Bone Infarct Associated Osteosarcoma: Epidemiologic and Survival Trends

2022 ◽  
Author(s):  
Roberta Laranga ◽  
Marco Focaccia ◽  
Andrea Evangelista ◽  
Enrico Lucarelli ◽  
Davide Maria Donati ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Distal Femur ◽  
Case Reports ◽  
Published Data ◽  
Chemotherapy Treatment ◽  
Literature Report ◽  
Elective Treatment ◽  
Bone Infarct ◽  
Grade 3

Background Bone tumors are not a frequent occurrence and bone-infarct-associated sarcomas are even rarer. The prognosis of this disease is poor and its treatment remains a challenge. Nevertheless, hardly any analyses in literature report on secondary osteosarcoma (SO) on bone infarct and most of the data available do not provide sufficient details. We evaluated whether this condition could be further characterized and if prognosis could be influenced by the chemotherapy treatment. In particular, we sought to determine (1) the main features of this rare disease; (2) the overall survival (OS) rate; (3) the OS rate associated to chemotherapy treatment; (4) the correspondence between our results and published data in terms of survival. Methods We retrospectively reviewed patients admitted at Rizzoli Orthopedic Institute of Bologna between 1992 and 2018 (1465 total cases of osteosarcoma). We identified a list of 11 cases of SO on bone infarct (cohort 1). We conferred about the epidemiology, surgical and chemotherapy (ChT) treatment and surveillance of infarct-associated osteosarcoma showing the correlation to data present in literature, corresponding to 15 case reports published within 1962-2018 (cohort 2). Results (1) cohort 1 was made of 11 patients: six females and five males, median age was 55 years. Nine (81%) were grade 4, two (19%) grade 3. Tumor predominantly arise on distal femur (64%). Most of patients had localized osteosarcoma at the diagnosis (81%); resection surgery was the elective treatment (73%) followed by amputation (18%). Of 11 patients, seven received also ChT (64%). (2) Five-years OS was 62% (95% CI: 28-84). Median OS was 74 months (95% CI: 12-not reached). The cumulative incidence of cancer-related deaths (CICRD) was 37.7% (95% CI: 11.4-64.5) at 120 months. (3) In the group treated with only surgery OS was 50% at 5 years. For patients treated with any form of ChT, OS was 71% at 5 years (p=0.4773) and hazard ratio (HR) 0.56. The CICRD was 29% (at 2 years of follow-up. Instead, it was of 50% for patients treated only with surgery. (4) Median survival was 74 months and 19 months for cohort 1 and cohort 2 respectively (p=0.09). Data analysis showed a decreased HR for cohort 1 compared to cohort 2 (HR 0.378). Results confirmed also stratifying for age and ChT administration (HR 0.355). Conclusions Based on this work, our opinion is that the choice to undergo the patients to ChT combined to surgery could improve their prognosis.

Editorial Volume 16 Issue 3

2017 ◽  
Vol 16 (3) ◽  
pp. 103-103
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Early Recognition ◽  
Case Reports ◽  
Local Level ◽  
Referral Letter ◽  
Published Data ◽  
Building Relationships ◽  
Phone Calls ◽  
Telephone Advice

