Osseous Tumors Research Articles

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

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

Osseous tumors of the foot, ankle, and lower leg: a cross-sectional observational study analysing 288 cases

BackgroundOsseous tumors of the foot and ankle are rarely encountered in general orthopaedic practice and represent only 3 % of osseous neoplasms. It can be difficult to distinguish between benign and malignant lesions, leading to misdiagnosis. Delays in diagnosis are the main cause of litigation in sarcoma of the extremities. Poor understanding of how sarcomas present in this region can lead to inappropriate initial procedures, limiting options for limb salvage and increasing rates of local recurrence. Our aim is to improve understanding of these rare tumors to reduce misdiagnosis and decrease the occurrence of inappropriate or unwarranted procedures. MethodsWe retrospectively analysed a prospectively maintained database of 288 new referrals to the West of Scotland regional musculoskeletal oncology service for osseous lesions of the foot, ankle and lower leg over a 10-year period. An analysis of patient demographics, presentation, anatomical location, diagnosis, classification, management and outcomes was performed. ResultsOf all new referrals, 52.4 % were diagnosed with primary benign osseous tumors, 8.7 % with primary malignant osseous tumors, 9.7 % with metastatic osseous lesions, and 29.2 % pseudotumors. The most common primary benign tumor in our population was osteoid osteoma (18.5 %), primary malignant tumor was osteosarcoma (32 %) and metastatic osseous lesions were from small cell lung cancer primary (14.3 %). In the foot and ankle, malignant bone tumors most commonly presented in the distal tibia and fibula (20 %). Rest pain was the most common symptom at presentation in all groups, followed by swelling. The average duration of symptoms was 5 months for malignant lesions before primary referral. ConclusionBone tumors in the foot and ankle remain a diagnostic challenge. We hope to have increased understanding of these rare lesions and have recommended a management protocol in order to reduce the number of inappropriate procedures performed, optimising clinical outcomes and reducing the cost of litigation to healthcare services. Level of EvidenceLevel III- Cross-sectional observational study

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.

Primary Intraosseous Hemangiomas of the Maxillary Bone: A Case Report and Literature Review.

Primary intraosseous hemangiomas of the maxillofacial region are rare lesions that comprise less than 1% of all osseous tumors. A review of the literature on primary intraosseous hemangiomas of the facial bones revealed a limited number of publications, much of which was largely limited to case reports. This case report summarizes the workup and surgical treatment of a 37-year-old female with a primary intraosseous hemangiomas of the left maxillary bone. The image, histology, treatment, and literature are reviewed.

Radiographic imaging and diagnosis of spinal bone tumors: AlexNet and ResNet for the classification of tumor malignancy

ObjectiveThis study aims to explore the application of radiographic imaging and image recognition algorithms, particularly AlexNet and ResNet, in classifying malignancies for spinal bone tumors. MethodsWe selected a cohort of 580 patients diagnosed with primary spinal osseous tumors who underwent treatment at our hospital between January 2016 and December 2023, whereby 1532 images (679 images of benign tumors, 853 images of malignant tumors) were extracted from this imaging dataset. Training and validation follow a ratio of 2:1. All patients underwent X-ray examinations as part of their diagnostic workup. This study employed convolutional neural networks (CNNs) to categorize spinal bone tumor images according to their malignancy. AlexNet and ResNet models were employed for this classification task. These models were fine-tuned through training, which involved the utilization of a database of bone tumor images representing different categories. ResultsThrough rigorous experimentation, the performance of AlexNet and ResNet in classifying spinal bone tumor malignancy was extensively evaluated. The models were subjected to an extensive dataset of bone tumor images, and the following results were observed. AlexNet: This model exhibited commendable efficiency during training, with each epoch taking an average of 3 s. Its classification accuracy was found to be approximately 95.6 %. ResNet: The ResNet model showed remarkable accuracy in image classification. After an extended training period, it achieved a striking 96.2 % accuracy rate, signifying its proficiency in distinguishing the malignancy of spinal bone tumors. However, these results illustrate the clear advantage of AlexNet in terms of proficiency despite a lower classification accuracy. The robust performance of the ResNet model is auspicious when accuracy is more favored in the context of diagnosing spinal bone tumor malignancy, albeit at the cost of longer training times, with each epoch taking an average of 32 s. ConclusionIntegrating deep learning and CNN-based image recognition technology offers a promising solution for qualitatively classifying bone tumors. This research underscores the potential of these models in enhancing the diagnosis and treatment processes for patients, benefiting both patients and medical professionals alike. The study highlights the significance of selecting appropriate models, such as ResNet, to improve accuracy in image recognition tasks.

Diagnostic performance of computed tomography-digital subtraction angiography and conventional magnetic resonance imaging for evaluating the vascularity of osseous spinal tumors

Background and purposePatients with hypervascular spinal tumors may have severe blood loss during tumor resection, which increases the risks of perioperative morbidity and mortality. However, the preoperative evaluation of tumor vascularity may be challenging; moreover, the reliability of the data obtained in conventional preoperative noninvasive imaging is debatable. In this study, we compared conventional magnetic resonance imaging (MRI) and subtraction computed tomography angiography (CTA) in terms of their performance in vascularity evaluation. The catheter digital subtraction angiography (DSA) technique was used as a reference standard. MethodsThis study included 123 consecutive patients with spinal tumor who underwent subtraction CTA, catheter DSA, and subsequent surgery between October 2015 and October 2021. Data regarding qualitative and semiquantitative subtraction CTA parameters and conventional MRI signs were collected for comparison with tumor vascularity graded through catheter DSA. The diagnostic performance of qualitative CTA, quantitative CTA, and conventional MRI in assessing spinal tumor vascularity was analyzed. ResultsQualitative subtraction CTA was the best noninvasive imaging modality in terms of diagnostic performance (area under the receiver operating characteristic curve [AUROC], 0.95). Quantitative CTA was relatively inferior (AUROC, 0.87). MRI results had low reliability (AUROC, 0.51 to 0.59). Intratumoral hemorrhage and prominent foraminal venous plexus were found to be the specific signs for hypervascularity (specificity 93.2%). ConclusionsQualitative subtraction CTA offers the highest diagnostic value in evaluating spinal tumor vascularity, compared to quantitative CTA and MRI. Although conventional MRI may not be a reliable approach, certain MRI signs may have high specificity, which may be crucial for assessing spinal tumor vascularity.

Single-cell sequencing reveals VEGFR as a potential target for CAR-T cell therapy in chordoma.

Chordomas are rare osseous neoplasms with a dismal prognosis when they recur. Here we identified cell surface proteins that could potentially serve as novel immunotherapeutic targets in patients with chordoma. Fourteen chordoma samples from patients attending Xuanwu Hospital Capital Medical University were subjected to single-cell RNA sequencing. Target molecules were identified on chordoma cells and cancer metastasis-related signalling pathways characterised. VEGFR-targeting CAR-T cells and VEGFR CAR-T cells with an additional TGF-β scFv were synthesised and their in vitro antitumor activities were evaluated, including in a primary chordoma organoid model. Single-cell transcriptome sequencing identified the chordoma-specific antigen VEGFR and TGF-β as therapeutic targets. VRGFR CAR-T cells and VEGFR/TGF-β scFv CAR-T cells recognised antigen-positive cells and exhibited significant antitumor effects through CAR-T cell activation and cytokine secretion. Furthermore, VEGFR/TGF-β scFv CAR-T cells showed enhanced and sustained cytotoxicity of chordoma cell lines in vitro compared with VRGFR CAR-T cells. This study provides a comprehensive single-cell landscape of human chordoma and highlights its heterogeneity and the role played by TGF-β in chordoma progression. Our findings substantiate the potential of VEGFR as a target for CAR-T cell therapies in chordoma which, together with modulated TGF-β signalling, may augment the efficacy of CAR-T cells.

Living with a tumor: A case of osteosarcoma involving the medullary region in Phrynops cf. P. geoffroanus (Testudines: Chelidae).

