Osteosarcoma with Orbital Metastasis in a Nigerian Child: A Case Report and Review of the Literature

Osteosarcoma is the most common primary bone tumour with a peak occurrence in adolescence. The occurrence of osteosarcoma in preadolescents is rare with a paucity of data in the developing world. Metastasis of osteosarcoma to the orbit is even a rarer presentation with few cases reported in the literature but to the best of the researchers’ knowledge, none of the previous cases had contralateral orbital metastasis to osteosarcoma. This is the first case report of orbital metastasis of osteosarcoma in Nigeria. The present case is presented for its rarity, to increase awareness and add to knowledge on the possibility of metastasis to contralateral orbit in osteosarcoma.

Paediatric bone lesions: diagnostic accuracy of imaging correlation and CT-guided needle biopsy for differentiating benign from malignant lesions

Objective: To determine the sensitivity, specificity and accuracy of CT-guided needle biopsy (CT-NB) for distinguishing benign and malignant lesions in children with suspected primary bone tumours, and to assess the correlation between imaging diagnosis and final diagnosis. Methods: Retrospective review of children who underwent CT-NB of a suspected primary bone tumour between October 2016 and October 2019. Data collected included anatomical location, imaging diagnosis, type of needle, type of biopsy sample, CT-NB diagnosis, final diagnosis and post-procedural complications. The final diagnosis was established based on surgical histology or clinical/imaging follow-up. Results: 125 patients met the inclusion criteria (68M, 57F: mean age 11 years; range 10 months–18 years). Biopsy was performed using a 10 cm Jamshidi needle (10G n = 96; 13 G n = 8); 14G Tru-Cut needle (n = 18); 14G Temno needle (n = 3). The commonest anatomical locations were the femur (n = 40), tibia (n = 25) and humerus (n = 16), while the commonest diagnoses were osteosarcoma (n = 35), CRMO (n = 15) and LCH (n = 14). A benign tumour was correctly identified on imaging in 100% of cases, and a malignant tumour in 95.8%. Sensitivity, specificity and diagnostic accuracy of CT-NB for distinguishing malignant from benign lesions were 98%, 100 and 99%. Of 24 indeterminate biopsy results, all that had a non-aggressive radiological appearance were benign. No immediate complications were recorded. Conclusion: CT-NB represents a safe and very effective tool for differentiating benign and malignant lesions in children presenting with a suspected primary bone tumour. Suspected radiological diagnosis plays a pivotal role in the management of indeterminate biopsy results. Advances in knowledge: Paediatric bone tumours pose a significant diagnostic and therapeutic challenge. The interpretation of the imaging findings is essential for the successful management of indeterminate histological results.

Long-term outcome of iliosacral resection without reconstruction for primary bone tumours

Aims Iliac wing (Type I) and iliosacral (Type I/IV) pelvic resections for a primary bone tumour create a large segmental defect in the pelvic ring. The management of this defect is controversial as the surgeon may choose to reconstruct it or not. When no reconstruction is undertaken, the residual ilium collapses back onto the remaining sacrum forming an iliosacral pseudarthrosis. The aim of this study was to evaluate the long-term oncological outcome, complications, and functional outcome after pelvic resection without reconstruction. Methods Between 1989 and 2015, 32 patients underwent a Type I or Type I/IV pelvic resection without reconstruction for a primary bone tumour. There were 21 men and 11 women with a mean age of 35 years (15 to 85). The most common diagnosis was chondrosarcoma (50%, n = 16). Local recurrence-free, metastasis-free, and overall survival were assessed using the Kaplan-Meier method. Patient function was evaluated using the Musculoskeletal Tumour Society (MSTS) and Toronto Extremity Salvage Score (TESS). Results At a mean follow-up of 159 months (1 to 207), 23 patients were alive without disease, one was alive with lung metastases, one was alive following local recurrence, four were dead of disease, and three had died from other causes. The overall ten-year survival was 77%. There was only one (3%) local recurrence, which occurred at 26 months. There were 18 complications in 17 patients; 13 wound healing complications/infections, three fractures, one pulmonary embolism, and one dislocation of the hip. Most complications occurred early. The mean functional scores were 21.1 (SD 8.1) for MSTS-87, 67.3 (SD 23.9) for MSTS-93 and 76.2 (SD 20.6) for TESS. Conclusion Patients requiring Type I or Type I/IV pelvic resections can expect a good oncological outcome and a high rate of local control. Complications are generally acute in nature and are easily manageable. These patients achieved a good functional outcome without the need for bony reconstruction. Cite this article: Bone Joint J 2020;102-B(6):779–787.

Primary Ewing’s sarcoma of the temporal bone: a rare entity and review of the literature

Ewing’s sarcoma (ES) is the second most common malignant primary bone tumour in children and adolescents. It primarily affects the diaphysis of long bones and pelvis. ES arising from temporal bone is extremely rare. To date, 43 such cases have been described in the literature. Clinical and radiological features are non-specific. Diagnosis is based mainly on immunohistochemistry. The present article presents an extremely rare case of ES of the temporal bone in a 20-year young man, and he was successfully treated with multiagent chemotherapy and radiotherapy.

Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

Giant cell tumour (GCT) is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge.