Bone Tumor-like Lesions Research Articles

Expect the unexpected: Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism.

Hyperparathyroidism (HPT) is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone (PTH), causing disturbances in calcium homeostasis. Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia. Brown tumors are rare, benign, tumor-like bone lesions, occurring in 1.5% to 4.5% of patients with HPT, as a complication of an uncontrolled disease pathway, and are nowadays rarely seen in clinical practice. The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass. Furthermore, it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion. The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium, phosphorus, and PTH. Although when present, brown tumor is quite pathognomonic for HPT, the histologic finding often suggests a giant cell tumor, while clinical presentation might suggest other more frequent pathologies such as metastatic tumors. Treatment of brown tumors frequently focuses on managing the underlying HPT, which can often lead to regression and resolution of the lesion, without the need for surgical intervention. However, in refractory cases or when dealing with large symptomatic lesions, surgical treatment may be necessary.

Diagnostic utility of CSF1 immunohistochemistry in tenosynovial giant cell tumor for differentiating from giant cell-rich tumors and tumor-like lesions of bone and soft tissue

BackgroundTenosynovial giant cell tumor (TSGCT) is a benign fibrohistiocytic tumor that affects the synovium of joints, bursa, and tendon sheaths and is categorized into localized TSGCT (LTSGCT) and diffuse TSGCT (DTSGCT). LTSGCT and DTSGCT are characterized by recurrent fusions involving the colony-stimulating factor 1 (CSF1) gene and its translocation partner collagen type VI alpha 3 chain. The fusion gene induces intratumoral overexpression of CSF1 mRNA and CSF1 protein. CSF1 expression is a characteristic finding of TSGCT and detection of CSF1 mRNA and CSF1 protein may be useful for the pathological diagnosis. Although there have been no effective anti-CSF1 antibodies to date, in situ hybridization (ISH) for CSF1 mRNA has been performed to detect CSF1 expression in TSGCT. We performed CSF1 immunohistochemistry (IHC) using anti-CSF1 antibody (clone 2D10) in cases of TSGCT, giant cell-rich tumor (GCRT), and GCRT-like lesion and verified its utility for the pathological diagnosis of TSGCT.MethodsWe performed CSF1 IHC in 110 cases including 44 LTSGCTs, 20 DTSGCTs, 1 malignant TSGCT (MTSGCT), 10 giant cell tumors of bone, 2 giant cell reparative granulomas, 3 aneurysmal bone cysts, 10 undifferentiated pleomorphic sarcomas, 10 leiomyosarcomas, and 10 myxofibrosarcomas. We performed fluorescence ISH (FISH) for CSF1 rearrangement to confirm CSF1 expression on IHC in TSGCTs. We considered the specimens to have CSF1 rearrangement if a split signal was observed in greater than 2% of the tumor cells.ResultsOverall, 50 of 65 TSGCT cases, including 35 of the 44 LTSGCTs and 15 of the 20 DTSGCTs, showed distinct scattered expression of CSF1 in the majority of mononuclear tumor cells. MTSGCT showed no CSF1 expression. Non-TSGCT cases were negative for CSF1. FISH revealed CSF1 rearrangement in 6 of 7 CSF1-positive cases on IHC. On the other hand, FISH detected no CSF1 rearrangement in all CSF1-negative cases on IHC. Thus, the results of IHC corresponded to those of FISH.ConclusionWe revealed characteristic CSF1 expression on IHC in cases of TSGCT, whereas the cases of non-TSGCT exhibited no CSF1 expression. CSF1 IHC may be useful for differentiating TSGCTs from histologically mimicking GCRTs and GCRT-like lesions.

Результаты хирургического лечения доброкачественных опухолевых и опухолеподобных заболеваний костей конечностей

Frequency of bone lesions appears from 2% to 28.5%, depending on the detection of tumors in various bones. Timely diagnosis and surgical treatment of tumor and tumor-like bone lesions do not lose relevance among orthopedists either.Purpose of our study was to search results of surgical treatment of benign tumor and tumor-like diseases of lomb bones.Materials and methods. The study was based on 112 patients with tumors and tumor-like diseases of limb bones, who were treated from 2015 to 2018. The results of treatment were evaluated 1, 3, 6, 9 and 12 months after the intervention according to the functional scale we proposed.Results. In adult patients before surgery, average score on the proposed scale was 17.02±0.15 in the main group, and 17.71±0.12 in the control group of patients. After 12 months of observation, sum of points was equal to 0.94±0.4 points in the main group and 1.44±0.19 points in the control group of patients.Conclusions. Analysis of data of patients in the postoperative period showed an improvement in the condition to good in both main and control groups. From 12 months after treatment, dynamics of assessment revealed an excellent condition of patients. In the long-term period, no signs of relapse of the disease were noted in patients.Key words: benign tumors, bone tumors, lower limb, tumor-like diseases.