The role of consultants in the referral process for acute medicine has been a subject of discussion for as long as I have been involved with the speciality. This journal has previously published data from individual sites which demonstrated benefits on a local level when consultants were directly involved in taking referral phone calls from general practitioners. This was further evaluated as part of the Society for Acute Medicine’s 2016 Benchmarking Audit, (SAMBA16), which generated some National data around outcomes according to the seniority of clinician receiving the referral. This is presented in the current edition. The authors acknowledge the limitations of the data, particularly the difficulty in comparing units with different facilities for assessment, treatment and follow-up, which may have influenced the options available for consultants when taking referrals. As with previous research in this area, the paper focuses on the quantitative benefits in terms of the admissions ‘avoided’ as a result of telephone advice given; the data collection does not allow any analysis of what subsequently happened to these patients, and it is possible that some were subsequently admitted to hospital. It is important also to remember the qualitative benefits of direct communication with GPs: the ability to glean important nuggets of information which may be omitted from a referral letter, as well as the value of regular conversations in building relationships between primary and secondary care. My own experiences over the past 2 decades suggest that these benefits are often at least as great, albeit more difficult to measure, than ‘admission avoidance’. Infections represent a large proportion of the acute medical intake, and this is reflected in many of the case reports we receive for consideration of publication. Three such cases are included in this edition. When the case history includes ‘visiting sewage-contaminated land’, many clinicians would be thinking along the lines of leptospirosis while awaiting serological testing. However in the case presented by Sarah Lawrence and colleagues from the Manchester area, it turned out to be the family pet which was responsible for their patient’s disseminated intravascular coagulation. Captocytophaga carnimorsis is not an organism with which I was previously familiar, but this case has reinforced my view that allowing your dog to lick your mucus membranes is something to be avoided. Lemierr’s syndrome is another condition which I have not previously encountered; however the authors of our third case report suggest this may be worth considering when a patient’s ‘simple sore throat’ fails to improve. In this case, it was the finding of another unusual bacterium – fusebacterium necrophorum – in the blood culture which led to the further investigation and diagnosis of this condition. Early recognition and initiation of appropriate antibiotic therapy is associated with an improved outcome, so this represents an important reminder of a condition which might otherwise be forgotten. Although this is technically the ‘autumn edition’, I suspect that Winter may already have arrived with a vengeance by the time it has been printed and mailed, so I hope that readers working in the NHS’ busy Acute Medical Units are managing to keep their spirits up, and have battened down the necessary hatches for whatever the months ahead choose to throw at us.

scholarly journals Spindle Epithelial Tumor with Thymus-like Element of the Thyroid Gland

2012 ◽  
Vol 4 (2) ◽  
pp. 74-76 ◽  
Author(s):  
V Satyanarayana ◽  
Dajiram Govonda Mote
Keyword(s):  
Thyroid Gland ◽  
Case Reports ◽  
English Literature ◽  
Diagnostic Feature ◽  
Published Data ◽  
Epithelial Tumor ◽  
Children And Adolescent ◽  
Long Term Follow Up

ABSTRACT Spindle epithelial tumor with thymus-like different ion (SETTLE) is an extremely rare tumor arising from thyroid gland which was first time recognized and reported by Chan and Rosai. It is believed to be arising from the branchial pouch or the remnant of thymus within the thyroid gland as it reveals primitive thymic elements. It has been reported more than 20 times as an individual case reports in the searched English literature. It mostly occurs in the children and adolescent but cases of SETTLE are reported in adults and even in elderly patients. Age of patient is not diagnostic feature of the SETTLE tumor. According to the published data, SETTLE tumor has an indolent course but delayed blood-borne distant metastases is seen in the cases with long-term follow-up. The present case is 13-year-old boy who presented with solitary nodule of left lobe of the thyroid without any other symptoms. The patient was subjected to ipsilateral hemithyroidectomy. The histopathological report revealed the diagnosis of SETTLE tumor which was confirmed with the immunohistochemistry. The patient is followed-up regularly and there is no evidence of metastasis with more than 4 years follow-up. There are no existing guidelines regarding the optimum treatment and the duration of follow-up due to paucity of data about management of SETTLE tumor. The long-term follow-up is needed to detect recurrence or metastases. How to cite this article Mote DG, Satyanarayana V. Spindle Epithelial Tumor with Thymus-like Element of the Thyroid Gland. World J Endoc Surg 2012;4(2):74-76.

scholarly journals A Series of Pure Ankle Dislocations without Associated Fracture: Our Clinical Experience

