Surgical Intervention for Enneking Stage-III Vertebral Hemangiomas and Literature Review

Introduction: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking stage-III vertebral hemangiomas. However, it is still controversial and a comprehensive treatment protocol is still lacking. Methodology: A retrospective clinical review was conducted on patients diagnosed with Enneking stage-III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia between 2010 and 2020. Result: A total of 11 patients with Enneking stage-III vertebral hemangiomas were included. The mean follow-up period was 47.5 ± 24.1 (9–120 months) months. All patients were symptomatic; the most common presentations were neurological deficit and/or myelopathy (n = 7). Ten patients underwent surgical intervention. Six patients had preoperative embolization, with a mean blood loss of 880.00 ± 334.46 ml. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during follow-up. No recurrence was reported. Conclusion: Intralesional spondylectomy showed good results in treating Enneking Stage-III vertebral hemangiomas. However, larger studies comparing treatment methods are needed to reach a gold standard approach.

IMPDH2 and HPRT expression and a prognostic significance in preoperative and postoperative patients with osteosarcoma

Osteosarcoma is one of the most aggressive bone tumors in children and adolescents. Development of effective therapeutic options is still lacking due to the complexity of the genomic background. In previous work, we applied a proteomics-guided drug repurposing to explore potential treatments for osteosarcoma. Our follow-up study revealed an FDA-approved immunosuppressant drug, mycophenolate mofetil (MMF) targeting inosine-5′-phosphate dehydrogenase (IMPDH) enzymes, has an anti-tumor effect that appeared promising for further investigation and clinical trials. Profiling of IMPDH2 and hypoxanthine–guanine phosphoribosyltransferase (HPRT), key purine-metabolizing enzymes, could deepen understanding of the importance of purine metabolism in osteosarcoma and provide evidence for expanded use of MMF in the clinic. In the present study, we investigated levels of IMPDH2, and HPRT in biopsy of 127 cases and post-chemotherapy tissues in 20 cases of high-grade osteosarcoma patients using immunohistochemical (IHC) analysis. Cox regression analyses were performed to determine prognostic significance of all enzymes. The results indicated that low levels of HPRT were significantly associated with a high Enneking stage (P = 0.023) and metastatic status (P = 0.024). Univariate and multivariate analyses revealed that patients with low HPRT expression have shorter overall survival times [HR 1.70 (1.01–2.84), P = 0.044]. Furthermore, high IMPDH2/HPRT ratios were similarly associated with shorter overall survival times [HR 1.67 (1.02–2.72), P = 0.039]. Levels of the enzymes were also examined in post-chemotherapy tissues. The results showed that high IMPDH2 expression was associated with shorter metastasis-free survival [HR 7.42 (1.22–45.06), P = 0.030]. These results suggest a prognostic value of expression patterns of purine-metabolizing enzymes for the pre- and post-chemotherapy period of osteosarcoma treatment.

Limb Salvage Surgery of Osteosarcoma Usingliquid Nitrogen at Rsup Dr. Moh. Hoesin Palembang: A Case Series

The five-year survival rate of osteosarcoma has gradually increased to 60% from 20% with Limb Salvage Surgery (LSS) combined with chemotherapy. Limb salvage surgery involves two main steps, wide resection of the bone tumor, followed by reconstruction of the defect. Reconstruction can be achieved with Cryosurgery. In this study, we presented a serial case of four patient at RSUP Dr. Moh. Hoesin Palembang with ages between 13-19 years old, 2 male and 2 females and diagnosed with Osteosarcoma Enneking stage IIB at the Lower Extremity Region that treated with Cryosurgery from October 2020- February 2021. The cryosurgery procedure on RSUP dr. Moh Hoesin Palembang, started with the bone soaked into liquid Nitrogen for 20 minutes. The bone than thawed at room temperature for 15 minutes and then soaked with normal saline in room temperature for another 15 minutes. The used of Cryosurgery for limb salvage surgery shown a good result for inducing osteosarcoma necrosis with all Histopathology results shown 50-90% to 91-99% post cryosurgery (Huvos grade II-III). The followed up however shown mixed results, with the patients have mixed knee flex ranged from 40o to 1100, but The LLD could still be preserved at 1-2 cm. During Followed up at 1-2 month postoperative, we found complication such as failure of fixation and skin necrotic. The followed-up research also still needed for long termed results, complications and for assessing the recurrency rated of the Osteosarcoma for these cases.

The relationship between the expression of Ki-67 and the prognosis of osteosarcoma

Background A number of studies have linked positive Ki-67 expression with the prognosis of osteosarcoma (OS) patients. However, the results have been conflicting. To address this controversy, we conducted an analysis using a meta-analysis and a TCGA dataset to estimate the value of Ki-67 expression in the prognosis of OS. Methods A comprehensive search for relevant papers was conducted using NCBI PubMed, Embase, Springer, ISI Web of Knowledge, the Cochrane Library, and CNKI regardless of the publication year. The associations between Ki-67 expression and the clinical features and main prognostic outcomes of OS were measured. The TCGA dataset was also analyzed. The pooled odds ratio (OR) and its 95% confidential intervals (CIs) were utilized for statistical analysis. Results Overall, a total of 12 studies with 500 cases were included, and the results indicated that the expression of Ki-67 was significantly associated with Enneking stage (OR = 6.88, 95% CI: 2.92–16.22, p < 0.05), distant metastasis (OR = 3.04, 95% CI: 1.51–6.12, p < 0.05) and overall survival (OR = 8.82, 95% CI: 4.68–16.65, p < 0.05) in OS patients. Additionally, we observed no significant heterogeneity among all retrieved studies. Associations between Ki-67 expression and overall survival and disease-free survival of sarcoma were confirmed using the TCGA and Kaplan-Meier plotter datasets. Conclusion The present study strongly suggests that positive Ki-67 expression was associated with Enneking stage, distant metastasis, and overall survival of OS, and it may be used as a potential biomarker to predict prognosis and guide clinical therapy for OS.

