim of this study is to describe our experience with resection of pediatric benign osseous spine tumors using a minimally invasive technique through a variety of surgical approaches. A retrospective review of prospectively collected data of pediatric patients who underwent minimally invasive resection of a benign osseous vertebral tumor from May 2013 through November 2018 was performed. Primary outcome measures included the extent of resection and pain resolution. Secondary outcomes included postoperative spinal instability evaluated by standing scoliosis x-rays and tumor recurrence evaluated by periodic follow-up magnetic resonance imaging scans. Our study group comprised 8 children, 3 males and 5 females, with a mean age of 12.2 years. The average follow-up period was 4.3 years. Complete removal of tumors was achieved in all cases and was verified by follow-up magnetic resonance imaging scans. There were no procedure-related complications. The average duration of surgery was 70 minutes, and the blood loss was less than 20 cc in all cases. The average inpatient length of stay was 1.6 days. Histopathology revealed osteoid osteoma in 6 patients and osteoblastoma in 2 patients. Average improvement of the pain scores was from 8 to 0.8. At the time of this report, no tumor recurrence was evident in all 8 patients and none of the cases developed spinal deformity. Our limited experience suggests that the minimally invasive technique is a valuable option for the surgical management of selected benign osseous spinal tumors in children.

SOFT TISSUE OSTEOCHONDROMA

<h3>Background</h3> Extraskeletal osteochondroma are rare soft tissue tumors occurring in extra-osseous and extrasynovial structures with features of enchondral ossification. Cases have been reported in the hands and feet but are extremely rare in head and neck region. This is a report of a rare case in an extrasynovial location in the head and neck. <h3>Case Report</h3> A 45-year-old male patient presented with a hard tissue lesion in the chin area, with duration >10 years. Bimanual palpation revealed a freely movable 3 × 2 mm feely movable cartilage-like lesion with no attachment to the mandible. A small protrusion through the skin of the chin area was observed. Imaging also revealed a hard tissue lesion lying within the soft tissue. The lesion was excised along with the skin surrounding it. Histology revealed an encapsulated benign lesion arranged in layers of fibrous tissue covering a cap of hyaline cartilage transitioning to trabecular bone with more maturity toward the skin. Features were consistent with a diagnosis of soft tissue osteochondroma. The patient is currently healthy about 14 months after lesion excision. <h3>Discussion</h3> Extraskeletal osteochondromas are believed to be derived pluripotent cells of joint synovium, tenosynovium, and connective tissue. Computed tomography scan helps in demonstrating its extraskeletal location and magnetic resonance imaging helps delineate its borders. Clinicohistopathologically, it has to be differentiated from pseudomalignant osseous tumors, myositis ossificans, ossifying fibromyxoid tumors, and sarcomas. Osteochondroma should be included in the differential diagnosis of some head and neck soft tissue calcified masses. Diagnosis will be aided by adequate imaging and histopathologic examination.

Clinical experience and treatment approaches in sinonasal osteomas from a Tertiary Care Hospital in Turkey

ObjectiveOsteomas are slow-growing benign osseous tumors that particularly located in the paranasal sinuses (PS). Here, we aimed to define the clinical symptoms and features, diagnostic conditions caused by osteomas located in four different PSs, to evaluate the surgical indications and methods, to compare the factors that can affect the surgical decision, radiological findings, and prognosis. Methods: The data of patients with paranasal sinus lesions and diagnosed as osteoma according to the radiological imaging, who applied to our clinic between 2010 and 2020, were retrospectively collected and re-evaluated in the light of clinical, radiological, and pathological data. Patients who underwent surgical treatments and were definitively diagnosed as osteoma by pathology were enrolled in this study. Results: We presented the data of 117 patients retrospectively. Most of these cases (n = 77, 65.8%) had an osteoma located in the frontal sinus, while 32 cases (27.4%) had osteoma in the ethmoid, two cases (1.7%) had in sphenoid and six cases (5.1%) had in maxillary sinus. We found that the presence of symptoms, diameter of osteoma, surgical indications including state of sinus drainage, and chronic/recurrent sinusitis influence the choices of physicians in management of frontal sinus osteomas. Moreover, we found a significant correlation between the grading systems defined to classify the frontal sinus osteoma to be operated (r = 0.878, 95% CI: 0.724–0.949, P<0.0001). Conclusion: There are several grading systems useful for the choice of surgical approaches, however, the clinical symptoms and surgical indications should not be neglected in the follow-up of patients with frontal sinus osteoma. If there are concerns about the grade of osteoma and the endoscopic approach is considered not to be sufficient for resection, the surgical procedure may be initiated endoscopically, and, if necessary, it can be combined with an external approach.

Comparison of pretherapeutic osseous tumor volume and standard hematology for prediction of hematotoxicity after PSMA-targeted radioligand therapy

PurposeHematotoxicity is a potentially dose-limiting adverse event in patients with metastasized castration-resistant prostate cancer (mCRPC) undergoing prostate-specific membrane antigen (PSMA)-directed radioligand therapy (RLT). We aimed to identify clinical or PSMA-targeted imaging-derived parameters to predict hematological adverse events at early and late stages in the treatment course.MethodsIn 67 patients with mCRPC scheduled for 177Lu-PSMA-617 RLT, pretherapeutic osseous tumor volume (TV) from 68Ga-PSMA-11 PET/CT and laboratory values were assessed. We then tested the predictive capability of these parameters for early and late hematotoxicity (according to CTCAE vers. 5.0) after one cycle of RLT and in a subgroup of 32/67 (47.8%) patients after four cycles of RLT.ResultsAfter one cycle, 10/67 (14.9%) patients developed leukocytopenia (lymphocytopenia, 39/67 [58.2%]; thrombocytopenia, 17/67 [25.4%]). A cut-off of 5.6 × 103/mm3 for baseline leukocytes was defined by receiver operating characteristics (ROC) and separated between patients with and without leukocytopenia (P < 0.001). Baseline leukocyte count emerged as a stronger predictive factor in multivariate analysis (hazard ratio [HR], 33.94, P = 0.001) relative to osseous TV (HR, 14.24, P = 0.01). After four cycles, 4/32 (12.5%) developed leukocytopenia and the pretherapeutic leukocyte cut-off (HR, 9.97, P = 0.082) tended to predict leukocytopenia better than TV (HR, 8.37, P = 0.109). In addition, a cut-off of 1.33 × 103/mm3 for baseline lymphocytes separated between patients with and without lymphocytopenia (P < 0.001), which was corroborated in multivariate analysis (HR, 21.39, P < 0.001 vs. TV, HR, 4.57, P = 0.03). After four cycles, 19/32 (59.4%) developed lymphocytopenia and the pretherapeutic cut-off for lymphocytes (HR, 46.76, P = 0.007) also demonstrated superior predictive performance for late lymphocytopenia (TV, HR, 5.15, P = 0.167). Moreover, a cut-off of 206 × 103/mm3 for baseline platelets separated between patients with and without thrombocytopenia (P < 0.001) and also demonstrated superior predictive capability in multivariate analysis (HR, 115.02, P < 0.001 vs.TV, HR, 12.75, P = 0.025). After four cycles, 9/32 (28.1%) developed thrombocytopenia and the pretherapeutic cut-off for platelets (HR, 5.44, P = 0.048) was also superior for the occurrence of late thrombocytopenia (TV, HR, 1.44, P = 0.7).ConclusionsPretherapeutic leukocyte, lymphocyte, and platelet levels themselves are strong predictors for early and late hematotoxicity under PSMA-directed RLT, and are better suited than PET-based osseous TV for this purpose.

