Search

Background: This study evaluated the incidence of de novo bone metastasis across all primary cancer sites and their impact on survival by primary cancer site, age, race, and sex., Questions/purposes: Our objectives were (I) characterize the epidemiology of de novo bone metastasis with respect to patient demographics, (II) characterize the incidence by primary site, age, and sex (2010-2015), and (III) compare survival of de novo metastatic cancer patients with and without bone metastasis., Methods: This is a retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 2010-2015. Incidence rates by year of diagnosis, annual percentage changes, Kaplan-Meier, univariate and multiple Cox regression models are included in the analysis., Results: Of patients with cancer in the SEER database, 5.1% were diagnosed with metastasis to bone, equaling ~18.8 per 100,000 bone metastasis diagnoses in the US per year (2010-2015). For adults >25, lung cancer is the most common primary site (2015 rate: 8.7 per 100,000) with de novo bone metastases, then prostate and breast primaries (2015 rates: 3.19 and 2.38 per 100,000, respectively). For patients <20 years old, endocrine cancers and soft tissue sarcomas are the most common primaries. Incidence is increasing for prostate (Annual Percentage Change (APC) = 4.6%, P < 0.001) and stomach (APC = 5.0%, P = 0.001) cancers. The presence of de novo bone metastasis was associated with a limited reduction in overall survival (HR = 1.02, 95%, CI = [1.01-1.03], p < 0.001) when compared to patients with other non-bone metastases., Conclusion: The presence of bone metastasis versus metastasis to other sites has disease site-specific impact on survival. The incidence of de novo bone metastasis varies by age, sex, and primary disease site., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This article discusses the most common diagnostic dilemmas when trying to distinguish between tumor and sports injury or other trauma. Bone tumors frequently occur in the same young active patients who experience sports injuries. If the pain persists longer than expected, imaging studies should be obtained to prevent a delay in diagnosis or an inappropriate arthroscopy. A history of spontaneous fracture or a fracture after minor trauma should raise suspicion for underlying lesion as the cause. Occasionally necrosis and/or hemorrhage within a soft tissue sarcoma is so extensive that only a small cuff of viable tumor tissue is present., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Surgical management of metastases to the extremities and pelvis has benefited from advances in the technology of internal fixation, as well as the increased availability of options for large endoprostheses. Contoured periarticular plates and the screws that attach rigidly to the plates have made fixation into weakened bone more reliable and easier to provide. For massive bone loss, modular endoprostheses are now widely available. These options supplemented with bone cement (polymethylmethacrylate) give patients the ability to have most bone defects reinforced or replaced such that the patient can begin using the affected limb almost immediately.

Unlabelled: Percutaneous biopsies are frequently used for musculoskeletal lesions. We suspect published accuracy rates (80-97%) overestimate clinical utility. We retrospectively reviewed 120 consecutive percutaneous biopsies performed by interventional radiologists at our institution. Patients underwent core biopsy, fine-needle aspiration (FNA), or both. The biopsy interpretations were considered clinically useful if they allowed proper treatment to proceed and not useful if they were nondiagnostic or if surgical specimens disagreed with percutaneous specimen. Patients were categorized by biopsy type, tissue type, and tumor type. Ninety of 120 percutaneous biopsies were clinically useful, 27 were nondiagnostic, and three were incorrect; in these latter 30 patients we proceeded to open biopsy. Patients with both biopsies had clinically useful results (80.6%) more often than FNA or core alone(68.0% and 66.7%, respectively). Biopsies of bone lesions were clinically useful more often than those of soft tissue. Myxoid histology was associated with decreased clinical accuracy. Clinical utility was independent of tumor type. No single characteristic predicted increased probability of open biopsy. The clinical utility rate was acceptable, but below published accuracy rates. The combination of both biopsies was better than FNA alone. Myxoid findings rarely helped to guide definitive treatment. Treatment decision making requires balancing biopsy results with clinical data., Level of Evidence: Diagnostic study, level IV.