The individual Geoffroy's side-necked turtle, Phrynops cf. P. geoffroanus, was diagnosed postmortem with osteosarcoma associated with the forelimb through morphological and histological analysis. Osteosarcoma stands as the most prevalent primary malignant bone tumor in tetrapods. The tumor presents itself as a large mass in the distal epiphysis, characterized by spicular outgrowths and a rugose external texture. Histologically, the afflicted humerus displayed a high degree of vascularity and exhibited an extensive bone resorption process involving the medullary and endosteal regions. Notably, a clear transition between the bone marrow and cortical bone was absent, indicative of a remodeling process featuring Haversian bone system apposition. Additionally, the diaphyseal region displayed the progression of neoplastic bone tissue along the bone. For comparative purposes, we describe a humeral thin section from a healthy specimen revealing compact primary bone interrupted by cyclical growth marks which differs from the continuous growth observed in the neoplastic humerus. To assess the neoplastic bone growth rate at the mid-diaphysis level, phylogenetic eigenvector maps (PEM) were employed, utilizing osteocyte density and vascular density as explanatory variables. The findings indicated that the osteosarcoma exhibited a slow-growing nature, suggesting that the turtle had to live with this condition for years. As the neoplasia continued to expand, it likely led to disadvantages for the pathological Phrynops individual due to humeral deformity. Furthermore, malignancy was associated with angiogenesis and the invasion of the medullary region by neoplastic bone tissue, raising the likelihood of metastasis as an additional factor contributing to the individual's sickness. The presence of numerous vascular canals in the diaphyseal thin section suggested a low-grade central osteosarcoma. It is worth noting that osseous neoplasms are rarely documented in Testudines, making this case of osteosarcoma in a South American freshwater chelid specimen a unique and rare occurrence.

Bone Reporting and Data System (Bone-RADS) and Other Proposed Practice Guidelines for Reporting Bone Tumors.

The purpose of this article is to review the different bone tumor radiology reporting systems [Bone Reporting and Data System (Bone-RADS), Osseous Tumor Reporting and Data System (OT-RADS), Solitary Bone Tumor Imaging Reporting and Data System (BTI-RADS), and Radiological Evaluation Score for Bone Tumors (REST)] and summarize their advantages and disadvantages. A selective search of PubMed was performed for literature regarding the definition and discussion of bone tumor reporting systems. No time frame was selected, but the search was particularly focused on current literature on musculoskeletal radiology lexicon. To date, four major reporting systems has been proposed to standardize and systematize the reporting of imaging studies of bone tumors: Bone-RADS, OT-RADS, BTI-RADS, and REST. Both Bone-RADS and OT-RADS aid in the characterization and management of bone lesions on CT and MRI. OT-RADS and REST can be applied to MRI and radiography, respectively. Radiologists play a central role in the detection and characterization of asymptomatic (or incidentally detected) and symptomatic bone tumors. There are several existing bone tumor reporting systems with various advantages and disadvantages including emphasis on lesion characterization as well as management of incidentally detected bone lesions. · Four bone tumor reporting systems have been proposed thus far.. · Bone-RADS guides management of incidental bone lesions on CT and MRI.. · OT-RADS guides management of bone lesions on MRI with high accuracy.. · BTI-RADS classifies bone tumors on CT and MRI..

Racial disparities in the management and outcomes of primary osseous neoplasms of the spine: a SEER analysis.

Primary osseous neoplasms of the spine, including Ewing's sarcoma, osteosarcoma, chondrosarcoma, and chordoma, are rare tumors with significant morbidity and mortality. The present study aims to identify the prevalence and impact of racial disparities on management and outcomes of patients with these malignancies. The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a cancer registry, was retrospectively reviewed to identify patients with Ewing's sarcoma, osteosarcoma, chondrosarcoma, or chordoma of the vertebral column or sacrum/pelvis. Study patients were divided into race-based cohorts: White, Black, Hispanic, and Other. Demographics, tumor characteristics, treatment variables, and mortality were assessed. 2,415 patients were identified, of which 69.8% were White, 5.8% Black, 16.1% Hispanic, and 8.4% classified as "Other". Tumor type varied significantly between cohorts, with osteosarcoma affecting a greater proportion of Black patients compared to the others (p < 0.001). A lower proportion of Black and Other race patients received surgery compared to White and Hispanic patients (p < 0.001). Utilization of chemotherapy was highest in the Hispanic cohort (p < 0.001), though use of radiotherapy was similar across cohorts (p = 0.123). Five-year survival (p < 0.001) and median survival were greatest in White patients (p < 0.001). Compared to non-Hispanic Whites, Hispanic (p < 0.001) and "Other" patients (p < 0.001) were associated with reduced survival. Race may be associated with tumor characteristics at diagnosis (including subtype, size, and site), treatment utilization, and mortality, with non-White patients having lower survival compared to White patients. Further studies are necessary to identify underlying causes of these disparities and solutions for eliminating them.

One Hundred Percent Tumor Necrosis is Associated with Survival in Ewing Sarcoma

Background and Objectives:Ewing sarcoma is a primary malignancy affecting both bone and soft tissue. Following preoperative chemotherapy and surgical resection, histologic response (tumor necrosis) is correlated with patient survival. The most prognostic cutoff for tumor necrosis continues to be debated. The objective of this study was to explore several cutoffs and determine their prognostic value in a contemporary cohort of Ewing sarcoma patients.&#x0D; Methods:The National Cancer Database was used to identify 564 patients with osseous and soft tissue tumors in the Ewing sarcoma family from 2010 to 2015. All patients had documented preoperative chemotherapy, surgical resection, and vital status. Survival was stratified by tumor necrosis using Kaplan Meier analysis. 356 patients with osseous tumors were included in multivariate logistic and cox regression analyses to identify predictors of histologic response and survival, respectively.&#x0D; Results:In a combined soft tissue and osseous tumor cohort, there was a significant difference (p = 0.01, log-rank test) in overall survival between patients with 100% necrosis and patients with less than 100% necrosis. This was observed over the 5-year study period. Other cutoffs were not statistically different. In patients with osseous tumors, less than 100% necrosis was negatively associated with survival (HR 3.48 [95% CI 1.19-10.13]; p&lt; 0.05), with only skip metastasis having a stronger negative association (HR 4.31 [95% CI 1.22-15.29]; p&lt; 0.05). Male sex (OR 0.50 [95% CI 0.28-0.90]; p&lt;0.05), tumors located in the axial skeleton (OR 0.30 [95% CI 0.12- 0.77]; p&lt;0.05), and positive surgical margins (OR 0.28 [95% CI 0.08-0.95]; p&lt;0.05) were negatively associated with 100% necrosis.&#x0D; Conclusion and Implications:A cutoff of 100% tumor necrosis was associated with improved survival in Ewing sarcoma. This association was strong relative to other commonly used prognostic factors in osseous cases and is a valuable tool to counsel patients and guide future clinical trials.

End Stage Hoffa’s Disease Presented as a Giant Osteochondroma: Case Report and Literature Review

Introduction: Hoffa’s disease appears to be an under-recognized ailment according to an extensive comprehensive literature assessment. Predisposing factors in sports training include torsion and hyperextexion at the knee should be taken into consideration when evaluating patients with chronic knee pain. We present the case of a young soldier suffering from left knee pain as a result of Hoffa’s disease Case report: A 29-year-old male patient admitted to orthopedic department to assess an anterior mechanical pain on the left knee. He reported that he had a sport accident with notion of hyperextension and anterior direct trauma to the left knee. On physical examination we found a painful mass that seems located under the patellar tendon, passive flexion of the left knee triggered a sharp pain from 100°. On X ray we found bone-like mass located behind the silhouette of the patellar tendon without attachment to the bones of the leg. MRI identified a 4.2 osseous tumor with no attachment to the patellar tendon. A surgical excision was preformed Conclusion: Hoffa disease is relatively a rare illness, its physiopathology is not yet completely clear. But many cases have been reported in literature. Its clinical presentation is not very specific, and its surgical excision which remains unavoidable, guarantees satisfying clinical and functional results. However, it remains to be determined whether it is a definitive solution in the context of “Hoffa’s disease”.

