A deep learning model for accurately predicting cancer-specific survival in patients with primary bone sarcoma of the extremity: a population-based study

Purpose Primary bone and joint sarcomas of the long bone are relatively rare neoplasms with poor prognosis. An efficient clinical tool that can accurately predict patient prognosis is not available. The current study aimed to use deep learning algorithms to develop a prediction model for the prognosis of patients with long bone sarcoma. Methods Data of patients with long bone sarcoma in the extremities was collected from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2014. Univariate and multivariate analyses were performed to select possible prediction features. DeepSurv, a deep learning model, was constructed for predicting cancer-specific survival rates. In addition, the classical cox proportional hazards model was established for comparison. The predictive accuracy of our models was assessed using the C-index, Integrated Brier Score, receiver operating characteristic curve, and calibration curve. Results Age, tumor extension, histological grade, tumor size, surgery, and distant metastasis were associated with cancer-specific survival in patients with long bone sarcoma. According to loss function values, our models converged successfully and effectively learned the survival data of the training cohort. Based on the C-index, area under the curve, calibration curve, and Integrated Brier Score, the deep learning model was more accurate and flexible in predicting survival rates than the cox proportional hazards model. Conclusion A deep learning model for predicting the survival probability of patients with long bone sarcoma was constructed and validated. It is more accurate and flexible in predicting prognosis than the classical CoxPH model (AU)

Impact of bone metastasis on the prognosis of non-small cell lung cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis

Background This review was implemented to examine the impact of bone metastasis on the prognosis of non-small cell lung cancer patients (NSCLC) treated with immune checkpoint inhibitors (ICIs). Methods A literature search was conducted in the PubMed, CENTRAL, Web of Science, and Embase databases up to 4th September 2022. Multivariable adjusted data were pooled in a random-effects model. Results 13 studies were included. On a combined analysis of 10 studies, it was noted that bony metastasis was associated with poor overall survival (OS) in NSCLC patients treated with ICIs (HR: 1.55 95% CI 1.24, 1.94 I2 = 69% p = 0.001). Meta-analysis of seven studies showed that bony metastasis was not associated with poor progression-free survival (PFS) in NSCLC patients treated with ICIs (HR: 1.31 95% CI 0.85, 2.01 I2 = 85% p = 0.22). Meta-regression analysis using the moderator's age, male gender, smoking history, squamous histology, and ICI as 1st line therapy for the outcome OS was not statistically significant. Conclusion The presence of bone metastasis is a predictor of poor OS in NSCLC treated with ICIs. However, PFS does not seem to be influenced by the presence of bone metastasis. Clinicians should prioritize the management of NSCLC patients with bone metastasis and explore the use of combination therapies to achieve optimal results. Further studies taking into account different combination therapies for such patients would strengthen the evidence (AU)

Update in Imaging Evaluation of Bone and Soft Tissue Sarcomas / Atualização na avaliação por imagens dos sarcomas ósseos e das partes moles

Abstract The evolution in imaging evaluation of musculoskeletal sarcomas contributed to a significant improvement in the prognosis and survival of patients with these neoplasms. The precise characterization of these lesions, using the most appropriate imaging modalities to each clinical condition presented, is of paramount importance in the design of the therapeutic approach to be instituted, with a direct impact on clinical outcomes. The present article seeks to update the reader regarding imaging methodologies in the context of local and systemic evaluation of bone sarcomas and soft tissues.

Resumo A evolução na avaliação por imagens dos sarcomas musculoesqueléticos contribuiu para melhora significativa no prognóstico e na sobrevida dos portadores destas neoplasias. A caracterização precisa destas lesões, mediante utilização das modalidades de imagem mais adequadas a cada condição clínica apresentada, é de suma importância no delineamento da abordagem terapêutica a ser instituída, com impacto direto sobre os desfechos clínicos. O presente artigo busca atualizar o leitor a propósito das metodologias de imagem no contexto da avaliação local e sistêmica dos sarcomas ósseos e das partes moles.

Coristoma óseo lingual. Nuevo caso de una entidad extremadamente infrecuente / Lingual osseous choristoma. New case of an extremely uncommon entity

Los osteomas constituyen un grupo de tumores óseos benignos que se localizan habitualmente en el cráneo y los huesos de la región facial, siendo rara su presencia en los tejidos blandos de la cavidad oral. También se les conoce como coristomas óseos, ya que están compuestos por tejido óseo maduro de aspecto normal. En la cavidad oral, la localización más frecuente es el tercio posterior de la lengua y suele aparecer en mujeres con edades comprendidas entre la segunda y tercera década de vida. A pesar de que la mayoría de los pacientes presentan un curso asintomático, no es infrecuente que su motivo de consulta sea la sensación de cuerpo extraño y disfagia. Afortunadamente, los osteomas linguales tienen buen pronóstico, ya que una vez realizada la extirpación no hay descritos casos de recurrencia. Debido a su insólita presentación, con menos de 100 casos publicados en la literatura, se decide presentar este caso clínico. (AU)

