Hand and foot osteosarcoma represents ~1% of all diagnosed cases of osteosarcoma. The rarity of osteosarcoma of the hand and foot leads to frequent misdiagnosis, delayed diagnosis or incorrect treatments, which can lead to fatal consequences. Typically, salvaging the affected limb is the treatment of choice, and with the use of chemotherapy, 60-65% of patients with osteosarcoma can be treated without amputation. Due to its rarity, misdiagnosis and treatment delays are common, yet detailed reviews and analyses of such cases are limited. The present retrospective cohort study aimed to review and analyze cases of osteosarcoma located in the hand and foot. From January 2007 to January 2019, 11 patients were treated at the Masaryk Memorial Cancer Institute Sarcoma Center (Brno, Czechia), 5 cases affected the hand and 6 affected the foot. A total of 6 male patients and 5 female patients, with a mean age of 30.9±16.74 years, were diagnosed with hand or foot osteosarcoma. The mean follow-up period was 90.36±66.14 months. The mean tumor size detected during diagnosis was 4.29±1.81 cm. Osteoblastic osteosarcoma was the most common histopathological type, accounting for 4 cases (33.4%). A majority of the osteosarcomas were identified as high grade (81.8%). A total of 5 patients experienced misdiagnoses following their initial biopsy, with 2 patients initially receiving treatment outside the Masaryk Memorial Cancer Institute Sarcoma Center. The most frequently encountered misdiagnosis was giant-cell tumor of the bone. A total of 3 patients underwent limb amputation and 2 patients developed lung metastasis and succumbed to the disease. The disease-free survival period and overall survival rate were calculated using Kaplan-Meier survival analysis. The mean disease-free survival period was 82.83±60.05 months, while the overall survival rate was 72%, with a mean survival time of 90.36±56.73 months. In summary, an examination of a case series involving 11 patients diagnosed with osteosarcoma of the hand and foot was conducted. The treatment approach, clinical characteristics and patient outcomes were described. A total of four case studies of patients with osteosarcoma in the hand or foot were presented. Misdiagnosis of this disease may result in the inappropriate treatment being administered to patients, therefore, the correct and rapid diagnosis of disease is necessary for effective treatment of hand and foot osteosarcomas.

• Publikační typ
• časopisecké články MeSH

Giant cell tumour of bone (GCTB) is one of the most common local aggressive tumourous lesions with a wide variety of biological behaviour. However, there are no clear indicative criteria when choosing the type of procedure and the complication rates remain high, especially in terms of local recurrence. The purpose of the study was to (1) identify the main risk factors for local recurrence, (2) evaluate the recurrence-free survival in dependence on neoadjuvant denosumab use and the type of procedure, and (3) compare the functional outcomes after curettage and en bloc resection. The group included 102 patients with GCTB treated between 2006 and 2020. The mean age of patients was 34.4 years (15-79). The follow-up period was 8.32 years (2-16) on average. Local recurrence occurred in 14 patients (29.8%) who underwent curettage and in 5 patients (10.6%) after en bloc resection. Curettage was shown to be a factor in increasing recurrence rates (OR = 3.64 [95% CI: 1.19-11.15]; p = 0.023). Tibial location was an independent risk factor for local recurrence regardless of the type of surgery (OR = 3.22 [95% CI: 1.09-9.48]; p = 0.026). The recurrence-free survival rate of patients treated with resection and denosumab was higher compared to other treatments at five years postoperatively (p = 0.0307). Functional ability and pain as reported by patients at the latest follow-up were superior after curettage compared to resection for upper and lower extremity (mean difference: -4.00 [95% CI: -6.81 to -1.18]; p < 0.001 and mean difference: -5.36 [95% CI: -3.74 to -6.97]; p < 0.001, respectively). Proximal tibia tumour location and curettage were shown to be major risk factors for local recurrence in GCTB regardless of neoadjuvant denosumab treatment. The recurrence-free survival rate of patients treated with resection and denosumab was higher compared to other treatments. The functional outcome of patients after curettage was better compared to en bloc resection.

• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The preferred treatment of giant cell tumor of bone is curettage with the use of local adjuvant. If the tumor spreads beyond the bone into soft tissues, en bloc excision should be performed. Intralesional curettage allows joint preservation, but it is associated with a high recurrence rate. The purpose of the study was to identify the risk factors for local recurrence and to compare the functional outcomes after both types of surgical procedures. MATERIAL AND METHODS The group included 16 patients (5 women, 11 men) with giant cell tumor of bone in distal forearm treated at the First Department of Orthopedic Surgery, St. Anne s University Hospital Brno in 2005-2019. The mean age of patients was 38 years (22-53). The follow-up period was 6.75 years (2-15) on average. The most common location of the tumor was distal radius (14). In 6 patients denosumab treatment was indicated. Based on the obtained data, we compared the effects of gender, Campanacci grade, type of surgery and administration of denosumab on the risk of local recurrence. The functional outcomes were evaluated retrospectively based on the Musculoskeletal Tumor Society scoring system for upper limb salvage surgeries. RESULTS Resection and reconstruction using an osteocartilaginous allograft was performed in 9 patients. Seven patients were treated with tumor curettage with bone cement used to fill the cavity. The group of patients who underwent curettage showed a significantly higher mean MSTS score 89% compared to the group of patients with resection with the mean MSTS score 66% (P < 0.05). Local tumor recurrence was reported in 3 patients (18.75%). No statistically significant difference was found in gender, tumor grade, radicality of surgery or administration of targeted therapy with respect to the incidence of local recurrence. Altogether 6 complications (37.5%) were observed in the group. DISCUSSION The treatment of a giant cell tumor of bone aims to completely remove the tumor and to preserve the best possible function of the limb. The complications in distal forearm involve particularly an increase incidence of local recurrence and painful or limited range of motion of the wrist. Whereas curettage with the use of local adjuvant is burdened with a higher recurrence rate, resection with allograft reconstruction of bone defect is usually associated with poorer functional outcomes. CONCLUSIONS Tumor curettage using local adjuvant is preferred in a well-circumscribed tumor and offers an excellent functional outcome. En bloc tumor resection and reconstruction using an osteocartilaginous allograft is a suitable treatment option for a locally advanced tumor with a low risk of local recurrence. Key words: giant cell tumor of bone, distal radius, distal ulna, curettage, osteocartilaginous allograft.

• MeSH
• denosumab MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory kostí * patologie   MeSH
• následné studie MeSH
• obrovskobuněčný nádor kosti * patologie   chirurgie   MeSH
• radius chirurgie   MeSH
• retrospektivní studie MeSH
• ulna patologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The purpose of this study was to evaluate the implant survival, functional score and complications of intercalary endoprostheses implanted for metastatic involvement of the femoral and humeral diaphysis. METHODS: The selected group covered patients with bone metastasis who were surgically treated with an intercalary endoprosthesis between 2012 and 2021. The functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system, and complications were evaluated by using the failure classification for prosthetics designed by Henderson. RESULTS: The mean follow-up was 29.8 months. In our group of 25 patients with 27 intercalary endoprostheses (18 femurs, 9 humeri), there were 7 implant-related complications (25.9%), which were more common on the humerus (4 cases, 44.4%) than on the femur (3 cases, 16.7%). Only type II failure-aseptic loosening (5 cases, 18.5%)-and type III failure-structural failure (2 cases, 7.4%)-occurred. There was a significantly higher risk of aseptic loosening of the endoprosthesis in the humerus compared with that in the femur (odds ratio 13.79, 95% confidence interval 1.22-151.05, p = 0.0297). The overall cumulative implant survival was 92% 1 year after surgery and 72% 5 years after surgery. The average MSTS score was 82%. The MSTS score was significantly lower (p = 0.008) in the humerus (75.9%) than in the femur (84.8%). CONCLUSIONS: The resection of bone metastases and replacement with intercalary endoprosthesis has excellent immediate functional results with an acceptable level of complications in prognostically favourable patients.

