Skeletal Lesions Research Articles

Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature.

Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures. PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors' known articles. The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence. Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.

Can We Predict Skeletal Lesion on Bone Scan Based on Quantitative PSMA PET/CT Features?

The increasing use of PSMA-PET/CT for restaging prostate cancer (PCa) leads to a patient shift from a non-metastatic situation based on conventional imaging (CI) to a metastatic situation. Since established therapeutic pathways have been designed according to CI, it is unclear how this should be translated to the PSMA-PET/CT results. This study aimed to investigate whether PSMA-PET/CT and clinical parameters could predict the visibility of PSMA-positive lesions on a bone scan (BS). In four different centers, all PCa patients with BS and PSMA-PET/CT within 6 months without any change in therapy or significant disease progression were retrospectively selected. Up to 10 non-confluent clear bone metastases were selected per PSMA-PET/CT and SUVmax, SUVmean, PSMAtot, PSMAvol, density, diameter on CT, and presence of cortical erosion were collected. Clinical variables (age, PSA, Gleason Score) were also considered. Two experienced double-board physicians decided whether a bone metastasis was visible on the BS, with a consensus readout for discordant findings. For predictive performance, a random forest was fit on all available predictors, and its accuracy was assessed using 10-fold cross-validation performed 10 times. A total of 43 patients were identified with 222 bone lesions on PSMA-PET/CT. A total of 129 (58.1%) lesions were visible on the BS. In the univariate analysis, all PSMA-PET/CT parameters were significantly associated with the visibility on the BS (p < 0.001). The random forest reached a mean accuracy of 77.6% in a 10-fold cross-validation. These preliminary results indicate that there might be a way to predict the BS results based on PSMA-PET/CT, potentially improving the comparability between both examinations and supporting decisions for therapy selection.

Chronic acquired polyneuropathy as presentation of skull based solitary bone plasmacytoma

Plasmacytomas can be solitary or multiple (osteosclerotic myeloma). Neuropathy resembling chronic inflammatory demyelinating polyradiculoneuropathy or POEMS syndrome has rarely been reported in literature in association of cranial vault plasmacytoma. A female patient with severe demyelinating sensori-motor polyneuropathy with conduction block, was found to have solitary skeletal lesion in the left frontal bone which confirmed to be a plasma cell neoplasm on biopsy. She had significant improvement in neurological signs and symptoms following local radiation and chemotherapy over next 3 months. Solitary bone plasmacytoma (SBP) is rare, accounting for 2-5% of all plasma cell neoplasms. The axial skeleton, especially vertebral body, is the most common site and cranial vault is one of the least commonly reported. Radiation therapy (RT) is the treatment of choice for SBP. There is no evidence that plasma exchange, IVIg or other immunosuppressive agents are effective when used alone in treatment of SBP-associated neuropathy.

Assessing tuberculosis in the skeleton with the use of decision tree analysis.

Diagnosis of specific infectious diseases in the skeleton is often difficult and relies on expert opinion. Statistics is not often used as a tool to assist in such diagnoses, and therefore this study aimed at employing data mining and machine learning in the form of decision tree analysis to aid in recognizing tuberculosis (TB) in skeletal remains and find patterns of skeletal involvement. The sample included 387 modern South African individuals (n = 207 individuals known to have died of TB and n = 180 as a control group) which were scored for the presence or absence of 21 skeletal lesions documented to be associated with TB. A pruned decision tree classification analysis was done to detect significant patterns and associations between variables which produced a model with a moderate classification rate based on four of the variables. As expected, vertebral changes were selected first, followed by rib, acetabular and lastly cranial changes. As a proof of concept, it was shown that machine learning was able to identify patterns of changes in TB skeletons versus a control group. However, further investigation into the use of machine learning in assessing skeletal changes associated with specific diseases is needed.

Incidental Detection of Sarcomatoid Lung Cancer by [18F] Choline Positron Emission Tomography/Computed Tomography.