Osteomas are rare benign tumors that can be located on the craniomaxillofacial skeleton, being unusual its presence in the soft tissues of the oral cavity. They are also known as osseous choristomas, as they consist of normal matured bone tissue. Osteomas of the tongue occur more frequently in women in their second or third decade and the most frequent location in the oral cavity is the posterior third of the tongue. Most patients are asymptomatic, though other forms of presentation could be complaining of the sensation of having a foreign body or, even, dysphagia. The fact that less than 100 cases have been reported in the literature, has motivated the presentation of this clinical case. (AU)

Tumor mesenquimático fosfatúrico de pelvis: abordaje multidisciplinario / Phosphaturic mesenchymal tumor of the pelvis: A multidisciplinary approach

El tumor mesenquimático fosfatúrico es una entidad clinicopatológica sumamente infrecuente. Además de provocar dolor óseo insidioso y polimialgias, se acompaña de alteraciones del metabolismo fosfocálcico de difícil manejo clínico. El abordaje multidisciplinario resulta la clave del éxito en esta enfermedad. Presentamos una paciente de 52 años de edad con antecedente de tumor mesenquimático fosfatúrico en la hemipelvis derecha con extensión a la cadera homolateral de 10 años de evolución. Clínicamente presentaba osteomalacia oncogénica (hipofosfatemia e hiperfosfaturia) que no se corregía, pese a un agente de última generación, el burosumab, un inhibidor del factor de crecimiento fibroblástico 23, que aumenta la reabsorción tubular renal de fosfatos. En un comité multidisciplinario, se decidió la resección con márgenes oncológicos y se logró una mejoría clínica franca. Comunicamos este caso, debido a que es un cuadro infrecuente. Nivel de Evidencia: IV

Phosphaturic mesenchymal tumor (PMT) is an infrequent clinicopathological entity. It presents insidious bone pain and polymyalgia, accompanied by alterations in calcium and phosphorus metabolism that are difficult to resolve clinically. A multidisciplinary approach is a key to success in this pathology. We present the case of a 52-year-old female patient with a 10-year history of PMT in the right hemipelvis with ipsilateral hip extension. From the clinical point of view, she presented oncogenic osteomalacia (hypophosphatemia and hyperphosphaturia) that did not correct despite being administered the latest generation medication, burosumab, an FGF-23 inhibitor that increases renal tubular phosphate reabsorption. Resection with oncological margins was decided by a multidisciplinary committee resolving her clinical condition. Due to the rarity of this pathology, we decided to report the case. Level of Evidence: IV

Plastia de rotación en escolar por osteosarcoma: Protetización y actualización / Rotationplasty in a schoolboy for osteosarcoma: Prosthesis fitting and update

Introducción La cirugía ablativa era la opción clásica para el tratamiento del osteosarcoma.Tras la aparición de la quimioterapia adyuvante aumenta la supervivencia de estos pacientes, y con ello los niños afectos en edad escolar con alto potencial de crecimiento. Se proponen cirugías reconstructivas con mayor preservación del miembro y mejor función que las amputaciones convencionales. Presentación del caso Describimos un caso de osteosarcoma en un niño de 9 años con antecedente de retinoblastoma. El tumor involucraba toda la longitud del fémur izquierdo. También presentaba una metástasis pulmonar. Ante la respuesta incompleta a la quimioterapia neoadyuvante, se optó por resección ósea abarcando la lesión, rotacionoplastia y protetización del miembro inferior izquierdo y toracoscopia para tratar la lesión pulmonar. Se inició proceso con una ortoprótesis bypass las 6 primeras semanas, hasta comprobar cicatrización, consolidación ósea y ausencia de complicaciones, y una ortoprótesis definitiva los siguientes 4 meses. Al cabo de un año el paciente realizaba marcha independiente con el uso de la ortoprótesis, natación con aleta adaptada al muñón y reiniciaba actividad en bicicleta. En la última revisión clínica, con 13 años, se encuentra libre de enfermedad y sigue controles periódicos en nuestra consulta para adaptaciones oportunas de ortoprótesis acorde a su crecimiento. Discusión Este caso destaca las diversas opciones reconstructivas y las dificultades encontradas en el manejo de estos procesos malignos tan agresivos. La cirugía de rotacionoplastia es una opción terapéutica viable en pacientes jóvenes con osteosarcoma, que permite al niño volver a participar en las actividades de la vida diaria y recreativa premórbidas (AU)

Introduction The classical treatment of osteosarcoma used to be ablative surgery. After the appearance of adjuvant chemotherapy, survival in these patients increased, and with it, the number of affected school age children with high growth potential. Hence, reconstructive surgeries are currently proposed instead of conventional bone resections due to greater limb preservation and better functional status than those achieved with conventional amputations. Case presentation We describe a case of osteosarcoma in a 9-year-old boy with a history of retinoblastoma. The tumour involved the entire length of the left femur. He also had a lung metastasis. Given the incomplete response to neoadjuvant chemotherapy, we chose bone resection, rotation and fitting of the left lower limb and thoracoscopy to treat the lung injury. A bypass ortoprosthesis was placed for the first 6 weeks, until there was healing, bone consolidation and absence of complications, followed by a definitive orthoprosthesis for the next 4 months. At one year, the patient was able to walk independently with the use of the ortoprosthesis, swimming with a fin adapted to the stump and was had restarted cycling. At the last clinical review, at the age of 13 years, he is disease free and continues to have periodic follow-up visits in our office for adaptations to the prosthesis according to his growth. Discussion This case highlights the various reconstructive options available and the difficulties encountered in the management of these aggressive malignant processes. Rotationplasty is a viable therapeutic option in young patients with osteosarcoma, which allows the child to participate again in premorbid daily and recreational activities (AU)

Updating on Bone and Soft Tissue Sarcomas Staging / Atualização no estadiamento dos sarcomas ósseos e das partes moles

Abstract Bone and soft tissue sarcomas consist of a heterogeneous group of malignant tumors of mesenchymal origin that can affect patients from any age. The precise staging of these lesions determines the best therapeutic strategies and prognosis estimates. Two staging systems are the most frequently used: the system proposed by the University of Florida group, led by Dr. William F. Enneking (1980) and adopted by the Musculoskeletal Tumor Society (MSTS), and the system developed by the American Joint Committee on Cancer (AJCC) (1977), currently in its 8th edition (2017). This paper updates the reader on the staging of bone and soft tissue sarcomas affecting the musculoskeletal system.

Resumo Os sarcomas ósseos e das partes moles consistem em grupo heterogêneo de neoplasias malignas de origem mesenquimal que podem ocorrer em qualquer faixa etária. O estadiamento preciso destas lesões determina as melhores estratégias terapêuticas e estimativas de prognóstico. Dois sistemas de estadiamento são os mais frequentemente empregados no manejo destas neoplasias: o sistema proposto pelo grupo da Universidade da Flórida, liderado pelo Dr. William F. Enneking (1980), adotado pela Musculoskeletal Tumor Society (MSTS) e o sistema desenvolvido pela American Joint Committee on Cancer (AJCC) (1977) que se encontra em sua 8a edição (2017). O presente artigo busca atualizar o leitor a respeito do estadiamento dos sarcomas ósseos e das partes moles que acometem o sistema musculoesquelético.

Extremities Soft Tissue Sarcomas, more Common and as Dangerous as Bone Sarcomas / Sarcomas de partes moles nos membros, mais comuns e tão graves quanto os sarcomas ósseos

Abstract Musculoskeletal sarcomas are rare diseases that require attention. They often present high degree of malignancy at diagnosis and, if underestimated, they can evolve aggressively locally and systemically. They present as soft tissues arcoma and bone sarcomas, with soft tissue being four to five times more common. Most soft tissue sarcomas occur in the extremities. The most common subtypes in children and adolescents are rhabdomyosarcoma and synovial sarcoma; in adults, undifferentiated pleomorphic sarcoma, liposarcoma, leiomyosarcoma, myxofibrosarcoma and synovial sarcoma; all with a high degree of histological malignancy. Many soft tissue sarcomas are confused with benign soft tissue tumors, 100 times more common, so they are resected without the necessary planning, resulting in amputation of a limb that could have been preserved. As in all cancers, the most important prognostic factor is metastatic disease. When it is present, the overall survival rate falls around 20 to 30%. Survival rates are generally similar between bone and soft tissue sarcomas. So soft tissue sarcomas, in addition to being more prevalent, are as aggressive as bones arcomas, deserving a lot of attention from orthopedic surgeons, who are often the first line of care of carriers of these tumors.

Resumo Os sarcomas musculoesqueléticos são doenças raras que exigem atenção. Frequentemente, apresentam alto grau de malignidade ao diagnóstico e se subestimados podem evoluir de forma agressiva local e sistemicamente. Apresentam-se como sarcoma de partes moles e sarcomas ósseos, sendo os de partes moles quatro a cinco vezes mais comuns. A maioria dos sarcomas de partes moles ocorre nos membros. Os subtipos mais comuns nas crianças e adolescentes são o rabdomiossarcoma e o sarcoma sinovial, nos adultos o sarcoma pleomórfico indiferenciado, lipossarcoma, leiomiossarcoma, mixofibrossarcoma e sarcoma sinovial; todos de alto grau de malignidade histológica. Muitos sarcomas de partes moles são confundidos com tumores benignos de partes moles, 100 vezes mais comuns, por isso são ressecados sem o planejamento necessário, acarretando em amputação de um membro que poderia ter sido preservado. Como em todos os cânceres, o fator prognóstico mais importante é a doença metastática. Na sua vigência, a taxa de sobrevida global cai em torno de 20 a 30%. As taxas de sobrevida no geral são parecidas entre os sarcomas ósseos e de partes moles, portanto o sarcoma de partes moles, além de mais prevalente, mostra-se tão agressivo quanto os sarcomas ósseos, por isso merece muita atenção dos ortopedistas que frequentemente são a primeira linha de atendimento dos portadores destes tumores.