Osseous and Myogenic Tumors of the Choroid

Myogenic and osseous tumors of the choroid are extremely rare clinical manifestations. The most common osseous choroidal tumor is choroidal osteoma, and the most common myogenic choroidal tumor is choroidal leiomyoma. Other common osseous lesions are listed as sclerochoroidal calcification and ossified choroidal hemangioma. It is of great importance to distinguish these lesions from malignant tumors, especially malignant melanoma. Multimodal imaging methods and tissue diagnosis with biopsy and immunohistochemical markers in myogenic tumors have an important place in the diagnosis. Although it is known that these lesions are systemically benign, they can threaten vision as a result of local mass effect and complications. Since some osseous tumors may accompany systemic metabolic disorders, systemic screening should be performed in necessary cases. Although rare, metastatic choroidal leiomyosarcoma cases have been described. In this case, it is important to diagnose the tumor quickly and accurately with a good anamnesis and tissue diagnosis, and to plan the appropriate treatment considering the sensitivity of the primary tumor.

Disparities in Primary Spinal Osseous Malignant Bone Tumor Survival by Medicaid Status: A National Population-Based Risk Analysis

The impact of Medicaid status on survival outcomes of patients with spinal primary malignant bone tumors (sPMBT) has not been investigated. Using the SEER-Medicaid database, adults diagnosed between 2006 and 2013 with sPMBT including chordoma, osteosarcoma, chondrosarcoma, Ewing sarcoma, or malignant giant cell tumor (GCT) were studied. Five-year survival analysis was performed using the Kaplan-Meier method. Adjusted survival analysis was performed using Cox proportional-hazards regression controlling for age, sex, marital status, cancer stage, poverty level, vertebral versus sacral location, geography, rurality, tumor diameter, tumor grade, tumor histology, and therapy. A total of 572 patients with sPMBT (Medicaid: 59, non-Medicaid: 513) were identified. Medicaid patients were more likely to be younger (P < 0.001), Black (P < 0.001), live in high poverty neighborhoods (P= 0.006), have distant metastases at diagnosis (P < 0.001), and less likely to receive surgery (P= 0.006). The 5-year survival rate was 65.7% (chondrosarcoma: 70.0%, chordoma: 91.5%, Ewing sarcoma: 44.6%, GCT: 90.0%, osteosarcoma: 34.2%). Medicaid patients had significantly worse 5-year survival than non-Medicaid patients (52.0% vs. 67.2%, P= 0.02). Minority individuals on Medicaid were associated with an increased risk of cancer-specific mortality compared with White non-Medicaid patients (adjusted hazard ratio [aHR]= 2.51, [95% CI 1.18-5.35], P= 0.017). Among Medicaid patients, those who received surgery had significantly better survival than those who did not (64.5% vs. 30.6%, P= 0.001). For all patients, not receiving surgery (aHR= 1.90 [1.23-2.95], P= 0.004) and tumor diameter >50 mm (aHR=1.89 [1.10-3.25], P= 0.023) were associated with an increased risk of mortality. Medicaid patients may be less likely to receive surgery and suffer from poorer survival. These disparities may be especially prominent among minorities.

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

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

Amplified Ferroptosis and Apoptosis Facilitated by Differentiation Therapy Efficiently Suppress the Progression of Osteosarcoma.

Osteosarcoma (OS) is the most frequent osseous neoplasm among young people aged 10-20. Currently, the leading treatment for osteosarcoma is a combination of surgery and chemotherapy. However, the mortality remains high due to chemoresistance, metastasis, and recurrence, attributing to the existence of cancer stem cells (CSCs) as reported. To target CSCs, differentiation therapy attracts increasing attention, inducing CSCs to bulk tumor cells with elevated reactive oxygen species (ROS) levels and less chemoresistance. Moreover, increasing studies have implied that ferroptosis is a promising approach to eliminating cancer cells through eliciting oxidative damage and subsequent apoptosis, effectively bypassing chemoresistance. Here, a cancer-cell-membrane-decorated biocompatible formulation (GA-Fe@CMRALi liposome) is constructed to combat OS efficiently by combining distinct differentiation and ferroptosis therapies through magnified ROS-triggered ferroptosis and apoptosis with homologous target capability to tumor sites. The combinational approach exhibited favorable therapeutic efficacy against OS in vitro and in vivo. Impressively, the potential mechanisms are revealed by mRNA sequencing. This study provides a tactical design and typical paradigm of the synergized differentiation and ferroptosis therapies to combat heterogeneous OS.