A 79-year-old man treated for prostate cancer (PCa) in 2018 with concurrent hormone therapy and radical radiotherapy (RT) was given metastasis-directed RT because of skeletal progression of PCa in 2021. On [18F]-choline positron emission tomography/computed tomography (CT) for biochemical recurrence (prostate-specific antigen level: 4.96 ng/mL), he showed significant uptake in multiple skeletal lesions and focal uptake in a left lung nodule. CT-guided biopsy revealed a sarcomatoid lung carcinoma. This case confirms that histopathological evaluation is mandatory in the event of significant radiolabeled choline uptake in a single lung nodule.

Somatostatin Receptor-Directed PET/CT Can Differentiate Between Different Subtypes of Head and Neck Paragangliomas.

Given their neuroendocrine origin, head and neck paragangliomas (HNPGLs) can be imaged with somatostatin receptor (SSTR)-directed PET/CT. We aimed to determine whether the in vivo PET signal can differentiate between varying HNPGL subtypes. Fourteen patients with HNPGL received pretherapeutic SSTR-PET/CTs using 68 Ga-DOTATOC. Six (42.9%) patients had a jugular paraganglioma (PGL-J), 5 (35.7%) were diagnosed with carotid paraganglioma (PGL-Cs), and the remaining 3 patients (21.4%) had PGL-C with pathogenic SDHx germline variants (PGL-C-SDH). A visual and quantitative assessment of the primary tumor on SSTR-PET was performed, including SUV max and target-to-background ratio (TBR). Quantitative values were then compared between subgroups of patients affected with different HNPGL entities. On visual assessment, all primary HNPGLs could be identified on SSTR-PET/CT. Quantification of HNPGL revealed substantially elevated SUV max in PGL-J (101.7 ± 58.5) when compared with PGL-C-SDH (13.4 ± 5.6, P < 0.05), but not when compared with PGL-C (66.7 ± 27.3, P = 0.4; PGL-C vs PGL-C-SDH, P = 0.2). TBR of PGL-J (202.9 ± 82.2), however, further differentiated between PGL-C (95.7 ± 45.4, P < 0.05) and PGL-C-SDH (20.4 ± 12.2, P < 0.01; PGL-C vs PGL-C-SDH, P = 0.3). Moreover, whole-body readout revealed metastases in 2/3 (66.7%) of PGL-C-SDH patients, with a single SSTR-expressing skeletal lesion in one subject and bipulmonary lesions in the other patient. In patients with HNPGL, SSTR-PET/CT identified the primary and metastatic disease and provides substantially elevated TBR, indicating excellent image contrast. PET-based quantification can also differentiate between varying HNPGL subtypes.

Interpersonal violence in colonial era in Papua, Indonesia: A case study of trauma patterns of a Biak individual

AbstractIn many world regions, conflict resulting from power struggles can lead to interpersonal violence. In the recent colonial past, tribes in Papua and Papua New Guinea engaged in war and raiding that resulted in interpersonal violence, abduction, slavery, and casualties. This case study focuses on the analysis of a colonial period individual from Biak Island, Papua, Indonesia, using a biocultural approach. Only the cranium was available for analysis. Standard osteological methods were used to determine that the individual was likely a young to mid‐aged (26‐ to 42‐year‐old) adult female. Skeletal lesion type and patterning were observed macroscopically with digital photography and a newly developed ultraviolet light photography technique. Multiple sharp force trauma injuries were identified on the frontal, temporal, and occipital bones of the cranium. Interpreting the pattern of trauma within the context of the colonial period in Papua, it is suggested that this female individual may have been murdered, possibly as a slave taken during tribal warfare. This report is a significant resource for future bioarchaeological studies in Papua as it provides one of the only accounts of skeletal trauma during the colonial period in the region.

Interrelationship between Skeletal and Visceral Metastases in Invasive Ductal Carcinoma of Breast- Observational Study at INMAS, Mitford, Dhaka

Background: Invasive Ductal Carcinoma (IDC) is the most common of all diagnosed breast cancers, and it frequently presents with metastatic spread to the bone as well as other viscera. Bone scintigraphy is the primary tool for detecting bone metastases, while different imaging modalities can be useful in detecting visceral metastases. The purpose of this study was to determine the relationship between skeletal and visceral metastases in female patients with IDC referred to INMAS, Mitford, for bone scintigraphy. Patients and Methods: This observational study was conducted at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford, Dhaka, from July 2020 to July 2021. Bone scintigraphy was done with a Siemens dual-head gamma camera after an intravenous injection of 20 mCi of 99mTc-MDP. Both anterior and posterior views were obtained, with additional SPECT images when needed. Images were interpreted and analysed by Nuclear Medicine (NM) physicians of this institute. Data about visceral metastases were collected from patients’ record files. Results: The patients were divided into two groups based on the presence of visceral metastases. Group-A had 95 patients with no known metastases to the viscera, and in Group-B, there were 50 patients who had documented visceral metastases. The majority of the patients in the first group (53.7%) showed no bone metastasis, while a small portion (5.3%) revealed a solitary skeletal metastatic lesion and the rest (41.1%) presented with multiple skeletal metastases. Sixty-six percent of patients in Group B had solitary visceral metastases, with the remaining 34% having metastases to multiple viscera. All the patients in this group were affected at various levels by secondary skeletal deposits. Conclusion: The findings of the study revealed that the presentation of visceral metastases was related to the extent and severity of bone metastases in patients with carcinoma of the breast. Bangladesh J. Nuclear Med. 25(2): 117-120, 2022

Percutaneous CT-Guided Bone Biopsies: Indications, Feasibility and Diagnostic Yield in the Different Skeletal Sites-From the Skull to the Toe.

CT-guided bone biopsies are currently the diagnostic tool of choice for histopathological (and microbiological) diagnoses of skeletal lesions. Several research works have well-demonstrated their safety and feasibility in almost all skeletal regions. This comprehensive review article aims at summarizing the general concepts in regard to bone biopsy procedures, current clinical indications, the feasibility and the diagnostic yield in different skeletal sites, particularly in the most delicate and difficult-to-reach ones. The choice of the correct imaging guidance and factors affecting the diagnostic rate, as well as possible complications, will also be discussed. Since the diagnostic yield, technical difficulties, and complications risk of a CT-guided bone biopsy significantly vary depending on the different skeletal sites, subdivided analyses of different anatomical sites are provided. The information included in the current review article may be useful for clinicians assisting patients with possible bone neoplasms, as well as radiologists involved in the imaging diagnoses of skeletal lesions and/or in performing bone biopsies.

Facial Trauma in Sports: Review and Return-to-Play

Maxillofacial trauma can occur with high frequency while playing sports. Skeletal and soft tissue lesions can occur, with different degrees of severity and impact for the athlete.Sports-related facial fractures most frequently affect the nose, zygoma and mandible, regardless of the country and sport. During initial evaluation it is important to distinguish between stable injuries that can be treated on the sidelines or after the match and emergencies requiring prompt hospital transfer.Athletes could benefit from a more personalized approach to treatment, aimed at optimizing the timeframe for return to play. There is a lack of evidence-based studies on return to play after facial trauma, and currently no specific guidelines exist. Return to sport depends on a variety of factors, such as type of fracture, the risk of impact within the sport, the player’s motivation for an early return and the surgeon’s knowledge and experience.

Oncological and perioperative outcomes of surgery with or without metastasis-directed therapy as part of a multimodal treatment in men with de-novo oligometastatic prostate cancer.