Host IL11 Signaling Suppresses CD4+ T cell-Mediated Antitumor Responses to Colon Cancer in Mice.

IL11 is a member of the IL6 family of cytokines and signals through its cognate receptor subunits, IL11RA and glycoprotein 130 (GP130), to elicit biological responses via the JAK/STAT signaling pathway. IL11 contributes to cancer progression by promoting the survival and proliferation of cancer cells, but the potential immunomodulatory properties of IL11 signaling during tumor development have thus far remained unexplored. Here, we have characterized a role for IL11 in regulating CD4+ T cell-mediated antitumor responses. Absence of IL11 signaling impaired tumor growth in a sporadic mouse model of colon cancer and syngeneic allograft models of colon cancer. Adoptive bone marrow transfer experiments and in vivo depletion studies demonstrated that the tumor-promoting activity of IL11 was mediated through its suppressive effect on host CD4+ T cells in the tumor microenvironment. Indeed, when compared with Il11ra-proficient CD4+ T cells associated with MC38 tumors, their Il11ra-deficient counterparts displayed elevated expression of mRNA encoding the antitumor mediators IFNγ and TNFα. Likewise, IL11 potently suppressed the production of proinflammatory cytokines (IFNγ, TNFα, IL6, and IL12p70) by CD4+ T cells in vitro, which we corroborated by RNAscope analysis of human colorectal cancers, where IL11RAhigh tumors showed less IFNG and CD4 expression than IL11RAlow tumors. Therefore, our results ascribe a tumor cell-extrinsic immunomodulatory role to IL11 during colon cancer development that could be amenable to an anticytokine-based therapy.See related Spotlight by van der Burg, p. 724.

Condrosarcoma de la pelvis en paciente joven / Pelvic chondrosarcoma in young patient

Introducción. Los sarcomas de la pelvis ósea constituyen un subgrupo muy pequeño dentro de la nosología tumoral ósea. El Condrosarcoma, frecuente a partir de la cuarta década de la vida, es la segunda neoplasia ósea más frecuente de los tumores óseos primarios malignos y su localización pélvica constituye un verdadero reto para los cirujanos actuantes. Objetivo. Reportar un caso de Condrosarcoma pélvico en edad temprana y revisar la literatura acerca del tema. Caso clínico. Paciente femenina de 19 años con antecedentes de salud que acude a consulta por dificultad al caminar y aumento de volumen en cadera derecha y dolor asociado. Luego de estudios radiológicos correspondientes, se interviene quirúrgicamente con diagnóstico presuntivo de Condrosarcoma que se corrobora a posteriori por histopatología. Conclusiones. El Condrosarcoma pélvico es una lesión de difícil abordaje quirúrgico. Su pronóstico depende de la posibilidad de exéresis amplia y del grado histológico del tumor. Para su tratamiento curativo se requiere habitualmente de intervenciones extensas, en su mayoría, mutilantes. Su escasa respuesta a la radioterapia y la quimioterapia hacen de la cirugía el arma fundamental para su resolución. (AU)

Introduction. Sarcomas of the bony pelvis constitute a very small subgroup within bone tumor nosology. Chondrosarcoma, common from the fourth decade of life, is the second most frequent bone neoplasm of malignant primary bone tumors and its pelvic locationconstitutes a real challenge for acting surgeons. Objective. To report a case of pelvic hondrosarcoma at an early age and to review the literature on the subject. Clinical case. 19-year-old female patient with a medical history who came to the clinic due to difficulty walking and increased volume in the right hip and associated pain. After corresponding radiological studies, he underwent surgery with a presumptive diagnosis of hondrosarcoma that is corroborated by histopathology. Conclusions. Pelvic chondrosarcoma is a lesion with a difficult surgical approach. Its prognosis depends on the possibility of extensive excision and the histological grade of the tumor. Its curative treatment usually requires extensive interventions, mostly mutilating. Its poor response to radiotherapy and chemotherapy make surgery the fundamental weapon for its resolution. (AU)

Post-operative fracture risk assessment following tumor curettage in the distal femur: a hybrid in vitro and in silico biomechanical approach.