• MeSH
• diafýzy chirurgie   MeSH
• femur chirurgie   MeSH
• humerus chirurgie   MeSH
• lidé MeSH
• nádory femuru * chirurgie   MeSH
• nádory kostí * chirurgie   MeSH
• pooperační komplikace MeSH
• protézy a implantáty MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Giant-cell tumor of bone (GCTB) is an intermediate type of primary bone tumor characterized by locally aggressive growth with metastatic potential. The aim of this study was to identify new druggable targets among the cell signaling molecules involved in GCTB tumorigenesis. Profiles of activated signaling proteins in fresh-frozen tumor samples and tumor-derived cell lines were determined using phosphoprotein arrays. Analysis of the obtained data revealed epidermal growth factor receptor (EGFR) and platelet-derived growth factor receptor beta (PDGFRβ) as potential targets, but only the PDGFR inhibitor sunitinib caused a considerable decrease in stromal cell viability in vitro. Furthermore, in the case of a 17-year-old patient suffering from GCTB, we showed that the addition of sunitinib to the standard treatment of GCTB with the monoclonal antibody denosumab resulted in the complete depletion of multinucleated giant cells and mononuclear stromal cells in the tumor tissue. To summarize, the obtained data showed that a specific receptor tyrosine kinase (RTK) signaling pattern is activated in GCTB cells and plays an important role in the regulation of cell proliferation. Thus, activated RTKs and their downstream signaling pathways represent useful targets for precision treatment with low-molecular-weight inhibitors or with other types of modern biological therapy.

• Publikační typ
• časopisecké články MeSH

Úvod: Cílem práce bylo zjistit rizikové faktory ovlivňující prognózu maligního fibrózního histiocytomu. Materiál a metody: Autoři hodnotili 43 nemocných s MFH z období 2001–2008 v průměrném věku 59 let (18–80). Doba sledování byla v průměru 2,8 let. Výsledky: V souboru přežilo 5 let od zahájení léčby 13 nemocných (58 %). Po široké resekci přežilo 77 % nemocných, po marginální resekci 58 %. Nemocní pod 60 let přežili v 73 %, nad 60 let ve 43 %. Při povrchové lokalizaci přežilo 100 % nemocných, při hluboké lokalizaci jen 52 %. Nemocní s histologickým stupněm I a II přežili v 73 %, se stupněm III v 46 %. Nemocní s velikostí tumoru do 8 cm v průměru přežili v 79 %, u velikosti nad 8 cm jen 36 %. Při přítomné metastáze bylo 5leté přežití ve 20 % a u nepřítomné metastázy v 63 %. Diskuze: Autoři považují za rizikový faktor přežití věk nad 60 let, marginální resekci, hlubokou lokalizaci tumoru, histologický stupeň III, velikost tumoru nad 8 cm v průměru a přítomnost metastázy v době stanovení diagnózy.

Introduction: The purpose of the study was to determine the risk factors influencing the prognosis of malignant fibrous histiocytoma. Material and methods: 43 MFH patients in the mean age of 59 years (18-80) from the period 2001-2008 were included in the study. The mean follow-up was 2.8 years. Results: Thirteen patients (58%) survived 5 years after surgery. 77% of patients survived after wide resection and only 58% after marginal resection. The survival rate was 73% and 43% in patients under 60 years of age at the start of treatment, and in patients over 60 years, respectively, and 100% in patients with surface localisation and only 52% in patients with deep localisation. The survival rate in patients with histological grade I and II was 73%, and 46% in patients with grade III. 79% of patients with the size of the tumour under 8cm in the diameter, and 36% of patients with tumour diameter exceeding 8cm survived. Survival rate in patients with metastasis at the time of the start of treatment was 20%, while in patients without metastasis the survival rate was 63%. Discussion: The authors have found the following risk factors of malignant fibrous histiocytoma survival: age over 60 years, marginal resection, deep localisation, histological grade III, size of the tumour exceeding 8cm, and the presence of metastasis at the time of diagnosis.

• MeSH
• chirurgie operační metody   MeSH
• dospělí MeSH
• Kaplanův-Meierův odhad MeSH
• kombinovaná terapie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• maligní fibrózní histiocytom mortalita   patologie   terapie   MeSH
• metastázy nádorů MeSH
• míra přežití MeSH
• mladý dospělý MeSH
• nádory měkkých tkání MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• staging nádorů statistika a číselné údaje   MeSH
• statistika jako téma MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH