Search

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterisedby sterile bone lesions. We report a case of a seven-year-old female patient who presented at a university hospitalin 2010 and 2018 with CRMO. While the most promising results have been observed in patients under treatment with bisphosphonates (BPs), the initial decision to treat the current patient with a dose of zoledronic acid every six months was recalled as the patient developed tonic-clonic seizures immediately following the second dose BP administration. Following recall, the patient maintained a prompt response at follow-up and her disease remained controlled with non-steroidal anti-inflammatory drugs. The current case report speculates a possible relationship between BP use and a possible seizure threshold reduction, thereby emphasising the need for closer monitoring when BPs are used.Keywords: Chronic Recurrent Multifocal Osteomyelitis; Bisphosphonate; Tonic-clonic seizure; Case Report; Tunisia.

Enzalutamide resistance has been observed in approximately 50% of patients with prostate cancer (PCa) bone metastases. Therefore, there is an urgent need to investigate the mechanisms and develop strategies to overcome resistance. We observed enzalutamide resistance in bone lesion development induced by PCa cells in mouse models. We found that the bone microenvironment was indispensable for enzalutamide resistance because enzalutamide significantly inhibited the growth of subcutaneous C4-2B tumors and the proliferation of C4-2B cells isolated from the bone lesions, and the resistance was recapitulated only when C4-2B cells were co-cultured with osteoblasts. In revealing how osteoblasts contribute to enzalutamide resistance, we found that enzalutamide decreased TGFBR2 protein expression in osteoblasts, which was supported by clinical data. This decrease was possibly through PTH1R-mediated endocytosis. We showed that PTH1R blockade rescued enzalutamide-mediated decrease in TGFBR2 levels and enzalutamide responses in C4-2B cells that were co-cultured with osteoblasts. This is the first study to reveal the contribution of the bone microenvironment to enzalutamide resistance and identify PTH1R as a feasible target to overcome the resistance in PCa bone metastases.

BACKGROUND The diagnosis of rheumatoid arthritis (RA) is complicated because of the complexity of symptoms and joint structures. Current clinical imaging techniques for the diagnosis of RA have strengths and weaknesses. Emerging imaging techniques need to be developed for the diagnosis or auxiliary diagnosis of RA. PURPOSE This study aimed to demonstrate the potential of thermoacoustic tomography (TAT) for in vivo detection of RA in the finger joints. METHODS Finger joints were imaged by a TAT system using three different microwave illumination methods including pyramidal horn antenna, and parallel in-phase and anti-phase microwave illuminations. Both diseased and healthy joints were imaged and compared when the three microwave illumination methods were used. Magnetic resonance imaging (MRI) of all the joints was performed to validate the TAT findings. In addition, two diseased joints were imaged at two time points by the pyramidal horn antenna-based TAT to track/monitor the progression of RA during a time period of 16 months. Three-dimensional (3-D) TAT images of the joints were also obtained. RESULTS The TAT images of the diseased joints displayed abnormalities in bone and soft tissues compared to the healthy ones. The TAT images by pyramidal horn antenna and in-phase microwave illumination showed high similarity in image appearance, while the anti-phase-based TAT images provided different information about the disease. We found that the TAT findings matched well with the MRI images. The 3-D TAT images effectively displayed the stereoscopic effect of joint lesions. Finally, it was evident that TAT could detect the development of the lesions in 16 months. CONCLUSION TAT can noninvasively visualize bone lesions and soft tissue abnormalities in the joints with RA. This first in vivo assessment of TAT provides a foundation for its clinical application to the diagnosis and monitoring of RA in the finger joints.

В огляді літератури розглянуто ключові питання клінічного застосування сучасних методів променевої діагностики у хворих із патологією кісток стоп і гомілковостопних суглобів. Алгоритм прийняття діагностичного рішення враховує мультидисциплінарний підхід для кожної ланки клінічного процесу — від етапу встановлення первинного діагнозу, стадіювання, рестадіювання до призначення лікувальних процедур. Синтез функціональної інформації, отриманої за допомогою однофотонної емісійної комп’ютерної томографії (ОФЕКТ) у комплексі з комп’ютерною томографією (КТ) високої роздільної здатності, дозволяє ефективно визначати патологічний метаболізм у кістках з одночасною оцінкою співіснуючих структурних змін. Розглянуто питання ролі ОФЕКТ/КТ щодо управління діагностично-лікувальним процесом, оптимізації шляхів місцевої анастезії та модифікацій хірургічного підходу.

BACKGROUND Whole-body magnetic resonance imaging (WBMRI) is a multiregional imaging technique suitable for investigating the extent of multisystemic diseases without exposure to radiation, with a high sensitivity to bone alterations. The aim of our study was to evaluate the role of WBMRI in the workup of children with non-specific musculoskeletal features and non-indicative laboratory and instrumental data, who were suspected to have a rheumatologic disease. METHODS We retrospectively analyzed medical records, including laboratory tests and radiological data of 34 children who had been evaluated due to non-specific musculoskeletal manifestations, for which a WBMRI was prescribed. RESULTS We included 34 children, 19 females and 15 males, mean age 10 years (range 2-16 years), with the following clinical features: diffuse arthralgia (12 children), persistent fever (2 children), persistent fever and diffuse arthralgia (20 children). Serologic inflammatory markers were increased in 29/34 patients. Twenty-five children had already received X-ray and / or ultrasound before WBMRI, with a negative / uninformative result. WBMRI was performed 3-6 weeks (median, 3.5 weeks) after the initial presentation of symptoms. In 22/34 (65%) children, WBMRI revealed some abnormalities that supported the final diagnosis. Twelve out of 34 children (35%) were be affected by chronic recurrent multifocal osteomyelitis. CONCLUSIONS WBMRI is helpful in pediatric rheumatology for the differential diagnosis of undefined inflammatory conditions. It appears to be a promising tool, especially in the detection of multifocal bone lesions. The diagnosis that mainly benefits from WBMRI in our series is chronic recurrent multifocal osteomyelitis. WBMRI can also help in excluding neoplastic diseases.

Background. The treatment outcomes for non-small cell lung cancer (NSCLC) depend on the tumor stage and treatment strategy. The imaging techniques play a significant role in the diagnosis, staging and choice of appropriate treatment for NSCLC.Purpose of the study: сomparison of the diagnostic capabilities of magnetic resonance imaging (MR) and positron emission computed tomography to select the optimal approaches to early detection of spinal and pelvic bone metastases.Material and Methods. The treatment outcomes were analyzed in 71 patients with NSCLC. Spinal and pelvic bone metastases were detected in 24 patients using magnetic resonance imaging (MRI) and positron emission computed tomography (PET/CT). Multiple bone lesions were the most common. A total of 69 metastatic lesions were identified. To compare the capabilities of diagnostic techniques, all patients underwent PET/CT with 18F-FDG, and MRI of the spine and pelvic bones using diffused-weighted images (DWI). Statistical data processing included the calculation of the sensitivity, specificity and diagnostic accuracy of the above techniques.Conclusion. The comparative analysis of the capabilities of modern high-tech diagnostic techniques (PET/CT with 18F-FDG and MRI of the spine and pelvic bones with DWI) in early detection of bone metastases in patients with NSCLC, PET/CT with 18F-FDG showed the greatest diagnostic value. However, taking into account the high sensitivity and specificity of MRI with DVI in detection of bone metastases and limited availability of PET/CT for patients, MRI with DVI is recommended to exclude bone metastases.

The examination of documented skeletal remains provides an exceptional opportunity for biohistorical research to answer questions about an individual's life and death. Research in this area also makes it possible to assess the reliability of historical records from the period of interest, which is often the subject of discussion, especially in cases of historically known individuals. The remains of K.B.C. (1895-1940), a prominent local landowner and politician, were exhumed because of the repair of a family tomb in Jilovistě, Czech Republic. The aim of this study was to analyze pathological changes in his bones and to interpret these by comparing them with the results of a historical medical records review of private family and public archives regarding his diseases and death, thus verifying their credibility. Morphological and X-ray examinations of the bones revealed several serious pathological changes, whose presence fully corresponded to the studied documents. This showed the records' reliability, and it was thus possible to accurately interpret the lesions found. The results demonstrated the need for interdisciplinary collaboration in the analysis of such cases, including the assistance of the living descendants of the studied individuals, if possible.

BACKGROUND Fracture risk assessment in children with benign bone lesions of long bones remains poorly investigated. AIM To investigate the risk factors for pathological fracture in children with benign bone lesions and to propose a modified scoring system for quantitative analysis of the pathologic fracture risk. METHODS We retrospectively reviewed 96 pediatric patients with benign bone lesions. We compared radiographic and clinical features between 40 patients who had fractures through a benign bone lesion and 56 who had no fracture. Information including histological diagnosis, anatomical site, radiographic appearance, severity of pain, and lesion size was recorded for the patients. A modified scoring system was proposed to predict the risk of fracture. RESULTS The univariate comparisons showed a significant difference between the fracture and non-fracture groups in terms of lesion type, pain, lesion-to-bone width, and axial cortical involvement of the patients (P < 0.05). Lesion type, pain, lesion-to-bone width, and axial cortical involvement were independently correlated with an increased risk of fracture. The mean score of the fracture group was 7.89, whereas the mean score of the non-fracture group was 6.01. The optimum cut-off value of the score to predict pathological fracture was 7. The scoring system had a sensitivity of 70% and a specificity of 80% for detecting patients with fractures. The Youden index was 0.5, which was the maximum value. The area under the receiver operator characteristic was 0.814. CONCLUSION Lesion type, pain, lesion-to-bone width, and axial cortical involvement are risk factors for pathological fracture. The modified scoring system can provide evidence for clinical decision-making in children with benign bone lesions. A bone lesion with a total score > 7 indicates a high risk of a pathologic fracture and is an indication for prophylactic internal fixation.

Aim Odontogenic tumors (OTs) and bone lesions of the oral cavity present diverse histological features and varying clinical behavior that makes predicting their biologic behavior difficult. The research undertaken in the current study aims to predict the biological behavior of oral hyalinizing odontogenic and bone lesions (OHO-BL) for the first time by employing four differential stains with clinicopathologic correlation. Materials and methods The study was performed on retrospectively diagnosed formalin-fixed paraffin-embedded cases of OTs (n = 53) and bone lesions (n = 10). The severity of hyalinization (SOH) was assessed from stained tissue sections. Polarizing microscopy was used to analyze hyalinization in tissues stained with differential special stains, namely periodic acid-Schiff (PAS), Safranin-O, Alcian Blue, and Picrosirius red. SOH was also analyzed for possible correlation with recurrence and clinicopathologic correlation in OHO-BL. Results Intense staining was observed with PAS, Alcian Blue, and Safranin-O in OTs with increased SOH with a statistical significance. Polarizing greenish yellow color correlated significantly with the recurrence potential of the OT group. Recurrence in individual lesions of the OT group showed a statistically significant association with SOH. Such individual correlation was not observed in bone diseases. Conclusion PAS, Alcian Blue, Safranin-O, and Picrosirius red are reliable stains to assess hyalinization in OHO-BL. Picrosirius red-polarizing microscopy is a dependable tool for identifying recurrent odontogenic lesions. Clinical significance SOH can be considered a histological predictor of aggressive biologic behavior in oral hyalinizing odontogenic lesions that can enable the surgeon to arrive at an appropriate management protocol.

Introduction:Currently, medical imaging has a limited capacity to achieve a final histopathological diagnosis of bone lesions. This study aimed to evaluate the use of machine learning (ML)-based computed tomography (CT) texture analysis to determine benign and malignant behaviors of lytic bone lesions needing a biopsy.Methods:This retrospective study included 58 patients with lytic bone lesions. Lesion segmentation was independently performed by two observers. After evaluating unenhanced CT images, a total of 744 texture features were obtained. Reproducibility analysis and feature selection were used for dimension reduction. A training data set with a nested cross-validation approach was used for feature selection, optimization, and validation. Testing was executed on the remaining unseen data set. Classifications were done using five base ML classifiers and three voting strategies.Results:The best predictive performance was achieved using the k-nearest neighbors algorithm with six features. The area under the curve, accuracy, sensitivity, and specificity of the best algorithm were, respectively, 0.774%, 78.1%, 78%, and 78.1% for the validation data set; and 0.861, 82.4%, 82.4%, and 81.5% for the unseen test data set.Conclusion:The ML-based CT texture analysis may be a promising non-invasive technique for determining benign and malignant behaviors of lytic bone lesions that need a biopsy.

Background When assessing sharply delineated bone lesions of the mandibular angle on X-rays, numerous diagnoses must be considered. The static bone cavity (Stafne's bone cavity, SBC) is a harmless lingual bone depression of the mandibular angle that usually does not require any treatment. It is essential to differentiate this bone deformity from other lesions that may require treatment. Case report The 22-year-old patient was referred for further diagnosis and therapy after osteolysis of the mandible was noticed on a panoramic view (PV). The location and size of the lesion was typical of SBC. Only the three-dimensional representation of the lesion on cone beam computed tomographs revealed an intraosseous lesion. Histological examination of the lesion provided evidence of a fibrous neoplasm. Conclusion The typical image of SBC is ambiguous on plain radiographs such as PV. The radiological diagnosis of the lesion should be based on the representation of the region of interest in different planes.