The distal femur is the predominant site for benign bone tumours and a common site for fracture following tumour removal or cementation. However, the lack of conclusive assessment criterion for post-operative fracture risk and appropriate devices for cement augmentation are serious concerns. Hence, a validated biomechanical tool was developed to assess bone strength, depending on the size and location of artificially created tumorous defects in the distal femora. The mechanics of the bone-cement interface was investigated to determine the main causes of reconstruction failure. Based on quantitative-CT images, non-linear and heterogeneous finite element (FE) models of human cadaveric distal femora with simulated tumourous defects were created and validated using in vitro mechanical tests from 14 cadaveric samples. Statistical analyses demonstrated a strong linear relationship (R2 = 0.95, slope = 1.12) with no significant difference between bone strengths predicted by in silico analyses and in vitro tests (P = 0.174). FE analyses showed little reduction in bone strength until the defect was 35% or more of epiphyseal volume, and reduction in bone strength was less pronounced for laterally located defects than medial side defects. Moreover, the proximal end of the cortical window and the most interior wall of the bone-cement interface were the most vulnerable sites for reconstruction failure.

What Are the Challenges and Complications of Sterilizing Autografts with Liquid Nitrogen for Malignant Bone Tumors? A Preliminary Report.

BACKGROUND: Reconstruction of defects after resection of malignant bone tumors with liquid nitrogen-sterilized recycled autografts is an alternative to bone allografts and endoprostheses in resource-constrained environments. Most studies reporting favorable outcomes with liquid nitrogen-sterilized autografts for bone reconstruction are geographically restricted to a few countries, and the technical challenges of routinely using liquid nitrogen intraoperatively, especially when using the pedicle freezing technique, has not been documented. QUESTIONS/PURPOSES: (1) What are the technical challenges of liquid nitrogen sterilization of bone tumors for inexperienced surgeons? (2) What are the complications associated with the procedure? METHODS: Between May 2017 and October 2019, 88 patients underwent limb salvage procedures for malignant bone tumors of the extremities at our institution. An endoprosthesis was used for reconstruction of the defect following resection in 45% (40 of 88) of these patients, mostly in adults (median age 21 years; range 9 to 68). In the remaining 55% (48 of 88) of patients undergoing biological reconstruction, liquid nitrogen-sterilized autograft was used in 90% (43 of 48), extracorporeal irradiation-sterilized autograft was used in 4% (2 of 48) and allograft was used in 6% (3 of 48). Of the 43 patients receiving liquid nitrogen-sterilized autograft, 5% (2 of 43) were excluded due to loss to follow-up and the remaining 95% (41 of 43) were included for the analysis. Liquid nitrogen-sterilized autograft was the preferred method of reconstruction at our institution during the study period, unless the patient had an indication for prosthesis reconstruction; extracorporeal irradiation-sterilized autograft was used due to resource constraints with liquid nitrogen and allograft was used when patients insisted.All surgical procedures were performed by the same team of trained orthopaedic oncology surgeons. The medical records of the included 41 patients were retrieved using an institutional database search in this retrospective study, and all were used to ascertain technical challenges associated with the operations as well as early (within 3 weeks of the index procedure) and late complications (those occurring 3 weeks or more after surgery). The technical challenges were defined as follows: the quantity of liquid nitrogen to be used; arranging, storing and handling of liquid nitrogen in the operating room, type and size of the container to be used for sterilization, the positioning of the container during pedicle freezing, level of fibular osteotomy for pedicle freezing of tibia, soft tissue protection, limb rotation during pedicle freezing, managing tourniquet time, and any other intraoperative factors with the use of liquid nitrogen for sterilizing the autograft. As our experience with the technique gradually grew, the answers to the above-mentioned factors were determined. Considering the removal of autograft as the endpoint of interest, survival of the autograft was determined by Kaplan-Meier analysis.The median (range) patient age was 14 years (2 to 49), and 54% (22 of 41) were males. Osteosarcoma was the most common diagnosis (68%, [28 of 41]) followed by Ewing's sarcoma (20%, [8 of 41]). On presentation, 27% of patients (11 of 41) had radiological evidence of pulmonary metastasis. Tumors were seen frequently around the knee (39% [16 of 41] proximal tibia and 22% [9 of 41] distal femur). Before resection 85% (35 of 41) underwent neoadjuvant chemotherapy. Sixty-six percent (27 of 41) underwent pedicle-freezing and the remaining 34% (14 of 41) underwent free-freezing of the tumor segment of the bone. The median (range) duration of surgery was 280 minutes (210 to 510). The patients were followed up for a median (range) duration of 21 months (5 to 30); two patients were lost to follow-up. RESULTS: With gradual experience using liquid nitrogen-sterilization over time at our institution, we determined that the following factors helped us in performing liquid nitrogen-sterilization more efficiently. For every operation 15 L to 20 L of unsterilized liquid nitrogen was arranged, 1 or 2 days before the procedure, and stored in industrial-grade cryocylinders in the operating complex. During the procedure, the operating surgeons wore additional plastic aprons under the surgical gowns, surgical goggles, and rubber boots. The staff managing the liquid nitrogen in the operating room wore thermal protective gloves. For most of the pedicle freezing procedures, we used a cylindrical stainless-steel container that was 30 cm in height and 15 cm in diameter, with a narrow opening. The container was kept on a separate moveable cart that was placed next to the operating table at a slightly lower level, and it was wrapped in multiple cotton rolls, plastic sheets, surgical sheets, and a crepe bandage. For pedicle freezing of the tibia, we performed the fibular osteotomy at least 5 cm away from the planned surgical margin, roughly around the axis of rotation of the limb. The soft tissue at the base of the delivered bone segment was dissected for at least 5 cm beyond the planned surgical margin of bone, and was protected with multiple layers of cotton rolls, plastic drapes, a single roll of Esmarch and crepe bandage. The tumor segment was externally rotated during pedicle freezing for all anatomic sites (proximal tibia, distal tibia, proximal humerus, and proximal femur). The tourniquet was inflated just before pedicle freezing to prevent tumor dissemination and not before the initial incision in all pedicle freezing procedures.Thirty-nine percent of patients (16 of 41) experienced complications associated with the procedures, and 15% (6 of 41) underwent revision surgery. Early complications (occurring within 3 weeks of the index procedure) were skin necrosis in four of 16 patients, intraoperative fracture in one of 16, superficial infection in one of 16, and neurapraxia in one of 16 patients. Late complications (occurring 3 weeks or more after surgery) were resorption of the recycled bone in four of 16 patients, nonunion of the osteotomy site in two of 12, delayed union of the osteotomy site in one of 16, collapse of the recycled bone in one of 16, and local recurrence in 1 of 16 patients. Kaplan-Meier survivorship free from removal of autograft at 2 years after surgery was 92% (95% confidence interval 89 to 96). CONCLUSION: Liquid nitrogen-sterilization is an alternative technique that requires some training and experience for the surgeon to become proficient in treating primary malignant bone tumors. Because it is widely available, it may be an option worth exploring in resource-constrained environments, where allografts and endoprostheses cannot be procured. The methods we developed to address the technical challenges will require more study and experience, but we believe these observations will aid others who may wish to use and evaluate liquid nitrogen sterilization of extremity bone sarcomas. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Tumor protein expression of the DNA repair gene BRCA1 and lethal prostate cancer.

DNA repair genes are commonly altered in metastatic prostate cancer, but BRCA1 mutations are rare. Preliminary studies suggest that higher tumor expression of the BRCA1 protein may be associated with worse prognosis. We undertook a prospective study among men with prostate cancer in the Health Professionals Follow-up Study and evaluated BRCA1 via immunohistochemical staining on tissue microarrays. BRCA1 was expressed in 60 of 589 tumors. Prevalence of BRCA1 positivity was 43% in the 14 men with metastases at diagnosis compared with 9% in non-metastatic tumors [difference, 33 percentage points; 95% confidence interval (CI), 7-59]. BRCA1-positive tumors had 2.16-fold higher Ki-67 proliferative indices (95% CI, 1.18-3.95), higher tumor aneuploidy as predicted from whole-transcriptome profiling, and higher Gleason scores. Among the 575 patients with non-metastatic disease at diagnosis, we evaluated the association between BRCA1 expression and development of lethal disease (metastasis or cancer-specific death, 69 events) during long-term follow-up (median, 18.3 years). A potential weak association of BRCA1 positivity with lethal disease (hazard ratio, 1.61; 95% CI, 0.82-3.15) was attenuated when adjusting for age, Gleason score and clinical stage (hazard ratio, 1.11; 95% CI, 0.54-2.29). In summary, BRCA1 protein expression is a feature of more proliferative and more aneuploid prostate tumors and is more common in metastatic disease. While not well suited as a prognostic biomarker in primary prostate cancer, BRCA1 protein expression may be most relevant in advanced disease.

Manifestaciones paraneoplásicas a propósito de un caso con sarcoma de partes blandas y metástasis ósea / Paraneoplastic manifestations regarding a case with soft tissue sarcoma and bone metastases