2021 ◽  
Author(s):  
Tingjiang Gan ◽  
Yaxing Li ◽  
Wei Deng ◽  
Boquan Qin ◽  
Xi Liu ◽  
...  
Keyword(s):  
Case Reports ◽  
Degenerative Change ◽  
Treatment Protocol ◽  
Case Series ◽  
Published Data ◽  
External Fixators ◽  
Functional Rehabilitation ◽  
Short Period ◽  
Ankle Dislocation

Abstract Background: Pure ankle dislocation without associated fracture is extremely rare, thus the literature almost limited to case reports and small case series. The standardized treatment protocol is in controversy and the studies of mechanism and outcome of the injury are still deficient. We report a series of eight cases of pure tibiotalar dislocations managed with emergency reduction and other heterogenic procedures, hoping to add some material to the published data on this topic and present our clinical experience.Methods: We retrospectively reviewed the eight cases of isolated ankle dislocations without associated fracture that were treated in our department from 2015 to 2019. Results: The eight cases were all posteromedial dislocations with six open and two closed. Emergency reduction was performed for all patients followed by average 6 weeks’ immobilization with external fixators in five and short leg cast in three. The mean follow-up period was 33 (range, 12 to 61) months. None of the eight patients showed obvious instability though only one patient underwent ligaments repair. The average range of motion (ROM) loss of the ankles was 10 degrees for plantarflexion and 3 degrees for dorsiflexion. Two patients complained of moderate stiffness and three complained of persistent mild pain in whom degenerative change was found. Neurovascular sequela was presented in one patient with numbness. Only one patient developed superficial infection. The average AOFAS score was 90 (range, 78 to 100) points at the final follow-up with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed sports activity.Conclusion: Pure ankle dislocation is a rare ligamentous ankle injury with complicated mechanism. Most of the injuries treated with emergency reduction and thorough debridement followed by a short period of immobilization and functional rehabilitation have good clinical outcomes. Ligaments repair should only be considered in cases of chronic ankle instability after failed conservative treatment.

Clinical Outcome for MCTs of Canine Pinnae Treated with Surgical Excision (2004–2008)

2014 ◽  
Vol 50 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Timothy M. Schwab ◽  
Catherine Popovitch ◽  
John DeBiasio ◽  
Michael Goldschmidt
Keyword(s):  
Local Recurrence ◽  
Surgical Excision ◽  
Tumor Grade ◽  
Published Data ◽  
Disease Free Interval ◽  
Mast Cell Tumors ◽  
Grade 3 ◽  
Record Review ◽  
Disease Free

Canine mast cell tumors (MCTs) are the most common cutaneous neoplasm in the dog. It has been suggested that MCT in certain locations may behave in a more biologically aggressive fashion than MCTs located in others; however, no published data are available for MCTs of canine pinnae treated with surgical excision. A retrospective study of 28 animals with surgical excision of MCTs of pinnae was completed with a medical record review and follow-up questionnaire to the operating veterinarian. The effect of tumor grade, clean or dirty excision, cartilage penetration, and mitotic index (MI) on local recurrence and survival time (ST) was evaluated. There was local recurrence in one dog with a grade 2 MCT and in seven of eight dogs with grade 3 MCTs. The median ST of animals with grade 1 and 2 MCTs was not reached, whereas the median ST of animals with grade 3 MCTs was 10 mo. There was no statistical association between histologically clean and dirty margins and either local recurrence or ST. A prolonged disease free interval without local recurrence may be achieved with local excision of grade 1 and 2 MCTs. Animals with grade 3 MCTs had a uniformly poor outcome with short times to local recurrence and death.