PURPOSE Racial disparities can influence surgical care in the United States. The purpose of this study was to determine if race and ethnicity were independent risk factors for adverse 30-day outcomes after surgical management of benign craniomaxillofacial bone tumors. METHODS This was a retrospective cohort study from 2012 to 2018 National Surgical Quality Improvement Program databases. Patients undergoing surgical removal of craniomaxillofacial benign lesions based on Current Procedural Terminology and International Classification of Diseases codes were included. Patients who had unrelated concurrent surgeries, or malignant, skull-based or soft tissue lesions were excluded. Primary outcomes were surgical complications and hospital length of stay (LOS). Univariate analyses were used with race as the independent variable to identify predictors of primary outcomes. Statistically significant factors were added to a multivariable logistic regression model. RESULTS This study included 372 patients. Postoperative complications were highest among Black patients, who had a 4-fold increase in minor complications (P = 0.023) and over a 6-fold increase in major complications (P = 0.008) compared to White patients. Black patients also had a mean increase of 2.3 days in LOS compared to White patients (P

Bone lesions pose challenges for diagnosis and management when encountered on imaging in pediatric patients. Sometimes developmental findings can mimic bone tumors, adding to the diagnostic difficulty. While the majority of the bone tumors are benign, unfamiliarity can lead to unnecessary workup. Therefore, an organized approach to diagnose benign tumors and tumor like lesions is essential.

Computed tomography (CT) -guided bone biopsy is a diagnostic procedure performed on the musculoskeletal system with a high diagnostic yield and low complications. However, CT-guided bone biopsy has the disadvantage that it is difficult to confirm the presence of tumor cells during the biopsy procedure. Recently, the clinical benefits of dual-energy CT (DECT) over single-energy CT have been revealed. DECT can provide material decomposition images including calcium suppression images, and effective atomic number (Zeff) and electron density (ED) maps. ED maps have been reported to indicate cellularity. A 61-year-old woman with a history of breast cancer surgery was admitted to our hospital and underwent a CT-guided bone biopsy of the right ilium using ED maps. As a result, she was diagnosed with breast cancer metastases of intertrabecular bone. A comparison of ED maps with a pathological specimen revealed that high ED values occurred exclusively in the tumor area with high cellularity. This study indicates that ED maps produced using DECT may have potential utility in the accurate identification of metastases with high cellularity in bone lesions.

Recent studies have identified numerous pathologies in the cranial domes of pachycephalosaurid dinosaurs. These studies utilized CT images of domes to identify secondary woven bone and sclerosis associated with the pathologies. These features were critical for diagnosing post-traumatic osteomyelitis, which supported the head-butting behaviour hypothesis. However, conventional CT image resolution may not be sufficient to identify secondary woven bone or sclerotic bone in fossil specimens. UALVP 8504 (cf. Foraminacephale brevis), a dome possessing putative bone lesions, was thin-sectioned and micro-CT scanned. Thin sections revealed the lesions are lytic, without any secondary woven bone or sclerosis, falsifying the diagnosis of osteomyelitis. The morphology and histology of the lesions of UALVP 8504 are not diagnostic and resemble both post-traumatic and non-traumatic lesions. However, UALVP 8504 possesses shifted vascular canals (repositioning via remodeling, which maintains anatomical position throughout ontogeny) that are decoupled from growth (), and drifting osteons (secondary osteons where resorption occurs longitudinally and transversely). These demonstrate that the dome has sustained external mechanical loading, likely resulting from an impact or multiple impacts, consistent with the head-butting hypothesis. These impacts may have damaged overlying soft tissues and formed the lesions along the surface. Therefore, we suspect that the pathologies in UALVP 8504 are post-traumatic.

[18F]PSMA-1007 offers advantages of low urinary tracer excretion and theoretical improved spatial resolution for imaging prostate cancer. However, non-specific bone lesions (NSBLs), defined as mild to moderate focal bone uptake without a typical morphological correlate on CT, are a common finding on [18F]PSMA-1007 PET/CT. The purpose of this study was to investigate the clinical outcomes of patients with [18F]PSMA-1007 avid NSBLs, to determine whether patients with NSBLs represent a higher risk clinical cohort, and to determine whether SUVmax can be used as a classifier of bone metastasis. A retrospective audit of 214 men with prostate cancer was performed to investigate the clinical outcomes of [18F]PSMA-1007 avid NSBLs according to defined criteria. We also compared the serum PSA, Gleason score, and uptake time of patients with [18F]PSMA-1007 avid NSBLs to patients without [18F]PSMA-1007 avid bone lesions. Finally, we analysed an SUVmax threshold to identify bone metastases using ROC curve analysis. Ninety-four of 214 patients (43.9%) demonstrated at least one NSBL. No [18F]PSMA-1007 avid NSBLs met criteria for a likely malignant or definitely malignant lesion after a median 15.8-month follow-up interval (11.9% definitely benign, 50.3% likely benign, and 37.7% equivocal). There were no statistically significant differences in serum PSA, Gleason score, and uptake time between patients with [18F]PSMA-1007 avid NSBLs and those without [18F]PSMA-1007 avid bone lesions. All NSBLs with adequate follow-up had SUVmax ≤ 11.1. The value of the highest SUVmax distinguished between NSBLs and definite prostate cancer bone metastases, whereby an SUVmax threshold of ≥ 7.2 maximized the Youden’s index. [18F]PSMA-1007 avid NSBLs rarely represent prostate cancer bone metastases. When identified in the absence of definite metastatic disease elsewhere, it is appropriate to classify those with SUVmax

El síndrome de Mazabraud es una rara asociación de lesiones del sistema musculoesquelético. Resulta de la combinación de uno o varios mixomas intramusculares y displasia fibrosa. Presentamos a un hombre de 46 años con lesiones óseas compatibles con displasia fibrosa asociada a mixoma intramuscular configurando un síndrome de Mazabraud y una revisión de la bibliografía.

Sodium-fluoride (NaF) positron emission tomography (PET) is a sensitive method to detect altered bone mineralization. Its increasing use in routine clinical practice for metastatic bone disease has also resulted in the detection or characterization of incidental benign bone lesions. A spectrum of NaF PET scan cases with benign bone tumors are presented in this article, including whole body PET bone scan and selected PET/computed tomography (CT), CT, or magnetic resonance imaging (MRI) of the region of interest. The reader will be able to improve their knowledge related to the clinical presentation of these entities, some are rare and recognize based on NaF PET and CT/MRI patterns by reviewing these cases.Sodyum-florür (NaF) pozitron emisyon tomografisi (PET), kemik mineralizasyonu değişimini tespit etmek için hassas bir yöntemdir. Metastatik kemik hastalığı için rutin klinik uygulamada artan kullanımı aynı zamanda insidental iyi huylu kemik lezyonlarının saptanması veya karakterizasyonu ile de sonuçlanmıştır. Bu makalede, tüm vücut PET kemik taraması ve ilgili bölgenin seçilmiş PET/bilgisayarlı tomografisi (BT), BT veya manyetik rezonans görüntüleme (MRG) dahil, benign kemik tümörlerinin NaF PET ile tarandığı olguların bir spektrumu sunulmuştur. Okuyucu, bu olguların klinik prezentasyonuyla ilgili bilgilerini geliştirebilecek, bazıları nadir olan bu olguları gözden geçirerek, NaF PET ve BT/MRG modellerine dayanarak tanıyabilecektir.

The majority of patients with a malignant bone lesion will have bone metastases from a distant primary tumour. This could be apparent at diagnosis or develop later in the course of the disease. Some primary tumour types are more likely than others to develop bone secondaries. This common clinical problem requires a multidisciplinary approach in order to reduce patient suffering and maintain quality of life. Almost all patients with metastatic bone disease will have incurable cancer and this needs to be acknowledged when considering treatment options. Conversely primary malignant bone tumours are relatively rare conditions and thus need to be managed by specialist centres. Multimodality, multiprofessional treatment is required which may last for many months and can be associated with considerable toxicity. Patients with localized disease can be cured but there remains a high risk of both local recurrence and metastases.

The spectrum of bone lesions in axial spondyloarthritis is of great interest. With inflammation and mechanical influence concurrence in the background, both tissue gain and tissue loss in a particular bone area can occur simultaneously. Moreover, if vertebral bone mass loss, perhaps, can be easily explained by chronic systemic inflammation, the reason of its gain, observed in axial spondyloarthritis remains a mystery. It is unclear whether it is a consequence of enhanced recovery processes after injury, adaptation to altered mechanical stress, response to inflammatory cells activation or cytokines, produced by them, or changes in Wnt signaling pathways (for example). Whether these factors act individually or collectively is also unclear.

Objective: To investigate the involvement of IL-6/STAT3 signaling pathway activation in macrophage polarization and bone destruction related to apical periodontitis (AP) stimulated by Porphyromonas gingivalis. Methodology: Macrophage polarization, IL-6/STAT3 expression, and the presence of P. gingivalis were detected in human AP tissues via RT-qPCR, western blotting, and immunohistochemistry staining. Murine bone marrow derived macrophages were isolated and cultured with P. gingivalis W83 in vitro, and levels of macrophage IL-6 expression, STAT3 phosphorylation, and macrophage polarization with or without the selective STAT3 phosphorylation inhibitor Stattic (5 μM) were detected via ELISA, western blotting, RT-qPCR, and flow cytometry, respectively. P. gingivalis-induced murine AP models were constructed, and bone destruction and macrophage polarization in the apical region were evaluated. Transwell co-culture systems were used to investigate the effects of macrophages infected with P. gingivalis on osteogenesis and osteoclastogenesis. Results: P. gingivalis was detected in human AP tissues that highly expressed IL-6/STAT3, and the M1 subtype of macrophages was more abundant in these tissues. P. gingivalis infection induced IL-6 expression, STAT3 phosphorylation, and M1 polarization of macrophages, while 5 μM of Stattic partially abolished these activation effects. Systemic STAT3 blockade via oral administration of Stattic at a dose of 25 mg kg-1 alleviated murine periapical bone resorption and apical infiltration of M1 macrophages induced by P. gingivalis infection in vivo. Furthermore, macrophages infected with P. gingivalis promoted bone destruction via secretion of IL-6, TNF-α, and RANKL, which hinder pre-osteoblast expression of Runx2 and accelerate pre-osteoclast expression of NFAT2. Conclusions: The activation of IL-6/STAT3 signaling pathway is involved in mediating macrophages M1 polarization in the P. gingivalis induced apical inflammatory context and may also be intimately involved in the bone loss caused by P. gingivalis infection, directing the M1 macrophage infiltration during the progression of AP.

Introduction Low- to high-energy impact trauma may cause from small fissures up to extended bone losses, which can be classified as closed or opened injuries (when they are visible at a naked eye). Objective The aim of this study was to investigate the feasibility of clinical diagnosis of bone trauma through medical infrared thermography, in a hospital emergency room. Methods Forty-five patients with suspected diagnosis of bone fracture were evaluated by means of medical infrared images, and the data correlated with the gold standard radiographic images, in the anteroposterior, lateral, and oblique views, at the orthopedic emergency department. The control group consisted of thermal images of the contralateral reference limb of the volunteers themselves. Data were acquired with a medical grade infrared camera in the regions of interest (ROIs) of leg, hand, forearm, clavicle, foot, and ankle. Results In all patients evaluated with a diagnosis of bone fracture, the mean temperature of the affected limb showed a positive difference greater than 0.9 °C (towards the contralateral), indicating the exact location of the bone trauma according, while the areas diagnosed with reduced blood supply, showed a mean temperature with a negative variation. Conclusion Clinical evaluation using infrared imaging indicates a high applicability potential as a tool to support quick diagnosis of bone fractures in patients with acute orthopedic trauma in an emergency medical setting. The thermal results showed important physiological data related to vascularization of the bone fracture and areas adjacent to the trauma well correlated to radiographic examinations.

Context.—A number of fibro-osseous and osteocartilaginous lesions, especially common in the small bones of the hand and feet, pose a diagnostic challenge and have historically been thought to be reactive lesions. However, modern molecular techniques when supplementing clinical, radiographic, and histologic evaluation suggest they may, in fact, be neoplasms.Objective.—To review the clinical presentation and histopathologic, molecular, and radiologic features of selective bone lesions, focusing most specifically on subungual exostosis, florid reactive periostitis, and bizarre periosteal osteochondromatous proliferation.Data Sources.—Literature review and personal experience are the sources of this review.Conclusions.—Some lesions previously thought to be reactive are locally aggressive and demonstrate reproducible molecular abnormalities, and thus may be neoplasms. Although most common in the bones of the fingers and toes, these lesions also occur in long and other bones. The clinical presentations, radiologic appearances, and histopathologic features often overlap, making the diagnosis challenging, and these lesions may require molecular evaluation to maximize accurate prognostication.

Pathologists infrequently see cases of bone tumours, which are rare entities, and their diagnosis is challenging. To achieve the correct diagnosis and for patients to be offered optimal treatment, it is critical that a multidisciplinary specialised team is involved. The last decade has seen exceptional advances in the molecular classification of bone tumours, which have not only made reaching diagnoses easier, but also makes the subspeciality an exciting area of research. Bone tumours are classified based on their histological features, irrespective of the anatomical site in which the tumour presents; however, not every tumour fits nicely into these categories as some share features. Bone tumours must be diagnosed in the context of the radiology, patient's symptoms, signs and family history. This article reviews key clinical, histologic features of bone tumours and highlights the recent advances made in understanding the pathology of bone lesions in the head and neck region.

Background This study aimed to identify the characteristic radiological signs for the diagnosis of Langerhans cell histiocytosis (LCH) of the bone. Methods We retrospectively studied 82 cases of LCH with bone lesions confirmed by pathology. Clinical and radiological features of the patients were analyzed. Results A total of 64 and 18 patients had single and multiple bone lesions, respectively. With regard to LCH with single bone lesions, 37.5% (24/64) of lesions were located in the skull and presented as bone destruction with or without soft tissue mass. The correct diagnosis rate of these lesions was 60.0% (9/15) in children and adolescents, but was only 22.2% (2/9) in adults. A total of 26.5% (17/64) of the solitary lesions were found in the spine. Of these, 88.2% (15/17) were located in the vertebral body and appeared to have different degrees of collapse, and 66.7% (10/15) of these lesions were correctly diagnosed. Of the unifocal lesions, 21.8% (14/64) were located in other flat and irregular bones and manifested as osteolysis. Only 21.4% (3/14) of these cases were correctly diagnosed. In total, 14.1% (9/64) of the isolated bone LCH lesions were located in the long bones. Of these, 77.8% (7/9) were located in the diaphysis and presented as central bone destruction with or without fusiform periosteal reaction and extensive peripheral edema, of which 42.9% (3/7) were correctly diagnosed before surgery or biopsy. With regard to LCH with multiple bony destructive lesions, 71.4% (10/14) of cases in children and adolescents were correctly diagnosed; however, all four cases among adults were misdiagnosed. Conclusion In all age groups, isolated diaphyseal destruction of the long bone with fusiform periosteal reaction and extensive peripheral edema, vertebra plana of the spine, and bevelled edge of skull defects accompanied by soft tissue masses strongly suggest LCH diagnosis. Moreover, the multiple bone osteolytic destruction in children and adolescents strongly suggests LCH diagnosis. Familiarity with these typical radiological signs of LCH is necessary to decrease misdiagnoses.

Bone sarcoidosis is usually considered a rare manifestation of multisystemic sarcoidosis. With the growing use of more sensitive imaging techniques, such as 18F-FDG PET, the detection rate of bone involvement seems to be increasing. We describe the case of a woman presenting with fatigue and general malaise having multiple bone lesions on 18F-FDG PET. A broad range of differential diagnoses was considered, including malignancy, infections, metabolic diseases and primary bone tumours, which may have delayed the diagnosis. Diagnostic work-up eventually led to an anatomopathological diagnosis of bone sarcoidosis. Immunosuppressive therapy is often necessary since sarcoid bone lesions - even asymptomatic - generally appear in more extensive forms of the disease with other organ involvement.

BACKGROUND: Bone cysts are characteristic tumor-like bone lesions occurring in childhood. Overall, they represent 21% to 57% of all benign tumors and tumor-like bone lesions in children. Clinical and X-ray symptoms of aneurysmal and simple bone cysts are similar. Like some other, often occurring, benign bone lesions, such as enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects. AIM: This study aims to identify the main clinical and instrumental characteristics of simple and aneurysmal bone cysts that allow us to differentiate them from some similar destructive bone neoplasms (enchondromas, giant cell tumors, fibrous dysplasia, and metaphysical fibrosis defects) and to develop indications for various diagnostic surgical interventions. MATERIALS AND METHODS: A retrospective analysis of the results of the survey of 206 patients aged 3 to 18 years who were treated at our facility from 2000 to 2015 was performed. The features of the diagnostic tactics and their effectiveness were rated. RESULTS: The main clinical and instrumental diagnostic criteria have been established. They enable the differentiation of bone cysts from some similar benign bone lesions at the pre-morphological stage. The indications for diagnostic surgical interventions have been formulated. CONCLUSION: The main difficulties in the differential diagnosis of bone cysts and some similar benign bone lesions have been revealed. An algorithm for applying various diagnostic surgical interventions in patients with these diseases has been proposed.

Background: Patients with osteoblastic bone metastases are candidates for radium-223 ((223)RaCl(2)) therapy and may undergo sodium fluoride-18 ((18)F-NaF) positron emission tomography-computed tomography imaging to identify bone lesions. (18)F-NaF has been shown to predict (223)RaCl(2) uptake, but intratumor distributions of these two agents remain unclear. In this study, the authors evaluate the spatial distribution and relative uptakes of (18)F-NaF and (223)RaCl(2) in Hu09-H3 human osteosarcoma mouse xenograft tumors at macroscopic and microscopic levels to better quantify their correlation. Materials and Methods: (18)F-NaF and (223)RaCl(2) were co-injected into Hu09-H3 xenograft tumor severe combined immunodeficient mice. Tumor content was determined from in vivo biodistributions and visualized by PET, single photon emission computed tomography, and CT imaging. Intratumor distributions were visualized by quantitative autoradiography of tumor tissue sections and compared to histology of the same or adjacent sections. Results: (18)F and (223)Ra accumulated in proportional amounts in whole Hu09-H3 tumors (r(2) = 0.82) and in microcalcified regions within these tumors (r(2) = 0.87). Intratumor distributions of (18)F and (223)Ra were spatially congruent in these microcalcified regions. Conclusions: (18)F-NaF and (223)RaCl(2) uptake are strongly correlated in heterogeneously distributed microcalcified regions of Hu09-H3 xenograft tumors, and thus, tumor accumulation of (18)F is predictive of (223)Ra accumulation. Hu09-H3 xenograft tumors appear to possess certain histopathological features found in patients with metastatic bone disease and may be useful in clarifying the relationship between administered (223)Ra dose and therapeutic effect.

Aneurysmal bone cyst is a benign highly vascular lesion that occurs in children. Traditionally ABCs were treated by surgical resection. However, lesions at difficult to access anatomical locations such as the pelvis have higher morbidity when treated surgically. Recently with the advances in endovascular treatment selective arterial embolization became a promising option for primary treatment of ABC. The authors present a case of a 14-year-old female with a pelvic ABC that was successfully treated by selective arterial embolization. Selective arterial embolization is a cost-efficient way of managing ABC especially in cases where surgical treatment carries high risk.

