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Background: Most aggressive benign bone tumours are treated surgically by an intralesional excision and bone defect filling. The primary aim of our study was to evaluate prognostic factors of recurrence after an intralesional excision of a benign bone tumour in the peripheral skeleton. We asked whether patient age and gender, maximal tumour diameter, histological diagnosis, and the tumour’s location statistically significantly impact postoperative tumour recurrences. The secondary aim was to evaluate preoperative differences between different histopathological groups of benign bone tumours and the impact of age and gender, maximal tumour diameter, histological diagnosis, and the tumour location on the number of diagnostic biopsies and curative surgical procedures. Methods: Retrospective analysis of prospectively collected data included a cohort of patients operated on at a single tertiary tumour centre between 2010 and 2020 with at least one-year follow-up. Ordinal logistic regression was used to assess the influence of input variables on the number of diagnostic/curative surgical procedures and postoperative recurrences. Results: The cohort analysis included 261 patients with 61 local recurrences. The risk of tumour recurrence was significantly lower with higher patient age (p = 0.001) and tumour location in the distal femur (p = 0.033). Higher number of diagnostical procedures correlated with higher patient age (p = 0.028), larger maximal tumour diameter (p = 0.035) and connective tissue tumour diagnosis (p = 0.027). Higher number of curative procedures correlated with larger maximal tumour diameter (p = 0.008) and lower patient age (p = 0.001). Conclusions: Preoperative features of benign bone tumours significant impact the number of surgical procedures needed to treat the tumour and the risk of postoperative recurrence. Although most of these factors are nonmodifiable, they represent an incentive to create evidence-based guidelines for biopsy indications, surgical techniques and consistent postoperative follow-up.

Purpose. To assess the role of preoperative embolisation in benign bone tumour excision. Methods. 3 men and 3 women aged 19 to 35 (mean 23) years with either a giant cell tumour or an aneurysmal bone cyst in limb girdle sites underwent preoperative embolisation a day prior to wide local excision by the same surgeon. Tumour size, blood loss, wound healing, infection, and tumour recurrence were assessed. Results. The mean total blood loss was 391 (range, 100–980) ml. No blood transfusion was needed. No patient had any surgery- or embolisation-associated complication. No tumour recurred within a minimum 5-year follow-up. All patients had satisfactory limb function. Conclusion. Preoperative embolisation is useful in the management of vascular and aggressive bone tumours located at limb girdle sites where a tourniquet cannot be used.

Background: Intraoperative cone-beam computed tomography (CBCT) offers the advantage of navigation on the current anatomical situation and the possibility to take a control scan. We assessed the feasibility of using intraoperative CBCT for navigated intralesional curettage., Methods: Nine benign bone tumour patients were studied. Feasibility was assessed by describing the workflow and indications for navigation, scoring CBCT image quality and registration accuracy, and measuring scan and navigation set-up times. Short-term follow-up was described., Results: CBCT navigation was successful in all patients. Median tumour visibility, tumour delineation, and vital structure visibility scores were good. Median registration accuracy score was very good. Median scan and verification times were 5 and 3 minutes, respectively. One patient had a tumour recurrence after 6 months., Conclusions: Intraoperative CBCT navigation is feasible and safe. Indications for use of navigation in clinical practice are closeness to vital structures, complexly shaped tumours or bone, minimally invasive surgery, and repeated surgery., (© 2019 The Authors. The International Journal of Medical Robotics and Computer Assisted Surgery published by John Wiley & Sons Ltd.)

Benign and low-grade malignant bone tumours are often treated with curettage and filling of the resultant defect using any of a number of materials, including autologous bone grafts, allografts, or synthetic materials. The objective of this study was to report our experience using a synthetic bone graft substitute in these patients. Ten consecutive cases (four males, six females; mean age, 36 years) of benign bone tumours were treated surgically at a tertiary musculoskeletal oncology centre, between 2019 and 2021. Following curettage, the contained defects were managed with injectable beta-tricalcium phosphate/calcium sulfate (GeneX; Biocomposites Ltd., Keele, UK). The desired outcomes were early restoration of function and radiographic evidence of healing. No other graft materials were used in any of the patients. The mean follow-up was 24 months (range, 20–30 months). All patients in this series (100%) demonstrated radiographic evidence of healing and resumed their daily living activities. There were no tumour recurrences and no complications were encountered with the use of GeneX. In patients with contained defects following curettage of benign bone tumours, we found GeneX to be a safe and effective filling agent. These findings contrast with some existing studies that have reported local complications with the use of injectable beta-tricalcium phosphate/calcium sulfate.

PurposeWe aim to retrospectively evaluate patients with non-ossifying fibroma (NOF) of the distal femur by radiographs, CT and MRI, and to provide a theory describing the reasoning for the distal femur NOF's location and aetiology.MethodsCharts of patients with NOFs between 2003 and 2014 were retrospectively reviewed. Inclusion criteria encompassed a diagnosis of NOF of the distal femur by imaging, and histologically, if available. Radiographs, CT and MRI were used to characterise the relationship of the NOF lesions with the surrounding soft tissues.ResultsThe 68 NOFs from 60 patients were included. By radiograph, 41 (60.3%) of the 68 lesions appeared at the medial and 25 (36.7%) at the lateral aspect of the distal femur. In total, 41 lesions had CT scans, showing 22 NOFs (53.7%) attached to the origin of the medial gastrocnemius, 12 (29.3%) to the origin of the lateral gastrocnemius and four (9.8%) at the attachment of the adductor magnus. Of the CT scans, 93% identified the NOF's relationship with an adjoining tendon of the distal femur. Six had MRIs, all of which showed attachment at the medial gastrocnemius.ConclusionThe study reveals a relationship between tendinous structures and NOFs. NOFs of the distal femur occur most commonly at the origin of the medial and lateral gastrocnemius. They may originate from the physis/metaphysis but they do not always attach to the physis, as we observe them 'migrating' as patients grow. More research is required to understand the exact aetiology of NOFs.

Fibrous dysplasia is a rare condition in which bone is replaced by fibroosseous tissue. It is a benign condition, divided into monostotic and polyostotic fibrous dysplasia, which accounts for about 5-7% of all benign bone tumours. Here, authors reported a case of a 38-year-old male that presented with left hip pain since 15 days and had a history of trauma. X-ray pelvis and Magnetic Resonance Imaging (MRI) showed shepherd’s crook deformity in the left proximal femur with pathological femur neck fracture. It was managed with valgus osteotomy for deformity correction and fracture fixation using long proximal femur nail and cannulated cancellous screws. At one and half year follow-up, the patient showed good hip and knee range of motion with no complications

Lipoma is a benign tumour originating from mature adipose tissue. It can occur in any place in the body where adipose tissue is located. Intraosseous lipoma is a very rare bone tumour. The authors present an infrequent case involving intraosseous lipoma of the mandible in a 32-year old man and provide a review of case studies documented earlier in the literature.

McCune Albright syndrome (MCA) is a rare complication of genetic origin. The authors present a case study of a patient with MCA diagnosed with multifocal fibrous dysplasia in his limb and craniofacial bones. The symptoms of the disease in the patient’s facial and oral tissue and the treatment administered have been described.

Simple Summary: Benign and intermediate bone tumours are often treated by intralesional curettage together with local adjuvants in order to the reduce risk of local relapse. However, the role of different adjuvants used is still discussed controversially. In the present systematic literature review, altogether 3316 cases of benign/intermediate bone tumours were summarised with regards to the use of local adjuvants, as well as their respective impact on local recurrence. Overall, 32 different combinations of local adjuvants were identified. Although some tumour entities may benefit from the addition of a local adjuvant, the main treatment step remains thorough curettage of the lesion. Local adjuvants are used upon intralesional resection of benign/intermediate bone tumours, aiming at reducing the local recurrence (LR) rate. However, it is under debate whether, when and which local adjuvants should be used. This PRISMA-guideline based systematic review aimed to analyse studies reporting on the role of adjuvants in benign/intermediate bone tumours. All original articles published between January 1995 and April 2020 were potentially eligible. Of 344 studies identified, 58 met the final inclusion criteria and were further analysed. Articles were screened for adjuvant and tumour type, follow-up period, surgical treatment, and development of LR. Differences in LR rates were analysed using chi-squared tests. Altogether, 3316 cases (10 different tumour entities) were analysed. Overall, 32 different therapeutic approaches were identified. The most common were curettage combined with high-speed burr (n = 774; 23.3%) and high-speed burr only (n = 620; 18.7%). The LR rate for studies with a minimum follow-up of 24 months (n = 30; 51.7%) was 12.5% (185/1483), with the highest rate found in GCT (16.7%; 144/861). In comparison to a combination of curettage, any adjuvant and PMMA, the sole application of curettage and high-speed burr (p = 0.015) reduced the LR rate in GCT. The overall complication rate was 9.6% (263/2732), which was most commonly attributable to postoperative fracture (n = 68) and osteoarthritis of an adjacent joint during follow-up (n = 62). A variety of adjuvants treatment options are reported in the literature. However, the most important step remains to be thorough curettage, ideally combined with high-speed burring. [ABSTRACT FROM AUTHOR]

Background: This study aims to look at the intermediate-term clinical, functional and radiological outcomes of patients with enchondroma in hand treated with osteoscopic-assisted curettage and artificial bone substitute or bone graft. The addition of osteoscopy allows direct visualisation of the bone cavity during and after curettage of tumour tissue without the need of creating a large opening in the bone cortex. This could lead to better clearance of tumour tissue and lower risk of iatrogenic fracture. Methods: A total of 11 patients who received surgery from December 2013 to November 2020 were retrospectively reviewed. All cases had histological diagnosis of enchondroma. Patients with a follow-up period of less than 3 months were excluded. The mean duration of follow-up was 20.9 months. For the clinical outcome, we measured the total active motion (TAM) and graded with Belsky score grip strength. For the functional outcome, the Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH) score was used. For the radiological outcome, we evaluated the X-ray for bone cavity filling defect, new bone formation according to the system proposed by Tordai. Results: The mean TAM of patients was 257º. A total of 60% patients had Belsky score grading excellent, 40% patients had Belsky score grading good. The mean percentage of grip strength compared with the contralateral side was 86.2%. The mean QuickDASH score was 7.7. For the wound aesthetic rating by patients, 81.8% patients reported as excellent. For the radiological outcome, the postoperative X-ray of all patients showed bone filling defect less than 3 mm. The mean time to complete bone consolidation was 3.8 months. None of the patients showed any radiological signs of recurrence. Conclusions: Our study showed that patients with enchondromas in hand treated with this minimally invasive method demonstrated good functional and radiological outcome. Its application may also be extended into treating other benign bone lesions in hand. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: Giant cell tumour of bone (GCTB) is a rare, locally aggressive benign bone tumour with slight female sex predilection and affecting young adults 20-40 years of age. World health organization (WHO) has recently categorized GCTB as an intermediate malignant tumour. GCTB is known to be driven pathologically via expression of pro-osteoclastic signals by stromal cells. This is mediated precisely via the expression of RANKL by stromal cells acting in an autocrine fashion on RANK receptor-positive osteoclast-like giant cells and their precursors. While the treatment is primarily surgical, we hypothesized that preoperative denosumab therapy facilitates conversion to a less morbid procedure in an aggressive campanacci grade 3 GCTB, otherwise amenable to joint resection and reconstruction/arthrodesis. Methods: A prospective, single arm, interventional study was conducted in Orthopaedics and radiation oncology department of combined military hospital (CMH) Rawalpindi. The duration of study was 36 months. Patients were recruited by purposive sampling technique as per inclusion/exclusion criteria. Denosumab was administered as preoperative adjuvant therapy for 3 months. Pain was assessed utilizing Brief Pain Inventory -Short Form (BPI-SF) and functional status was assessed as per Musculoskeletal tumour society score at baseline and 12 weeks after commencement of denosumab therapy. The intent of surgery pre and post denosumab therapy was ascertained. Results: Total of 23 patients were a part of this study. Mean pain scores and MSTS scores prior to and after denosumab were statistically significant with p-value <0.01. Pre-denusomab, there was inclination towards resection arthroplasty as the treatment procedure (56.5%). After denusomab therapy, intralesional curettage was choice of procedure with intent executed for 78.3% of cases. Conclusion: Denosumab has potential role for giant cell tumour of bone, it makes a less morbid surgery technically feasible. However, recurrence needs to be probed in long term follow up studies. [ABSTRACT FROM AUTHOR]

Giant cell tumours (GCTs) of bone have been described as the most challenging benign bone tumors. It is very unusual for GCT to occur in patients younger than 20 yrs or older than 55 years. GCT is seen with a slightly increased frequency in females. The typical giant cell tumor (GCT) is a solitary neoplasm that occurs in the epiphysis or metaphysis of long bones. The most common sites include the distal femur, proximal tibia and distal radius. The sacrum, distal tibia, proximal humerus, proximal femur, pelvis and proximal fibula are not infrequent sites. Here we report cytologically diagnosed case of GCT distal end radius in 75 yrs male patient. We discuss its clinicopathologic features, differential diagnosis and its optimal treatment.

Background: To investigate the method of reconstruction of the sacroiliac joint in patients who underwent benign tumour curettage and analyse the effect of internal fixation with lumbo‐iliac screws and connecting rod insertion after filling the defect with bone cement. Methods: Twenty‐four patients with benign sacroiliac joint tumours underwent curettage and filling of the defect with bone cement, followed by lumbo‐iliac screw and connecting rod insertion. The visual analogue scale (VAS) was used to assess pain, and the Musculoskeletal Tumour Society (MSTS) score was used to assess hip function. Results: All patients were followed‐up for 24–96 months (average, 42.2 months). The postoperative VAS score was significantly lower than the preoperative score (p < 0.05), while the postoperative MSTS score was significantly higher than the preoperative score (p < 0.05). One patient had delayed healing of the surgical incision; no complications occurred in the remaining patients. Conclusion: For benign sacroiliac joint tumours, the combination of filling of defects with bone cement and internal lumbo‐iliac fixation can relieve pain quickly, and achieve good limb function. [ABSTRACT FROM AUTHOR]

Aims: Chondromyxoid fibroma (CMF) is a rare, benign bone tumour which arises primarily in young adults and is occasionally diagnostically challenging. Glutamate metabotropic receptor 1 (GRM1) gene encodes a metabotropic glutamate receptor and was recently shown to be up‐regulated in chondromyxoid fibroma through gene fusion and promoter swapping. The aim of this study was to interrogate cases of CMF for the presence of GRM1 gene rearrangements, gene fusions and GRM1 protein overexpression. Methods and results: Selected cases were subjected to testing by fluorescent in‐situ hybridisation (FISH) with a GRM1 break‐apart probe, a targeted RNA sequencing method and immunohistochemical study with an antibody to GRM1 protein. Two cases were subjected to whole transcriptomic sequencing. In 13 of 13 cases, GRM1 protein overexpression was detected by immunohistochemistry using the GRM1 antibody. Of the 12 cases successfully tested by FISH, nine of 12 showed GRM1 rearrangements by break‐apart probe assay. Targeted RNA sequencing analysis did not detect gene fusions in any of the eight cases tested, but there was an increase in GRM1 mRNA expression in all eight cases. Two cases subjected to whole transcriptomic sequencing (WTS) showed elevated GRM1 expression and no gene fusions. Conclusion: GRM1 gene rearrangements can be detected using FISH break‐apart probes in approximately 75% of cases, and immunohistochemical detection of GRM1 protein over‐expression is a sensitive diagnostic method. The gene fusion was not detected by targeted RNA sequencing, due most probably to the complexity of fusion mechanism, and is not yet a reliable method for confirming a diagnosis of CMF in the clinical setting. [ABSTRACT FROM AUTHOR]