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Background/Objectives: One of the most important diagnostic tools in bone tumors is X-rays. Preliminary and, in the case of some benign lesions, definitive diagnoses are formed using this basic tool. Part of the decision making in this stage is based on statistical probability using the patient's age, as well as the incidence and predilection sites of different entities. The information used today is based on older and fragmented data. To verify the underlying principles, we retrospectively evaluated all bone tumors in children and adolescents treated by our tertiary center in the last 20 years. Methods: For this retrospective study, patients under the age of 18 years suffering from histopathologically verified bone tumors were evaluated. Data were retrieved from our local musculoskeletal tumor database. Results: We were able to include 420 children treated for bone tumors in our tertiary center. The cohort consisted of 335 benign and 85 malignant lesions. The most common lesions were 137 osteochondromas; the malignant tumors consisted mainly of osteosarcomas (53) and Ewing's sarcomas (28). The primary predilection sites were the metaphyses of long bones. Conclusions: We were able to confirm and supplement the fragmentary data of these rare diseases using our own cohort. [ABSTRACT FROM AUTHOR]

Background: Chondrosarcomas (CS) are a rare and heterogenic group of primary malignant bone tumors. In the literature, data on prognostic factors in chondrosarcomas are scarce, and most studies are limited by a short follow-up. The aim of this retrospective study was therefore to determine factors associated with the survival and local recurrence of chondrosarcomas and to compare the results with previous studies. Methods: We retrospectively evaluated 77 patients who were treated for chondrosarcoma of the extremities or pelvis at our tertiary sarcoma center between 1998 and 2007. Patient-related data (age, sex, etc.), tumor characteristics (localization, grading, presence of metastases, etc.), and treatment-related data (previous surgical treatment, type of local treatment, surgical margins, etc.) were evaluated and analyzed for possible correlation with patients' outcomes. A statistical analysis was performed, including multivariate analysis. Results: The mean survival in our patients was 207 months, which resulted in a five-year survival rate of 76%. Negative prognostic factors for survival were histopathological grading, a patient aged over 70 years, and metastatic disease. The quality of the resection (clear or contaminated margins) negatively influenced both the development of local recurrence and survival too, at least in the univariate analysis. In contrast, factors such as tumor localization (extremities vs. pelvis), pathological fractures, or an initial inadequate resection elsewhere had no significant effect on survival. Conclusions: In accordance with results in the literature, the survival of patients with chondrosarcomas is mainly influenced by factors such as tumor grading, age, and metastases. However, complete resection remains paramount for the outcome in patients with chondrosarcoma—a primary malignant bone tumor with limited alternative treatment options. [ABSTRACT FROM AUTHOR]

Background/Aim: Benign and tumor-like lesions of the hindfoot and ankle are common, whereas malignant entities are rare. Accurate evaluation and timely management of these lesions can be challenging, making it crucial to understand their incidence and anatomic localization. This study retrospectively analyzed the distribution of benign and malignant bone and soft tissue tumors in the hindfoot and ankle. Patients and Methods: This study included patient data from a single center, such as age, sex, histologic diagnosis, and anatomic location over a 12.5 year period. Results: Of the 105 cases reviewed, 19 cases (18.1%) were osseous lesions and 86 cases (81.9%) were soft tissue lesions. The latter were divided into 77 benign and 9 malignant cases, resulting in an overall malignancy rate of 8.6%. The most common osseous lesion was the intraosseous ganglion (n=12). The majority of benign soft tissue lesions (75.3%) were located in the hindfoot, with TGCT, schwannoma, and ganglion cysts being the most common types. The nine malignant cases were distributed among seven entities and were evenly distributed among both regions and sexes. Malignant cases had a higher mean age (59.2 years) compared to benign cases (40.8 years; p=0.001). Conclusion: Tumors, tumor-like lesions, and pseudotumors represent an important aspect of ankle pathology. The majority of focal masses and swellings are benign soft tissue or osseous lesions, but malignant entities can occur and may be mistaken for benign conditions. Preoperative imaging and histopathologic examination are essential, and preoperative presentation to a multidisciplinary tumor board is recommended in unclear cases. [ABSTRACT FROM AUTHOR]

Background: The diagnostic work-up of musculoskeletal tumors is a multifactorial process. During the early phase, differential diagnoses are made using basic radiological imaging. In this phase, part of the decision making is based on the patient's age, as well as the incidence and predilection sites of different entities. Unfortunately, this information is based on older and fragmented data. In this study, we retrospectively evaluated all soft-tissue and bone tumors around the knee in children treated at our tertiary center in the last 20 years, with the aim of verifying the data used today. Methods: In this retrospective study, the databank of our tertiary center was used to give an overview of treated tumors around the knee in children. Results: We were able to include 224 children with bone and soft-tissue tumors around the knee. The cohort consisted of 184 bone tumors, of which 144 were benign and 40 malignant. The 40 soft-tissue tumors comprised 30 benign and 10 malignant masses. The most common lesions were osteochondromas (88) in the bone and tenosynovial giant-cell tumors (12) in the soft tissue. Conclusions: With this original work, we were able to verify and supplement earlier studies, as well as deepen our insight into these very rare diseases. [ABSTRACT FROM AUTHOR]