Association of MMP-9 and PCNA Protein Expression in Osteosarcoma are Associated with Clinical Stage, Metastasis, and Prognosis

ABSTRACT Present work studies the expressions of MMP-9 and PCNA in osteosarcoma patients and its correlation with clinical stage. 53 specimens of osteosarcoma were surgically removed and 28 osteochondroma tissues were used for immunohistochemical staining to detect the expression of proliferating cell nuclear antigen (PCNA) as well as matrix metalloproteinase-9 (MMP-9). The expression rates of MMP-9, as well as PCNA, were 75.5 percent and 86.8 percent in osteosarcoma, while were 10.7 percent and 7.5 percent in osteochondroma, respectively, which was statistically significant (P<0.05). The expression levels of MMP-9, PCNA, and the total survival time were connected with the Enneking stage. It shows an upward trend for the expression levels of PCNA and MMP- 9 in osteosarcoma tissues. The expression levels of MMP-9 and PCNA are related to the clinical stage, metastasis, and prognosis.

The Prognostic Value of A Preoperative Lymphocyte Count and C-Reactive Protein Ratio In Osteosarcoma

Background: Systemic inflammatory response and nutritional status are closely related to tumor development, and both have been recognized as predictors of tumors. Our study investigated the effect on the prognosis of osteosarcoma by analyzing the ratio of lymphocytes to C-reactive protein (LCR) before surgery.Methods: Patients who were diagnosed with osteosarcoma and underwent surgery in the First Affiliated Hospital of Guangxi Medical University from 2012 to 2019 were included in this retrospective study. The albumin (g/L) +5 × total lymphocyte count (PNI), neutrophil/lymphocyte count (NLR), platelet/lymphocyte count (PLR) and platelet × neutrophil/lymphocyte count (SII) were calculated from preoperative peripheral white blood cells, C-reactive protein and serum albumin. The optimal cutoff values of LCR, PNI, NLR, PLR and SII were determined by receiver operating characteristic (ROC) analysis. According to the Optimal cutoff values, LCR, PNI, NLR, PLR and SII were divided into high and low groups. The Kaplan-Meier method was used to compare the overall survival (OS) between the high and low LCR groups. Univariate analysis was used to determine the influence of age, gender, tumor size, Enneking stage and neoadjuvant chemotherapy on the prognosis of osteosarcoma.The independent predictors of OS were determined by Cox multivariate analysis.Results: The optimal cutoff values for LCR, PNI, NLR, PLR and SII were 0.093, 48.4, 1.23, 157.03 and 314.27, respectively. A low preoperative LCR was significantly correlated with tumor metastasis, stage, NLR, PLR and SII. However, a low preoperative PNI was significantly associated with tumor metastasis, stage, and PLR.Kaplan-Meier survival analysis indicated that the postoperative OS was significantly correlated with preoperative LCR and PNI (P < 0.05). Univariate analysis showed that Enneking stage, metastasis and preoperative LCR, PNI, NLR, PLR and SII were important factors affecting OS (P < 0.05). For multivariate analysis, the results revealed that the preoperative LCR (HR, 0.401; 95% CI, 0.199-0.807; P = 0.01) and Enneking stage (HR, 2.717; 95%CI, 1.067-6.919; P = 0.036) is an independent prognostic factor affecting the postoperative OS of osteosarcoma.Conclusions: The high preoperative LCR is strongly associated with longer survival time in patients with osteosarcoma. Enneking stage and preoperative LCR may be important parameters for the prognosis of osteosarcoma.

Neuro Deficit Caused by Vertebral Hemangioma Enneking Stage 3: Incidence, Treatment Options and One Extraordinary Serious Case

Objective Aggressive Vertebral Hemangiomas (VH) are very rare lesions that may present with compression fractures or bony expansion and erosion into the epidural space resulting in neurological symptoms. Especially in these patients a surgical treatment is essential. We illustrate our institutional experience and discuss the relevant literature. Method Our database was searched for cases with vertebral hemangioma and the appearance of a neurological deficit between 2015 and 2020. We were able to identify one very extraordinary case which showed a very aggressive nature and resulted in paraparesis twice in the patient. Furthermore a Medline analysis was performed to identify data of this rare illness (aggressive VH, Enneking stage 3, S3) to assess the incidence and therapeutic options for this so called benign vascular tumor. Results One patient was identified in the database with an extraordinary course which resulted in paraparesis twice. A 54-year-old man presented with an acute onset of paraparesis of the legs. Contrast-enhanced magnetic resonance imaging (MRI) revealed a hypervascular tumor of the entire L3 vertebral body and the surrounding tissue with subtotal compression of the spinal canal (Enneking stage 3). After decompression and spinal stabilization a complete recovery of the paraparesis was seen. Two weeks after the initial presentation a recurrence of the paraparesis was noted. The subsequent MRI demonstrated a recurrent increase in the tumor size with spinal canal compression. After endovascular embolization, a gross total tumor resection with a vertebral replacement was performed. The patient was noted to have a complete recovery. Conclusion The number of cases with aggressive vertebral hemangiomas (Enneking Stage 3) is limited. However, despite limited treatment algorithms for these rare cases due to the lack of data, surgical treatment should be recommended, especially in the presence of neurological symptoms. That can be underlined by our institutional experience.