To investigate the feasibility, safety, and oncological outcomes of Radical Prostatectomy (RP; either Robot-Assisted [RARP] or Open RP [ORP]) in oligometastatic prostate cancer (omPCa). Additionally, we assessed whether there was an added benefit of metastasis-directed therapy (MDT) in these patients in the adjuvant setting. Overall, 68 patients with omPCa (≤ 5 skeletal lesions at conventional imaging) treated with RP and pelvic lymph node dissection between 2006 and 2022 were included. Additional therapies (androgen deprivation therapy [ADT] and MDT) were administered according to the treating physicians' judgment. MDT was defined as metastasis surgery/radiotherapy within 6months of RP. We assessed Clinical Progression (CP), Biochemical Recurrence (BCR), post-operative complications and overall mortality (OM) of RP and the impact of adjuvant MDT + ADT versus RP + ADT alone. Median follow-up was 73months (IQR 62-89). RARP reduced the risk of severe complications after adjusting for age and CCI (OR 0.15; p = 0.02). After RP, 68% patients were continent. Median 90-days PSA after RP was 0.12ng/dL. CP and OM-free survival at 7years were 50% and 79%, respectively. The 7-years OM-free survival rates were 93 vs. 75% for men treated with vs. without MDT (p = 0.04). At regression analyses, MDT after surgery was associated with a 70% decreased mortality rate (HR 0.27, p = 0.04). RP appeared to represent a safe and feasible option in omPCa. RARP reduced the risk of severe complications. Integrating MDT with surgery in the context of a multimodal treatment might improve survival in selected omPCa patients.

Evaluating the relationships between climate change, population pressure, economic intensification, and childhood stress in the Prehispanic Nasca region of Peru

Climate change can adversely affect population health by limiting resource availability. Climate shocks may cause resource shortfalls directly via declining economic productivity, but favorable climate conditions may also create food shortages indirectly by promoting demographic growth that then pressures a resource base. Current population health and capacities for resilience reflect long-term human-environment interactions, highlighting the need for studies on the relationship between climate and population health through time. In this article, we combine theory from population ecology and life history with structural equation models to evaluate archaeological evidence of changing population health in response to climate change in the Nasca highlands of Peru from the terminal Middle Horizon to Late Intermediate period (1250 - 500 cal BP). Specifically, we examine potential causal chains between local precipitation, population growth, agricultural intensification, and two skeletal indicators of childhood physiological stress—cribra orbitalia (CO) and porotic hyperostosis (PH)—in 149 radiocarbon dated individuals. We find that higher precipitation has a positive indirect impact on PH frequency that is entirely mediated by local population pressure and maize agricultural intensification. Precipitation has a negative direct effect on CO, which is most common during intervals of extreme drought, low dietary maize inputs, and in periods of higher fertility. Additionally, we find that PH and CO negatively co-vary over time. These findings add to a growing body of evidence that, though PH and CO have historically been considered manifestations of the same pathological process, these two skeletal lesions likely result from distinct sources of physiological stress in the Prehispanic central Andes.

Bone Growth Induction in Mucopolysaccharidosis IVA Mouse.

Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is caused by a deficiency of the N-acetylgalactosamine-6-sulfate-sulfatase (GALNS) enzyme, leading to the accumulation of glycosaminoglycans (GAG), keratan sulfate (KS) and chondroitin-6-sulfate (C6S), mainly in cartilage and bone. This lysosomal storage disorder (LSD) is characterized by severe systemic skeletal dysplasia. To this date, none of the treatment options for the MPS IVA patients correct bone pathology. Enzyme replacement therapy with elosulfase alpha provides a limited impact on bone growth and skeletal lesions in MPS IVA patients. To improve bone pathology, we propose a novel gene therapy with a small peptide as a growth-promoting agent for MPS IVA. A small molecule in this peptide family has been found to exert biological actions over the cardiovascular system. This work shows that an AAV vector expressing a C-type natriuretic (CNP) peptide induces bone growth in the MPS IVA mouse model. Histopathological analysis showed the induction of chondrocyte proliferation. CNP peptide also changed the pattern of GAG levels in bone and liver. These results suggest the potential for CNP peptide to be used as a treatment in MPS IVA patients.