Background: Diffusion-weighted imaging (DWI) is widely used in neuroradiology or abdominal imaging but not yet implemented in the diagnosis of musculoskeletal tumors. Aim: This study aimed to evaluate how including diffusion imaging in the MRI protocol for patients with musculoskeletal tumors affects the agreement between radiologists and non-radiologist. Methods: Thirty-nine patients with musculoskeletal tumors (Ewing sarcoma, osteosarcoma, and benign tumors) consulted at our institution were included. Three raters with different experience levels evaluated examinations blinded to all clinical data. The final diagnosis was determined by consensus. MRI examinations were split into 1) conventional sequences and 2) conventional sequences combined with DWI. We evaluated the presence or absence of diffusion restriction, solid nature, necrosis, deep localization, and diameter >4 cm as known radiological markers of malignancy. Agreement between raters was evaluated using Gwet’s AC1 coefficients and interpreted according to Landis and Koch. Results: The lowest agreement was for diffusion restriction in both groups of raters. Agreement among all raters ranged from 0.51 to 0.945, indicating moderate to almost perfect agreement, and 0.772–0.965 among only radiologists indicating substantial to almost perfect agreement. Conclusion: The agreement in evaluating diffusion-weighted MRI sequences was lower than that for conventional MRI sequences, both among radiologists and non-radiologist and among radiologists alone. This indicates that assessing diffusion imaging is more challenging, and experience may impact the agreement.

Background/Objectives: One of the most important diagnostic tools in bone tumors is X-rays. Preliminary and, in the case of some benign lesions, definitive diagnoses are formed using this basic tool. Part of the decision making in this stage is based on statistical probability using the patient’s age, as well as the incidence and predilection sites of different entities. The information used today is based on older and fragmented data. To verify the underlying principles, we retrospectively evaluated all bone tumors in children and adolescents treated by our tertiary center in the last 20 years. Methods: For this retrospective study, patients under the age of 18 years suffering from histopathologically verified bone tumors were evaluated. Data were retrieved from our local musculoskeletal tumor database. Results: We were able to include 420 children treated for bone tumors in our tertiary center. The cohort consisted of 335 benign and 85 malignant lesions. The most common lesions were 137 osteochondromas; the malignant tumors consisted mainly of osteosarcomas (53) and Ewing’s sarcomas (28). The primary predilection sites were the metaphyses of long bones. Conclusions: We were able to confirm and supplement the fragmentary data of these rare diseases using our own cohort.

Background: Surgical resection is the primary treatment for bone and soft tissue tumors. Negative margin status is a key factor in prognosis. Given the three-dimensional (3D) anatomic complexity of musculoskeletal tumor specimens, communication of margin results between surgeons and pathologists is challenging. We sought to perform ex vivo 3D scanning of musculoskeletal oncology specimens to enhance communication between surgeons and pathologists. Methods: Immediately after surgical resection, 3D scanning of the fresh specimen is performed prior to frozen section analysis. During pathologic grossing, whether frozen or permanent, margin sampling sites are annotated on the virtual 3D model using computer-aided design (CAD) software. Results: 3D scanning was performed in seven cases (six soft tissue, one bone), with specimen mapping on six cases. Intraoperative 3D scanning and mapping was performed in one case in which the location of margin sampling was shown virtually in real-time to the operating surgeon to help achieve a negative margin. In six cases, the 3D model was used to communicate final permanent section analysis. Soft tissue, cartilage, and bone (including lytic lesions within bone) showed acceptable resolution. Conclusions: Virtual 3D scanning and specimen mapping is feasible and may allow for enhanced documentation and communication. This protocol provides useful information for anatomically complex musculoskeletal tumor specimens. Future studies will evaluate the effect of the protocol on positive margin rates, likelihood that a re-resection contains additional malignancy, and exploration of targeted adjuvant radiation protocols using a patient-specific 3D specimen map. [ABSTRACT FROM AUTHOR]

Background: Chondrosarcomas (CS) are a rare and heterogenic group of primary malignant bone tumors. In the literature, data on prognostic factors in chondrosarcomas are scarce, and most studies are limited by a short follow-up. The aim of this retrospective study was therefore to determine factors associated with the survival and local recurrence of chondrosarcomas and to compare the results with previous studies. Methods: We retrospectively evaluated 77 patients who were treated for chondrosarcoma of the extremities or pelvis at our tertiary sarcoma center between 1998 and 2007. Patient-related data (age, sex, etc.), tumor characteristics (localization, grading, presence of metastases, etc.), and treatment-related data (previous surgical treatment, type of local treatment, surgical margins, etc.) were evaluated and analyzed for possible correlation with patients’ outcomes. A statistical analysis was performed, including multivariate analysis. Results: The mean survival in our patients was 207 months, which resulted in a five-year survival rate of 76%. Negative prognostic factors for survival were histopathological grading, a patient aged over 70 years, and metastatic disease. The quality of the resection (clear or contaminated margins) negatively influenced both the development of local recurrence and survival too, at least in the univariate analysis. In contrast, factors such as tumor localization (extremities vs. pelvis), pathological fractures, or an initial inadequate resection elsewhere had no significant effect on survival. Conclusions: In accordance with results in the literature, the survival of patients with chondrosarcomas is mainly influenced by factors such as tumor grading, age, and metastases. However, complete resection remains paramount for the outcome in patients with chondrosarcoma—a primary malignant bone tumor with limited alternative treatment options.

Clinical cancer researchers have been studying means of predicting the prognosis of cancer and the effectiveness of treatment based on various patient data. The information that can be obtained from patients is diverse, including medical images, genetic data, bio-signals, text data, and biochemical tests. Although traditional epidemiological methodologies have been used for data analysis, recent studies have revealed the superior performance of machine learning algorithms. On the other hand, medical staff directly involved in utilizing artificial intelligent (AI) medical devices in the future will need to understand the strengths and limitations of these algorithms in detail. Machine learning algorithms do not work on a single principle, and various algorithms originating from various backgrounds are available. Each algorithm may or may not be suitable, depending on the purpose. Algorithms not correctly applied for this purpose often cannot be used clinically, even if their performance is excellent. This review aims to provide an overview of the clinical utility and constraints of AI medical devices by introducing various AI algorithms applicable to clinical practice and highlighting relevant case studies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess if radiologists assisted by deep learning (DL) algorithms can achieve diagnostic accuracy comparable to that of pre-surgical biopsies in benign–malignant differentiation of musculoskeletal tumors (MST). Methods: We first conducted a systematic review of literature to get the respective overall diagnostic accuracies of fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) in differentiating between benign and malignant MST, by synthesizing data from the articles meeting our inclusion criteria. To compared against the accuracies reported in literature, we then invited 4 radiologists, respectively with 2 (A), 6 (B), 7 (C), and 33 (D) years of experience in interpreting musculoskeletal MRI to perform diagnostic tests on our own dataset (n = 62), with and without assistance of a previously developed DL algorithm. The gold standard for benign–malignant differentiation was histopathologic confirmation or clinical/radiographic follow-up. Results: For FNAB, a meta-analysis containing 4604 samples met the inclusion criteria, with the overall diagnostic accuracy reported to be 0.77. For CNB, an overall accuracy of 0.86 was derived by synthesizing results from 7 original research articles containing a total of 587 samples. On our internal MST dataset, the invited radiologists, respectively, achieved diagnostic accuracies of 0.84 (A), 0.89 (B), 0.87 (C), and 0.90 (D), with the assistance of DL. Conclusion: Use of DL algorithms on musculoskeletal dynamic contrast-enhanced MRI improved the benign–malignant differentiation accuracy of radiologists to a level comparable to that of pre-surgical biopsies. The developed DL algorithms have a potential to lower the risk of miss-diagnosing malignancy in radiological practice. [ABSTRACT FROM AUTHOR]

The majority of the sarcomas are deep in location, larger than 5 cm in size, and heterogenous in imaging appearance. However, when sarcomas occur superficially, these typical features may be absent, failing to alert the radiologist to a malignancy and mimicking one of the more numerous benign superficial tumors that make up the bulk of soft tissue mass evaluations. This manuscript will discuss the current role of imaging in recognizing features concerning for superficial soft tissue sarcomas. Provided is an overview of the demographic, clinical, and imaging features of the most commonly encountered superficial soft tissue sarcomas, including undifferentiated pleomorphic, leiomyosarcoma, synovial sarcoma, liposarcoma, myxofibrosarcoma, dermatofibrosarcoma protuberans, epithelioid sarcoma, and angiosarcoma. A less common but primary superficial tumor, angiomatoid fibrous histiocytoma, is also reviewed as the diagnosis may be confounding both clinically and on imaging studies. [ABSTRACT FROM AUTHOR]

Abstract Background Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) and other contrast agents has shown its efficacy in improving resection margins, local recurrence and survival rates in several medical disciplines. It is the objective of this study to analyze the engraftment rate of musculoskeletal tumor specimens on the chick chorio-allantoic membrane (CAM), the rate of tumor fluorescence (PDD), and the effects of photodynamic therapy (PDT) after exposure of tumors to 5-ALA in an in vivo environment. Methods A total of 486 CAMs were inoculated with macroscopic tumor grafts (n = 26; n = 478 eggs) and primary cell culture suspensions (n = 2; n = 8 eggs) from 26 patients on day 10 of egg development. On day 16, 2 mg/200 µl 5-ALA were topically applied per egg. After 4 h of incubation, Protoporphyrin IX was excited using blue light (420 ± 10 nm). Tumor fluorescence (PDD) was photo-documented. A subgroup of specimens was additionally exposed to red light (635 nm ± 10 nm; PDT). After the termination of the experiment, CAM-grown tumors were histopathologically analyzed. Results Benign and borderline tumors (chondroblastoma, giant cell tumor of bone and atypical chondrogenic tumor) presented with high rates of detectable fluorescence. Comparable results were found for chondrosarcoma, osteosarcoma and Ewing’s sarcoma among bone and dedifferentiated liposarcoma, myxofibrosarcoma and undifferentiated pleomorphic sarcoma among soft tissue sarcomas. Overall, tumor fluorescence was negative for 20.2%, single-positive (+) for 46.9% and double-positive (++) for 32.9% of macroscopic xenografts, and negative in 20% and (+) in 80% of primary cell culture tumors. Macroscopic tumor xenografts (n = 478) were identified as viable in 14.8%, partially viable in 2.9% and partially to completely regressive in 45.2%. All (n = 8) tumors grown from primary cell culture were viable. After PDT, tumor samples were found viable in 5.5%, partially viable in 5.5% and partially to completely regressive in 68%. Egg survival increased with decreasing PDT doses. Conclusions The CAM model proves to be a suitable in vivo model for the investigation of short-term observation questions in musculoskeletal tumors. The findings of this study warrant further investigation of PDT effects on musculoskeletal tumors and a possible incorporation of 5-ALA FGS in clinical Orthopedic Oncology care.

Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of spinal metastases. However, there is still controversy in terms of clinical treatment, such as indication, power, time, and temperature. To standardize the application of microwave ablation technology and reduce the risk of surgical-related complications in spinal metastases, in this report, we aimed to summarize the current evidence and clinical experience of microwave ablation and developed a clinical guideline, initiated by the Musculoskeletal Tumor Group of the Committee for Minimally Invasive Therapy in Oncology of the Chinese Anti-Cancer Association. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in to rate the quality of evidence and the strength of recommendations, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist was strictly followed to report the guideline. Finally, 15 evidence-based recommendations were formulated based on the 15 most concerned clinical questions among orthopedic surgeons, oncologists, and interventional radiologists in China. This guideline aims to promote the science-based normalization of microwave ablation for the treatment of spinal metastases. [ABSTRACT FROM AUTHOR]

