Intramedullary Well-Differentiated Osteosarcoma: Imaging and Pathologic Findings in 17 Patients

Background: Intramedullary well-differentiated osteosarcoma (IMWDOS) is rare and may easily be misdiagnosed. Objective: This study was to investigate the clinical, imaging and pathological features of IMWDOS for correct diagnosis. Results: There were 13 males and 4 females with an age range of 19-55 years (mean 32). The lesion was located at long bones in 16 patients and at the second region of acetabulum in one patient. Except for three patients with limited areas of lesions, all the other patients had wide areas of disease, and the lesion in long bones all involved the metaphysis area with possible extension towards the diaphysis. In imaging, the lesion usually had an unclear boundary with destruction of bone cortex, uneven thickness of the bone cortex, thick and coarse trabecula in the lesion, but few periosteal reaction and soft tissue masses. The lesion was histologically composed of spindle cells with slight atypia. Follow-up was performed 2-101 months (mean 37.7) in 14 cases, 10 years in one case and 26 years in the remaining two. At follow-up, 12 patients (12/17 or 70.6%) who had complete resection including amputation (n=2), wide excision (n=8) and endoprosthetic replacement (n=2) had no recurrence or metastasis. Among five patients with curettage, three (3/17 or 17.6%) were recurrent with two deaths, and the third one died during post-operation chemotherapy. Conclusion: Intramedullary well-differentiated osteosarcoma tends to occur at the metaphysis of long bones, especially at the distal femur. Histological, clinical and imaging findings lack characteristics and should be closely combined to reach a correct diagnosis. The prognosis of patients with complete lesion resection is good while incomplete lesion curettage or resection will lead to recurrence and transformation into a highly malignant tumor.

Nora’s lesion of the distal ulna: a case report

Nora’s lesion, also known as bizarre parosteal osteochondromatous proliferation (BPOP), is a very rare benign lesion with few published cases. BPOP is more common in adults during the second to third decades of life, and usually occurs on the hands and feet. Radiologically, it appears as a calcified mass attached to the bone cortex that grows rapidly and that recurs easily following resection. Aggressive features on imaging and confusing histopathological findings usually result in misdiagnosis or mistreatment. Herein, we present a case of a rare bony tumour involving the distal ulna presenting as a painless growing mass. An excisional biopsy with clear margins was performed without disturbing the ulnar nerve and arteries. There was no recurrent mass or calcified lesion 1 year after surgery. Based on its rarity and difficult diagnosis, BPOP should be considered in the differential diagnosis of a painless mass in the distal ulnar region. Careful follow-up after surgery is essential, even without lesion recurrence.

Robot-assisted Anterior Odontoid Screw for the Treatment of Type Ⅱ Odontoid Fractures: Safety and Effectiveness Analysis

Background: Anterior odontoid screw fixation is considered to be preferred surgical treatment for the type Ⅱ odontoid fractures. However, due to the high difficulty to insert odontoid screw with barehand, the high risk of screw misalignment and damage to surrounding important tissue structures, we urgently need robot-assisted screw insert navigation technology to improve the safety and accuracy of inserting odontoid screws.Methods: We retrospectively analyzed 7 patients with type II odontoid fractures who underwent Tinavi robot-assisted screw insert technology from May 2018 to May 2019 at our hospital. All patients had received 64-row CT scans and 3D reconstructions completed preoperatively, and magnetic resonance (MRI) were performed to verify the severity of odontoid fractures, soft tissue injuries and vertebral artery height. Postoperative CT was repeated in 6 months after surgery to evaluate cervical stability and confirm whether the screw had breached the bone cortex, the accuracy of screw placement based on Rampersaud A-D grade. Functional recovery was assessed using the post-traumatic Mayor scoring system for the cervical spine.Results: All 7 patients successfully completed the robot-assisted operation without nerve and blood vessel damage. What is the operation time 103.3 minutes, intraoperative blood loss 11.1 ml. The angulation and displacement of the fracture were basically corrected by closed reduction during the operation. Postoperative CT of these 7 patients showed that the cervical spine was stable, the accuracy of “perfect” and “clinically acceptable” odontoid screw implantation was 100% (7/7), none of the seven odontoid screws breached the bone cortex. Reexamination of X-rays showed that the fractures were all healed, and the average fracture healing time was average 13.7weeks (12-15weeks). During the follow-up period, 7 patients had no surgical complications, postoperative cervical spine trauma mayo score: excellent in 6 cases and good in 1 case. Conclusion: Tinavi robot-assisted screw insert technology is a minimally invasive, accurate, safe and feasible method for the treatment of type Ⅱ odontoid fractures.