Chondrosarcoma arising in monostotic fibrous dysplasia treated with total femur resection and megaprothesis: A case report.

IntroductionFibrous dysplasia is tumor like lesions of bone which develop as substitution of bone by an expansion of fibrous connective tissue mixed with hard trabeculae. Chondrosarcomas is one of common malignant primary bone tumor derived from heterogenous group of neoplasm producing chondroid matrix. Chondrosarcoma arising in fibrous dysplasia, especially in monostotic fibrous dysplasia is a very rare case.Case reportA 54-year-old male presented with chief complaint of pain on left thigh. Patient with history of pathological fracture on left femoral diaphysis 3 years ago due to fibrous dysplasia and had underwent curettage, open reduction, and internal fixation at other hospital. Plain radiography revealed expansive lytic lesion, interrupted periosteal reaction with plate and screw attached to the lesion, and soft tissue mass. MRI T2FS sequence showed hyperintense mass extending from subtrochanteric to distal of left femoral diaphysis. Histopathological result from biopsy suggested chondrosarcoma.ConclusionsMalignant transformation of monostotic type was less frequently compared to polyostotic type. Among all malignant transformation cases, alteration to chondrosarcoma was more scarce than other malignancy such as osteosarcoma and fibrosarcoma. Wide surgical margin and reconstruction in chondrosarcoma provide good local control and functional outcome.

Differential diagnosis of bone cysts of long tubular bones of the extremities in children

BACKGROUND: Bone cysts are characteristic tumor-like bone lesions occurring in childhood. Overall, they represent 21% to 57% of all benign tumors and tumor-like bone lesions in children. Clinical and X-ray symptoms of aneurysmal and simple bone cysts are similar. Like some other, often occurring, benign bone lesions, such as enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects.
 AIM: This study aims to identify the main clinical and instrumental characteristics of simple and aneurysmal bone cysts that allow us to differentiate them from some similar destructive bone neoplasms (enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects) and to develop indications for various diagnostic surgical interventions.
 MATERIALS AND METHODS: A retrospective analysis of the results of the survey of 206 patients aged 3 to 18 years who were treated at our facility from 2000 to 2015 was performed. The features of the diagnostic tactics and their effectiveness were rated.
 RESULTS: The main clinical and instrumental diagnostic criteria have been established. They enable the differentiation of bone cysts from some similar benign bone lesions at the pre-morphological stage. The indications for diagnostic surgical interventions have been formulated.
 CONCLUSION: The main difficulties in the differential diagnosis of bone cysts and some similar benign bone lesions have been revealed. An algorithm for applying various diagnostic surgical interventions in patients with these diseases has been proposed.

Tumor-like Lesions of Bone and Soft Tissues and Imaging Tips for Differential Diagnosis.

In the musculoskeletal system, tumor-like lesions may present similar imaging findings as bone and soft tissue tumors and can be defined as tumors on radiologic examinations. Misinterpretation of the imaging findings can lead to inappropriate clinical management of the patient.There is still some debate regarding the pathophysiology and origin of tumor-like lesions that include congenital, developmental, inflammatory, infectious, metabolic, reactive, posttraumatic, post-therapeutic changes, and some miscellaneous entities causing structural changes. Although tumor-like lesions are historically defined as non-neoplastic lesions, some of them are classified as real neoplasms.We discuss a spectrum of entities mimicking tumors of bone and soft tissues that include various non-neoplastic diseases and anatomical variants based on imaging findings.

Ten Commandments for the Diagnosis of Bone Tumors.

The diagnosis of tumors and tumorlike lesions of bone is a routine part of both general and specialist radiologic practices. The spectrum of disorders ranges from the small incidental lesion to the potentially life-limiting malignancies whether primary or secondary. In this review, authored by experts from several European orthopaedic oncology centers, we present a collection of pieces of advice in the form of 10 commandments. Adherence in daily practice to this guidance should help minimize adverse patient experiences and outcomes.