Unlabelled: Grade III Campanacci lesions are traditionally treated with wide resections based on their postulated aggressiveness and potential for local recurrence and metastasis. The purpose of this study was to determine if there was a difference in local recurrence rates of Grade II and III lesions treated with intralesional curettage, burring, phenol cauterization, and polymethylmethacrylate application. Sixty-three patients (26 Campanacci Grade II and 37 Grade III lesions) met the inclusion criteria. No pathologic fractures, including intraarticular fractures, were included in this study. Followup averaged 108 months (range, 25-259 months). The overall local recurrence rate was 6% (4 of 63 patients), with no observed difference between Grade II and III lesions. The average Musculoskeletal Tumor Society functional score was 27.9/30 (93%). The mean range of motion of the adjacent joint was 97%. Patients with radiographic signs of osteoarthritis before treatment did not show substantial progression, and only one patient developed radiographic signs of degenerative arthritis postoperatively. Our distal metastatic rate was 3.2%. These data support the use of intralesional curettage and burring with adjuvant phenol and polymethylmethacrylate even in Grade III lesions, in the absence of pathologic fracture, regardless of the presence or extent of extraosseous extension., Level of Evidence: Therapeutic study, Level III-1 (retrospective cohort). See the Guidelines for Authors for a complete description of levels of evidence.

Unlabelled: Our primary goal in doing this study was to determine the effect of prosthesis location, patient age, periprosthetic infection, and primary versus revision placement on endoprosthetic survival. We also examined our endoprosthetic survival rates and reasons for failure. We retrospectively studied 139 endoprosthetic reconstructions performed between 1984 and 2002, including 57 distal femur, 27 proximal femur, 26 proximal tibia, 17 proximal humerus, 4 distal humerus, 3 total scapula, 3 total femur, and 2 total humerus reconstructions. Location of reconstruction and presence of periprosthetic infection significantly affected endoprosthetic survival. Survival was not affected by patient age or primary versus revision placement. Overall, Kaplan-Meier event-free endoprosthetic survival was 86%, 80%, and 69% at 3, 5, and 10-year followup. The trend for endoprosthetic survival from best to worst was proximal femur, proximal humerus, distal femur, proximal tibia, and distal humerus. Reasons for failure included mechanical failure (eight patients), tumor recurrence (eight patients), aseptic loosening (six patients), dislocation (two patients), periprosthetic infection (two patients), and endoprosthetic malalignment (one patient). Our periprosthetic infection rate was 2.2%. The local recurrence rate in patients treated for primary malignant tumors was 6.8%, similar to previous limb-salvage and amputation studies. Overall, we have found that endoprosthetic reconstruction is a reliable limb-salvage technique., Level of Evidence: Therapeutic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

This report describes a chondromyxoid fibroma which developed in the distal part of the second metacarpal of a 12-year-old girl. The tumor is rare, perhaps the rarest of all bone tumors, and the occurrence in a metacarpal of a young female is extraordinarily uncommon.

Background and Objectives: Malignant cartilage tumors demonstrate chemotherapeutic resistance through undetermined mechanisms. P-glycoprotein is the protein product of the multiple drug resistance gene 1 (MDR-1) and confers multidrug chemotherapeutic resistance in a variety of malignancies., Methods: MDR-1 expression was examined in 55 benign and malignant cartilage tumor specimens by immunohistochemistry using C219, C494, and JSB-1 antibodies, and by in situ hybridization with an MDR-1 specific oligonucleotide cDNA probe., Results: Constitutive expression of P-glycoprotein was observed in all benign and malignant cartilage tumor specimens with a similar pattern of immunohistochemical staining present with all three antibodies. In benign tumors and low grade chondrosarcomas, the staining pattern was weak to intermediate and localized to clusters of cells. However, higher grade-tumors (Grade II and III) expressed P-glycoprotein in a higher percentage of cells and with more intense staining. P-glycoprotein expression was absent in normal human articular cartilage, but was focally present in costal and growth plate cartilage. The immunohistochemistry results were confirmed by in situ hybridization in 10 cases., Conclusions: P-glycoprotein is expressed constitutively in cartilaginous tumors, with greatest expression in high grade malignancies. The findings may account for the resistance of cartilage tumors to chemotherapeutic agents.