Primary Osseous Spine Tumors in Adults: A Review and Update on Diagnosis and Treatment

Objective: This article aims to provide a convenient and comprehensive review describing unique features of the most common primary osseous spine tumors, as well as current diagnostic and therapeutic modalities for each tumor. Background: Primary osseous spine tumors are a rare and diverse group of neoplasms with varying biologic behavior. Clinical, radiographic, and pathologic correlation is critical in making a correct diagnosis. Prompt treatment is necessary to optimize clinical outcomes, and is based on tumor type, location, and disease stage. Most patients with spinal tumors present with a history of pain often similar in quality and intensity as non-tumoral etiologies of back pain. Spinal neoplasms, especially malignant tumors, require a multidisciplinary approach and are best treated in dedicated cancer centers to mitigate incorrect diagnoses and inappropriate treatment. Methods: A literature review was conducted using PubMed and EBSCO. Multiple search queries for relevant articles between 2014 to present were included. Preference was given to recent articles with clinical evidence, current treatment, diagnostic modalities and/or future potential therapies and diagnostic strategies. Results: Numerous modalities including surgery, chemotherapy, evolving immunologic and targeted therapies as well as stereotactic external beam radiation therapy are utilized to optimize care. Still, current therapeutic strategies result in significant morbidity and mortality and local disease recurrence and systemic relapse are common despite chemotherapy and advanced surgical techniques. Conclusion: Because primary spinal tumors are uncommon, level I and II data are scarce though novel treatment strategies are emerging. Medical and orthopaedic oncologists and spine surgeons therefore should have a fundamental knowledge of the current state of literature pertaining to this topic.

Conservative surgical management of Juvenile Central Cemento- Ossifying Fibroma of anterior mandible. - Case report and literature review

Cemento-ossifying fibroma (COF) is a benign neoplasm that arises from the periodontal membrane which contains multipotential cells that are capable of forming cementum, lamellar bone and fibrous tissue. Juvenile cemento-ossifying fibroma is a type of fibro osseous lesion which contains cementoid tissue and developed in first two decades of life. Majority of the juvenile COF are aggressive in nature that necessitates extensive radical surgery to prevent the recurrence. This case report describes the conservative surgical management of juvenile cemento- ossifying fibroma in an 8 year old child with the preservation of permanent teeth and long term follow up. Key words: Anterior mandible, Cemento-ossifying fibroma , Fibro osseous lesion, Juvenile osseous neoplasm, Periodontoma

Carbon fiber-reinforced PEEK instrumentation in the spinal oncology population: a retrospective series demonstrating technique, feasibility, and clinical outcomes.

The authors aimed to demonstrate the feasibility and advantages of carbon fiber-reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors. Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. The study population included 14 females and 14 males with a mean age of 60 years (range 30-86 years). Five patients had primary bone tumors, and the remaining patients had metastatic tumors. Breast cancer was the most common metastatic tumor. The most common presenting symptom was axial spine pain (25 patients, 89%), and the most common Spine Instability Neoplastic Score was 7 (range 6-14). Two patients in this series had anterior cervical procedures. The remaining patients underwent posterior thoracolumbar fixation. The average fusion length included 4.6 vertebral segments (range 3-8). The mean clinical follow-up time with surgical or oncology teams was 6.5 months (range 1-23 months), and the mean interval for last follow-up imaging (CT or MRI) was 6.5 months (range 1-22 months). Eighteen patients received postoperative radiation at the authors' institution (16 with photon therapy, 2 with proton therapy). Eleven of the patients (39%) in this series died. At the last clinical follow-up, 26 patients (93%) had stable or improved neurological function compared with their preoperative status. At the last imaging follow-up, local disease control was observed in 25 patients (89%). Two patients required reoperation in the immediate postoperative period, one for surgical site infection and the other for compressive epidural hematoma. One patient was noted to have lucencies around the most cephalad screws 3 months after surgery. No hardware fracture or malfunction occurred intraoperatively. No patients required delayed surgery for hardware loosening, fracture, or other failure. Early tumor recurrence was detected in 3 patients. Early detection was attributed to the imaging characteristics of the CFRP hardware. CFRP spinal implants appear to be safe and comparable to conventional titanium implants in terms of functionality. The imaging characteristics of CFRP hardware facilitate radiation planning and assessment of surveillance imaging. CFRP hardware may enhance safety and efficacy, particularly with particle therapy dosimetry. Larger patient populations with longer-term follow-up are needed to confirm the various valuable aspects of CFRP spinal implants.

Abstract No. 233 Practice patterns in the United States for ablation of osseous tumors using Medicare claims analysis

To describe national practice trends in bone radiofrequency ablation (RFA) and cryoablation for osseous lesions by physician specialty and site-of-service from 2015 to 2018. This study used data from the US Centers for Medicare and Medicaid Services public use files for 2015 to 2018. Current Procedural Terminology (CPT) codes for bone RFA (20982) and cryoablation (20983) were analyzed. Based on the specialty code, the specialty was sorted into five categories: radiology (diagnostic and interventional), orthopedic surgery, neurosurgery, pain management (pain management, anesthesiology, physical medicine and rehabilitation, and interventional pain management), and all others. Annual volume of billed services was additionally evaluated by site of service (inpatient, outpatient, office-based). Aggregate claims dramatically increased from 2015 to 2018. The enrollment adjusted overall growth averaged 45.2% year-over-year, strongly driven by growth in RFA. Annual market share for radiology decreased slightly from 80.6% to 73.3% with neurosurgery making the largest gain, increasing from 4.7% to 11.3% from 2015 to 2018. Clinical site-of-service analysis demonstrated that outpatient is the main site-of-service for ablation (62.7% cumulatively from 2015 to 2018). Growth rates of outpatient and inpatient services are about the same over this time. There has been significant growth in osseous ablation between 2015 and 2018, with the growth dominated by radiology, although the overall growth rate and the market share of radiology are declining as the growth is outstripped by neurosurgery and orthopedics. Further consideration of these trends will be important for interventional radiologists to assure their involvement and expertise in ablation procedures.

Juvenile ossifying fibroma of the orbit: a rare location

&lt;p class="abstract"&gt;Osseous tumors in the craniofacial skeleton of young patients are not very frequent, and tumors involving the walls of the orbital cavity are even more infrequent. Despite being usually slow-growing, even small neoformations can have a local aggressive behavior, displacing and compressing vital structures, and so it is important to perform an early diagnosis in order to avoid the tumor to pose problems on the optic nerve and threaten vision. The case that we are presenting shows an ossifying fibroma in a 19-year-old male from Ethiopia, a benign lesion whose progressive growth caused proptosis and downward displacement of the left eye. Following an adequate radiological diagnosis, we were able to delimit the fibroma existence and location. The surgery was conducted in a conservative form, allowing the patient not to suffer from post-surgery malformations. Histopathological diagnosis was compatible with juvenile ossifying fibroma, psammomatoid variant, arising from an uncommon location – the roof of the orbit. &lt;/p&gt;

Bone-related disorders of the jaw: A clinico-radiological diagnostic algorithm.

Bone-related disorders of the jaw (BRDJ) include a spectrum of non-neoplastic and neoplastic lesions of the maxillofacial region that have been recently classified into fibro-osseous lesions, giant cell lesions and osseous tumours. The histopathological features of BRDJ can be similar and overlie each other. Imaging is important in order to reach a specific diagnosis. However, the appearance of BRDJ on imaging is non-specific in some cases. Computed tomography (CT) and magnetic resonance imaging (MRI) are used for accurate localisation, characterisation of the tumour matrix, delineation of the lesion extension and establishment of the relation of BRDJ to the surrounding structures. Imaging is usually done to detect the relationship with the adjacent surrounding vital structures and to diagnose aggressive forms, malignant transformation and associated syndromes. The correlation of the demographic findings, the location and the clinical presentations with the imaging features are important for the diagnosis of BRDJ. The proposed clinico-radiological diagnostic algorithm with CT and MRI helps a specific diagnosis to be reached in some cases.

Nomograms to predict lung metastasis probability and lung metastasis subgroup survival in malignant bone tumors.

The aim of this study was to construct and validate nomograms for predicting lung metastasis and lung metastasis subgroup overall survival in malignant primary osseous neoplasms. Least absolute shrinkage and selection operator, logistic and Cox analyses were used to identify risk factors for lung metastasis in malignant primary osseous neoplasms and prognostic factors for overall survival in the lung metastasis subgroup. Further, nomograms were established and validated. A total of 3184 patients were collected. Variables including age, histology type, American Joint Committee on Cancer T and N stage, other site metastasis, tumor extension and surgery were extracted for the nomograms. The authors found that nomograms could provide an effective approach for clinicians to identify patients with a high risk of lung metastasis in malignant primary osseous neoplasms and perform a personalized overall survival evaluation for the lung metastasis subgroup.

Primary tumors of the ribs – A pictorial essay

Primary tumors of the ribs are rare. However, they are often seen due to the high number of bones of the ribs and also the frequency of chest films taken for various conditions. They may be benign or malignant. Tumor like lesions are more in number than primary tumors of the ribs. Chest film is the first one to detect the tumor. Benign tumors include tumors arising from the osseous tissue, cartilaginous tissue, fibrous tissue, vascular tissue and other miscellaneous tumors arising from the other part of tissues. Similarly, primary malignant lesions arise from the tissues as mentioned earlier. Radiologically, there are several signs to identify and diagnose these tumors. Some of the lesions need advanced imaging such as CT, ultrasound, MRI, nuclide scan and PET CT.

Correlation of the MRI findings with clinical assessment, intraoperative and biopsy findings: Osseous spine tumors

The annual incidence of primary spine neoplasms has been estimated at 2.5 per 1,00,000 per year.' The careful study of plain roentgenograms of spine is the first step for proper evaluation of diseases of the osseous spine. Not only the bone and joint structures of the vertebral column are important from the neurologic standpoint but also the contour and calibre of the vertebral canal and foramina of exit of the spinal nerve roots. In the case of a patient with clinical suspicion of osseous spine tumor, a complete clinical history with special reference to neurological symptoms was taken, followed by general physical examination and detailed central nervous system examination. Other systems were also examined and findings were noted. Next, the procedure for MRI was explained to the patient and consent was taken. In this study, 7 cases showed paraspinal soft tissue component. Contrast was given in all the cases. The paraspinal soft tissue component enhanced well on post contrast in all the cases.

A study on the distribution of osseous spine tumors in terms of age, sex and Incidence: MRI Study

Magnetic resonance is defined as the enhanced absorption of energy that occurs when the nuclei of atoms within an external magnetic field are exposed to radiofrequency energy at a specific frequency called

Central hemangioma of Zygoma - A rare case report with CT and MRI features

Intraosseous hemangiomas are uncommon, constituting less than 1% of all osseous tumors. The most frequent sites are the calvaria and the vertebral column. The involvement of the facial bones is rare, and if occurs, it can involve maxilla, mandible, nasal bones and zygomatic bone. Zygomatic hemangioma is a benign, slow-growing tumor occurring mostly in adult women. The radiographic findings are diagnostic. Total excision of the tumor with the primary reconstruction of the defect is the preferred treatment modality. Here, we are reporting a case of a 37-year-old woman who presented with a painless hard swelling in the right zygomatic prominence, which was diagnosed as intraosseous hemangioma after the radiological examination because of its characteristic radiological picture. An Excisional biopsy also proved the swelling to be a cavernous hemangioma.

Ewing's sarcoma: A rare case report

Ewing's sarcoma is an uncommon malignancy, constituting 4%–10% of the entire malignant osseous tumors involving children and young people. Rarely does it affect the facial bones, and added to its nonspecific presentation, its diagnosis remains challenging. Its occurrence is