Primary Tumor and Tumor-Like Lesions of Bones of the Foot: Single-Center Experience of 166 Cases

Primary bone tumors of the foot are rare lesions. The purpose of the present study was to evaluate the clinical manifestations, treatment modalities, and recurrences of various primary bone tumors of the foot from a specialized center for orthopedic oncology. Among 3681 musculoskeletal tumor cases, which were diagnosed and surgically treated in our hospital from 1983 to 2013, 166 primary tumor and tumor-like bone lesions of the foot (4.5%) were retrospectively reviewed regarding age, gender, localization, biopsy-revealed diagnosis, applied treatment modalities, follow-up period, and recurrence, if any. Of the 166 primary bone tumors of the foot, 155 (93.4%) were benign and 11 (6.6%) were malignant. The most common primary benign bone tumor was a unicameral bone cyst (57 of 155; 36.8%), and the most common malignant tumor was chondrosarcoma (7 of 11; 63.6%). The hindfoot was the most common location for both primary benign (104 of 155; 67.1%) and malignant (6 of 11; 54.5%) bone tumors of the foot. The results of our study have confirmed that the radiologic findings can be confusing owing to the structural and histopathologic features of the bones of the foot; thus, histopathologic diagnosis should be considered for foot involvement. Because the characteristics of the compartments in the foot allow for the rapid spread of malignant lesions, aggressive surgical management and wider resection are recommended to prevent recurrence and further spread.

ESSR Consensus Document for Detection, Characterization, and Referral Pathway for Tumors and Tumorlike Lesions of Bone.

AbstractBenign bone tumors are rare but are more common than primary malignant bone tumors. The early accurate diagnosis and reliable differentiation of these rare benign tumors and tumor mimickers from the even rarer malignant tumors with subsequent appropriate treatment or watchful waiting is crucial for the clinical outcome. Bone tumors are often a source of diagnostic and therapeutic uncertainty. Thus this European Society of Musculoskeletal Radiology consensus document is intended to help radiologists in their decision making and support discussion among clinicians who deal with patients with suspected or proven bone tumors. Evaluating these tumors starts with a patient history and physical examination. Radiography is the principal imaging modality and often can reliably diagnose a benign bone tumor by providing information about localization, matrix, aggressiveness, size, and (potential) multiplicity. In a significant number of cases, additional imaging is not necessary. Potentially malignant entities recognized by radiography should be referred for magnetic resonance imaging, which also serves as a preoperative local staging modality, with specific technical requirements. Indeterminate tumors, or tumors in which therapy depends on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist regional sarcoma treatment center (RSTC), where a multidisciplinary tumor team, including a specialist pathologist, radiologist, and sarcoma surgeon, are involved. Additional staging modalities are entity specific and should be performed according to the recommendations of the RSTC.

Receptor Activator of Nuclear Transcription Factor NF-κB (RANK), Its Ligand RANKL, and Natural Inhibitor of RANKL Osteoprotegerin (OPG) in the Blood Serum of Patients with Primary Bone Tumors.

The content of components of the RANK/RANKL/OPG system, the key regulator of homeostasis in the bone tissue, in blood serum samples from 199 patients with primary bone neoplasms and 131 practically healthy volunteers was measured by ELISA. Borderline giantcell tumor of the bone with high osteoclastogenic and osteolytic activity is characterized by an increase in the level of all components of this system and highest ratio of sRANKL/OPG in the blood serum. Study indexes in patients with various benign neoplasms and tumor-like bone lesions were lower than in patients with giant-cell tumor. The patients with malignant bone tumors could be divided into 2 subgroups with opposite indexes of the RANK/RANKL/OPG system. The patients with osteosarcoma and Ewing sarcoma had a low level of sRANK, but a high level of sRANKL. The patients with chondrosarcoma and chordoma had a high level of sRANK, but a low level of sRANKL.

Tumor-like lesions of bone

Historically, tumor-like lesions of bone were defined as non-neoplastic bone lesions. Today, however, some of them are considered real neoplasms. They are among the most frequent bone lesions. They usually growslowly, but occasionally they grow rapidly. Many of them can be diagnosed by plain films alone; in others, CT and MRI yield additional features for acorrect diagnosis. Some lesions do not need treatment; others should be resected, and some may even recur. Non-ossifying fibroma, juvenile and aneurysmal bone cysts, fibrous and osteofibrous dysplasia and eosinophilic granuloma are presented.

