Misdiagnosis of cystic tuberculosis of the olecranon.

Osteoarticular tuberculosis accounts for only 1-2% of all cases of tuberculosis, and tuberculosis of the olecranon is extremely rare. In the present study, we describe a case of a 54-year-old woman with cystic tuberculosis of the olecranon, which was initially misdiagnosed as a malignant tumor. The patient subsequently underwent regular antituberculosis treatment and autogenous bone graft, which resulted in relief of all symptoms.

Pseudomyogenic hemangioendothelioma secondary to fibrous dysplasia of the left lower extremity in a 14-year-old female: a case report.

BACKGROUND: Pseudomyogenic hemangioendothelioma is a rare soft tissue tumor usually found in young adults, predominantly males. Fibrous dysplasia is a common benign bone tumor, which accounts for 5~7 % of all the primary benign bone tumors. However, pseudomyogenic hemangioendothelioma secondary to fibrous dysplasia is extremely rare. To the best of our knowledge, this is the first case of pseudomyogenic hemangioendothelioma secondary to fibrous dysplasia. CASE PRESENTATION: This study describes a case of a 14-year-old female who suffered from pseudomyogenic hemangioendothelioma secondary to fibrous dysplasia of the left lower extremity. The patient underwent two operations successively due to pathological fractures in the left femur and tibia in a local hospital. She was diagnosed with fibrous dysplasia according to the postoperative pathological examinations. However, less than 1 year later, she was diagnosed with a recurrence of fibrous dysplasia in her left femur during a follow-up in our hospital. She underwent a curettage and grafting in the left femur. Postoperative pathological examinations demonstrated the diagnosis of fibrous dysplasia. Nevertheless, she presented to our clinic with a chief complaint of pain and swelling in her left tibia and calcaneus 4 months later. The patient underwent fine-needle aspiration in her left tibia. According to the histological and immunohistochemical findings, the diagnosis of pseudomyogenic hemangioendothelioma was confirmed by an expert pathology consultant. Finally, the patient had to undergo an amputation of the left thigh. Postoperative pathological examinations confirmed the diagnosis of pseudomyogenic hemangioendothelioma. Postoperative follow-up at 3 months disclosed no evidence of recurrent disease and no residual side effects from therapy. CONCLUSIONS: Pseudomyogenic hemangioendothelioma is a rare endothelial neoplasm which often mimics myoid and epithelioid tumors morphologically. For the diagnosis, the immunostaining is very important but not decisive and enough. Analysis based on any single factor or incomplete information may easily lead to arbitrary conclusion. Clinical information including age, gender, tumor location, disease course, and recurrence is important for appropriate diagnosis, and full understanding of the tumor is indispensable.

Erratum: miR-30d inhibits cell biological progression of Ewing's sarcoma by suppressing the MEK/ERK and PI3K/Akt pathways in vitro.

[This corrects the article DOI: 10.3892/ol.2018.7900.].

Erratum: Beclin-1 knockdown decreases proliferation, invasion and migration of Ewing sarcoma SK-ES-1 cells via inhibition of MMP-9.

[This corrects the article DOI: 10.3892/ol.2017.7667.].

Risk Factors for Metastasis at Initial Diagnosis With Ewing Sarcoma.

Purpose: We aimed to identify potential risk factors predictive of metastasis at initial diagnosis in Ewing sarcoma patients. Patients and methods: We enrolled selected patients diagnosed with Ewing sarcoma between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) Program database. Demographic and clinical features of patients were analyzed to demonstrate the potential risk factors of distant metastasis at presentation. We utilized descriptive statistics, univariate methods, and a series of regression models to analyze the significance of risk factors. Moreover, we conducted survival analysis in patients with different metastatic sites through Kaplan-Meier analysis. Results: We identified 1,066 cases of Ewing sarcoma and 332 (31.1%) of the patients had metastasis at initial diagnosis. In the univariate logistic regression analysis, patients had higher probability of metastasis at initial diagnosis if they aged between 18 and 59 years old (OR = 1.43; 95% CI, 1.09 to 1.86), had a tumor located in the axial or cranial bones (OR = 1.38; 95% CI, 1.05 to 1.81), or had a tumor over 8 cm (OR = 2.55; 95% CI, 1.66 to 3.89). These three factors were still significant when analyzed in a multivariate logistic regression model or another multivariate logistic regression model controlling for age, location, and tumor size, which had univariate p < 0.1. Besides, we found that patients with lung metastasis alone had a better prognosis than patients with bone metastasis alone or with two or more metastatic sites (p < 0.01). Conclusion: Ewing sarcoma patients with an age between 18 and 59 years old, a tumor in the axial or cranial bones, and a tumor size over 8 cm had an increased likelihood to have metastatic diseases at initial diagnosis.

miR-30d inhibits cell biological progression of Ewing's sarcoma by suppressing the MEK/ERK and PI3K/Akt pathways in vitro.

MicroRNAs (miRNAs) are small, single-stranded, non-coding RNA molecules involved in cancer initiation and progression. The present study aimed to determine the effect of miRNA-30d (miR-30d) on the growth, malignant phenotype, and apoptosis of Ewing's sarcoma (ES) SK-ES-1 cells, and to elucidate the underlying molecular mechanism and signaling pathway involved. Cell proliferation, invasion, migration, morphological changes, cell cycle distribution and apoptosis were investigated. Furthermore, the expression of matrix metalloproteinase (MMP)-2, MMP-9, B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), caspase-3 and poly (ADP-ribose) polymerase (PARP) were examined, as was the activity of the mitogen-activated protein kinase kinase (MEK)/extracellular signal-regulated kinase (ERK) and phosphoinositide 3-kinase (PI3K)/Akt pathways. It was found that the overexpression of miR-30d repressed the proliferation, migration and invasion, and promoted morphological changes, S-phase arrest and apoptosis of SK-ES-1 cells. Additionally, it was observed that increased miR-30d levels inhibited the expression of MMP-2 and MMP-9, and inhibited the activity of the MEK/ERK and PI3K/Akt pathways, but elevated the ratio of Bax/Bcl-2 and the cleavage of caspase-3 and PARP. Taken together, the results demonstrated that miR-30d suppressed the biological progression of SK-ES-1 cells by targeting MMP-2 and MMP9, the Bax/Bcl-2 and caspase-3 cascade, and the MEK/ERK and PI3K/Akt signaling pathways. Therefore, miR-30d is a promising target in the treatment of ES. However, further investigations are urgently required to investigate the underlying molecular mechanisms of the effects of miR-30d on ES for a comprehensive understanding of the tumorigenesis and progression of this cancer.

miR-145 suppresses the proliferation, invasion and migration of NSCLC cells by regulating the BAX/BCL-2 ratio and the caspase-3 cascade.

Although microRNA (miR)-145 has been identified to be a tumor suppressor in various types of tumor, it promotes the progression of non-small cell lung cancer (NSCLC). However, the precise underlying molecular mechanism of its action remains unclear. The present study investigated the effects of miR-145 on the proliferation, invasion, metastasis and apoptosis of the NSCLC A549 cell line and the underlying molecular mechanism of its action. In vitro cell proliferation, invasion, migration and apoptosis assays were employed, and the expression levels of matrix metalloproteinase (MMP)-2, MMP-9, B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), caspase-3and poly(ADP-ribose) polymerase (PARP) were evaluated by western blot analysis. The results demonstrated that ectopic expression of miR-145 inhibited the proliferation, invasion and migration of A549 cells, but promoted the apoptosis of A549 cells. Western blot analysis indicated that increased miR-145 levels led to a marked decrease in the expression of MMP-2, MMP-9 and Bcl-2. Upregulation of miR-145 expression increased the expression of Bax, thus increasing the Bax/Bcl-2 ratio. Additionally, the results indicated that miR-145 over expression promoted the cleavage of caspase-3 and PARP. Taken together, these results indicated that miR-145 suppresses the proliferative, invasive and migratory ability of A549 cells. Additionally, miR-145 upregulation induced apoptosis of A549 cells possibly by decreasing MMP-2 and MMP-9 expression, the Bax/Bcl-2 ratio and the activity of the caspase-3 cascade.

Double-level lumbar spondylolysis and spondylolisthesis: A retrospective study.

BACKGROUND: Lumbar spondylolysis and isthmic spondylolisthesis are common conditions. However, double-level lumbar spondylolysis and spondylolisthesis are rare. We report 24 cases of it along with a review of literature and a briefly description of the clinical and radiological features and integrated management of patients with this condition. METHODS: Of 1700 inpatients diagnosed with lumbar spondylolisthesis at our hospital between January 2008 and September 2015, we selected those with a diagnosis of double-level spondylolisthesis who underwent surgery. We analyzed the data regarding age, sex, and heavy physical labour. Japanese Orthopaedic Association (JOA) and Visual Analog Scale (VAS) scores were used to evaluate preoperative and postoperative neurological function and back pain. All patients underwent decompression, reduction, and posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with a cage. After the operation, we were followed up for more than 2 years to observe the effect of the operation. In the meantime, the height of the intervertebral discs was measured at follow-up, and all data are analyzed in SPSS stastic. RESULTS: Double-level spondylolisthesis occurred at the L2/L3 and L3/L4 levels in one patient, L3/4 and L4/L5 levels in 11 patients, and L4/L5 and L5/S1 levels in 12 patients. Nine patients also had spondylolysis. Twenty patients underwent posterior lumbar interbody fusion and internal fixation with autologous bone chip, and 4 of them underwent cage and autogenous bone graft fixation. Postoperatively, the major symptoms (neurological dysfunction and low-back pain) improved significantly. Comparison of JOA and VAS scores indicated effective recovery of neurological function (p < 0.05). Postoperative follow-up demonstrated satisfactory interbody fusion and pars interarticularis healing. CONCLUSIONS: Double-level lumbar spondylolysis and spondylolisthesis occurred more often in women. Most common site of double lumbar spondylolisthesis was L3-L5. The treatment principle was the same as that for single-level spondylolisthesis, but the reset order is questionable. Both, posterior lumbar interbody fusion (PLIF) with autogenous bone chips from posterior decompression or with cage can relieve discomfort in most patients. In our follow-up, we found that there was a high degree of loss in disk height when autogenous bone was used. Therefore, we suggest the use of a cage.

Beclin-1 knockdown decreases proliferation, invasion and migration of Ewing sarcoma SK-ES-1 cells via inhibition of MMP-9.

Although Beclin-1, a well-known key regulator of autophagy, has been demonstrated to serve a function in a number of disorders, including cancer, aging and degenerative diseases, its biological function in Ewing sarcoma (ES) remains unresolved. The objective of the present study was to determine the in vitro effect of Beclin-1 knockdown on the growth and malignant phenotype of ES SK-ES-1 cells, which have increased endogenous expression of Beclin-1 compared with RD-ES cells, and to investigate the underlying molecular mechanism. Cell proliferation, invasion and migration were investigated using CCK-8, Boyden chamber Transwell, and wound healing assays, respectively. Western blot analysis was used to detect expression levels of matrix metalloproteinase (MMP)-2 and MMP-9, which are associated with the malignant phenotype. Beclin-1 knockdown significantly inhibited proliferation, invasion and migration of SK-ES-1 cells. Western blot analysis revealed that Beclin-1 knockdown caused a significant reduction in the expression of MMP-9; no marked changes in MMP-2 expression were observed in the si-Beclin-1 group compared with the control group. The results of the present study suggest that Beclin-1 serves a function in proliferation, tumor progression and inhibition of autophagy in ES, and demonstrates it's potential as a target to increase the efficacy of anticancer agents.

Osteosarcoma in the coracoid process that mimicked an osteochondroma: A case report.

RATIONALE: Osteosarcomas are the most common primary malignant bone tumors in children and young adults; these tumors often affect the metaphyses of long bones such as the proximal humerus, proximal tibia, and distal femur. In contrast, osteosarcoma of the coracoid process is extremely rare. PATIENT CONCERNS: Herein, we describe a case of osteosarcoma affecting the coracoid process in a 40-year-old woman. The patient presented with shoulder pain, weakness, and an inability to raise her left arm. She had no previous record of shoulder injury and no significant family history. DIAGNOSES: Her C-reactive protein levels were normal, whereas her erythrocyte sedimentation rate and alkaline phosphatase levels were elevated. Imaging studies led to the initial diagnosis of osteochondroma. INTERVENTION: The patient underwent surgical resection. However, the postoperative pathological results revealed an osteosarcoma. The patient transferred to another hospital for subsequent treatment, and her outcome is unknown. LESSONS: A misdiagnosis or inadequate and/or delayed treatment for a coracoid process osteosarcoma could have grave consequences. Computed tomography and magnetic resonance imaging are essential for a diagnosis, and a biopsy can effectively confirm the diagnosis. Our findings suggest that considering only a single factor, or using incomplete information, can lead to an arbitrary diagnosis.

Chondrosarcoma of the patella: A case report.

RATIONALE: Chondrosarcoma, characterized by the production of cartilage matrix, is a common bone tumor, accounting for 20% to 27% of all malignant bone tumors. It often occurs in the cartilage of the pelvis, femur, tibia, and humerus. However, chondrosarcoma of the patella is extremely rare. PATIENT CONCERNS: The present study describes a case of chondrosarcoma affecting the right patella in a 68-year-old woman. The chief complaints were painful swelling and limitation of motion of the right knee for about half a year. The pain was a kind of dull ache. The skin around the right knee was red and hot. Moreover, she had a claudication gait due to the symptoms. DIAGNOSES: Irregular lytic lesions with ill-defined margins in the patella were determined through computed tomography and magnetic resonance imaging. The diagnosis of primary grade II chondrosarcoma was finally confirmed on the basis of postoperative pathological examination. INTERVENTIONS: The patient underwent an open surgery named extensive resection of patellar tumor to remove the tumor tissue completely. OUTCOMES: The patient was discharged without any complications 1 week after the surgery. At the 3-month follow-up, the patient was completely free from pain during daily activities, and normal range of motion of the right knee was achieved. Her gait was normal. There was no evidence of recurrence. LESSONS: We believe that an extensive resection is suitable for treating chondrosarcoma to avoid as far as possible local recurrence. An awareness of the potential for chondrosarcoma to present in the patella is crucial for both orthopedic surgeons and radiologists when confronted with similar cases. Besides, as reports of chondrosarcoma of the patella are rare, this study adds a better understanding of this rare condition to the medical literature.

Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures.

It is generally acknowledged that short-segment pedicle screw instrumentation is the preferred surgical method for thoracolumbar fractures. However, the use of short-segment instrumentation with or without intermediate screws at the fracture level remains controversial.We retrospectively evaluated 44 patients (28 men, 16 women) with unstable thoracolumbar fractures. The patients were divided into 2 groups according to the surgical method used. In group 1, 24 patients underwent surgery with a posterior approach via short-segment pedicle screw instrumentation (1 level above and 1 level below the fractured level). In group 2, 20 patients received an additional 2 screws at the fractured vertebrae. Clinical and radiologic parameters were evaluated before surgery and at 1 week, 6 months, and 1 year after surgery.We found no significant difference in the demographic characteristics between the 2 groups. No significant difference was observed in the operative time and intraoperative blood loss between the 2 groups. Clinical outcomes also showed no significant differences between the groups preoperatively or at all follow-up periods. The correction of the Cobb angle (CA) 1 week after surgery was better in group 2, whereas the anterior vertebral body height of the fractured level (AVHF) and compression ratio of the AVHF (AVHFCR) were not significantly different between the 2 groups 1 week after surgery. Moreover, group 2 had better maintenance of restored CA, AVHF, and AVHFCR at the fractured level than did group 1 at 6 months and 1 year postoperatively. In addition, the reduction of mid-sagittal diameter (MSD) of spinal canal 1 week and 1 year after surgery was better in group 2. Besides, bone fragments in the spinal canal have a tendency to be less in group 2 1 week and 1 year after surgery.Reinforcement with intermediate screws for a single thoracolumbar fracture not only enhanced the stability of the internal fixation system, but it was also conducive to the correction of kyphosis and the maintenance of the reduction effects. Furthermore, this method is helpful to restore the spinal canal and reduce the bone fragments in the spinal canal. However, more long-term follow-up studies are needed.

Effects of baicalein on proliferation, apoptosis, migration and invasion of Ewing's sarcoma cells.

Ewing's sarcoma (ES) is a rare tumor that is more frequent in pediatric and adolescent age groups. In the past few decades, long-term survival in affected patients has improved due to the success of multimodal therapy. However, long-term survival is inevitably restricted by the late side-effects of chemotherapy. Besides, early metastasis also contributes to the poor prognosis of ES. Recently, traditional Chinese medicines (TCMs) have increasingly attracted interest due to the promising clinical results and fewer side-effects for the treatment of cancers. Among the various TCMs, the root of Scutellaria baicalensis exerts anti-inflammatory properties as a well-known herb in traditional Chinese medicine. Baicalein (5,6,7-trihydroxyflavone) derived from the root of Scutellaria baicalensis is a bioactive compound, which possesses a powerful pro-apoptotic activity in various cancers such as hepatocellular carcinoma and myeloma. However, the effects of baicalein on ES cells remain still unknown. We anticipated that baicalein also has apoptotic activity in ES. The aim of the present study was to investigate the effects of baicalein on viability, apoptosis, migration and invasion of ES cells, and further to elaborate the molecular mechanism of baicalein-induced ES cell apoptosis. We found that baicalein markedly inhibited ES cells viability in a time- and dose-dependent manner, especially SK-ES-1 cells and could promote the apoptosis of ES cells. Additionally, baicalein was capable of upregulating the expression of the pro-apoptotic proteins Bax and cytochrome c, reducing the expression of the anti-apoptotic protein Bcl-2, elevating the ratio of Bax/Bcl-2, and triggering the mitochondrial apoptotic pathway, which led to caspase-3 and caspase-9 activation and PARP cleavage. Meanwhile, the activation of caspase-8 and the death receptor pathway was also observed. Besides, baicalein could reduce ES migration and invasion in vitro, which showed its potential to inhibit ES metastasis, besides contributing to the decrease in the expression of matrix metalloproteinases (MMP)-2 and MMP-9. In conclusion, baicalein has a potent tumor-suppressor activity by inducing cell apoptosis through the mitochondrial apoptotic pathway and the death receptor pathway in ES cells, thus it may serve as a novel and effective candidate agent for ES treatment.

Osteopoikilosis found incidentally in a 17-year-old adolescent with femoral shaft fracture: A case report.

RATIONALE: Osteopoikilosis is a rare and asymptomatic disease of the bone, which is often discovered occasionally on radiography for irrelevant complaints. Characterized by multiple, small, circular, or oval-shaped radiodense lesions, it may be confused with bony metastatic tumors. PATIENT CONCERNS: The present study describes a case of a 17-year-old adolescent who suffered from pain and movement limitation of his left thigh following a fall from standing height. DIAGNOSES: Plain radiographs showed spiral fracture in left femoral shaft; besides, multiple scattered sclerotic lesions of variable size were also observed over the bilateral proximal femurs, left distal femur, proximal tibia, and distal tibia and fibula through X-rays, computed tomography, and magnetic resonance imaging. The patient was finally diagnosed with left femoral shaft fracture and osteopoikilosis. INTERVENTIONS: The patient underwent reduction and internal fixation with intramedullary nail a week after injury. OUTCOMES: The patient was discharged without any complications 12 days after the surgery. At the 3-month follow-up, the patient recovered well and remained symptom-free with no changes to his sclerotic lesions. LESSONS: Although this case is not so complicated, we have to be cautious when differentiating osteopoikilosis and bony metastases in clinical practice in future, which should avoid causing undue distress to both the patients and doctors.

Therapeutic effect of neoadjuvant chemotherapy combined with curettage to treat distal femoral osteosarcoma: A case report.

RATIONALE: Osteosarcoma is the most common malignant bone tumor in children and adolescents. Metastasis occurs early, the mortality rate is high, and the tumor results in a tremendous physical, mental, and economic burden on patients. Therefore, the treatment of osteosarcoma has been important for orthopedic surgeons. However, treatment has always been a difficult problem globally. PATIENT CONCERN: We present the case of a 22-year-old girl with increasing local pain in the distal left thigh. DIAGNOSES: The patient was initially diagnosed as bone cancer according to computed tomography (CT) and X-ray imaging. And the patient was further diagnosed as osteosarcoma via to puncture biopsy of the left distal femur. INTERVENTIONS: Local arterial infusion chemotherapy, systemic intravenous chemotherapy, and curettage was conducted because of limb salvage program. OUTCOMES: The patient was doing well with no evidence of local or distant recurrence 7 years after the surgery. LESSONS: Our case indicated that limb osteosarcoma patients can undergo a limb salvage program of local arterial infusion chemotherapy, systemic intravenous chemotherapy, and curettage.