Solitary Radiolucent Erdheim-chester Disease: A Case Report and Literature Review

Background: Erdheim-chester disease (ECD) is a rare non-Langerhans histiocytosis of unknown etiology, which typically presents with bilateral symmetric osteosclerosis and multi-organ involvement. Lesions may be intraosseous or extraosseous and involve the heart, pulmonary system, CNS, and skin in order of decreasing likelihood. Objective: The objective of this study is to discuss a case of erdheim-chester disease and conduct a review of the literature. Case: We describe a rare case of erdheim-chester in an asymptomatic 37-year-old male who was diagnosed after suffering a right ulnar injury. Subsequent evaluation revealed a solitary radiolucent ulnar lesion without multi-system involvement. Results & Conclusion: The case is unique in its solitary distribution, lytic radiographic appearance, and asymptomatic presentation preceding pathologic fracture. This presentation may simulate multiple other bone lesions.

An Adverse Case of Spinal Tumor Embolization with Gelfoam in a Patient Whose Vertebral Artery Has Shared Origin with Ipsilateral Costocervical Trunk

Tumor embolization is performed before surgical excision. The Gelfoam temporarily occludes the vessels supplying the tumor by facilitating thrombus formation. We report an adverse case of Gelfoam embolization in a patient with a certain vascular anatomy. A 75-year-old man previously diagnosed with lung cancer in 2015 was admitted to Korea University Guro Hospital. He had bilateral arm paresthesia and lower extremity weakness that had progressed for 2 weeks. Cervical spine magnetic resonance imaging revealed a metastatic pathologic fracture of the C6 vertebral body and subsequent cord compression. A C6 corpectomy was scheduled, and preoperative spinal tumor embolization was planned. Angiography revealed that the left deep cervical artery (DCA) and the ipsilateral vertebral artery shared origin. Two Nester coils were positioned at the right distal DCA, one at the left DCA, and two at the left proximal DCA. Gelfoam was infused in each location. However, the patient’s mental status worsened after the left DCA embolization. A diffusion-weighted image showed diffuse cytotoxic edema in the posterior circulation without significant lesions on magnetic resonance angiography. In Gelfoam embolization, special attention is required with neurological monitoring when maneuvering DCA if it has a nearby entrance with a vertebral artery.

Three Staged Revision Arthroplasty Using Structural Allograft in Chronic Periprosthetic Joint Infection Accompanied by Fracture: A Case Report

Revision arthroplasty for chronic periprosthetic joint infection is complex and determined by many variables. Generally, two-staged revision arthroplasty is the standard treatment for the management of chronic periprosthetic joint infection. However, it is difficult to resolve chronic infection accompanied by large bone deficiency due to pathologic fracture. I report a case of successful three-staged revision arthroplasty using frozen structural allograft in chronic periprosthetic knee joint infection accompanied by extensive bone defect due to fracture.

An unusual case of bone regeneration of a necrotic mandible with pathologic fracture in an elderly hemodialysis patient with medication-related osteonecrosis of the jaw: a case report and review of the literature

Background Bisphosphonates are frequently used for osteoporosis. Medication-related osteonecrosis of the jaw, a complication of bone-modifying agents, including bisphosphonates or angiogenic inhibitors, can be challenging to treat in elderly patients with numerous preexisting conditions. Achieving good treatment outcomes is especially difficult in patients with pathological fractures accompanied with extraoral fistulae. Case presentation We report an unusual case of prominent bone regeneration following palliative surgical treatment in a 72-year-old Japanese female patient undergoing hemodialysis. She previously had severe osteoporosis due to renal osteodystrophy and was receiving antiresorptive intravenous bisphosphonate. Computed tomography revealed a discontinuous left lower mandibular margin with a pathologic fracture and extensive, morphologically irregular sequestrum formation (80 × 35 × 20 mm). The patient was diagnosed with stage III medication-related osteonecrosis of the jaw and pathologic mandibular fracture. Immediately before the surgery, the anticoagulant used for dialysis was changed from heparin to nafamostat mesylate to reduce the risk of intraoperative bleeding. Sequestrectomy was performed under general anesthesia. Postoperative infection was not observed, the intraoral and submandibular fistula disappeared, and, surprisingly, prominent spontaneous bone regeneration was observed postoperatively at 6 months. Despite the severe systemic condition of the patient, the conservative surgical approach with sequestrectomy has yielded desirable results for more than 6 years since the surgery. Conclusions This rare report of spontaneous bone regeneration in a patient of advanced age and poor general condition is the oldest case of mandibular regeneration ever reported.

The frequency of demand and options for surgical treatment of breast cancer metastases in long and flat bones, depending on the histological subtype of the tumor

Introduction. Bone metastases increase the risk of developing a pathological fracture, spinal cord compression, pain syndrome and require palliative, radiation therapy and oncoortopedic operations. The appearance of these metastases and the above complications is associated with an unfavorable prognosis and negatively affects the quality of life of patients.Objective – to analyze the outcomes of surgical treatment in patients with breast cancer metastases to long and flat bones and to identify an optimal surgical tactics depending on the morphological subtype of the tumor.Materials and methods. Between April 2015 and April 2021, a total of 731 patients with breast cancer and bone metastases were consulted in the departments of the Russian Research Center of Radiology, Ministry of Health of Russia. Two hundred and thirty patients (31.5 %) had indications for orthopedic surgery. This study included 78 patients with breast cancer metastases to long or flat bones. Of them, 50 individuals had metastases to bones only, whereas 28 participants additionally had metastases to other organs. Luminal A and B breast cancer was diagnosed in 27 patients (34.6 %) and 40 patients (51.2 %), respectively. Ten participants (12.8 %) were found to have HER2-positive tumors, whereas one patient (1.3 %) had triplenegative cancer.Results. Eighteen patients with metastatic lesions in long bones have undergone bone grafting; 17 patients had intramedullary internal fixation with osteoplasty; and 1 patient had extramedullary internal fixation with osteoplasty. Forty two patients with metastatic lesions in the flat bones have undergone 39 osteoplasty surgeries of the iliac bone, while 3 patients had osteoplasty surgeries of the sternum. The survival rates of patients with luminal A, luminal B, HER2- positive, and triple-negative breast cancer were as follows: 1-year survival – 95, 84, 87 and 100 %, respectively; 3-year survival – 83, 64, 23 and 0 %, respectively; 5-year survival – 66, 32, 23 and 0 %, respectively. Thirty-one patients were lost to follow-up between month 0 and month 46. Eighteen patients died between month 1 and month 58.Conclusion. Patients with luminal A and B breast cancer and threatened pathologic fracture should undergo intramedullary/extramedullary internal fixation, while for patients who already developed pathologic fracture and their estimated life expectancy does not exceed 1 months, it is recommended to perform bone grafting regardless of the tumor immunohistochemical type. Patients with threatened pathologic fractures demonstrated a more favorable prognosis, better functional status, and higher survival rates than patients with pathologic fractures: 1-year survival was 90 and 87 %, respectively; 3-year survival was 67 and 58 %, respectively, and 5-year survival was 54 and 0 %, respectively. Radiation therapy increases the risk of pathological fractures, but is not a contraindication for orthopedic surgery.

Indolent Enhancing Spinal Lesions Mimicking Spinal Metastasis in Pediatric Patients With Malignant Primary Brain Tumors

BackgroundSpinal metastasis from malignant primary brain tumor (MPBT) in pediatric is rare, often appearing as enhancing lesions on MRI. However, some indolent enhancing spinal lesions (IESL) resulting from previous treatment mimic metastasis on MRI, leading to unnecessary investigation and treatment. MethodsIn 2005-2020, we retrospectively enrolled 12 pediatric/young patients with clinical impression of spinal metastasis, and pathological diagnosis of their spinal lesions. Three patients had MPBT with IESL, and 9 patients had malignant tumors with metastases. The histopathologic diagnosis of IESL was unremarkable marrow change. We evaluated their MRI, CT, and bone scan findings.Results Image findings of IESL vs spinal metastasis were 1) shape: round/ovoid (3/3, 100%) vs irregular (9/9, 100%) (P= .005); 2) target-shaped enhancement: (3/3, 100%) vs (0/9, 0%) (P= .005); 3) pathologic fracture of vertebral body: (1/3, 33.3%) vs (9/9, 100%) (P= .045); 4) expansile vertebral shape (0/3, 0%) vs (9/9, 100%) (P= .005); 5) obliteration of basivertebral vein: (0/3, 0%) vs (9/9, 100%) (P= .005); 6) osteoblastic change on CT: (3/3, 100%) vs (2/9, 22.2%) (P= .034).ConclusionsIESL in pediatrics with MPBT can be differentiated from metastasis by their image characteristics. We suggest close follow-up rather than aggressive investigation and treatment for IESL.