CXCL8, MMP1, MMP2, and FN1 Gene Expression and Tumor Extension in Nasopharyngeal Cancer Patients: A Cross-sectional Study.

BACKGROUND: There are correlations between tumor staging, lymph node involvement, and patient survival in Nasopharyngeal cancer (NPC) which is one of the most common types of cancer in Indonesia.  The inflammation process plays a role in tumor progression over the long term and this marked by increased proinflammatory cytokine and gene overexpression. This study aims to identify differentially expressed genes (DEGs) in NPC using T and N staging. METHODS: This is a cross-sectional study of NPC patients in Cipto Mangunkusumo, Jakarta, between 2018 and 2022. DEGs were identified based on the amount of mRNA detected on paraffin blocks with a 1.5- to -1.5-fold change and an adjusted p-value of <0.05. RESULTS: We included 48 subjects. The mean age of subjects was 47.75 (10.48) years, and most were male (77.1%). Non-keratinized squamous cell carcinoma was the most common histopathology type. Differences in the tumor size of the T4 and non-T4 in metastatic (33.3%) group when compared to the non-metastatic (37.5%) group were insignificant (p = 0.763). The proportion of N3 subjects in the metastatic vs non-metastatic group was different significantly (83.3% vs. 50%, p = 0.030). Gene expression analysis showed that C-X-C motif ligand 8 (CXCL8), matrix metalloproteinase-1 (MMP1), matrix metalloproteinase-1 (MMP2), and fibronectin-1 (FN1) genes of the T4 and non-T4 group to be different significantly. CONCLUSION: There was significant finding in the N3 subjects of the metastatic and non-metastatic groups. The DEGs of CXCL8, MMP1, MMP2, and FN1 were statistically significant in the T4 when compared to the non-T4 group.

Massage manipulation and progression of osteosarcoma, does it really correlate: a combination of prospective and retrospective cohort study.

In Indonesia, the challenge of osteosarcoma progression is further worsened by patients' dependence on traditional massage therapy, low socio-economy, and educational status. This study aims to analyze the differences in the characteristics, laboratory findings, surgery techniques, degree of histopathological necrosis, and metastasis between osteosarcoma patients with and without prior massage manipulation therapy. This research is an analytical observational study with a prospective and retrospective cohort design. Patients were treated and followed for one year to evaluate the occurrence of metastasis. Prospective data was collected through interviews, and secondary data was collected from the patient's medical record. Of 84 subjects analyzed, 69% had a history of massage. There was an increase in LDH and ALP in patients with massage manipulation (p = 0.026). The median time to metastasis from baseline in the massage group (4 months) was statistically significant compared to the non-manipulation group (12 months) (p < 0.0001). This research found that massage therapy significantly increases LDH and ALP levels, making amputations more likely to be performed and a higher risk of metastasis that lowered the survival rate. The onset of metastasis was three times faster in patients with prior massage therapy. Therefore, we strongly recommend against massage manipulation therapy in osteosarcoma patients.

Intra-articular injection of secretome, derived from umbilical cord mesenchymal stem cell, enhances the regeneration process of cartilage in early-stage osteo-arthritis: an animal study.

BACKGROUND AND PURPOSE: Mesenchymal stem cells (MSCs), both endogenous and exogenous, enhance chondrocyte proliferation by stimulating collagen type II. Secretome, an MSC derivate, has shown to also provide this mechanism through a paracrine effect. We aimed to evaluate the use of secretome and MSC in the management of early osteoarthritis (OA). ANIMALS AND METHODS: 19 (1 control) male sheep (Ovies aries), which were operated on with total lateral meniscectomy to induce knee OA, were divided into 3 groups: the secretome group, hyaluronic acid group, and MSC group. Each group was injected with the respective substances and was evaluated macroscopically and microscopically. The Osteoarthritis Research Society International (OARSI) score was calculated for all subjects and a descriptive and comparative statistical analysis was undertaken. RESULTS: The macroscopic analysis of the treated groups revealed better OARSI score in the secretome group compared with the other 2 groups. The secretome group showed a significantly better microscopic score compared with the hyaluronic acid group (mean difference [MD] 6.0, 95% confidence interval [CI] 0.15-12), but no significant difference compared with the MSC group (MD 1.0, CI -4.8 to 6.8). CONCLUSION: Intra-articular injection of secretome is effective in managing early-stage osteoarthritis in the animal model compared with hyaluronic acid and has similar efficacy to MSC injection.