LONG-TERM RESULTS OF CRYOSURGICAL TREATMENT OF BONE TUMOR-LIKE LESIONS

In order to optimize surgical intervention the results of surgical treatment of 324 patients with tumor-like lesions of bone were studied. Study group comprised 211 people who were executed cryosurgical intervention. In 113 patients (control group) a similar intervention was performed, but without the cryosurgical exposure. In the study group the subjective and objective assessment of outcome of treatment was significantly different (at χ2 = 9,5 p

Orbital eosinophilic granuloma in a child: a case report

Eosinophilic granuloma is a rare disease belonging to the Langerhans' cell histiocytosis group. It accounts for only 1% of all tumor-like lesions of bone. A 6-year-old girl presented with proptosis, and a mass and pain in her right eye. Cranial computerized tomography and magnetic resonance imaging revealed a mass in her right orbital area. The patient was operated through a right frontotemporal craniotomy and orbitozygomatic osteotomy. The tumour was totally removed. The postoperative course was uneventful. Histopathological examination revealed a diagnosis of eosinophilic granuloma with typical Langerhans cells and eosinophylic leucocyte infiltration. We report an orbital eosinophilic granuloma case, which is rarely seen, and discuss its clinical and pathological features.

Clinical-morphological peculiarities of osteoblastomata and their differential diagnosis

Osteoblastoma (OB) is a rare benign osteogenic tumour formed by interwoven with one another osteal trabeculae, which are surrounded by a lot of osteoblasts. The purpose of the present work was to elucidate the nomenclature and main clinical-visualizing pathohistologic features of OB as a true osteogenic tumor, as well as some aspects of its differential diagnosis with other osteogenic tumors and tumor-like bone lesions. Forty-three cases of biopsies obtained from 39 patients with OB served as the material for this research. The article contains data about clinical-visualizing features of OB (X-ray and CT), its macropathology, histopathology and differential diagnosis, as well as clinical-morphological gradations of osteogenic tumours. It was found out that OB passed clinically as an active or aggressive form with signs of a local destructive growth and inclined to relapsing in case of its incomplete removal, but very seldom it subjected to malignancy. OB often becomes an object of complicated differential-diagnostic solutions, which are possible only with application of both clinical-visualizing and histological methods with priority of the latter ones. The nosological units for differential diagnosis of OB should include the following ones: osteoid-osteoma, ossifying periostitis, chronic osteomyelitis (corticolitis-periostitis), osteoblastoma-like central osteosarcoma with a low grade of malignancy.

Benign bone tumors

Benign bone tumors are neoplasms which have their origin in bone and lack criteria of malignant tumors, i.e. infiltrative growth pattern and distant metastases. They are classified according to the WHO criteria concerning the tumor matrix (osseous, cartilaginous, fibrous etc.). Traditionally there are also some non-neoplastic bone lesions which are classified as benign bone tumors and belonging to the group of tumor-like bone lesions. For the physician it is important to know those entities which are harmless, as well as those which can tend to re-occur or which ones can be locally destructive. Finally, some tumors are at risk of becoming malignant (large and proximal enchondromas or multiple tumors within a syndromal disease). Treatment is in most cases uncomplicated and can range between observation, curettage and sometimes extensive resection with complex defect reconstruction.

EFFICACY OF THE ENNEKING STAGING SYSTEM IN RELATION TO TREATING BENIGN BONE TUMORS AND TUMOR-LIKE BONE LESIONS

Objective: To evaluate the efficacy of the Enneking staging system for determining the prognosis, planning surgical treatment and indicating adjuvant therapy for benign bone tumors (BBT) and tumor-like bone lesions (TBL). Methods: A retrospective multicenter, descriptive, nonrandomized study was carried out on a representative sample comprising a large series of 165 patients with a total of 168 benign bone tumors and tumor-like bone lesions. The patient sample was typical, and matched the literature in all respects. All the patients were classified according to the Enneking staging system, and the initial staging of each lesion was correlated with its behavior after either conservative or surgical treatment, in order to determine the efficacy of the system. The treatment options and complications were described and analyzed. Results: The results from the treatment provided 95.2% agreement with the Enneking staging system, with a 95% confidence interval of between 90.8 and 97.9%. Of the 168 tumors treated, only eight (4.8%) could not be controlled in relation to the initial treatment indicated by the Enneking staging system. Tumors classified as active were the most prevalent, comprising 73.2% of the lesions. Tumor recurrence was significantly more frequent (p < 0.001) in the aggressive stage. All the patients staged as latent evolved to cure. The study suggested that surgery with wide margins, for aggressive lesions, could provide better lesion control, with a lower recurrence rate (p > 0.001). For latent and active lesions, the study demonstrated the efficacy of both expectant treatment and excision, with or without autogenous bone graft. Conclusion: The results confirm that the Enneking staging system was very efficient in determining the prognosis, enabling surgical planning and indicating adjuvant therapy for treatment of BBT and TBL.

BENIGN BONE TUMORS AND TUMOR-LIKE BONE LESIONS: TREATMENT UPDATE AND NEW TRENDS

The treatment of benign bone tumors (BBT) and tumor-like bone lesions (TBL) has observed the introduction of new drugs, such as intravenous bisphosphonates, which have ossified bone lesions caused by fibrous dysplasia. Aneurismal bone cyst has been treated with sclerosing agents by percutaneous injection, yielding good results. Adjuvants allow joint salvage, maintenance of movements and function, with low rates of recurrence. Among them, the most used ones are bone cement (PMMA), phenol, nitrogen-based cryotherapy, hydrogen peroxide, ethanol and radiotherapy. New methods of treatment include thermal ablation with radiofrequency and laser, mainly utilized for treating osteoid osteoma. Arthroscopy allows resection of benign intra-joint lesions and assists the surgery of subchondral tumors. A great advance is the utilization of synthetic bone substitutes, which are a mixture of osteoinductive growth factors and osteoconductive ceramics, and have presented comparable results to autogenous bone grafts. There is a recent trend for closed treatments, with percutaneous injection of demineralized bone matrix (DBM) and calcium sulfate. Autogenous cancellous bone graft remains as the gold standard. Vascularized fibula graft, on the other hand, incorporates faster in the treatment of large destructive lesions. Also, allogenic cortical support allows structural augmentation for aggressive tumors. Freeze-dried allografts are used to fill contained defects and as expanders of autografts. Joint endoprosthesis may be used in large destructive lesions of the distal femur, hip and shoulder.

Fracture pathologique de la patella sur kyste anévrismal osseux. À propos d’un cas

Aneurysmal bone cyst is a tumor-like lesion which accounts for about 1% of all biopsied tumors and tumor-like lesions of bone. We report an extremely rare case of aneurysmal bone cyst of the patella in an 18-year-old patient revealed by a pathological fracture. The unexpected appearance of a pathological fracture affects the whole therapeutical management. However, in the case of a well-preserved articular surface, curettage and corticocancellous grafting are considered to be successful methods of treatment for aneurysmal bone cyst of the patella, as revealed in our study.

Benign bone tumors and tumor-like lesions: value of cross-sectional imaging.

This article reviews the role of CT and MR imaging in the diagnosis of benign bone tumors and tumor-like lesions of bone with with regard to differential diagnosis, the assessment of tumor-related complications, and the detection of postoperative recurrence. Indications for cross-sectional imaging of specific lesions, including osteoid osteoma, osteoblastoma, enchondroma, osteochondroma, intraosseous lipoma, hemangioma, giant cell tumor, aneurysmal bone cyst, simple bone cyst, and eosinophilic granuloma, are discussed, and advantages and disadvantages of the different imaging modalities are illustrated on the basis of pathologically confirmed cases.

Metachronous multifocal osteosarcoma: A case report and literature review

Metachronous multifocal osteosarcoma (MFOS) is a rare form of osteosarcoma manifested by one or more new tumors developing after the initial treatment of primary osteosarcoma. The pathogenesis of metachronous MFOS is still obscure whether it represents multiple true primaries or metastatic disease. However, there is a clinical significance that metachronous MFOS is a potentially curable disease [Resnick D, Kyriacos M, Greenway GD. Tumors and tumor-like lesions of bone: imaging and pathology of specific lesions. In: Resnick D, editor. Diagnosis of bone and joint disorders. Philadelphia: Saunders, 1995: p. 3697–9.]. To our knowledge, there have been only a few reports about metachronous MFOS. We report a case of MFOS in a 14-year-old boy with review of the literature.