Fibroma cementoossificante bilateral mandibular apresentando diferentes estágios de maturação: relato de caso clínico / Bilateral ossifying fibroma of the jaw with different maturation stages: a case report

The ossifying fibroma (OF) is characterized as a benign neoplasm originated from the mesenchymal periodontal membrane, being composed of different amounts of mineralized material and fibrocellular stroma, leading to a mixed aspect. More commonly found as solitary lesions, the OF can be multiple in rare cases, normally associated with hyperparathyroidism-jaw tumor syndrome (HPT-JT). The aim of this study is to report a case of bilateral OF in the mandible with different stages of maturation, not associated with HPT-JT. This case shows a 20-year-old female patient with asymptomatic intraoral hard swelling in both sides of the mandible, presenting a slight expansion in the buccal bone cortex, near to the molars, hard to palpation. CBCT showed a unilocular, well-circumscribed hypodense image, with calcified masses only on the right side. Incisional biopsies were performed and a diagnosis of bilateral OF was reached. Due to the different stages of maturation of the lesions, two different surgical approaches were performed, curettage in the left side and surgical resection in the right side with extraction of the lower second premolar and lower first molar. These areas were restored with bone grafts and the left first molar was unresponsive to the pulp vitality test and endodontic treatment was performed. The patient is undergoing periodic clinical and radiographic follow-up, and after 12 months no signs or evidence of recurrence were observed.

Intramedullary Well-Differentiated Osteosarcoma: Imaging and Pathologic Findings in a Group of 17 Patients

Background: Intramedullary well-differentiated osteosarcoma (IMWDOS) is rare and may easily be misdiagnosed. Objective: This study was to investigate the clinical, imaging and pathological features of IMWDOS for correct diagnosis. Materials and methods: Seventeen patients with IMWDOS were enrolled and the clinical, imaging and pathological data were analyzed. Results: There were 13 males and 4 females with an age range of 19-55 years (mean 32). The lesion was located at long bones in 16 patients and at the second region of acetabulum in one patient. Except for three patients with limited areas of lesions, all the other patients had wide areas of disease, and the lesion in long bones all involved the metaphysis area with possible extension towards the diaphysis. In imaging, the lesion usually had an unclear boundary with destruction of bone cortex, uneven thickness of the bone cortex, thick and coarse trabecula in the lesion, but few periosteal reaction and soft tissue masses. The lesion was histologically composed of spindle cells with slight atypia. Follow-up was performed 2-101 months (mean 37.7) in 14 cases, 10 years in one case and 26 years in the remaining two. At follow-up, 12 patients (12/17 or 70.6%) who had complete resection including amputation (n=2), wide excision (n=8) and endoprosthetic replacement (n=2) had no recurrence or metastasis. Among five patients with curettage, three (3/17 or 17.6%) were recurrent with two deaths, and the third one died during post-operation chemotherapy. Conclusion: Intramedullary well-differentiated osteosarcoma tends to occur at the metaphysis of long bones especially at the distal femur involving a large area. Histological, clinical and imaging data have to be closely combined to reach the correct diagnosis.

Biomechanical Factors May Be the Main Contributor to Entheseal Changes in Normal Adults

We compliment Bakirci, et al for their article1 on the prevalence of ultrasound (US) elementary lesions at mainly lower extremity enthesis sites in 80 (50 female, 30 male) healthy adults (20–80+ yrs) and their analyses of contributory factors. We also compliment the accompanying editorial by Hánová, et al2. The core set of US enthesitis elementary lesions defined by the Outcomes in Rheumatology (OMERACT) group3 were analyzed in the following categories: (1) inflammation (hypoechogenicity and/or increased thickening of the tendon insertion, and power Doppler activity); (2) damage (enthesophytes, calcification, and erosions); and (3) total US scores, all within a 2-mm distance of the bone cortex1.