Augmentation of adoptive T-cell therapy for Merkel cell carcinoma with avelumab.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3044-3044 ◽  
Author(s):  
Kelly Garneski Paulson ◽  
Maurizio Perdicchio ◽  
Rima Kulikauskas ◽  
Felecia Wagener ◽  
Candice Church ◽  
...  
Keyword(s):  
T Cells ◽  
T Cell ◽  
Triple Therapy ◽  
Response Rate ◽  
Adoptive T Cell Therapy ◽  
Published Data ◽  
Merkel Cell ◽  
T Cell Therapy ◽  
Grade 3

3044 Background: 80% of Merkel cell carcinomas (MCCs) are caused by Merkel cell polyomavirus (MCPyV) oncoproteins. Although absent in most cases, abundant MCPyV-specific CD8+ TIL are associated with good MCC outcomes, implying tumor susceptibility to immune attack. Indeed, anti-PD-1 axis blockade has a response rate of 32-56%. However, half of patients do not respond, suggesting a lack of adequate MCPyV-specific T cells and/or tumor evasion from MCC-related reduced HLA expression. We hypothesized the combination of adoptive transfer of MCPyV-specific T cells with HLA upregulation and PD1 axis blockade would be more effective than either approach alone. Methods: 8 adult patients with MCPyV-associated metastatic MCC without pre-existing immune deficiencies were enrolled. The safety and efficacy of ex vivo expanded MCPyV-specific T-cells plus HLA-upregulation (radiation or interferon) with (triple therapy) and without (double therapy) avelumab (mAb against PD-L1, dose 10 mg/kg IV q2weeks) were compared in 2 related phase I/II studies. Results: All 4 patients who received triple therapy (100%) are alive (median follow-up 10 months), and experienced objective responses (RECIST 1.1) with 3 of 4 sustained complete responses (CRs) at last follow-up (longest 13 mo). This compared favorably to outcomes among the 4 patients who received double therapy (3 with progression and 1 CR (25%) for 14 months before progression) and published data for avelumab monotherapy – response rate 32% and CR rate 9% in patients who had failed chemotherapy (Kaufman et al, Lancet Oncol, 2016). Grade 3-4 T cell-related adverse events were similar and anticipated in both groups, including transient lymphopenia (n = 7) and modest cytokine release syndrome lasting < 24 hours, manageable on the general ward (n = 4). No grade 3-4 toxicities were attributed to avelumab. Among patients receiving triple therapy, transferred T cells persisted, and peak frequencies correlated with rate of tumor regression. Conclusions: The combination of MCPyV-specific T cells, avelumab and HLA upregulation is safe and correlative studies suggest avelumab enhances the T cell responses to MCC. This strategy has potential for MCC treatment, and can be readily applied to other solid tumors. Clinical trial information: NCT01758458 and NCT02584829.

scholarly journals COVID-19-Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Pierpaolo Trimboli ◽  
Carlo Cappelli ◽  
Laura Croce ◽  
Lorenzo Scappaticcio ◽  
Luca Chiovato ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Case Reports ◽  
Case Series ◽  
Subacute Thyroiditis ◽  
Nasopharyngeal Swab ◽  
Published Data ◽  
Viral Origin ◽  
Reactive Protein

Subacute thyroiditis (SAT) is a thyroid disease of viral or post-viral origin. Whether SAT represents a complication of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear. Our aim was to systematically review the literature to 1) explore the size of the literature about SAT in COVID-19 and 2) evaluate the clinical characteristics of SAT. PubMed/MEDLINE, Embase, and Scopus were searched until April 20, 2021. Original papers, case reports, and case series reporting SAT in COVID-19 patients were included. Authors and their country, journal, year of publication, COVID-19 and SAT clinical presentation, thyroid function, therapy, and follow-up data were extracted. Nineteen papers (17 case reports and 2 case series) were included, describing 27 patients, 74.1% females, aged 18 to 69 years. COVID-19 was diagnosed by nasopharyngeal swab in 66.7% cases and required hospitalization in 11.1%. In 83.3% cases, SAT occurred after COVID-19. Neck pain was present in 92.6% cases and fever in 74.1%. Median TSH, fT3, and fT4 were 0.01 mU/l, 10.79 pmol/l, and 27.2 pmol/l, respectively. C-reactive-protein and erythrocyte sedimentation rate were elevated in 96% of cases. Typical ultrasonographic characteristics of SAT were observed in 83.3% of cases. Steroids were the most frequent SAT therapy. Complete remission of SAT was recorded in most cases. In conclusion, the size and quality of published data of SAT in COVID-19 patients are poor, with only case reports and case series being available. SAT clinical presentation in COVID-19 patients seems to be similar to what is generally expected.