Periosteal ganglion cyst of tibia: A rare case report.

INTRODUCTION AND IMPORTANCE: Periosteal ganglion cyst is a rare disorder, found only in 55 out of 100,000 people annually. Periosteal ganglion location may cause partial external cortical destruction with irregular saucerization and erosion. This report presents a rare case of periosteal ganglion cyst that occurred of the cruris sinistra. CASE PRESENTATION: A male patient, 68 years old, came with complaint of a lump in the left cruris since one year ago. Nine months later, the lump has increased in size like a chicken egg and still felt painless. MRI result revealed a well-circumscribed multilocular cystic lesion in the peri-osseous soft tissue of the tibia. We performed directly excisional biopsy within the mass, and the histopathology result was periosteal ganglion cyst. CLINICAL DISCUSSION: The exact pathogenesis of periosteal ganglion is unclear. Synovial herniation and mucoid degeneration of the connective tissue of the periosteum are two suggested mechanisms. In some cases, ganglion cysts may compress nearby nerves. Surgical treatment is recommended for patients who still experience symptoms after non-surgical management has failed. Complete resection of the cyst and surrounding periosteum is recommended to prevent recurrence. After 6 months post-operative follow up clinical examination, no recurrence symptoms founded on the patient. CONCLUSION: Periosteal ganglion is a rare lesion and may mimic other bone surface lesions. Resection of the periosteal ganglion cyst with surrounding periosteum is important to prevent recurrence.

The Outcome of Orthopedics Treatment of Lombok Earthquake Victim 2018: A Cohort of One-Year Follow-Up Study-Lesson Learned After Lombok Earthquake.

Introduction: There was a magnitude 7 on the Richter scale earthquake on Lombok Island in 2018, causing more than 500 deaths. In the event of earthquakes, there is often an imbalance between overcrowding in hospitals and inadequate resources. The initial management of earthquake victims with musculoskeletal injuries is controversial, arguing over whether to utilize debridement, external or internal fixation, or conservative or operative treatment in an acute onset disaster situation. This study aims to determine the outcome of initial management after the 2018 Lombok earthquake, between immediate open-reduction and internal fixation (ORIF) and Non-ORIF procedures after one year follow-up. Methods: This is a cohort study to evaluate radiological and clinical outcomes one year after orthopedic treatment in the Lombok earthquake 2018. The subjects were recruited from eight public health center and one hospital in Lombok in September 2019. We evaluate radiological outcomes (non/malunion and union) and clinical outcomes (infection and SF-36 score). Results: Based on 73 subjects, the ORIF group has a higher union rate than the non-ORIF group (31.1% vs. 68.9%; p = 0.021). Incidence of infection only appeared in the ORIF group (23.5%). Clinical outcome as measured by SF36 showed the ORIF group had a lower mean of general health (p = 0.042) and health change (p = 0.039) clinical outcomes than the non-ORIF group. Discussion: The most affected public group is the productive age with significant impact on social-economy. ORIF procedure is a major risk factor of infection in initial treatment after earthquake. Therefore, definitive operation with internal fixation is not recommended in the initial phase of a disaster. Damage Control Orthopedic (DCO) surgery protocol is the treatment of choice in acute disaster setting. Conclusion: The ORIF group had better radiological outcomes than the non-ORIF group. However the ORIF group had higher cases of infection and lower SF-36 than the non-ORIF group. Definitive treatment in acute onset disaster setting should be prevented.

Double-bundle ACL reconstruction versus anatomic single-bundle ACL reconstruction combined with anterolateral ligament reconstruction: a comparative study of clinical outcome.

INTRODUCTION: Recent studies showed increasing evidences of anterolateral ligament (ALL) reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction that proves to be more superior to the previous double-bundle (DB) ACLR technique especially in improving knee stability in biomechanic studies. However to date, there have been no studies evaluating the functional outcome of DB-ACLR vs single-bundle (SB) with ALL in ACLR. METHODS: A total of 138 patients with ACL deficient knee were enrolled to the study. Double-bundle ACL reconstruction (DB-ACLR) was performed in 75 patients and single-bundle ACL reconstruction with anterolateral ligament reconstruction (SB + ALL) ACLR was performed in 63 patients. Surgical outcomes were compared with The International Knee Documentation Committee Subjective Knee Form (IKDC) and the Kujala score at the 3rd, 6th and 9th month post-operative. RESULTS: The IKDC score in the 3rd and 6th month was superior in the SB + ALL group compared to the DB group. However, this difference was not statistically significant. In the meantime, there were no statistically significant difference between the Kujala Score at the 3rd, 6th, and 9th months consecutively. There were no statistically significant differences in the functional outcomes of DB-ACLR and SB + ALL groups at the 3rd, 6th, and 9th months post-operative period. CONCLUSION: The functional outcome comparison showed non-superiority of SB + ALL group compared to the DB-ACLR group. The patellar pain was less found in DB-ACLR group at 6- and 9-months post-operative period.

Clinical Outcomes of Delayed Osteoarticular Tuberculosis: A Review of 30 Cases.

Purpose: The lack of knowledge regarding osteoarticular tuberculosis (TB) cases in Indonesia leads to delayed and chronic conditions. This study aims to evaluate clinical outcomes of patients with osteoarticular TB. Materials and Methods: Thirty osteoarticular cases were retrospectively analyzed, with a focus on non-immunocompromised patients without spine involvement. Chemotherapy length, operative treatment method, and infection recurrence were evaluated. Results: The majority (60%) of patients were aged between 19 to 49 years. The most common complaint was painful swelling, particularly during physical activity. Weight-bearing joints, such as the hips, knees, and ankles, were the most affected. Laboratory results showed over half of the patients had anemia, 96% had elevated erythrocyte sedimentation rate (ESR), and 76% had elevated C-reactive protein (CRP) levels. Radiological findings varied, with lytic lesions, abscesses, and joint destruction observed. All patients presented with pathognomonic histological tubercle appearances, with caseous necrosis, lymphocytes, and Langhans giant cells present. Twenty-nine cases were treated with anti-TB drugs for 12 months, while one recurrent case received the drugs for 24 months. All patients underwent surgery to gain local infection control. Conclusion: Osteoarticular TB is a common manifestation of extrapulmonary TB and must not be overlooked. Early detection of osteoarticular TB may prevent limb morbidity. Although anti-TB drugs are the primary treatment for osteoarticular TB, in some cases, surgery is required to establish a diagnosis and gain local infection control.

Giant cell tumor with secondary aneurysmal bone cyst of the left calcaneus.

INTRODUCTION AND IMPORTANCE: Giant cell tumors (GCT) of the feet bones are rare, comprising of <1 % of cases. The lack of well-documented cases and similarity with other tumors under radiologic and histological evaluation makes diagnosis difficult. Current treatment modalities for GCT still result in a relatively high recurrence rate, making the overall management of the case a challenge. We reported a 27-year-old male diagnosed with GCT of the left calcaneus with secondary aneurysmal bone cyst (ABC) treated with curettage and femoral head allograft combined with bone cement application. CASE PRESENTATION: A 27-year-old male presented with lump on the left heel since seven months before admission. Physical examination demonstrated solid, palpable mass on the left heel region and limited ankle motion. Magnetic resonance imaging examination demonstrated expansile bone tumor at the left calcaneus with cystic components building fluid levels and hemorrhagic components, suggestive of giant cell tumors with secondary ABC. The patient is diagnosed with giant cell tumor with secondary ABC of the left calcaneus Campanacci grade 2. The patient was managed limb salvage surgery by curettage and subsequent mix of femoral head allograft and bone cement application to fill the defect. DISCUSSION: Conservative surgery via careful curettage is typically preferred for lower Campanacci grade lesions followed by bone reconstruction. In terms of filling bone defects, it is known that both bone cement and allografts have advantages and disadvantages. We hence decided to perform limb salvage surgery via curettage due to the size of the tumor and bone reconstruction using a mix of femoral head allograft and bone cement to fill the defect. CONCLUSION: Curettage and bone allograft with bone cement reconstruction is an option for surgical management of lower Campanacci grade 2 GCT of the calcaneus.

Particular precautions and the role of intraoperative neuromonitoring in cervical cord injury in elder recreational cyclist: A case report.

INTRODUCTION AND IMPORTANCE: The trend in cycling nowadays affects all age groups. However, special precautions must be considered in the elderly group. Minor trauma to the cervical region can cause severe neurological deterioration, leading to fatality because of the pre-existing degenerative process. CASE PRESENTATION: We present a case of a 61-year-old male recreational cyclist with acute onset of tetraplegia following a minor fall. The radiological result revealed a long-standing degenerative process. Unfortunately, the patient deceased due to the sequelae of the paralysis and cardiac event despite our prompt surgical decompression and the improvement shown on intraoperative neuromonitoring. CLINICAL DISCUSSION: The degenerative process can aggravate cervical cord injury even in its mildest form of injury. In this study, immediate improvement was detected by the intraoperative neuromonitoring (IONM) - although the clinical improvement had not improved yet as the general condition is poor. CONCLUSION: The elder cycling population is increasing. Safety measures and injury avoidance are advisable along with expert consultation before the exercise. In a pre-existing degenerative condition of the cervical, a special precaution is also needed during the exercise. If the surgery has been indicated, the use of intraoperative neuromonitoring is found to be useful to guide the decompression and potentially beneficial as a predictive value for the clinal outcome.

A challenging diagnosis: Lesson from case series of sacral Ewing sarcoma.

BACKGROUND: Ewing's sarcoma is an aggressive bone and the surrounding soft tissue cancer primarily found in children and young adults. It is mostly observed in the trunk and long bones while unusually seen in the sacrum. Sacral Ewing sarcoma has a unique anatomic limitation due to neurological structures, vertebral column, and pelvic involvement. Hence, identifying sacral Ewing's sarcoma remains a challenge. METHOD: This is a case series including three patients diagnosed with Sacral Ewing's sarcoma. These three cases have been diagnosed based on clinical and radiographic examination, MRI, histopathology, and immunohistochemistry examination. DISCUSSION: Sacral Ewing's sarcoma remains a challenge to diagnose due to its unique anatomy site. MRI examination is sensitive to detect lesions but nonspecific. Thus, require histopathological confirmation. CONCLUSION: Early diagnosis of Ewing's sarcoma is essential and we need to perform further examinations, such as immunohistochemistry examination, to confirm the diagnosis of Ewing's sarcoma.

A rare case of oxidized zirconium - All polyethylene tibia unicompartmental arthroplasty failure: A case report.

Oxidized zirconium (Oxinium) implants has been claimed as the best material in terms of wear reduction. However, longevity of an all polyethylene uni knee arthroplasty (UKA) has been a long debate. We reported a rare case of 74 year old female who was performed all polyethylene UKA 6 years prior and fell 3 months prior. After the incident, patient was wheel-chair ridden afterwards. There was no evidence of fracture upon conventional radiography examination. Conversion of UKA to total knee replacement (TKA) was performed and patient was able to walk with aid after the surgery. The failed Oxinium all polyethylene UKA failure in this case is suspected due osteoarthritis progression.

Clinical Outcome Following Prolonged Neoadjuvant Chemotherapy and Delayed Surgery in Osteosarcoma Patients: An Evidence-based Clinical Review.