A history of violence in the Mesolithic female skeleton from Mezzocorona-Borgonuovo (Trento, northeastern Italy)

Scholars have long been interested in understanding conflict in prehistoric times. Skeletal lesions attributable to interpersonal violence constitute the most direct evidence available to make inferences on the diachronic changes in the frequency, scale, and motivation for conflict among human communities. It has been proposed that evidence of violence becomes more common among Early Holocene Mesolithic hunter-gatherers; however, the skeletal record becomes increasingly fragmentary in more ancient periods, making the finding of new evidence of great importance. We present here a case of traumatic recidivism in a Mesolithic female from the site of Mezzocorona-Borgonuovo (MBN-1) in the northeastern Italian Alps (Trento). This female displays a perimortem perforating defect in the frontal bone, as well as healed cranial and forearm fractures. Although it is possible to interpret these injuries as resulting from falls from height, we propose that they are most compatible with MBN-1 being victim over time of multiple episodes of interpersonal violence. In addition, probably a few months before death, MBN-1 suffered another traumatic injury of the ankle, and in this case the fall from height appears the most likely scenario. We further propose that the attacks leading to the cranial and forearm fractures were presumably perpetrated by individuals coming from outside MBN-1's group. Conversely, her group most likely cared for her through medical treatment – as suggested by the successful healing of forearm and ankle fractures – and by according her a formal burial. The traumatic history of MBN-1 provides rare glimpses into the life experience of a Mesolithic female from northeastern Italy, a context where human remains are extremely rare. However, being a single case, more findings are needed to understand whether or not MBN-1 can be viewed as emblematic of the overall exposure to interpersonal or accidental trauma for Mesolithic groups in the area, and to explore issues of frequency, origin, and motivation for ancient conflict.

Association of dynamic changes in serological markers with survival in de novo metastatic hormone-sensitive prostate cancer.

5069 Background: Prognostic association of serological markers of systemic inflammatory response have been demonstrated in metastatic castrate resistant prostate cancer. However, it remains unknown whether dynamic changes in these markers over time are prognostic earlier in the disease process, namely in metastatic hormone sensitive prostate cancer (mHSPC). We performed a secondary analysis of LATITUDE trial to determine if dynamic changes in hemoglobin (Hb), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lymphocyte to monocyte ratio (LMR) are predictive of prostate cancer-specific survival (PCSS), and overall survival (OS). Methods: We used a joint model approach to determine the association of the dynamic change in the marker levels with PCSS, and OS. For the time-to-event submodel, a multivariable Cox regression model was constructed with treatment arm, skeletal lesion number, liver or lung metastasis, ECOG performance status, and age. For the longitudinal submodel, a linear mixed-effects model was built with an interaction term for treatment arm and time of evaluation in addition to treatment arm, time of evaluation, and baseline value of the serological markers. The two submodels were linked through a shared random effect. Results: Overall 1172 patients were eligible - 580 from the abiraterone plus ADT arm and 592 from the ADT alone group. Median follow-up for surviving patients was 52 months (IQR 47-57). Median number of post-baseline assessments was 16 (IQR 10-28). On univariate joint models, every 10 g/L dynamic increase in Hb was associated with superior PCSS (HR 0.71 [0.67-0.75]) and OS (HR 0.74 [0.68-0.79]) while every 5 points dynamic increase in LMR was associated with a superior PCSS (HR 0.38 [0.26-0.53]) and OS (HR 0.41 [0.29-0.56]). In contrast, dynamic increase in NLR was associated with inferior PCSS (HR 1.29 [1.22-1.36]) and OS (HR 1.29 [1.23-1.36]) while every 10-point dynamic increase in PLR was associated with a small but significant deterioration in PCSS (HR 1.05 [1.04-1.06]) and OS (HR 1.05 [1.04-1.06]), respectively. On multivariate joint modeling, dynamic increase in Hb was also associated with superior PCSS (HR per 10g/L increase 0.74 [0.69-0.79]) and OS (HR per 10g/L rise 0.75 [0.71-0.80]). When dynamic changes in Hb, LMR, NLR, and PLR were included in the same multivariate model with dynamic change in PSA, dynamic increase in Hb continued to show association with significantly superior PCSS (HR per 10g/L rise 0.80 [0.75-0.86]), and OS (HR per 10g/L rise 0.81 [0.75-0.86]), respectively. Conclusions: Our findings suggest that dynamic increase in hemoglobin can predict for superior PCSS, and OS in men with de novo mHSPC treated with ADT with or without abiraterone. These findings need additional validation before implementing routine use of hemoglobin as a prognostic biomarker in de novo mHSPC.

