Surgical outcomes of extraskeletal myxoid chondrosarcoma.

BACKGROUND: Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft tissue sarcoma. The aim of this study is to present the results of the patients we treated with the diagnosis of EMC as an oncology reference center. METHODS: Information on 13 patients diagnosed with EMC between 2006 and 2018 was retrospectively reviewed. Patients' demographic information, tumor sizes, surgical treatments, chemotherapy and radiotherapy statuses, follow-up times, recurrences, and metastases were recorded. RESULTS: Mean patient age was 53.6 ± 15 years (range: 28-73). In 8 patients, the tumor was located in the lower limbs, most commonly in the thigh (46.2%). Mean follow-up period was 52.8 ± 19.9 (24-96) months. All patients underwent wide resections and only one had a positive surgical margin. In follow-up, 5 (38.5%) patients experienced recurrence; 6 patients had lung metastasis (46.2%) and 7 patients (53.8%) died. Mean tumor size was 10.4 ± 3.2 (5-17) cm. Median survival time was 61 (50.5-71.4) months and 5-year survival rate was 51.8%. There was no significant difference between survival times according to age, gender, side, limb location, postoperative radiotherapy, recurrence, or presence of lung metastasis. The cut-off value for death obtained by ROC analysis of tumor size was 11 cm. DISCUSSION: EMC is a rare soft tissue sarcoma with high local recurrence and metastasis capacity. Tumor size and metastatic disease are poor prognostic criteria. If it is a localized disease, the first option should be wide resection.

Diagnostic role of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in patients with enchondroma and low-grade chondrosarcoma.

OBJECTIVES: This study aims to evaluate the role of elevated neutrophil-to-lymphocyte ratio (NLR) and monocyte-to- lymphocyte ratio (MLR) in differential diagnosis of enchondroma and low-grade chondrosarcoma. PATIENTS AND METHODS: One-hundred-and-one patients (44 males, 57 females; mean age 53.6±11.5 years; range, 21 to 85 years) diagnosed with enchondroma and low-grade chondrosarcoma in Ankara Oncology Training and Research Hospital between January 2010 and December 2019 were included in this retrospective study. Patients' age, gender, location and type of tumor, and pre-treatment complete blood count results were acquired. One-hundred patients (48 males, 52 females; mean age 50.9±13.6 years; range, 19 to 76 years) with complete blood count results admitted to the same center for reasons other than fracture, infection or tumors with similar age and gender to the aforementioned study group were included as healthy controls. RESULTS: Neutrophil-to-lymphocyte ratio and MLR of the study group were found to be significantly higher than the control group (p<0.001). Neutrophil-to-lymphocyte ratio and MLR held diagnostic importance with statistically significant cut-off values. Statistically significant cut-offs for NLR and MLR were ≥2.0 (sensitivity=73.3%, specificity=67%) and ≥0.2 (sensitivity=76.2%, specificity=63%), respectively. Multivariate logistic regression analysis was performed adjusting for age and gender and NLR ≥2 [odds ratio (OR)=3.1] or MLR ≥0.2 (OR=2.9) were found to be associated with approximately three-fold risk for diagnosis of enchondroma or low-grade chondrosarcoma. CONCLUSION: The NLR and MLR have diagnostic value in cartilaginous tumors such as enchondroma and low-grade chondrosarcoma. However, our results do not support utilization of NLR and MLR as diagnostic value for differentiation of enchondroma and low-grade chondrosarcoma.

Surgical management of primary malignant proximal fibular tumors: Functional and clinical outcomes of 23 patients.

OBJECTIVES: This study aims to evaluate the clinical characteristics and treatment outcomes of patients with primary malignant tumors located in the proximal fibula. PATIENTS AND METHODS: This retrospective study included 23 patients (15 males, 8 females; mean age 22.1 years; range, 9 to 63 years) with primary malignant tumors located in the proximal fibula between May 2007 and May 2017. The anamnesis or medical history, physical examination, plain chest radiography, lung computed tomography, direct radiograph, and magnetic resonance imaging of the affected extremity and routine laboratory tests of all patients were evaluated. RESULTS: Of the patients, 11 were diagnosed with osteosarcoma (47.8%), nine with Ewing's sarcoma (39.1%), two with chondrosarcoma (8.7%), and one was diagnosed with synovial sarcoma (4.3%). Pain and palpable mass were the most common symptoms. Six patients had lung metastases at the time of diagnosis. Of the patients, eight were performed Malawer type 1 resection (34.8%), nine type 2 resection (39.1%), four above knee amputation (17.4%), and two proximal tibia tumor resection prosthesis (8.6%). Mean follow-up duration was 36 months (range, 12 to 119 months). Local recurrence developed in three patients. Mean Musculoskeletal Tumor Society (MSTS) score of all patients was 62. CONCLUSION: Surgical treatment of primary malignant tumors of the proximal fibula is problematic. In appropriate indications, Malawer type 1 resection should be the treatment of choice due to lower local recurrence rates and higher MSTS scores.

Chondrosarcomas of the phalanges of the hand.

OBJECTIVES: This study aims to evaluate the diagnosis and treatment approaches of the rarely seen chondrosarcomas of the phalanges of the hand. PATIENTS AND METHODS: Fifty-two patients (27 males, 25 females; mean age 41.2 years; range 12 to 70 years) with chondroid lesions localized in hand phalanges who were performed surgical treatment between December 2012 and September 2016 were retrospectively reviewed. The study included 62 phalangeal chondroid lesions. Patients' mean follow-up duration was 60.6 months (range 13 to 165 months). Incisional biopsy was performed for the diagnosis. One patient with bilateral and multiple involvement was performed tru-cut biopsy. Phalangeal chondrosarcoma was diagnosed in five patients (9.6%). RESULTS: Of the chondroid lesions, 37 were localized in proximal phalanges (59.6%), 16 in midphalanges (25.8%), and nine in distal phalanges (14.6%). Chondrosarcoma was detected in 15 phalanges of five patients. Of the two patients with Ollier disease, localization was detected in nine phalanges (four proximal, two mid, three distal phalanges) of one patient and in three phalanges (one proximal, two midphalanges) of the other patient. None of the patients had distant metastasis on diagnosis. Ray amputation was performed in two patients under general anesthesia and amputation was performed in one patient. One patient did not give consent for operation. The other patient with Ollier disease gave consent for amputation of only one finger. No local recurrence was seen. CONCLUSION: The hand localization of chondrosarcomas is rare with scarce information in the literature. Their metastasis potential is low but local recurrence rates are high after insufficient surgery. Amputation or ray amputation is the applicable treatment.