Severe Head Injury linked to Subsequent Development of Malignant Brain Tumour within a Short Period- A Case Report

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Head Injury ◽  
Brain Tumour ◽  
Severe Head Injury ◽  
Case Reports ◽  
Subsequent Development ◽  
Malignant Brain Tumour ◽  
Tumour Development ◽  
Short Period ◽  
The Brain

There have been a few case reports of head injury leading to brain tumour development in the same region as the brain injury. Here we report a case where the patient suffered a severe head injury with contusion. He recovered clinically with conservative management. Follow up Computed Tomography scan of the brain a month later showed complete resolution of the lesion. He subsequently developed malignant brain tumour in the same region as the original contusion within a very short period of 15 months. Head injury patients need close follow up especially when severe. The link between severity of head injury and malignant brain tumour development needs further evaluation. Role of anti-inflammatory agents for prevention of post traumatic brain tumours needs further exploration.

Patients with “benign” Chiari I malformations require surgical decompression at a low rate

2019 ◽  
Vol 23 (4) ◽  
pp. 498-506 ◽  
Author(s):  
Tofey J. Leon ◽  
Elizabeth N. Kuhn ◽  
Anastasia A. Arynchyna ◽  
Burkely P. Smith ◽  
R. Shane Tubbs ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Multivariate Logistic Regression Analysis ◽  
Large Cohort ◽  
Initial Evaluation ◽  
Published Data ◽  
Posterior Fossa Decompression ◽  
Signal Abnormality ◽  
Chiari I

OBJECTIVEThere are sparse published data on the natural history of “benign” Chiari I malformation (CM-I)—i.e., Chiari with minimal or no symptoms at presentation and no imaging evidence of syrinx, hydrocephalus, or spinal cord signal abnormality. The purpose of this study was to review a large cohort of children with benign CM-I and to determine whether these children become symptomatic and require surgical treatment.METHODSPatients were identified from institutional outpatient records using International Classification of Diseases, 9th Revision, diagnosis codes for CM-I from 1996 to 2016. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, 3) had previously undergone posterior fossa decompression, or 4) had imaging evidence of syringomyelia at their first appointment. To include only patients with benign Chiari (without syrinx or classic Chiari symptoms that could prompt immediate intervention), any patient who underwent decompression within 9 months of initial evaluation was excluded. After a detailed chart review, patients were excluded if they had classical Chiari malformation symptoms at presentation. The authors then determined what changes in the clinical picture prompted surgical treatment. Patients were excluded from the multivariate logistic regression analysis if they had missing data such as race and insurance; however, these patients were included in the overall survival analysis.RESULTSA total of 427 patients were included for analysis with a median follow-up duration of 25.5 months (range 0.17–179.1 months) after initial evaluation. Fifteen patients had surgery at a median time of 21.0 months (range 11.3–139.3 months) after initial evaluation. The most common indications for surgery were tussive headache in 5 (33.3%), syringomyelia in 5 (33.3%), and nontussive headache in 5 (33.3%). Using the Kaplan-Meier method, rate of freedom from posterior fossa decompression was 95.8%, 94.1%, and 93.1% at 3, 5, and 10 years, respectively.CONCLUSIONSAmong a large cohort of patients with benign CM-I, progression of imaging abnormalities or symptoms that warrant surgical treatment is infrequent. Therefore, these patients should be managed conservatively. However, clinical follow-up of such individuals is justified, as there is a low, but nonzero, rate of new symptom or syringomyelia development. Future analyses will determine whether imaging or clinical features present at initial evaluation are associated with progression and future need for treatment.

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Sign in / Sign up

Export Citation Format

Share Document