Pathological fracture of subtrochanter femur, soft tissue infection along the fracture site, shaft femur bone cortex thickening and blastic lession on contralateral shaft femur due to renal osteodystrophy on the end stage renal disease patient: a case report

Renal osteodystrophy (ROD) is a skeletal complication resulting from pathologic alterations in calcium, phosphate, and bone metabolism. The potential link between bone turnover and bone quality is an important question meriting study because of the relatively high incidence of fractures reported. In this case presents a pathological fracture on a routinely hemodialyzed woman. She complained pain on her left subtrochanteric area after low energy trauma accident. A thickening of the shaft femoral bone cortex was also found, reflecting the osteosclerosis event due to imbalance of proliferation and differentiation of osteoblast with increase bone formation. She also had a blastic lesion on her contralateral shaft femoral during the bone survey, but this finding remains asymptomatic. Decreased osteoclastic activity may contribute to cortical thickening, resulting in overall bone mass increase, which may lead to decreased elasticity of the bone or impaired repair capabilities, therefore increasing the risk of fracture. The blastic lesion that occurred on contralateral side may indicated effect of ROD or primary bone lesion. Careful assessment and holistic management of patients with kidney disease is necessary to achieve optimal outcome. The prevention of falls is also an important strategy to prevent pathological fractures. End stage renal disease (ESRD) have reduced bone mineral density, a risk factor for fracture incidence. Careful anamnesis and clinical examination are needed for diagnosis and management.

BACTERIOLOGICAL STUDY AND ANTIMICROBIAL SENSITIVITY PATTERN IN CASES OF OSTEOMYELITIS

Introduction- Osteomyelitis refers to infection of bone marrow which spread to the bone cortex and periosteum. Osteomyelitis is most commonly caused by pyogenic bacteria. Despite greater advances in treatment the management of osteomyelitis is quite challenging due to increasing development of antibiotic resistance. Material and Methods -100 patients were evaluated. Samples like pus or exudates or pieces of necrotic tissue were taken. Samples were subjected to gram’s staining and culture. Antimicrobial sensitivity was done using Kirby Bauer disc diffusion method. RESULTS - Staphylococcus aureus was the most common organism isolated followed by E.coli, Klebsiella pneumoniae P. aeuroginosa and Proteus. Staphylococcus aureus + E coli was the most common polymicrobial organism isolated. In trauma cases most common organism isolated was Staphylococcus aureus. Gentamycin was the commonest antibiotic which was effective for treatment of osteomyelitis followed by amikacin, tobramycin and levofloxacin.In cases of gram positive organism max were seen to sensitive to vancomycin and linezolid.

Clinicopathological analysis of 55 cases of ossifying fibroma of the jaw

Objective : The purpose of this study was to investigate 55 cases of ossifying fibroma to analyze their clinical and pathological data. Methods : The clinical data, age, imaging performance, serology and their prognosis of 55 cases were analyzed and also Chi-square Test for statistical analysis were made. Results : The COF took up 70.9%, JPOF took up 20.0%, and JTOF took up 5.5%. 62.5% COF were the females, 75% JPOF concentrated in females, 66.7% JTOF concentrated in males. 66.7% COF located in the mandible. 54.5% JPOF were in the maxilla, in which 4 cases (4/11,36.4%) involved the para-nasal sinus. JTOF mainly concentrated in the mandible (66.7%). 2 cases (3.6%) exhibited multi-lesions. 7 cases (12.7%) were found the level of serum ALP up-regulated, and the up-regulation concentrated in younger patients (0~29 years) ( P <0.05). In radiographic presenting, only 7.3% displayed unclear borderline, and 87.3% exhibited mixed lesions, 7.3% was X-ray transparent, 5.5% was X-ray opaque. 29.1% had thinning bone cortex and 1 cases was found the bone cortex destructed (1/55,1.8%).18.2% OF appeared tooth displacement, and 9.1% displayed the amputated-like absorption of tooth root. 32 cases were followed up, 31.3% underwent conservative treatment suffered relapse, there was significant differences between the conservative and radical treatment ( P <0.05). Conclusions: The main subtype of OF was COF, JPOF and JTOF were relatively less. The majority of sporadic OF was single lesion, multi-lesions were rare. COF occurred with the female predilection in mandible, while JPOF occurred with the female predilection in maxilla; JTOF was the youngest, most occurred in adolescent males in mandible. Tooth displacement was often seen, and the root appeared as an amputated-like resorption. Younger patients were more likely to have elevated ALP. The patients underwent conservative curettage had relatively higher rate of relapse, the lesion should be resected radically to prevent relapse. Keywords: ossifying fibroma, clinical, pathological, jaw