BACKGROUND: The incidence of osteosarcoma reached 16.8 cases annually at dr. Cipto Mangunkusumo Hospital in 1995-2008. Previous studies suggested that prolonged neoadjuvant chemotherapy followed by delayed surgery improves the clinical outcome. Prolonged neoadjuvant chemotherapy followed by delayed surgery commonly occurs in Indonesia, as diagnostic imaging and surgery waiting list will delay the surgery. The aim of this study is to observe the survival rate and the event-free survival rate of osteosarcoma patients with prolonged neoadjuvant chemotherapy and delayed surgery. METHODS: This review included randomized controlled trials (RCTs), cohort studies, retrospective cohort studies, clinical trials, and reviews. Literature search was conducted through MEDLINE (PubMed search engine), Cochrane Central Register of Controlled Trial, and Scopus. The studies were screened and selected according to inclusion criteria by author and contributors independently. RESULTS: Six studies were included in the qualitative synthesis of this study. Overall survival rate, event-free survival rate, histological response and recurrence as well as neoadjuvant chemotherapy duration, cycle and regiment were assessed in this study. CONCLUSION: Prolonged neoadjuvant chemotherapy and delayed surgery results in 5-years survival rate of 43.2% to 96.6% and 5-years event-free survival rate of 35.7% to 86.4%.

Cement arthrodesis of the knee using combined intramedullary nail, plate and screws after wide excision in huge chondromyxoid fibroma of proximal tibia, a case report.

INTRODUCTION AND IMPORTANCE: Chondromyxoid fibroma is a rare benign cartilaginous neoplasm, a mixture of benign cartilage and fibrous and myxoid tissue. It usually affects young people, commonly in the second and third decades of life with male being predominant. Differential diagnosess in chondromyxoid fibroma, are giant cell tumor, bone cyst, enchondroma, osteoblastoma, and low-grade chondrosarcoma. CASE PRESENTATION: We present a case of an 18-years-old male, with chief complaint of pain on the right knee since 3 year ago with an increasing size reaching diameter of 55 cm within three years. The radiograph and MRI revealed lytic blastic expansile multiloculated lesion, with wide transitional zone, and periosteal reaction on the epymetadiaphyseal part of right proximal tibia. The surgical procedure was performed consist of wide excision, reconstruction by cement knee arthrodesis using Kuntscher-nail, dynamic compression plate, bone cement and gastrocnemius flap. CLINICAL DISCUSSION: After 3 months of surgery follow-up, there was no sign of recurrence, the patient walked partially weight bearing with a crutch. In 1 years post operative follow up, the Muscukoskeletal Tumor Society Scoring (MSTS) was 80%. There was no sign of recurrence. CONCLUSION: In cases with large tumor size, wide excision with bone and soft tissue reconstructive surgery is required as mechanical and biological reconstruction. The cement arthrodesis provides a faster duration of surgery, lower risk of infection, and good functional outcome.

A simple management of massive bone defect after en-bloc resection of osteofibrous dysplasia of tibial shaft: A case report.

INTRODUCTION: Osteofibrous dysplasia is a relatively rare disease, exclusively found in children, affecting the tibial diaphysis. Various management approaches are already available, but an internationally approved management guideline is not yet established. There is a major concern in the current management of wide excision technique as it frequently results in massive bone defect. CASE PRESENTATION: Here we present a case of osteofibrous dysplasia on a 10-year-old girl in Cipto Mangunkusumo Hospital with chief complaint of mild persistent pain of her lower leg since two years before with slight bowing deformity. The radiograph and histopathological examination support the diagnosis of osteofibrous dysplasia. She was managed with en-bloc resection (wide excision) of the tumor, followed with reconstruction using biomaterials substitute; combination between demineralized bone matrix (BonegenerR) and bone substitute "hydroxyapatite and calcium sulphate" and internal fixation using plate and screw. RESULTS: Clinical and radiological evaluation showed successful improvement and outcome. The patient showed progressive functional outcomes and achieved functional score of 100% LEFS at 3 years follow-up. The plate and screw was removed at 48 weeks after adequate callus formation andradiological union was achieved. CONCLUSION: Simple reconstruction using biomaterial bone substitute not only created new bone formation with good stability, but also enabled patient to have an improved quality of life. This method is recommended to overcome the massive bone defect after tumor resection in osteofibrous dysplasia patient.

