Chronic recurrent multifocal osteomyelitis: A multidisciplinary experience of 22 pediatric cases with a mean follow-up of 27 months.

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is not a well known disorder among nonpediatricians. The aim of this study is to retrospectively evaluate the clinical outcomes of twenty-two CRMO patients presenting to two referral centres. METHODS: This retrospective study included twenty-two children (12 males, 10 females; mean age 13 years; range 7-17 years). The diagnosis was based on clinical, radiological, and pathological findings. Data were retrieved from hospital charts. RESULTS: The mean delay in diagnosis was 26 months (range, 0-96 months). The mean follow-up after diagnosis was 27.4 months (range, 6-47 months). Symptoms included pain, limping, local swelling, morning stiffness, and fever. 18 patients had multifocal and 4 patients had unifocal disease. Bone lesions were detected with whole-body or local MRI (Magnetic Resonance Imaging). The mean number of bone lesions was 2.5 (range, 1-8). Ten cases underwent biopsy to exclude malignancy and infection. Prior to diagnosis, cast immobilization or curettage was erroneously performed in four patients. One patient suffered from vertebral compression fracture. There is no growth disturbance or deformity in any patient. CONCLUSION: This study demonstrated that early recognition of the disease can be improved by using Bristol criteria which should be evaluated by a multidisciplinary team rather than one single specialist. In this way, the reliability of these criteria is improved and the treatment could be given earlier with decreased delay in diagnosis. This multidisciplinary approach is also important for decision for biopsy, timely aggressive medical treatment, and follow-up of the disease to minimise possible complications.

PD-L1 Status in Tenosynovial Giant Cell Tumors.

Background and Objectives: Tenosynovial giant cell tumors (TSGCTs) are benign soft tissue tumors that are divided into localized- and diffuse-type tumors, according to the World Health Organization classification of soft tissue tumours. The diffuse-type TSGCT sometimes behave aggressively and poses treatment challenges especially in patients with neurovascular involvement. Symptomatic patients who are not good candidates for surgery due to high morbidity risk may benefit from medical therapy. Objectives: Drugs that target programmed death ligand 1 (PD-L1) are among a new generation of medical therapy options, which, recently, have been explored and have displayed promising results in various cancer types; therefore, we aimed to investigate the PD-L1 status of TSGCTs as a possible therapeutic target. Materials and Methods: We assessed the PD-L1 status of 20 patients (15 men and 5 women, median age = 39 years) that had been diagnosed with TSGCTs in a single institution, between 2018 and 2020. The patients had localized- (n = 7) and diffuse-type (n = 13) TSGCTs. Formalin-fixed paraffin-embedded (FFPE) blocks were retrospectively retrieved from the pathology department. An immunohistochemical analysis was performed in sections of 3 micron thickness from these blocks. Results: Seventy-five percent of our patients with TSGCTs were immunopositive to PD-L1 staining. Conclusions: Taking into consideration the high positivity rate of PD-L1 staining in TSGCTs, PD-L1 blockage may be used as a valuable medical treatment for TSGCTs; however, further studies are needed.

The Impact of COVID-19 Pandemic Restrictions on Musculoskeletal Pathology Services.

BACKGROUND AND OBJECTIVES:  The COVID-19 pandemic has had a negative impact on healthcare in musculoskeletal pathology. There is no standard protocol for pathology services during a pandemic. The study aimed to assess the impact of COVID-19 restrictions on the workload of the musculoskeletal pathology service and the hurdles faced in collaboration with the orthopedic oncology unit in a tertiary reference center in a developing country. MATERIALS AND METHODS:  The pathology reports from mid-March to mid-June 2019, 2020, and 2021 were retrospectively reviewed. RESULTS:  Significant differences were found between the pandemic period (2020) and the non-pandemic periods (2019-2021) in benign bone and soft tissue lesions, resection surgeries, and soft tissue tumors, which were more prevalent in the non-pandemic periods. However, there was no significant decrease in biopsy procedures. Conclusion: During the pandemic period, the biopsy procedure appears to be feasible for bone and soft tissue lesions without the need for anesthesia.

Bizarre Parosteal Osteochondromatous Proliferation (Nora's Lesion) of the Foot: A Case Report and Literature Review of Nora's Lesion of the Foot.

Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion is a rare, benign, but locally aggressive tumor. We present a case of a 45-year-old patient with progressive swelling of his toe for four years, pain, and difficulty with shoe wear. The lesion was excised after adequate evaluation and the resection histopathology was compatible with Nora's lesion. There was no local recurrence at 24 months of follow-up. Nora's lesion can be effectively treated by complete surgical excision or en bloc resection. Though rare, Nora's lesion should be considered in the differential diagnoses of osteogenic and/or chondrogenic overgrowths in the bones of feet such as subungual exocytosis, osteochondroma, chondrosarcoma, periosteal chondroma/chondrosarcoma, and parosteal osteosarcoma.

A Never-Ending Challenge: Intestinal Tuberculosis or Inflammatory Bowel Disease.

Intestinal tuberculosis is an uncommon form of tuberculosis, and its diagnosis remains a challenge in patients with Crohn's disease. The clinical, endoscopic, radiologic, and histologic features of Crohn's disease and tuberculosis are remarkably similar, posing a diagnostic challenge. Accurate diagnosis of these two conditions remains vital to the decision on the treatment of the patients. Computerized tomography, endoscopic ultrasound (EUS), capsule endoscopy, balloon enteroscopy, ascitic fluid adenosine deaminase (ADA), tuberculosis polymerase chain reaction (TB-PCR), GeneXpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and laparoscopy can be beneficial in the diagnosis of intestinal tuberculosis. Herein, we report a case where tuberculosis could not be documented, although the patient displayed lymphocytosis in ascites and weight loss. Laparoscopy was diagnostic and the patient benefited from the correct treatment.

Recurrent Gastrointestinal Bleeding in an HIV-Positive Patient: A Case Report.

HIV is a global epidemic that needs a multidisciplinary approach. Gastrointestinal bleeding is uncommon in HIV-positive patients. In cases such as bacillary angiomatosis, Kaposi sarcoma, herpes simplex, histoplasmosis, and cytomegalovirus (CMV) colitis, the underlying reason could be HIV. The reason could also be unrelated to HIV, such as peptic ulceration, esophageal varices, and Mallory-Weiss. In our case, we report a patient who was admitted to the hospital three times. In the first admittance, he indicated using multiple nonsteroidal anti-inflammatory drugs (NSAIDs); however, we could not find the bleeding focus. He underwent surgery, at which time we detected a Kaposi sarcoma.