Langerhans' cell histiocytosis (LCH) is a rare disease observed in childhood characterized by the proliferation of Langerhans' cells resulting in focal or systemic manifestations (including the bones). Here, we present a pediatric case with a localized biopsy-proven LCH, who underwent progression from solitary to multifocal form detected on bone scintigraphy and single photon emission computerized tomography/computed tomography (SPECT/CT) performed within four months. Emphasizing on localized bone pain (predictive of osseous LCH) and local tenderness and swelling usually guides the nuclear physician to perform additional SPECT/CT with presumably an improvement of the diagnostic accuracy as demonstrated in our case.Langerhans hücreli histiyositoz (LHH), genellikle çocukluk çağında görülen, Langerhans hücrelerinin çoğalmasıyla birlikte kemikler de dahil olmak üzere lokal veya sistemik tutulum ile seyreden nadir bir hastalıktır. Burada, soliter olup dört ay sonra yapılan kemik sintigrafisi ve tek foton emisyon tomografisi/bilgisayarlı tomografide (SPECT/BT) multifokal forma ilerlediği saptanan, biyopsi ile kanıtlanmış LHH tanılı pediatrik bir olgu sunulmaktadır. Bu olguda görülmektedir ki; lokalize kemik ağrısı şikayeti olan ve/veya fizik muayenede lokal hassasiyet ve şişme gibi bulguları olan hastalarda, ilgili alanın ek SPECT/BT görüntülerinin alınması ile tanısal doğrulukta iyileşme sağlamaktadır.

Spinal osteochondromas are very rare, and they present with nonspecific localized pain owing to bone involvement. Diagnosis is made based on direct X-ray and computed tomography (CT) imaging of the exophytic bone lesion with pedunculated or sessile structure. Although asymptomatic patients can be observed, surgical excision is the main treatment modality. We present the case of a 34-year-old man with solitary thoracic osteochondroma. The patient presented with complaints of pain in the legs, numbness, and inability to walk. The diagnosis was confirmed with CT imaging showing calcified heterogeneous bone lesion originating from the left side of T1-2 facet joint. After total excision, histopathological examination revealed the diagnosis of osteochondroma. No new clinical or radiological findings were detected in the 10-month follow-up.

Fluid-fluid levels result from the separation of two fluids of differing densities within a cavernous space with the boundary between the two layers running in a horizontal plane at 90 degrees to the direction of gravity. Magnetic resonance imaging is the most sensitive imaging modality to identify fluid-fluid levels. Although the most common bone lesions containing fluid-fluid levels are aneurysmal bone cyst and telangiectatic osteosarcoma, fluid-fluid levels can be observed in a wide variety of bone and soft tissue lesions. Therefore, fluid-fluid levels cannot be considered diagnostic of any particular type of tumor and the diagnosis should be made on the basis of other clinical, radiological and pathological findings. This article summarizes the pathophysiology and imaging characteristics of fluid-fluid levels and discusses the differential diagnosis of tumors with this imaging sign.

Rationale: Whether assessment of potential bone lesions in metastatic breast cancer (MBC) by means of 18F-fluorodeoxyglucose (FDG)-PET instead of 99mTechnetium (99mTc) bone scintigraphy (BS) supports clinically relevant changes in MBC management, is currently unknown. Therefore, we retrospectively compared the management recommendations based on bone lesion assessment by FDG-PET plus contrast enhanced computed tomography (ceCT) or BS plus ceCT, for patients with newly diagnosed MBC. Methods: Baseline ceCT, BS and FDG-PET of all patients included in the IMPACT-MBC study (NCT01957332) at location University Medical Center Groningen (UMCG), were reviewed for bone lesions. In case of bone lesions on any imaging modality, virtual MBC management recommendations per patient were made by a multidisciplinary expert panel, based on either FDG-PET plus ceCT, or BS plus ceCT. The panel had access to standard clinicopathological information and baseline imaging findings outside the skeleton. Clinically relevant management differences between the two recommendations were defined as 1) different treatment intent, (curative, non-curative or unable to determine and/or 2) different systemic or local treatment. In case of absence of bone lesions with any imaging modality, patients were included in the analyses without expert review. Results: A total of 3,473 unequivocal bone lesions was identified in 102 evaluated patients (39% by ceCT, 26% by BS, 87% by FDG-PET). Additional bone lesions on FDG-PET plus ceCT compared to BS plus ceCT led to change of MBC management recommendations in 16% of all patients (95% confidence interval (CI) 10-24%). BS also changed management compared to FDG-PET in one patient (1%; 95%CI 0-5%). In 26% (95%CI 19-36%) of patients, an additional FDG-PET was requested, because BS provided insufficient information. Conclusion: In this exploratory analysis of newly diagnosed MBC patients, FDG-PET versus BS to assess bone lesions, resulted in clinically relevant management differences in 16% of all patients. BS delivered insufficient information in over one fourth of patients, resulting in additional request for FDG-PET. Based on this data, FDG-PET should be considered as primary imaging modality for assessment of bone lesions in newly diagnosed MBC.

The regularities of complexation of scandium with oxabis(ethylenenitrilo)tetramethylenephosphonic acid (OBEP), which is actively used nowadays in the clinical practice for the synthesis of bone-seeking radiopharmaceuticals, have been studied by means of potentiometric titration and NMR spectroscopy. The stability constant of the deprotonated complex (log β110 = 20.25 ± 0.74, 0.1 M NaClO4, 25°C) and the pH range of effective binding of scandium to OBEP (3 to 9) have been found comparable to these of similar lanthanide complexes. The possibility of efficient synthesis of [44Sc]Sc–OBEP complexes without an isotopic carrier with radiochemical purity of at least 98% has been shown. Preliminary evaluation of the applicability of [44Sc]Sc–OBEP complex as a bone-seeking radiopharmaceutical for PET visualization of metabolic skeletal lesions has been performed. The accumulation of [44Sc]Sc–OBEP in the bone lesion has been found to be 3.0–3.5 times higher than that in the intact bone.

Purpose: To evaluate the contribution of CT Bone Unfolding software to the diagnostic accuracy and efficiency for the detection of osteoblastic pelvic bone lesions in patients with prostate cancer. Methods: A total of 102 consecutive (January 2016-September 2019) patients who underwent abdominopelvic CT with prostate cancer were retrospectively evaluated for osteoblastic pelvic bone lesions, using commercially available the post-processing-pelvic bone flattening-image software package “CT Bone Unfolding.” Two radiologists with 3 and 15 years of experience in abdominal radiology evaluated CT image data sets independently in 2 separate reading sessions. At the first session, only MPR images and at the second session MPR images and additionally unfolded reconstructions were assessed. Reading time for each patient was noted. A radiologist with 25 years of experience, established the standard of reference. Results: In the evaluations performed with the MPR-Unfold method, the diagnostic accuracy were found to be 2.067 times higher compared to the MPRs method ( P < 0.001). The location of the lesions or the reader variabilities did not show any influence on accuracy ( P > 0.05) For all readers the reading time for MPR was significantly longer than for MPR-Unfold ( P < 0.05). For both methods substantial to almost-perfect inter-reader agreement was found (0.686-0.936). Conclusions: The use of unfolded pelvic bone reconstructions increases diagnostic accuracy while decreasing the reading times in the evaluation of pelvic bone lesions. Therefore, our findings suggest that utilizing unfolded reconstructions in addition to MPR images may be preferable in patients with prostate cancer for the screening of osteoblastic pelvic bone lesions.