Functional and oncological outcome of patients with benign hindfoot tumors treated by curettage

BackgroundOnly 3 % of osseous tumors occur in the foot. The metatarsals are the –most common site whereas the calcaneus and talus are less common sites. Because these tumors are rare, the aim of our study is to assess the functional and the oncological outcome of patients with benign hindfoot tumors managed by curettage. MethodsThe clinical and radiological data of 41 patients diagnosed with benign hindfoot tumors were retrospectively reviewed. The study included 31 males and 10 females. The average age was 23.68 (range, 5–49) years. The average follow-up period was 92.7 (range, 12–244) months. ResultsAt the last follow-up visit, the average Musculoskeletal Tumor Society scoring system (MSTS) score was 28.12 (range, 21–30). MSTS scores were higher in patients with latent tumors (P = .028) and patients managed by simple curettage (P = .018). The recurrence rate in calcaneal tumors was higher than those in the talus. The overall complication rate was 12.2 % (5 of 41 patients). Infection and subtalar arthritis were the most common complications. ConclusionCurettage of benign bone tumors of talus or calcaneus proved to be an effective method in the management of these patients. Their functional outcome is also excellent. All the complications are manageable without long term morbidity. Level of evidenceLevel IV Therapeutic study.

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.

Evaluation of Oral and Maxillofacial Masses in Sample Received in Pathology Department SMC/SGTH KPK

Cysts, polyps and inflammatory process are the major benign tumors of the oral cavity. The SCC, lymphomas, sarcomas of bones and soft tissues and rarely melanomas are malignancies of oral cavity. Distal metastases from of breast carcinoma, lungs, abdominal organs and prostate can occur in oral cavity. The age of these lesions is among less than one year kids up to 85 years old, almost 90% of the patient’s average age of 40 years. These tumors distributed in all over the world especially in the socio-demographic area. Objectives: To evaluate the histopathological outlines of OMF specimens received in pathological Department of SMC/SGTH KPK. Methods: A cross sectional retrospective study. Results: Of a total of 321 samples 164 (51%) were male while 157 (49%) were women with a proportion of M: F=1.05: 1. Mesenchymal tumors, other than osseous tumor, have the maximum quantity of 33.9% cases trailed by epithelioid lesions, 20%, odontogenic masses 5.3%, lesions of salivary gland were 14.6%, lesions of benign cyst were 12.5%, inflammatory lesions 11% and the minimum numbers of oral and maxillofacial specimens was bone tumor with 2.9% cases. From the benign tumors fibro epithelial tumor 23% is the commonest. The SCC was 57%, the largest contributor among all malignancies. Conclusion: Our study demonstrates the variations of age, sex and location in the oral and maxillofacial masses. The malignant masses are common an elderly aged patient, while the benign are more common an early and middle age people.

Efficacy and safety of COVID-19 vaccines for patients with spinal tumors receiving denosumab treatment: An initial real-clinical experience study.

Even if COVID-19 vaccine has gradually been adopted in the world, information of side effects and crosstalk in patients with spinal tumors is absent due to the exclusion from clinical research. In this research, we aimed to investigate the efficacy and safety for the patients with spinal tumors treated by denosumab. In this retrospective research, 400 patients under treatment of denosumab against spinal tumors in real-clinical experience were grouped into two cohorts according to the treatment of COVID-19 vaccine. And linked hospital data, serum samples and unsolicited related adverse events had been collected from January 22nd 2021 to June 1st 2021 respectively. 233 patients of all participants who received regular treatment of denosumab were vaccinated by mRNA or inactivated vaccine. Patients of metastatic disease and primary osseous spinal tumor showed similar distribution in both two groups. Over the study period, within 176 patients tested the status of serologic response of vaccine, 88(81.48%) and 41(87.23%) individuals injected one or two inactivated vaccines had effective antibody against SARS-CoV-2 infections. As 21 patients (85.71%) treated by mRNA vaccine did. Considering of the safety of vaccine, most common systemic adverse events were nausea or vomiting (45 events vs 23events). Interestingly, fewer participants in the vaccine group were statistically recorded in local adverse events than in the placebo group (16 events vs 33 events). Our initial real-clinical experience suggests that COVID-19 vaccines are likely safe and effective in in patients with spinal tumors receiving denosumab treatment.