Etiology Understanding Is the Core of Skeletal Diagnosis

Background: The term idiopathic is a non-specific disease label, which fails account for proper etiological understanding. The frequent usage of the term idiopathic may indicate clinical incompetence. We describe a number of patients from our practice with a history of complex bone disorders who were falsely given the term idiopathic by other Institutes. The sole tool used by other Institutes to conclude osteoporosis as a diagnosis is the bone mineral density. Material and Methods: Two Austrian families and one unrelated adult female patient (total number of 12 subjects) have been referred to our department with referral letters confirming the diagnosis of idiopathic osteoporosis. All patients manifested a diverse constellation of skeletal deformities. In all these patients, regular courses of anti-resorptive treatment plus calcium and vitamin D supplements. These have been excessively prescribed. Results: Our diagnostic process which is based heavily on detailed clinical and radiological phenotypic characterizations, we refuted the diagnosis of idiopathic osteoporosis for all patients because of the clear-cut clinical features. For the first family, we suggested the diagnosis of a novel type of mucopolysaccharidosis (the genetic results confirmed the diagnosis of a novel subtype of mucopolysaccharidosis (through the identification of arylsulfatase K ARSK). For the second family which has been subjected to a lengthy useless investigation for almost more than a decade, we refuted the diagnosis of idiopathic osteoporosis and the whole exome sequencing was consistent with the phenotypic diagnosis Nasu-Hakola disease (heterozygous missense mutations in TYROBP gene). The other unrelated 42-year-old- female patient was correctly diagnosed with Nasu-Hakola disease. Conclusion: The objective of this study is to minimize and suppress the usage of the term idiopathic. It has been imperative to understand the sequence of pathological events that occurred in these families. The core for diagnosis is the etiological understanding, which stemmed from professional conscientiousness. Patients underwent misdiagnosis of idiopathic osteoporosis and were treated extensively with anti-resorptive agents, calcium supplements and vitamin D. Strikingly, these medications resulted in a combination of serious cranial and cerebral lesions because of massive pathological calcifications. Imaging analysis via conventional radiographs, MRI and CT scan showed massive calcifications of the cranial sutures, inter-clinoid ligaments and hyper-calcification of the skull base. Sadly speaking, early onset dementia emerged in connection with sclerosing leukoencephalopathy. We believe that the exogenous toxic effects of the huge amounts of bone supplements consumed by these patients enhanced the pre-existing metabolic bone and cerebral disorders. Our findings can ameliorate the etiological understanding of early onset dementia and other correlated cranial and skeletal lesions.

Analysis of the epidemiological characteristics of multiple myeloma and clinical factors affecting the course of the disease

Multiple myeloma (MM) is the second most common malignant neoplasm of the hematopoietic system. Survival rate has improved significantly in patients over the past decade with the use of new therapeutic strategies. The absence of adverse factors at the time of diagnosis does not always determine a positive course of the disease. Therefore, the search for prognostic factors is relevant. The article presents data based on the epidemiological characteristics and clinical factors of MM that affected the progression-free survival. We have shown that a significant excess of the levels of IL2, IL6, TNF, the level of clonal CD138+ &gt;20% at the time of diagnosis is associated with an increase in the frequency of disease progression.A decrease in progression-free survival was detected at kidney damage, anemic syndrome, infectious complications, multiple skeletal bone lesions, genetic changes at the time of diagnosis and did not depend on the type of immunoglobulin secretion.