Malignant or aggressive primary musculoskeletal tumors are rare and encompass a wide variety of bone and soft tissue tumors. Given the most common site for metastasis from these primary musculoskeletal tumors is to the lung, chest imaging is integral in both staging and surveillance. Extrapulmonary metastases are rarely encountered with only a few exceptions. Following primary tumor resection, surveillance of the primary tumor site is generally recommended. Local surveillance imaging recommendations differ between primary tumors of bone origin versus soft tissue origin. This document consolidates the current evidence and expert opinion for the imaging staging and surveillance of these tumors into five clinical scenarios. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is used to perform perfusion imaging without administration of contrast media. However, the reliability of ASL for musculoskeletal tumors and the influence of post-labeling delay (PLD) have not been fully clarified. This study aimed to evaluate the performance of ASL with different PLDs in the imaging of musculoskeletal tumors. Forty-five patients were enrolled and were divided into a malignant group, a hypervascular benign group, a hypovascular benign group and a control group. The tissue blood flow (TBF) of the lesions and normal muscles was measured and the lesion-to-muscle TBF ratio and differences were calculated. The results showed that both the TBF of lesions and muscles increased as the PLD increased, and the TBF of muscles correlated significantly and positively with the TBF of lesions (all p < 0.05). The TBF and lesion-to-muscle TBF differences of the malignant lesions were significantly higher than those of the hypovascular benign lesions and the control group in all PLD groups (all p < 0.0125) and only those of the hypervascular benign lesions in the longest PLD (3025 ms) group (p = 0.0120, 0.0116). In conclusion, ASL detects high TBF in malignant tumors and hypervascular benign lesions, and a longer PLD is recommended for ASL to differentiate musculoskeletal tumors. [ABSTRACT FROM AUTHOR]

Abstract Background Proximal femoral replacement (PFR) is a technically demanding procedure commonly performed to restore extensive, oncological or non-oncological bone defects in a severely debilitated patient collective. Depending on different indications, a varying outcome has been reported. The aim of the study was to assess the functional outcomes and complication rates of PFR with the modular Munich-Luebeck (MML) femoral megaprosthesis (ESKA/Orthodynamics, Luebeck, Germany), and to highlight outcome differences in patients treated for failed revision total hip arthroplasty (THA) or malignant bone disease. Methods A retrospective review of patients treated with PFR for failed THA or malignant tumor disease between 2000 and 2012 was performed. Patient satisfaction, functional outcome (VAS, SF-12, MSTS, WOMAC, TESS), complications and failure types (Henderson’s failure classification) were assessed. A Kaplan-Meier analysis determined implant survival. Results Fifty-eight patients (age: 69.9 years, BMI: 26.7 kg/m2, mean follow-up: 66 months) were included. The mean SF-12 (physical / mental) was 37.9 / 48.4. MSTS averaged 68% at final follow-up, while mean WOMAC and TESS scored 37.8 and 59.5. TESS and WOMAC scores demonstrated significantly worse outcomes in the revision group (RG) compared to the tumor group (TG). Overall complication rate was 43.1%, and dislocation was the most common complication (27.6%). Implant survival rates were 83% (RG) and 85% (TG; p = n.s.) at 5 years, while 10-year survival was 57% (RG) and 85% (TG, p

Myxofibrosarcoma (MFS) is a common entity of adult soft tissue sarcomas (STS) characterized by a predilection of the extremities and a high local recurrence rate. Originally classified as a myxoid variant of malignant fibrous histiocytoma, this musculoskeletal tumor has been recognized since 2002 as a distinct histotype showing a spectrum of malignant fibroblastic lesions with myxoid stroma, pleomorphism and curvilinear vessels. Currently, the molecular pathogenesis of MFS is still poorly understood and its genomic profile exhibits a complex karyotype with a number of aberrations including amplifications, deletions and loss of function. The diagnosis is challenging due to the unavailability of specific immunohistochemical markers and is based on the analysis of cytomorphologic features. The mainstay of treatment for localized disease is represented by surgical resection, with (neo)-adjuvant radio- and chemotherapy. In the metastatic setting, chemotherapy represents the backbone of treatments, however its role is still controversial and the outcome is very poor. Recent advent of genomic profiling, targeted therapies and larger enrollment of patients in translational and clinical studies, have improved the understanding of biological behavior and clinical outcome of such a disease. This review will provide an overview of current diagnostic pitfalls and clinical management of MFS. Finally, a look at future directions will be discussed. [ABSTRACT FROM AUTHOR]