A 66‐year‐old man with hypopharyngeal carcinoma with a single bone metastasis was treated with definitive chemo/radiotherapy omitting local treatment of the single bone lesion. He remained relapse‐free for 6 years. We have concluded that radiotherapy‐dependent abscopal effect might have allowed to avoid ablative treatment of metastatic site.

BACKGROUND Though histopathology is the gold standard investigation for diagnosing most benign and malignant lesions of bone, the decalcification process required for removing bone hardness makes it a time-consuming process. Sediment cytology is a rapid investigative procedure utilising the cells in the specimen containers after proper fixation, processing and staining. The objective of this study was to compare the diagnostic efficacy of sediment cytology of bone lesions with the histopathology. METHODS The study was conducted in 50 samples of bony tissues received in the histopathology lab during the study time. The fixative fluid containing specimens were first agitated for procuring the cells from the sample. The sediment obtained was processed and stained as a cytology sample and studied under microscope. Based on cytology findings they were classified into benign, malignant, inflammatory and inconclusive. The specimen was processed as routine histopathologic sample and final diagnosis was made from it. RESULTS Sediment cytology of malignant bone lesions showed a very high specificity (100 %) but only a moderate sensitivity of 80 %. Sediment cytology of benign bone lesions also showed a higher specificity of 100 % but only a moderate sensitivity of 84.6 %. CONCLUSIONS If adequately cellular, biopsy sediment cytology is a simple, inexpensive, rapid tool for the early diagnosis of bone lesions. Sediment cytology can act as a good complementary test to histopathology. KEYWORDS Bone Lesions, Cytology, Sediment Cytology, Histopathology

Aneurysmal bone cyst (ABC) is a benign progressive expansile bone lesion that usually involves often located in vertebrae, long tubular bones and flat bones. A small percentage of aneurysmal bone cysts arise from the skull base. Skull base involvement is very rare. Here, we describe a 22-year young man presented with diplopia, right sided facial paresis and right sided sensori-neural hearing loss. CT scan and MRI showed a right petrous apex skull base mass that was confirmed as ABC in histopathology after surgical removal. Journal of Science Foundation, January 2020;18(1):25-28

With recent advances in molecular research, an ever-increasing number of undifferentiated round cell sarcomas without the characteristic gene fusions of Ewing sarcoma are being discovered. One specific subtype termed BCOR-rearranged sarcoma belongs to this group. Previously termed 'Ewing-like' sarcoma, it was formally included with undifferentiated round cell tumours in the 2013 WHO Classification of Soft Tissue and Bone Tumours. However, in the 2020 WHO Classification, BCOR-sarcoma is now recognized as a distinct entity due to particular morphological and immunohistochemical features and differing clinical outcomes. As with classical Ewing sarcoma, osseous BCOR-rearranged sarcoma is an aggressive tumour with a similar clinical presentation. However, there are only a small handful of case series and isolated reports detailing the imaging characteristics, typically demonstrating an aggressive bone lesion with a large soft tissue mass. Soft tissue BCOR-sarcoma is even rarer. The aim of the current review is to describe the patient demographics, lesion locations and various imaging characteristics of histologically proven cases of musculoskeletal bone and soft tissue BCOR-sarcoma as described in the literature.

Background Multiple pathological manifestations are rarely present in patients with primary hyperparathyroidism (PHPT). Here we described a case of a young woman who presented with multiple skeletal destructions and received an unclear diagnosis at several hospitals. Case presentation A 30-year-old woman was admitted to our hospital due to pain in both knees and walking difficulty that lasted for 6 and 2 years, respectively. Her laboratory test results revealed a high parathyroid hormone level (822 pg/ml) and hypercalcemia (2.52 mmol/L) in the blood. Parathyroid imaging revealed a lumpy concentration of radioactive uptake detected at the lower pole in the right lobe of the thyroid, and was nearly 2.2 cm * 2.4 cm in size. Next, the patient was treated with parathyroidectomy that resulted in a significant improvement in physiological and clinical symptoms. Moreover, the skeletal destruction and bone mineral density were significantly improved after a 5-years follow-up period. Conclusions Multiple skeletal destructions can be caused by PHPT that should be taken into consideration in young patients with complex bone lesions.

Background: The purpose of our study was to evaluate the osteolytic lesions of bone reported at the department of pathology in a tertiary care hospital in West Bengal. Materials and Methods: We performed a retrospective study over a period of 7 years from February 2013 to January 2020. Entirely osteosclerotic lesions were excluded from our study. The lesions were classified as nonneoplastic lesions, benign lesions, tumor like lesions and malignant lesions. Results: Over 7 years, 147 cases of osteolytic lesions of bone were reported. Of these, 36.1% were malignant lesions. The most common sites of osteolytic lesions were the femur (n = 46), tibia (n = 24), and humerus (n = 20). The most frequent histological diagnosis was of giant cell tumor (GCT) (n = 31), followed by chronic osteomyelitis (n = 19) and osteosarcoma (n = 17). The most frequent benign neoplasm was GCT and osteosarcoma was the predominant malignant lesion. Relatively uncommon lesions like adamantinoma were also reported. Conclusions: Malignant neoplasms are the most common osteolytic lesions. Bones of the extremities are the most frequent sites of involvement by both benign and malignant tumors. In addition to radiological correlation, a thorough knowledge of the age, sex, site of the common bone lesions is required for a correct histopathological diagnosis so that proper treatment can be instituted. Most of these lesions do not require immunohistochemistry for diagnosis. The possibility of rare tumors presenting at a given age and at a particular site is to be considered.