Correlation between Prognostic Factors and the Histopathological Response to Neoadjuvant Chemotherapy in Osteosarcoma: A Retrospective Study.

BACKGROUND: Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. Patients and Methods. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients' survival and follow-up information. RESULTS: We reviewed 64 patients within 5-65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender (p = 0.012), age (p = 0.029), symptom duration (p = 0.004), and tumor enlargement after neoadjuvant chemotherapy (p < 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy. CONCLUSIONS: Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.

Osteosarcoma of the rib: A challenge of diagnosis and surgical intervention: A case report.

INTRODUCTION AND IMPORTANCE: Chest wall tumour could grow from various tissues composing the chest wall. Diagnosis and treatment of patients with chest wall tumour pose several challenges. CASE PRESENTATION: We present a case of 55 year old woman with chief complaint of a painfull mass on her chest wall. Patient was diagnosed with osteosarcoma of the ribs. Patient underwent surgery and was hospitalized for seven days before discharged. CLINICAL DISCUSSION: Osteosarcoma of the ribs is a rare case with wide resection as the main treatment. In this case, chest wall reconstruction was needed to prevent impaired chest wall mechanical function in respiration. CONCLUSION: Diagnosis and treatment of osteosarcoma of the ribs pose challenges. The main treatment of the osteosarcoma of the ribs is wide resection, followed by reconstruction of chest wall when needed. Reconstruction could be performed with autologous tissue, gore-tex, and mesh. The adjuvant chemotherapy was considered to give for better outcome.

Alkaline phosphatase, lactic dehidrogenase, inflammatory variables and apparent diffusion coefficients from MRI for prediction of chemotherapy response in osteosarcoma. A cross sectional study.

BACKGROUND: This present study aimed to assess if clinical, laboratory and MRI were an accurate benchmark in assessing the effectiveness of neoadjuvant chemotherapy in osteosarcoma patients. METHODS: This was an observational analytic study with a cross-sectional design. We correlated among clinical, laboratory and magnetic resonance imaging (MRI) data before and after neoadjuvant chemotherapy; and percentage of tumor necroses from osteosarcoma patients during the period between January 2017-July 2019. RESULTS: Of the 58 patients included in this study, 38 were male and 20 were female aged 5 - 67 years (mean: 16-year-old. 37(63.8%) patients underwent neoadjuvant chemotherapy with CAI regimens and 13 (36.2%) with CA regiments. The tumors were classified as stage IIB in 43 (74.1%) patients and stage III in 15 (25.9%) patients. Wilcoxon test showed significant differences between alkaline phosphatase (ALP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR) before and after neoadjuvant chemotherapy in the poor-response group. We found no significant difference between lactic dehydrogenase (LDH) and lymphocyte-to-monocyte ratio (LMR) before and after neoadjuvant chemotherapy in the good-response group. MRI revealed decreased tumor volume in patients in the good-response to chemotherapy. CONCLUSION: We demonstrated that ALP level was statistically significant in the poor-response group. We also found that LDH value before neoadjuvant chemotherapy had a strong correlation with degree of necrosis and could be used as a predictive indicator. MRI plays an important role in evaluating tumor volumes and preoperative radiological changes to predict histological necrosis.

Thromboembolism in Malignant Musculoskeletal Tumour: A Literature Review.