Bone and soft tissue sarcomas of lower and upper extremities may sometimes be in close contact with neurovascular structures. In such cases, it is controversial that whether en bloc resection and vascular reconstruction to reach wider surgical margins or planned marginal resection with the help of adjuvant therapies should be preferred. This study aimed to determine surgical and oncological outcomes of planned marginal and wide resection of extremity sarcomas that are associated with major vascular structures in the extremities. The collected database of 54 patients treated by the same orthopedic and vascular surgeon for primary or locally recurrent soft and bone tissue sarcoma of extremities was retrospectively reviewed. Eligible subjects for this study were patients diagnosed with upper and lower extremity soft and bone tissue sarcomas that encased a maximum of 50% of the circumference of the major vascular structures, requiring limb-sparing resection. When microscopic positive (19 patients, 33.9%) and negative cases' (35 patients, 66.1%) surgical margins were compared, local recurrence, metastasis, amputation, and tumor type (soft/bone) parameters showed no statistically significant difference. When metastatic and non-metastatic patients were compared, it was shown that bone tumors metastasized more than soft tissue tumors (p = 0.001). However, there was no difference between metastasis and amputation, histopathology, grade, nerve involvement, surgical margins, or local recurrences. The mean survival was 1460.6 ± 137.4 days, and the 6-year mortality was 87.5%. Anesthetic and surgical complication rates may be higher since en bloc resection surgeries of large tumors with vascular reconstructions take a very long time. Therefore, we suggest marginal resection with sub-adventitial dissection in those locations and wide resection at other areas according to the surgeon's experiences about safe margin with the contribution of radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Fluorescence-guided surgery (FGS) with 5-aminolevulinic acid (5-ALA) and other contrast agents has shown its efficacy in improving resection margins, local recurrence and survival rates in several medical disciplines. It is the objective of this study to analyze the engraftment rate of musculoskeletal tumor specimens on the chick chorio-allantoic membrane (CAM), the rate of tumor fluorescence (PDD), and the effects of photodynamic therapy (PDT) after exposure of tumors to 5-ALA in an in vivo environment. Methods: A total of 486 CAMs were inoculated with macroscopic tumor grafts (n = 26; n = 478 eggs) and primary cell culture suspensions (n = 2; n = 8 eggs) from 26 patients on day 10 of egg development. On day 16, 2 mg/200 µl 5-ALA were topically applied per egg. After 4 h of incubation, Protoporphyrin IX was excited using blue light (420 ± 10 nm). Tumor fluorescence (PDD) was photo-documented. A subgroup of specimens was additionally exposed to red light (635 nm ± 10 nm; PDT). After the termination of the experiment, CAM-grown tumors were histopathologically analyzed. Results: Benign and borderline tumors (chondroblastoma, giant cell tumor of bone and atypical chondrogenic tumor) presented with high rates of detectable fluorescence. Comparable results were found for chondrosarcoma, osteosarcoma and Ewing's sarcoma among bone and dedifferentiated liposarcoma, myxofibrosarcoma and undifferentiated pleomorphic sarcoma among soft tissue sarcomas. Overall, tumor fluorescence was negative for 20.2%, single-positive (+) for 46.9% and double-positive (++) for 32.9% of macroscopic xenografts, and negative in 20% and (+) in 80% of primary cell culture tumors. Macroscopic tumor xenografts (n = 478) were identified as viable in 14.8%, partially viable in 2.9% and partially to completely regressive in 45.2%. All (n = 8) tumors grown from primary cell culture were viable. After PDT, tumor samples were found viable in 5.5%, partially viable in 5.5% and partially to completely regressive in 68%. Egg survival increased with decreasing PDT doses. Conclusions: The CAM model proves to be a suitable in vivo model for the investigation of short-term observation questions in musculoskeletal tumors. The findings of this study warrant further investigation of PDT effects on musculoskeletal tumors and a possible incorporation of 5-ALA FGS in clinical Orthopedic Oncology care. [ABSTRACT FROM AUTHOR]

Abstract: Musculoskeletal tumors are relatively rare, with 0.2%-0.5% of all malignant tumors in all ages. The geographic distribution of musculoskeletal tumors varies significantly around the world. This study aims to describe the musculoskeletal tumor profile in Saiful Anwar General Hospital. All data were obtained from the department of orthopaedic and traumatology database, Saiful Anwar general hospital. Thus, patients who were diagnosed with either bone tumor or soft tissue tumor between January 2011 to December 2018 were selected for the present study. The clinical-pathological conference (CPC) was carried out to ensure the validity of all the registered data. A total of 577 patients with tumors from January 2011 to December 2018 was obtained. Out of all the cases, 439 (76%) cases are bone tumors, and the remaining 138 (24%) cases are soft tissue tumors. The most frequent locations of the musculoskeletal tumors are the long bones of the thigh and lower leg. This study shows an increasing trend in musculoskeletal tumors incidence, despite decreasing numbers in several years. This result goes along with a rising trend in malignancy cases with a higher amount compared to the benign one. Moreover, MBD and osteosarcoma were found to be the most common tumor and primary bone tumors, respectively. However, the fact that there is some data loss in the study limited the study for a more accurate result. Keywords: Musculoskeletal tumor; Bone tumor; Osteosarcoma; Malang; East Java

Synovial sarcoma is a type of soft tissue sarcoma that commonly occurs around large joints. However, primary intra-articular synovial sarcoma is considered an extremely rare variant of synovial sarcoma. We present a case of synovial sarcoma arising from the hip joint in a 17-year-old female patient. Clinical, radiographic, magnetic resonance imaging and histopathology findings are described. The patient underwent neoadjuvant chemoradiation therapy followed by right hemipelvectomy, and there was no local recurrence in the subsequent follow ups. Unfortunately, the patient had pleural metastasis, and she was treated with palliative chemotherapy. To the best of our knowledge, there is only one published case report in the English literature on intra-articular synovial sarcoma from the hip joint.