Ultrasound-Guided Percutaneous Bone Biopsy: Feasibility, Diagnostic Yield and Technical Notes.

While nowadays, CT-guided bone biopsy represents the gold standard tool for histopathological and microbiological diagnosis of skeletal lesions, the role of US-guided bone biopsy has not yet been fully explored. US-guided biopsy offers several advantages, such as the absence of ionizing radiation, fast acquisition time, as well as good intra-lesional echo, and structural and vascular characterization. Despite that, a consensus in regard to its applications in bone neoplasms has not been established. Indeed CT-guided technique (or fluoroscopic ones) still represents the standard choice in clinical practice. This review article aims to review the literature data about US-guided bone biopsy, underlying clinical-radiological indications, advantages of the procedure and future perspectives. Bone lesions taking the best advantages of the US-guided biopsy are osteolytic, determining the erosion of the overlying bone cortex and/or with an extraosseous soft-tissue component. Indeed, osteolytic lesions with extra-skeletal soft-tissue involvement represent a clear indication for US-guided biopsy. Moreover, even lytic bone lesions with cortical thinning and/or cortical disruption, especially located in the extremities or pelvis, can be safely sampled with US guidance with very good diagnostic yield. US-guided bone biopsy is proven to be fast, effective and safe. Additionally, it offers real-time needle evaluation, an advantage when compared to CT-guided bone biopsy. In the current clinical settings, it seems relevant to select the exact eligibility criteria for this imaging guidance since the effectiveness can vary depending on the type of lesion and body site involved.

Two cases of concha bullosa in a contemporary Cypriot skeletal collection

Concha bullosa is the hypertrophy of the superior, middle, or inferior nasal conchae, most commonly referring to the pneumatisation of the middle conchae. It is considered to be the most common anatomical variant of the osteomeatal complex, rather than a pathological development. Though it is common, its aetiology is poorly understood. It is unclear whether sex or ethnicity impacts on the prevalence of concha bullosa, though some research suggests a correlation. Some researchers have argued that concha bullosa predisposes individuals to sinusitis, but the link is not consistent. In this paper, the authors present two new skeletal cases of bilateral concha bullosa identified in female individuals taken from the Cyprus Reference Research Collection (CRRC). This work aims to highlight the limitations associated with the palaeopathological diagnosis of inflammation and the interpretation of skeletal lesions that may be related to sinusitis or infection of the osteomeatal complex in archaeological bone, in relation to the presence of concha bullosa.

Murine models of HRAS-mediated cutaneous skeletal hypophosphatemia syndrome suggest bone as the FGF23 excess source.

Cutaneous skeletal hypophosphatemia syndrome (CSHS) is a mosaic RASopathy characterized by the association of dysplastic skeletal lesions, congenital skin nevi of epidermal and/or melanocytic origin, and FGF23-mediated hypophosphatemia. The primary physiological source of circulating FGF23 is bone cells. However, several reports have suggested skin lesions as the source of excess FGF23 in CSHS. Consequently, without convincing evidence of efficacy, many patients with CSHS have undergone painful removal of cutaneous lesions in an effort to normalize blood phosphate levels. This study aims to elucidate whether the source of FGF23 excess in CSHS is RAS mutation-bearing bone or skin lesions. Toward this end, we analyzed the expression and activity of Fgf23 in two mouse models expressing similar HRAS/Hras activating mutations in a mosaic-like fashion in either bone or epidermal tissue. We found that HRAS hyperactivity in bone, not skin, caused excess of bioactive intact FGF23, hypophosphatemia, and osteomalacia. Our findings support RAS-mutated dysplastic bone as the primary source of physiologically active FGF23 excess in patients with CSHS. This evidence informs the care of patients with CSHS, arguing against the practice of nevi removal to decrease circulating, physiologically active FGF23.