Thromboembolism in Malignant Musculoskeletal Tumour: A Literature Review

Malignant musculoskeletal tumour may cause considerable burden to general health. The fast growth combined with the tumour characteristics and its invasion capability resulted in the poor prognosis of malignant musculoskeletal tumour. Malignant musculoskeletal tumour may cause significant disability by destroying normal tissue that plays important role in body kinematics. Thromboembolism, including deep vein thrombosis, pulmonary embolism, and other kinds of venous thromboembolism, is one of the most underestimated complications of musculoskeletal tumour. Normally, thrombosis ensues when pathologic factors overcame the body hemostatic regulatory capabilities, which will predispose the body to the formation of thrombus. Venous thromboembolism in musculoskeletal tumour may develop as a result of interaction between the tumour pathologic capabilities and its interaction with normal bodily functions. In this study, we reviewed the burden of musculoskeletal tumour and its complication on global health. Then, the review will focus on the pathologic and clinical aspect of thromboembolism in malignant musculoskeletal tumour, including pathophysiology, diagnosis, and treatment based on recent findings and literature.

Management of extra-abdominal fibromatosis in a musculoskeletal tumour centre in Hong Kong

Introduction: Fibromatosis is a benign disease yet prone to recurrence. The best treatment option remains controversial. The purpose of this study was to analyse the management approach in our musculoskeletal tumour centre. Materials and Methods: Thirty-four patients with extra-abdominal fibromatosis referred to our centre between 2000 to 2018 were included. Patients’ demographics, tumour location and size, year of diagnosis, treatment modalities, surgical margins, recurrence, and subsequent management were analysed. Results: Patients mostly presented in the second and third decade, with female predominance. Twenty-seven patients underwent excision. Other management options included ‘watchful waiting’, pharmacological treatment and radiotherapy. Recurrence rate was 51.9%. There was no statistically significant relationship between marginal status and recurrence. Conclusion: We report our experiences on management of fibromatosis, with strategy shifted from early excision to a conservative approach over the years. Surgical excision is still indicated in some situations. Tumour recurrence is not rare but second excision is not always necessary.

Determinants of Delayed Presentation of Patients with Primary Malignant Musculoskeletal Tumours Managed in a Tertiary Referral Hospital

Background: Malignant musculoskeletal tumours are comparatively rare tumours and delays in diagnosis and treatment are common. Understanding the factors that influence delay is important so as to improve the outcomes for cancer patients. Aim: To describe factors associated with delay in presentation of patients with primary musculoskeletal tumours. Study Design: Descriptive cross-sectional study. Setting: The study was conducted in a tertiary referral hospital from July to December 2014. Methodology: 56 patients with a confirmed histopathological diagnosis of a primary malignant musculoskeletal tumour and who had consented to the study were included. Data was collected using a pre-tested questionnaire. The clinical findings, laboratory results and radiographs of the lesions and the chest, as well as histopathological results were used to stage the musculoskeletal tumour. Data was analyzed using SPSS software version 20.0. Univariate and bivariate analysis was done for associations and results presented in the form of tables, pie charts and bar graphs. Results: A total of 56 patients were studied, 34 (60.7%) males and 22 (39.3%) females with a male to female ratio of 1.5:1. 73.2% (41) of the patients were adults while children comprised 26.8% (15). The age range was 4yrs-78yrs, with a mean of 32.25yrs. The mean patient delay was four months with 50% (28) of the patients seeking care for the first time after three months. Males were twice as likely to present late compared to females (OR 2.5, P=0.10) while patients younger than 40 years were more likely to present late (OR 1.4, P=0.59). Low educational level (OR 3.7, P=0.15) and low family income (OR 2.3, P=0.38) were associated with delayed presentation. Conclusion: Delayed presentation of patients with MS tumours is influenced by a multitude of factors ranging from the socio-demographics (age, sex, education level), socio-economic status and tumour knowledge, beliefs and perception.

Epidemiology of Osteosarcoma : Single Center Study in Indonesia

Objective- To assess osteosarcoma epidemiology in Haji Adam Malik General Hospital. Material and Methods- This study is a retrospective descriptive study with a crosssectional approach. Patient with musculoskeletal tumour (especially osteosarcoma) in Haji Adam Malik Hospital from January 2012 to Desember 2017 period, got their age, gender, musculoskeletal tumour type, biopsy result, tumour sites, treatment completion, metastasis and amputation status recorded from their medical record. Result-Primary bone tumors is the most cases and found in 50% of musculoskeletal tumors followed by soft tissue tumors and metastatic bone disease. Male (60%) have slightly higher prevalence than female in (40%). The incidence of primary bone tumors shows osteosarcoma, GCT, and osteochondroma are in the top three with 63%, 13%, and 6% respectively. Specifically for osteosarcoma, male and female have 1.9 : 1 prevalence ratio. The most common sites for osteosarcoma is distal the femur (45%) and proximal tibia (29%). About 63% of patients undergo complete treatment and with 55% recorded with metastasis in the first diagnosis and amputation was performed in 89% of patients. Conclusion- Primary bone tumors dominate the data with 50% for musculoskeletal tumors followed by 31% soft tissue tumors and 19% metastatic bone disease. The incidence of musculoskeletal tumors shows that men are slightly higher than women in 60% and 40%. The incidence of primary bone tumors shows osteosarcoma, giant cell tumor, and osteochondroma are in the top three with 63%, 13%, and 6% respectively.