Background: Diffusion-weighted imaging (DWI) is widely used in neuroradiology or abdominal imaging but not yet implemented in the diagnosis of musculoskeletal tumors., Aim: This study aimed to evaluate how including diffusion imaging in the MRI protocol for patients with musculoskeletal tumors affects the agreement between radiologists and non-radiologist., Methods: Thirty-nine patients with musculoskeletal tumors (Ewing sarcoma, osteosarcoma, and benign tumors) consulted at our institution were included. Three raters with different experience levels evaluated examinations blinded to all clinical data. The final diagnosis was determined by consensus. MRI examinations were split into 1) conventional sequences and 2) conventional sequences combined with DWI. We evaluated the presence or absence of diffusion restriction, solid nature, necrosis, deep localization, and diameter >4 cm as known radiological markers of malignancy. Agreement between raters was evaluated using Gwet's AC1 coefficients and interpreted according to Landis and Koch., Results: The lowest agreement was for diffusion restriction in both groups of raters. Agreement among all raters ranged from 0.51 to 0.945, indicating moderate to almost perfect agreement, and 0.772-0.965 among only radiologists indicating substantial to almost perfect agreement., Conclusion: The agreement in evaluating diffusion-weighted MRI sequences was lower than that for conventional MRI sequences, both among radiologists and non-radiologist and among radiologists alone. This indicates that assessing diffusion imaging is more challenging, and experience may impact the agreement., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is used to perform perfusion imaging without administration of contrast media. However, the reliability of ASL for musculoskeletal tumors and the influence of post-labeling delay (PLD) have not been fully clarified. This study aimed to evaluate the performance of ASL with different PLDs in the imaging of musculoskeletal tumors. Forty-five patients were enrolled and were divided into a malignant group, a hypervascular benign group, a hypovascular benign group and a control group. The tissue blood flow (TBF) of the lesions and normal muscles was measured and the lesion-to-muscle TBF ratio and differences were calculated. The results showed that both the TBF of lesions and muscles increased as the PLD increased, and the TBF of muscles correlated significantly and positively with the TBF of lesions (all p < 0.05). The TBF and lesion-to-muscle TBF differences of the malignant lesions were significantly higher than those of the hypovascular benign lesions and the control group in all PLD groups (all p < 0.0125) and only those of the hypervascular benign lesions in the longest PLD (3025 ms) group (p = 0.0120, 0.0116). In conclusion, ASL detects high TBF in malignant tumors and hypervascular benign lesions, and a longer PLD is recommended for ASL to differentiate musculoskeletal tumors.

Background: Proximal femoral replacement (PFR) is a technically demanding procedure commonly performed to restore extensive, oncological or non-oncological bone defects in a severely debilitated patient collective. Depending on different indications, a varying outcome has been reported. The aim of the study was to assess the functional outcomes and complication rates of PFR with the modular Munich-Luebeck (MML) femoral megaprosthesis (ESKA/Orthodynamics, Luebeck, Germany), and to highlight outcome differences in patients treated for failed revision total hip arthroplasty (THA) or malignant bone disease.Methods: A retrospective review of patients treated with PFR for failed THA or malignant tumor disease between 2000 and 2012 was performed. Patient satisfaction, functional outcome (VAS, SF-12, MSTS, WOMAC, TESS), complications and failure types (Henderson's failure classification) were assessed. A Kaplan-Meier analysis determined implant survival.Results: Fifty-eight patients (age: 69.9 years, BMI: 26.7 kg/m2, mean follow-up: 66 months) were included. The mean SF-12 (physical / mental) was 37.9 / 48.4. MSTS averaged 68% at final follow-up, while mean WOMAC and TESS scored 37.8 and 59.5. TESS and WOMAC scores demonstrated significantly worse outcomes in the revision group (RG) compared to the tumor group (TG). Overall complication rate was 43.1%, and dislocation was the most common complication (27.6%). Implant survival rates were 83% (RG) and 85% (TG; p = n.s.) at 5 years, while 10-year survival was 57% (RG) and 85% (TG, p < 0.05).Conclusions: PFR is a salvage procedure for restoration of mechanical integrity and limb preservation after extensive bone loss. Complications rates are considerably high. Functional outcomes and 10-year implant survival rate were worse in the RG compared to the TG. Strict indications and disease-specific patient education are essential in preoperative planning and prognosis. [ABSTRACT FROM AUTHOR]

Background Accurate diagnosis of musculoskeletal tumors is essential for guiding appropriate treatment strategies. Percutaneous core needle biopsy (PCNB) is increasingly recognized as a valuable method for obtaining tissue samples for histopathological examination. This study aims to evaluate the diagnostic accuracy and clinical utility of PCNB in diagnosing musculoskeletal tumors. Methodology A total of 152 cases suspected of musculoskeletal tumors underwent PCNB at our tertiary care center between 2020 and 2023. Pre-biopsy evaluation included comprehensive clinical assessment and imaging studies. Core biopsies were performed under image guidance, with specimens sent for histopathological examination and culture sensitivity analysis. Diagnostic yield, accuracy, and performance metrics of PCNB were assessed. Results PCNB demonstrated a diagnostic yield of 93.4%. However, in cases where initial biopsies were inconclusive, repeat core biopsy or open biopsy provided the necessary diagnostic clarity. PCNB demonstrated a remarkable diagnostic accuracy of 97.9%, with a specificity and positive predictive value of 100%. There were no post-biopsy complications and no instances of local recurrence from the biopsy tract. Conclusions PCNB can be a reliable method for diagnosing musculoskeletal tumors, offering high diagnostic accuracy and minimal complications. The utilization of image guidance enhances precision and reduces the risk of complications. PCNB proves effective in diagnosing both primary tumors and bone infections, facilitating timely and appropriate treatment strategies in orthopedic oncology., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Arvind Kumar et al.)

ObjectiveThe purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy.Materials and methodsFour hundred forty-four consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and low-or intermediate-to-high-grade neoplasm).ResultsOf 444 biopsies, 71% were diagnostic, 86% were accurate, and 70% were successful. Biopsy success and diagnostic yield were greater in bone lesions, malignant neoplasms, and intermediate-to-high-grade neoplasms compared with soft-tissue lesions (p < 0.01), benign neoplasms (p < 0.0001), and low-grade neoplasms (p < 0.0001). Success and diagnostic yield were not significantly associated with technical or imaging factors. Biopsy accuracy was not associated with any of the tested variables. Of the 128 nondiagnostic biopsy results, 53% were accurate with respect to subsequent surgical pathologic findings. Most of these biopsy results were of benign soft-tissue lesions.ConclusionCT biopsy of musculoskeletal lesions is accurate and effective. It may be limited in the evaluation of benign and low-grade soft-tissue neoplasms.