Malignant musculoskeletal tumour may cause considerable burden to general health. The fast growth combined with the tumour characteristics and its invasion capability resulted in the poor prognosis of malignant musculoskeletal tumour. Malignant musculoskeletal tumour may cause significant disability by destroying normal tissue that plays important role in body kinematics. Thromboembolism, including deep vein thrombosis, pulmonary embolism, and other kinds of venous thromboembolism, is one of the most underestimated complications of musculoskeletal tumour. Normally, thrombosis ensues when pathologic factors overcame the body hemostatic regulatory capabilities, which will predispose the body to the formation of thrombus. Venous thromboembolism in musculoskeletal tumour may develop as a result of interaction between the tumour pathologic capabilities and its interaction with normal bodily functions. In this study, we reviewed the burden of musculoskeletal tumour and its complication on global health. Then, the review will focus on the pathologic and clinical aspect of thromboembolism in malignant musculoskeletal tumour, including pathophysiology, diagnosis, and treatment based on recent findings and literature.

Osteofibrous dysplasia-like adamantinoma versus osteofibrous dysplasia in children: A case report of challenging diagnosis.

INTRODUCTION: Osteofibrous dysplasia (OFD) and Osteofibrous dysplasia-like Adamantinoma have a similar appearance both in clinical and radiography, but different in its histopathology. Despite this similarity, the treatment and prognosis are different, therefore the diagnosis should be established precisely. CASE ILLUSTRATION: A three-year-old boy was admitted to hospital after falling on his lower leg. A bead size lump appeared on his tibia with pain and swelling, which later became enlarged. Diagnosis of osteofibrous dysplasia and adamantinoma was considered. We performed limb-salvage procedure by curretage, bone grafting, and internal fixation application. The histology section showed woven bone rimmed by polygonal osteoblast cell with intervening fibrous stroma and small nests of tumour cells raised the possibility of epithelial differentiation. The positivity for cytokeratin immunostaining confirmed the diagnosis as osteofibrous dysplasia-like adamantinoma. In this case it is a very rare spectrum of malignancy in children. DISCUSSION: These two tumor entities have identical radiographic characteristics, histopathology features the distinction between classic adamantinoma and OFD-like adamantinoma based on the predominant epithelial component. The relationship of osteofibrous dysplasia with adamantinoma is unclear. Several authors considered possible calling relationship osteofibrous dysplasia as "juvenile adamantinoma". However, does not rule out the possible existence of de novo osteofibrous dysplasia not related to adamantinoma. CONCLUSIONS: OFD-like adamantinoma and Osteofibrous Dysplasia had similar histopathology pattern, a pathologist must be aware of this feature and perform immunohistochemical staining for keratin particularly when the histopathological feature of osteofibrous dysplasia showed small nests of tumor cells within the fibrous stroma. diagnostic challenging and require multidisciplinary approach.

Emergency orthopaedic surgery in the pandemic era: A case series at Cipto Mangunkusumo national tertiary hospital in Jakarta, Indonesia.

INTRODUCTION: Every emergency surgery performed is aimed at saving lives; however, during COVID-19 pandemic, surgeries are often postponed. Many existing recommendations take into account postponing surgery during a pandemic. How these surgeries can lead to increasing infection rates has not been widely published. This study aims to investigate the relationship of emergency orthopaedic surgery and the incidence rate of COVID-19. PRESENTATION OF CASE: This was a case series of 14 patients. The study was performed at the emergency department unit at a national tertiary hospital in Jakarta, Indonesia. A total of 14 patients underwent orthopaedic surgery in the emergency room of our institution. The mean age of the subjects was 40.07 ± 20.5 years. Twelve (85.7%) were male patients and 2 (14.3%) were female patients. The average duration of surgery was 125 minutes. The most used type of anaesthesia was general anaesthesia for 6 operations (50%). Patients were hospitalized for an average length of 4 days. Three patients had infiltrates found on plain x-ray examination, which required further examination to determine whether the cause was COVID-19 infection or not. There was no ground glass appearance (GGO) in the three patients in further follow-up examination. CONCLUSIONS: We found that emergency orthopaedic surgery was not associated with increasing number of COVID-19 cases. Factors including duration of surgery, length of stay, types of anaesthesia and comorbidities were also not associated with COVID-19 cases in this study.