Background Langerhans cell histiocytosis (LCH) is a rare disease that originates from the uncontrolled proliferation and accumulation of bone marrow-derived immature myeloid dendritic cells. Dendritic cells are a type of histiocyte that play an important role in the human immune system and are found in the bone, skin, stomach, eyes, intestines, and lungs. Objective This systematic review aimed to collect and report published case reports of rare bone disease caused by LCH to avoid misdiagnoses or delays in diagnosis. Methods We systematically searched Scopus, PubMed, Embase, and Web of Sciences from August 1, 2000 to December 31, 2019. Studies reporting cases of LCH with rare bone involvement were included. Results We identified 60 articles including 64 cases. Of the identified cases, 31 (48.4%) involved children, and 33 (51.6%) involved adults. Additionally, 46.9% (30 individuals) were from Asian countries. The mean age of the children was 7.6 ± 4.3 years and that of the adults was 36 ± 12 years. The findings indicated that unifocal bone involvements were the most prevalent form of the disease (68.7%), and, overall, the skull and chest wall were the most commonly affected bones in both adults and children. The spine and long bones were the second most commonly affected bones in children, and the spine and jaw were the second most commonly affected bones in adults. Pain and swelling were the most frequent presenting signs among the investigated cases, and loss of consciousness, myelopathy, nerve palsy, visual loss, torticollis and clicking sounds were rare signs. Osteolytic lesions were the most frequent radiologic feature (62.5%), and intracranial hemorrhage, fluid–fluid level, dura and intracranial extension and pathologic fractures were rare radiological features. Total excision, curettage and observation in the unifocal group of patients and systemic chemotherapy in the other groups (i.e., multifocal and multisystem) were the most frequent management approaches. The recovery rates of the unifocal and multifocal groups were 77.3% and 81.8%, respectively, while that of the multisystem group was 55.5%. The rates of recurrence and mortality in the multisystem group were 11% and were higher than those in the other groups. Conclusions LCH is a rare disease that can affect any organ in the human body. However, bone is the most commonly involved organ, and rare bone involvements may be the first or only symptom of the disease due to the rarity of such lesions; a lack of familiarity with them may result in misdiagnosis or delayed diagnosis.

Introduction: Pathological lesions in skeletal system can be viewed radiologically as lytic lesions of bone. They can be either inflammatory conditions or neoplastic lesions. If they are neoplastic it can be again either benign or malignant. On radiological examination the nature of the disease cannot be assessed. Histopathology is the ultimate tool for the final diagnosis of such conditions. Aims and objectives: The main aim is to study the different lytic bone lesions, uncommon locations at which they can occur and the histopathological features of the same. Materials and Methods: This study was done at Mahadevappa Rampure Medical College from June 2017 to June 2018. A total of 12 bone lesions were analysed. Different investigations were done in different cases after radiological examination. The procedures done were fine needle aspiration cytology, bone biopsy and bone excision. Once they were done the specimens were taken for processing and the staining was done. After that histopathological diagnosis was made. Results: This study included a total number of 12 cases out of which 6 cases (50%) are between 25 – 50 years of age. Female predominance was observed. The incidence of non-neoplastic lesions was 8.3% and of neoplastic lesions was 91.67%. In the neoplastic lesions, the benign lesions were 25%, malignant tumours were 41.67% and metastatic tumours were 25%. Solitary plasmacytoma was most common tumour among malignant tumours. Also secondary metastasis was common among the malignant bone tumours. Conclusion: Bone tumours are not routinely found in clinical practice. If the presentation is at rare site it is difficult to come to a diagnosis. Though clinical and radiological approach is available, the histopathology can make the correct diagnosis. Keywords: Lytic bone lesions, Uncommon location, Histopathology.

Background Differentiation of multiple myeloma (MM) from osteolytic metastatic (OM) bone lesions may be critical in patients with lytic bone lesions but can be challenging for radiologists. Purpose To determine whether computed tomography (CT) can be used to distinguish between MM and other OM bone lesions. Material and Methods In this retrospective study, 320 lesions of 207 patients diagnosed with MM or OM, based on biopsy or clinical examination, were evaluated. Eight qualitative features were evaluated by two radiologists blinded to the diagnoses. The chi-square and Fisher exact tests, and logistic regression analysis, were used to evaluate the relationships between the CT findings and diagnoses. Results High-density areas were more common in OM than MM lesions (85.2% and 19%, P 2 = 0.516, P Conclusion MM and OM lesions can be differentiated by CT; OM lesions exhibit high- density areas.

Interventional radiology procedures are being increasingly used to mitigate chronic pain. In addition to established therapies such as thermal bone lesion ablation, kyphoplasty, and chemical neurolysis, ongoing research has shown promising results for the use of embolization in treatment of osteoarthritic knee pain and chronic pain secondary to adhesive shoulder capsulitis. This review will highlight some of the most common interventional radiology pain procedures, as well as provide insight into future pain-relieving embolization.

This article presents a dexterous robotic system for autonomous debridement of osteolytic bone lesions in confined spaces. The proposed system is distinguished from the state-of-the-art orthopedics systems because it combines a rigid-link robot with a continuum manipulator (CM) that enhances reach in difficult-to-access spaces often encountered in surgery. The CM is equipped with flexible debriding instruments and fiber Bragg grating sensors. The surgeon plans on the patient’s preoperative computed tomography and the robotic system performs the task autonomously under the surgeon’s supervision. An optimization-based controller generates control commands on the fly to execute the task while satisfying physical and safety constraints. The system design and controller are discussed and extensive simulation, phantom and human cadaver experiments are carried out to evaluate the performance, workspace, and dexterity in confined spaces. Mean and standard deviation of target placement are 0.5 and 0.18 mm, and the robotic system covers 91% of the workspace behind an acetabular implant in treatment of hip osteolysis, compared to the 54% that is achieved by conventional rigid tools.

Una donna di 30 anni si presenta all’osservazione degli autori presso il Settore di Medicina Orale (Università degli Studi di Palermo) per la comparsa di una neoformazione gengivale a livello del V sestante. In anamnesi patologica remota non risultano patologie sistemiche attuali o pregresse, la paziente è in apparenti buone condizioni di salute, riferisce di non assumere farmaci e non ha subito in passato interventi chirurgici. La paziente, non fumatrice, non riferisce dolore nella sede interessata ma progressivo accrescimento della lesione. All’esame obiettivo extra-orale non si apprezzano linfoadenopatie latero-cervicali o altre anomalie. All’esame obiettivo intra-orale si rileva una neoformazione, localizzata nel V sestante su mucosa masticatoria e alveolare tra gli elementi 4.1 e 4.3, del diametro di circa 1 cm, che si presenta di colorito roseo, rivestita da mucosa di aspetto fisiologico e integro e non mobile rispetto ai piani sottostanti. Alla palpazione è possibile apprezzare una consistenza dura-elastica. La paziente non è portatrice di protesi mobili, non sono rilevabili fattori traumatici associabili alla presenza di tale condizione; si rileva la presenza di affollamento dentario e tartaro diffuso. In considerazione della crescita della lesione e dell’aspetto clinico, si prescrive alla paziente una TC Cone-Beam