Abstract: Primary tumours of musculoskeletal tissues are relatively uncommomn, they represent only 1% of all malignancies in all ages groups, but the incidence is arising each year. Many medical research and experiments were developed to found appropriate methods of treatment for tumor patients. Mortality rates of malignant musculoskeletal tumor patients still higher than benign cases. The aim of this study was to describe the incidence, age and sex distribution, location and histology of benign and malignant musculoskeletal tumors diagnosed and/or treated at a tertiary referral Orthopaedic Department serving the East Java. This was a retrospective analysis of prospectively collected data of medical records of all patients diagnosed and/or treated for any type of musculoskeletal tumor at Orthopaedic and Traumatology Department of Saiful Anwar Hospital, in the period from January 2011 to December 2017. This study resulted there were 531 cases of musculoskeletal tumor, within the characteristic: the peak of incidence occurs in the patient older than 60; the highest case was Osteosarcoma (92 cases); and breast metastases (40 cases) distributed highest mortality rates for metastastic bone tumor patients. Result of this study was people at age 60 and older have higher risk for Muskulokeletal Tumor, and Osteosarcoma was the most frequent case. Keywords: Musculoskeletal tumor, data based system, incidence, East Java

Abstract Background Bone and soft tissue masses of the foot and ankle are not particularly rare but true neoplasia has to be strictly differentiated from pseudotumorous lesions. Diagnosis is often delayed as diagnostic errors are more common than in other regions. Awareness for this localization of musculoskeletal tumors is not very high and neoplasia is often not considered. The purpose of this study is to provide detailed information on the incidence and distribution patterns of foot and ankle tumors of a university tumor institute and propose a simple definition to facilitate comparison of future investigations. Methods As part of a retrospective, single-centre study, the data of patients that were treated for foot and ankle tumors between June 1997 and December 2015 in a musculoskeletal tumor centre were analyzed regarding epidemiologic information, entity and localization. Included were all cases with a true tumor of the foot and ankle. Exclusion criteria were incomplete information on the patient or entity (e.g. histopathological diagnosis) and all pseudotumoral lesions. Results Out of 7487 musculoskeletal tumors, 413 cases (5,52%) of tumors of the foot and ankle in 409 patients were included (215 male and 198 female patients). The average age of the affected patients was 36 ± 18y (min.3y, max.92y). Two hundred sixty-six tumors involved the bone (64%), among them 231 (87%) benign and 35 (13%) malignant. There were 147 soft tissue tumors (36%), 104 (71%) were benign, 43 (29%) malignant. The most common benign osseous tumor lesions included simple bone cysts, enchondroma and osteochondroma. By far the most common malignant bone tumor was chondrosarcoma. Common benign soft tissue tumors included pigmented villo-nodular synovitis, superifcial fibromatosis and schwannoma whereas the most common malignant members were synovial sarcoma and myxofibrosarcoma. Regarding anatomical localization, the hindfoot was affected most often. Conclusions Knowledge of incidence and distribution patterns of foot and ankle tumors will help to correctly assess unclear masses and initiate the right steps in further diagnostics and treatment. Unawareness can lead to delayed diagnosis and inadequate treatment with serious consequences for the affected patient.

Background: The aim of the current study was to evaluate the impact of the coronavirus disease (COVID-19) pandemic on musculoskeletal tumor service by conducting an online survey of physicians. Methods: The survey was conducted among the members of the ISOLS (International Society of Limb Salvage) and the EMSOS (European Musculo-Skeletal Oncology Society). The survey consisted of 20 questions (single, multiple-response, ranked): origin and surgical experience of the participant (four questions), potential disruption of healthcare (12 questions), and influence of the COVID-19 pandemic on the particular physician (four questions). A matrix with four different response options was created for the particular surgical procedures). Results: One hundred forty-nine physicians from five continents completed the survey. Of the respondents, 20.1% and 20.7% stated that surgery for life-threatening sarcomas were stopped or delayed, respectively. Even when the malignancy was expected to involve infiltration of a neurovascular bundle or fracture of a bone, still 13.8% and 14.7% of the respondents, respectively, stated that surgery was not performed. In cases of pending fractures of bone tumors, 37.5 to 46.2% of operations were canceled. Conclusion: The SARS-CoV-2 pandemic caused a significant reduction in healthcare (surgery, radiotherapy, chemotherapy) for malignancies of the musculoskeletal system. Delaying or stopping these treatments is life-threatening or can cause severe morbidity, pain, and loss of function. Although the coronavirus disease causes severe medical complications, serious collateral damage including death due to delayed or untreated sarcomas should be avoided. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate differences in parameters of diffusion kurtosis imaging (DKI) and minimum apparent diffusion coefficient (ADCmin) between benign and malignant musculoskeletal tumors.Materials and Methods: In this prospective study, 43 patients were scanned using a DKI protocol on a 3-T MR scanner. Eligibility criteria were: non-fatty, non-cystic soft tissue or osteolytic tumors; > 2 cm; location in the retroperitoneum, pelvis, leg, or neck; and no prior treatment. They were clinically or histologically diagnosed as benign (n = 27) or malignant (n = 16). In the DKI protocol, diffusion-weighted imaging was performed using four b values (0-2000 s/mm2) and 21 diffusion directions. Mean kurtosis (MK) values were calculated on the MR console. A recently developed software application enabling reliable calculation was used for DKI analysis.Results: MK showed a strong correction with ADCmin (Spearman's rs = 0.95). Both MK and ADCmin values differed between benign and malignant tumors (p < 0.01). For benign and malignant tumors, the mean MK values (± SD) were 0.49 ± 0.17 and 1.14 ± 0.30, respectively, and ADCmin values were 1.54 ± 0.47 and 0.49 ± 0.17 × 10-3 mm2/s, respectively. At cutoffs of MK = 0.81 and ADCmin = 0.77 × 10-3 mm2/s, the specificity and sensitivity for diagnosis of malignant tumors were 96.3 and 93.8% for MK and 96.3 and 93.8% for ADCmin, respectively. The areas under the curve were 0.97 and 0.99 for MK and ADCmin, respectively (p = 0.31).Conclusions: MK and ADCmin showed high diagnostic accuracy and strong correlation, reflecting the accuracy of MK. However, no clear added value of DKI could be demonstrated in differentiating musculoskeletal tumors. [ABSTRACT FROM AUTHOR]

