Skeletal EWSR1-NFATC2 sarcoma previously diagnosed as Ewing-like adamantinoma: A case report and literature review emphasizing its unique radiological features.

Ewing-like adamantinoma (EAD) is a rare bone tumor. It remains unclear whether EAD belongs to adamantinoma, Ewing sarcoma (ES), or an independent category. Herein, we present a case of femoral sarcoma previously diagnosed as EAD in a 26-year-old woman. We observed amplified EWSR1 and NFATC2 fusion signals using fluorescence in situ hybridization. Prompted by its unique radiological features, we reviewed the current literature on skeletal EWSR1-NFATC2 sarcoma (ENS) and EAD. In addition to the similar histological features, we found that both ENS and EAD displayed similar characteristic radiological features, such as the tendency to occur in the diaphysis of long bones, cortical expansion and buttressing-type thickening, and bone surface involvement with saucer-like erosion without cortical destruction. We believe that these unique radiological features were related to its indolent behavior. Altogether, it is possible that previously reported EAD cases may be neither ES nor the classic adamantinoma but ENS. Further studies are needed to clarify the relationship between EAD and ENS.

Simple curettage without bone grafting for enchondromas of the foot.

BACKGROUND: Simple curettage without bone grafting for enchondromas of the hand and its good clinical results have been reported. Yet, there have been no reports regarding simple curettage without bone grafting for enchondromas of the foot. The purpose of this study is to elucidate the clinical results of this method for enchondromas of the foot. METHODS: We studied eight patients (ten bones) with enchondromas of the foot treated with simple curettage without bone grafting. After making an oval or round fenestration, the enchondroma was curetted. The cortical window of the fenestration was excised in five bones, whereas it was replaced at the fenestration site in the other five bones. RESULTS: The affected toe was immobilized with a tape in two patients. All patients began to walk on the day of surgery or the next day without crutches. Sclerotic changes on the plain radiographs were seen 6.4 weeks (range: 4-10 weeks) postoperatively. The patients returned to their normal daily activity including occupation and sport in 8.6 weeks (range: 0-12 weeks) postoperatively. The radiographic appearance was almost normalized in 8.4 months on average (range: 3-14 months). Function was classified as excellent in all bones according to a modified Tordai classification. CONCLUSION: We conclude that simple curettage without bone grafting can be one of the standard surgical treatments for enchondromas of the foot.

Juxtacortical osteoma of the ulna.

Acase of juxtacortical osteoma of the ulna in a 47-year-old woman is presented. She had a dense bony mass on the ulna. Radiological examinations (plain radiography, computed tomography, magnetic resonance imaging) strongly suggested a rare case of juxtacortical osteoma of a long tubular bone. The differential diagnosis included parosteal osteosarcoma, melorheostosis, osteochondroma, end-stage juxtacortical myositis ossificans, and fibrous dysplasia protuberans. The tumor was excised totally for thorough pathological examination, which revealed it to be composed of lamellar bone, suggesting that the origin was periosteal.

Intraosseous lipoma: a clinical study of 12 patients.

We studied 12 patients (13 bones) with intraosseous lipoma to elucidate the clinical features of this disease. The patients ranged in age from 14 to 54 years. Eleven patients were men and 1 was a woman. The involved bones were the calcaneus in 6 patients (7 bones), humerus in 3, ischium in 2, and sacrum in 1. Three bones were in Milgram's stage I, 8 were in stage II, and 2 were in stage III. On plain radiographs, all bones showed a well-circumscribed radiolucent area. Nine bones showed calcification or ossification. Computed tomography or magnetic resonance imaging showed low density or high signal intensity, respectively, identical to the findings in normal adipose tissue. The tumor was curetted in 3 patients (3 bones), in whom local recurrence was not seen thereafter. In the remaining 9 patients (10 bones), we observed the natural course; in 1 of these patients, incisional biopsy was performed. During the follow-up period, only 1 patient showed slight enlargement of the lesion, while the findings in the others remained unchanged. Three patients had pain, which disappeared after the surgery or during the course of the observation. Partly because intraosseous lipoma tends to undergo spontaneous involution, and partly because diagnosis is easy from the radiological findings, surgery does not seem to be necessary in most patients.