Introducción: El sarcoma de tejidos blandos (STB) constituye un grupo variado de más de 60 neoplasias que solo suponen 1 por ciento del total de los tumores. Objetivo: Describir el caso de un paciente con sarcoma de partes blandas con metástasis ósea y manifestaciones paraneoplásicas. Caso clínico: Se presenta el caso de un paciente masculino de 55 años de edad con antecedentes de diabetes mellitus tipo 2 e hipertensión arterial que refiere que hace 50 días inició con decaimiento marcado, luego de permanecer 1 mes con este síntoma inició con dolor en la columna en la parte más baja de la espalda, conjuntamente iniciando con un cuadro febril. Además, tuvo pérdida de la fuerza principalmente en las piernas, y hablaba cosas incoherentes sin sentido, gran inapetencia, con pérdida de peso de 50 lb en 20 días. Ante cuadro de pérdida de la conciencia y de la fuerza principalmente en las piernas se decidió su remisión hacia el Hospital Clínico Quirúrgico Lucía Íñiguez Landín de Holguín donde se concluyó como sarcoma de partes blandas con manifestaciones paraneoplásicas y metástasis ósea. Conclusiones: El caso presentado de sarcoma de partes blandas pretende aportar información sobre esta enfermedad tan infrecuente en nuestro medio(AU)

Introduction: Soft tissue sarcoma (STB) constitutes a varied group of more than 60 malignancies that only accounts for 1% of all tumors. Objective: To report a case of a patient with soft tissue sarcoma with bone metastases and paraneoplastic manifestations. Clinical case report: We report the case of a 55-year-old male patient with a history of type 2 diabetes mellitus and hypertension, who stated that 50 days ago he began to feel markedly listless. And after a month he began to suffer pain in the spine, in the lower back, and have a fever. In addition he had loss of strength mainly in the legs, and spoke inconsistently, nonsense, great loss of appetite, with weight loss of 50 lbs in 20 days. Given the condition of loss of consciousness and strength, mainly in the legs, it was decided to refer him to Lucía Iñiguez Landín Surgical Clinical Hospital in Holguín, where a soft tissue sarcoma with paraneoplastic manifestations and bone metastases was diagnosed. Conclusions: The report of this case of soft tissue sarcoma aims to provide information about this disease, which is so rare in our setting(AU)

Osteoblastoma in the Distal Humerus of a Cat.

A 7-year-old neutered male domestic shorthair cat was presented with chronic lameness in the right forelimb. A cystic bony lesion was identified in the distal right humerus and amputation was performed. The epiphyseal trabecular bones of the capitulum and trochlea was replaced by a tan to pink, expansile mass that was surrounded by a thin rim of cortical bone. Microscopically, the tumour was composed of a bland, osteoid producing spindle cell population within a well-vascularized fibrous stroma. Radiographical and histological features were consistent with osteoblastoma. Osteoblastoma and the related osteoid osteoma are uncommon, benign osteoblastic tumours that are reported rarely in animals. These tumours should be considered as differential diagnoses for slow growing, cystic bony lesions in cats.

Metástasis óseas: enfoque ortopédico / Bone metastasis: orthopedic point of view

Fundamento: el cáncer constituye una causa frecuente de morbi-mortalidad a nivel internacional y nacional. Dentro de las formas de presentación se encuentran las metástasis óseas. Objetivo: profundizar los conocimientos de la enfermedad ósea metastásica enfocada en el manejo desde el punto de vista de la especialidad de Ortopedia y Traumatología. Métodos:la búsqueda de la información se realizó en un periodo de tres meses (primero de enero de 2018 al 31 de marzo de 2018) y se emplearon las siguientes palabras: bone metastasis, pathologic fracture, y metastasic bone disease, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 259 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 50 citas seleccionadas para realizar la revisión, de ellas 41 de los últimos cinco años, se incluyeron diez libros. Desarrollo: se describen las metástasis óseas de acuerdo a su aspecto radiográfico en blásticas, líticas y mixtas; así como los principales sitios de origen. Se hace referencia a los principales estadios, con especial énfasis en el riesgo de fractura patológica, para lo que se plasman criterios, que permiten definir la conducta a seguir. Se mencionan las indicaciones y variantes del tratamiento quirúrgico, así como el pronóstico de estos enfermos. Conclusiones: la enfermedad ósea metastásica es un reto para el cirujano ortopédico, tiene indicaciones quirúrgicas específicas y uno de los elementos de más importancia es definir el riesgo de fractura patológica(AU)

Background: cancer is a common cause of morbidity-mortality affecting many people internationally and nationally. One way of presentation is bone metastases. Objective: to deepen the knowledge about the management of patients suffering from bone metastasis from a point of view of the Orthopedics and Traumatology specialties. Methods: a search of information was carried out in a period of three months (January 1st, 2018 to March 31st, 2018) in the databases PubMed, Hinari, SciELO and Medline through the information locator EndNote by using the words bone metastasis, pathologic fracture, and metastatic bone disease, resulting in a total of 259 articles which 50 of them were selected for the review, 41 of them of the last five years, including ten books. Development: bone metastasis types were described according to radiographic aspects as: litic, blastic and mix, so like the most common origin sites. The main stages were shown, specially the one related to the risk of pathologic fracture, so that criteria were stated to define treatment. Indication and treatment modalities were described, as well as prognostic factors.Conclusions: metastatic bone disease is a great challenge for orthopedic surgeon, there are specific indications for surgery and one of the most important aspects to take in mind is the risk of pathologic fracture(AU)

Tumores óseos benignos osteolíticos / Benign osteolytic bone tumors

INTRODUCCIÓN: Los tumores óseos primarios son raros. La localización, extensión y el carácter lítico dificultan el tratamiento aunque el comportamiento biológico sea benigno. OBJETIVO: Valorar las características y tratamientos de los tumores óseos benignos primarios líticos activos o agresivos tratados en el Hospital El Cruce. Comparar la resección realizada con la sugerida por los criterios de Enneking. MATERIAL Y MÉTODOS: se evaluaron historias clínicas y ateneos postquirúrgicos de pacientes con diagnóstico de tumores músculoesqueléticos atendidos en el Servicio de Ortopedia y Traumatología del Hospital El Cruce desde agosto de 2008 hasta junio de 2017. Se utilizaron los criterios de Ennekingde comportamiento biológico y resección. RESULTADOS: Se evaluaron 26 pacientes con diagnóstico de tumor benigno lítico activo o agresivo sobre un total de 124 tumores musculoesqueléticos primarios operados. Un paciente se reclasificó como maligno en la resección completa, por lo que se consideraron 25. Se trató de 16 mujeres, 9 varones, edad media 28,4.La localización fue: 13 miembro inferior (1coxal, 7 fémur, 3 tibia y 2 calcáneo), 9 miembro superior (1 húmero, 2 radio, 2 cúbito, 3 metacarpianos y 2 falanges) y 3 columna (1 cervical, 1 torácica y 1 sacra). Un paciente tuvo localización múltiple en la mano. Según Enneking 10 eran activos y 13 agresivos. Histología: 12 Tumores de células gigantes (TCG), 5 condromas, 4 quiste óseo simple, 3 quiste óseos aneurismáticos y 1 hemangioma. La resección fue intralesional en 16, en 3 marginal y en 6 amplia (1 amputación). La media de días de estada fue 7 días (0 a 33), 5 internación en UTI. La reconstrucción se hizo con: Injerto de Banco 7, Injerto de cresta 7, Injerto M.sup 3, Prótesis 2, Peroné vascularizado 2, Sustituto óseo y cemento en 1. Sin reconstrucción en 2. Dos tuvieron adyuvancia con denosumab. Once tuvieron complicaciones. Hubo un óbito. En 18/25 la resección realizada coincidió con los criterios de resección (Enneking). CONCLUSIONES: A pesar de la benignidad histológica, los tumores líticos primarios requirieron procedimientos complejos, con un 40 % de complicaciones. En el 72% la resección realizada concordó con los criterios de resección de Enneking.

INTRODUCTION: Primary bone tumors are rare. The localization, extension and lytic character make the treatment difficult even though the biological behavior is benign. OBJECTIVES: Assess the characteristics and treatments of active or aggressive benign primary lytic bone tumors treated in the El Cruce hospital. Compare the resection made with the one suggested by Enneking criteria. MATERIALS AND METHODS: Clinical records and postsurgical grand rounds were evaluated on patients diagnosed with musculoskeletical tumors treated in the Orthopedics and Traumatology Service of Hospital El Crucefrom August 2008 to June 2017. Enneking's criteria based on biologic behavior and resection were used. RESULTS:Twenty-six patients diagnosed with active or aggressive lytic bone tumor were evaluated out of a total of 124 operated primary musculoskeletal tumors. A patient was reclassified as malignant on the complete resection, therefore 25 were considered. There were 16 women, 9 men; average age was 28.4.The tumor localization was: 13 in lower extremity (1 coxal, 7 femoral, 3 tibial and 2 in calcaneus), 9 in upper extremity (1 humeral, 2 radial, 2 ulnar, 3 metacarpal y 2 in phalanges) and 3 in spine (1 cervical, 1 thoracic y 1 sacral). A patient had multiple localizations in his hand. Based on Enneking, 10 were active and 13 were aggressive. Histology: 12 giant-cell tumors (GCT), 5 chondromas, 4 simple bone cysts, 3 aneurysmal bone cysts and 1 hemangioma. The resection was intralesional in 16, marginal in 3 and ample in 6 (1 amputation). Mean hospitalization stay was 7 days (0 to 33), 5 days in ICU. The reconstruction was made with: draft from banks in 7, drafts from crests in 7, draft from upper extremity in 3, prosthesis in 2, vascularized fibula in 2, bone substitute and cement in 1. No reconstruction in 2.Two had adjuvant therapy with denosumab. Eleven had complications. There was one death. In 18 out of 25, the resection matched the resection criteria (Enneking). CONCLUSIONS: Despite the histological benignity, primary lytic tumors required complex procedures and there were 40% complications. In72%, the resection matched the resection criteria (Enneking).