Background: Bone and soft tissue masses of the foot and ankle are not particularly rare but true neoplasia has to be strictly differentiated from pseudotumorous lesions. Diagnosis is often delayed as diagnostic errors are more common than in other regions. Awareness for this localization of musculoskeletal tumors is not very high and neoplasia is often not considered. The purpose of this study is to provide detailed information on the incidence and distribution patterns of foot and ankle tumors of a university tumor institute and propose a simple definition to facilitate comparison of future investigations.Methods: As part of a retrospective, single-centre study, the data of patients that were treated for foot and ankle tumors between June 1997 and December 2015 in a musculoskeletal tumor centre were analyzed regarding epidemiologic information, entity and localization. Included were all cases with a true tumor of the foot and ankle. Exclusion criteria were incomplete information on the patient or entity (e.g. histopathological diagnosis) and all pseudotumoral lesions.Results: Out of 7487 musculoskeletal tumors, 413 cases (5,52%) of tumors of the foot and ankle in 409 patients were included (215 male and 198 female patients). The average age of the affected patients was 36 ± 18y (min.3y, max.92y). Two hundred sixty-six tumors involved the bone (64%), among them 231 (87%) benign and 35 (13%) malignant. There were 147 soft tissue tumors (36%), 104 (71%) were benign, 43 (29%) malignant. The most common benign osseous tumor lesions included simple bone cysts, enchondroma and osteochondroma. By far the most common malignant bone tumor was chondrosarcoma. Common benign soft tissue tumors included pigmented villo-nodular synovitis, superifcial fibromatosis and schwannoma whereas the most common malignant members were synovial sarcoma and myxofibrosarcoma. Regarding anatomical localization, the hindfoot was affected most often.Conclusions: Knowledge of incidence and distribution patterns of foot and ankle tumors will help to correctly assess unclear masses and initiate the right steps in further diagnostics and treatment. Unawareness can lead to delayed diagnosis and inadequate treatment with serious consequences for the affected patient. [ABSTRACT FROM AUTHOR]

Background: Limb salvage surgery with endoprosthesis for bone tumor around the knee is reported to have good functional and oncological outcomes. However, the functional assessment using musculoskeletal tumor society (MSTS) and Toronto extremity scoring system remains subjective. We performed gait analysis as an objective assessment of their functional outcome. Materials and Methods: Gait analysis was performed in 20 patients with endoprosthesis replacement around the knee. The temporal parameters assessed during gait analysis were walking velocity, stride length, duration of stance, and goniometry of the knee. These parameters were compared with the functional outcome score of the MSTS. Results: The mean free-paced walking velocity was 0.91 m/s (normal is 1.33 m/s), which was 68% lower than normal gait. The stride length and stance phase were shorter for the affected limb compared to normal (P < 0.05). However, the gait was symmetrical with no difference in stride length (P = 0.148), velocity (P = 0.918), knee flexion (P = 0.465), and knee extension (P = 0.321) between the affected and unaffected limbs. Sixteen patients demonstrated stiff knee gait, two had a flexed knee gait, and only two patients had normal gait during the stance phase. The mean MSTS score was 21. There was significant correlation between overall MSTS scores (P = 0.023), function (P = 0.039), and walking scores (P = 0.007). Conclusion: Limb salvage surgery with endoprosthesis reconstruction around the knee gives good functional outcome, both objectively and subjectively, as evidenced by the symmetrical gait pattern and significant correlation with MSTS score. Despite decreased walking velocity, stride length, and stance phase of the operated limb, the patient still has a symmetrical gait. [ABSTRACT FROM AUTHOR]

Introduction: Reconstruction using a total femur prosthesis (TFP) remains a challenging procedure in musculoskeletal tumor surgery. The purpose of this study was to show the clinical outcomes of total femur replacement (TFR) in our institute. Methods: Nine patients underwent reconstruction with a TFP after the wide resection of malignant bone and soft-tissue tumors of the femur between January 2003 and April 2014. The mean age of the patients at the time of TFR was 47.5 years, and the mean follow-up period was 52.9 months. The histological diagnoses were as follows: bone sarcoma (n = 4), soft-tissue sarcoma invading the femoral bones (n = 4), and metastatic bone tumor (n = 1). Results: The oncological outcomes were as follows: three patients achieved continuous disease free, two patients were alive with disease, and four patients died from disease. The 3- and 5-year overall survival rates were 88.9% and 55.6%, respectively. The rate of the overall survival in patients with primary bone tumors (100% at 5 years) was significantly better than that in patients with primary soft tissue sarcomas (0% at 5 years) (p = 0.015). A deep infection occurred postoperatively in one patient, but the patient was successfully treated with surgical debridement and revision surgery. There were no patients who showed dislocation or aseptic loosening. The mean Musculo-Skeletal Tumor Society functional score was 58.5% (46.7–80.0), with scores of 65.5% in patients with a primary bone tumor and 50.8% in those with a primary soft-tissue sarcoma. Discussion: In the present study, the patients who underwent TFR due to bone invasion by soft tissue sarcoma had a worse prognosis than the bone sarcoma patients.