Radiologists utilize pictures from X-rays, magnetic resonance imaging, or computed tomography scans to diagnose bone cancer. Manual methods are labor-intensive and may need specialized knowledge. As a result, creating an automated process for distinguishing between malignant and healthy bone is essential. Bones that have cancer have a different texture than bones in unaffected areas. Diagnosing hematological illnesses relies on correct labeling and categorizing nucleated cells in the bone marrow. However, timely diagnosis and treatment are hampered by pathologists' need to identify specimens, which can be sensitive and time-consuming manually. Humanity's ability to evaluate and identify these more complicated illnesses has significantly been bolstered by the development of artificial intelligence, particularly machine, and deep learning. Conversely, much research and development is needed to enhance cancer cell identification-and lower false alarm rates. We built a deep learning model for morphological analysis to solve this problem. This paper introduces a novel deep convolutional neural network architecture in which hybrid multi-objective and category-based optimization algorithms are used to optimize the hyperparameters adaptively. Using the processed cell pictures as input, the proposed model is then trained with an optimized attention-based multi-scale convolutional neural network to identify the kind of cancer cells in the bone marrow. Extensive experiments are run on publicly available datasets, with the results being measured and evaluated using a wide range of performance indicators. In contrast to deep learning models that have already been trained, the total accuracy of 99.7% was determined to be superior.
Úvod: Mnohočetný myelom (MM) je nádorové onemocnění způsobené klonální proliferací plazmatických buněk v kostní dřeni. Věkový medián nově diagnostikovaných pacientů je 69 let. Kostní forma tohoto onemocnění se objeví u většiny pacientů v průběhu nemoci. Součástí léčby je i chirurgické řešení kostní formy MM. Kost postižená osteolytickými ložisky je oslabena a vyžaduje stabilizaci pomocí implantátu či endoprotézy. Jako ideální volba pro stabilizaci osteolytických ložisek dlouhých kostí se jeví metoda nitrodřeňové osteosyntézy. Cílem naší studie bylo analyzovat, zda profylaktická fixace těchto ložisek přináší zlepšení kvality života pacientů a ovlivňuje kostní změny. Metody: Hodnocení pacienti s profylaktickou intramedulární osteosyntézou byli operováni na Klinice úrazové chirurgie ve Fakultní nemocnici Brno mezi lety 2013 až 2023. Pacienti zahrnutí do této studie měli osteolytická ložiska dlouhých kostí, Mirelsovo skóre rovno nebo větší než 8 a minimální délku sledování 12 měsíců. Hodnotili jsme intenzitu bolesti prostřednictvím vizuální analogové škály (VAS) udávanou v době před provedenou operací, po operaci a v odstupu jednoho roku od operace. U pacientů bylo sledováno The Musculoskeletal Tumour Society score (MSTS) skóre těsně před plánovanou stabilizací a po roce od ní. Výsledky: V čase hodnocení byl nalezen statisticky významný rozdíl mezi hodnou VAS před operací a 14 dní po operaci (p<0,001), stejně tak mezi VAS před operací a rok po operaci (p<0,001). I porovnání MSTS skóre před operací a rok po operaci vyšlo jako statisticky významné (p=0,006). Závěr: Profylaktická nitrodřeňová stabilizace osteolytických ložisek u pacientů s MM je účinná metoda, která snižuje bolest a zlepšuje kvalitu života těchto pacientů.
Introduction: Multiple myeloma (MM) is a neoplastic disease caused by clonal proliferation of plasma cells in the bone marrow. The median age of newly diagnosed patients is 69 years. Bone involvement occurs in most patients during the course of the disease. The management of bone involvement in MM includes surgical intervention. Bones affected by osteolytic lesions are weakened and require stabilization through implants or endoprostheses. The intramedullary osteosynthesis method appears to be an ideal choice for stabilizing osteolytic lesions in long bones. The aim of our study was to analyze whether prophylactic fixation of these lesions improves the quality of life of the patients and has any impact on bone changes. Methods: Patients undergoing prophylactic intramedullary osteosynthesis were operated on at the University Hospital Brno between 2013 and 2023. Patients included in this study had osteolytic lesions in long bones, Mirels’ score equal to or greater than 8, and a minimum follow-up of 12 months. We evaluated the intensity of pain using a visual analog scale (VAS) assessed before the operation, after the operation, and one-year post-operation. The Musculoskeletal Tumour Society score (MSTS) score was assessed just before the planned stabilization procedure and one year later. Results: At the time of the assessment, a statistically significant difference was found between the VAS score before the operation and 14 days post-operation (p<0.001), as well as between the VAS score before the operation and one-year post-operation (p<0.001). The comparison of MSTS scores before the operation and one-year post-operation also showed statistical significance (p=0.006). Conclusion: Prophylactic intramedullary stabilization of osteolytic lesions in MM patients is an effective method that reduces pain and improves the quality of life for these patients.
- Klíčová slova
- nitrodřeňová stabilizace,
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů MeSH
- mnohočetný myelom * komplikace terapie MeSH
- nádory kostí * chirurgie diagnostické zobrazování sekundární MeSH
- profylaktické chirurgické výkony MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
Calcified chondroid mesenchymal neoplasm is a term proposed for tumors with a spectrum of morphologic features, including cartilage/chondroid matrix formation, that frequently harbor FN1 gene fusions. We report a series of 33 cases of putative calcified chondroid mesenchymal neoplasms, mostly referred for expert consultation out of concern for malignancy. Patients included 17 males and 16 females, with a mean age of 51.3 years. Anatomic locations include the hands and fingers, feet and toes, head and neck, and temporomandibular joint; 1 patient presented with multifocal disease. Radiologic review showed soft tissue masses with variable internal calcification, which occasionally scalloped bone but in all cases appeared indolent/benign. Tumors had a mean gross size of 2.1 cm and a homogenous rubbery to fibrous/gritty tan-white cut surface. Histology demonstrated multinodular architecture with a prominent chondroid matrix and increased cellularity towards the periphery of the nodules. The tumor cells were polygonal with eccentric nuclei and bland cytologic features and showed a variable amount of increased spindled / fibroblastic forms in the perinodular septa. The majority of cases had notable grungy and/or lacy calcifications. A subset of cases demonstrated at least focal areas of increased cellularity and osteoclast-like giant cells. Herein, we confirm the distinct morphologic and clinicopathologic features associated with this entity with the largest series to date, with a focus on practical diagnostic separation from similar chondroid neoplasms. Awareness of these features is critical in avoiding pitfalls, including a malignant diagnosis of chondrosarcoma.
- MeSH
- chondrosarkom * patologie MeSH
- chrupavka patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory kostí * diagnostické zobrazování genetika patologie MeSH
- nádory z pojivové a měkké tkáně * diagnostické zobrazování genetika MeSH
- prsty nohy patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Osteoid osteoma is a primary benign bone tumor with rare intra-articular occurrence. Our case report describes a rare case of a 21-year-old man with long-term severe pain in the right hip region caused by osteoid osteoma managed by arthroscopic excision. The clinical finding of pains and a limited range of motion did not correlate with the normal plain X-ray finding. The osteoid osteoma was suspected based on the CT scan. In literature, several methods of resection of intraarticular osteoid osteoma of the hip are described. Since our department has long specialised in arthroscopic hip surgery and based on the available examinations the tumor appeared to be located within the arthroscopic reach, we decided for arthroscopic resection of the tumor. Our study comprises a detailed description of the entire surgical procedure, the used arthroscopic approaches and the arthroscopic technique of tumor excision. The histological examination of samples taken from the mass confirmed the suspected osteoid osteoma. The success of arthroscopic excision of the tumor was later confirmed also by very positive postoperative recovery when the patient very soon experienced a considerable reduction of pain observed during our five-year follow-up of the patient (Day 13, Week 2 and 6, Year 1, 2 and 5). During the follow-up period, an increase of the Harris Hip Score (13.5 preoperatively vs 76.6/91/94/96/96 postoperatively) and a decrease in VAS (9 preoperatively vs. 3/1/1/1/1) were reported. The follow-up CT and MRI performed at 2 or 5 years after surgery did not show tumor recurrence. The case report includes also illustrations consisting of X-rays, CT and MRI scans before and after surgery as well as multiple scans taken intraoperatively. It has to be emphasized that this is a rare case and an evaluation of a larger group of patients would be necessary to verify the successful outcomes of arthroscopic technique in treatment of the hip joint osteoid osteoma.
- MeSH
- bolest MeSH
- dospělí MeSH
- hlavice femuru MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- mladý dospělý MeSH
- nádory kostí * diagnostické zobrazování chirurgie MeSH
- osteom osteoidní * diagnostické zobrazování chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
64letý pacient byl odeslán na scintigrafii skeletu k určení stadia nádoru prostaty v březnu 2021. Pacientovi byl v únoru 2021 diagnostikován karcinom prostaty. Byla provedena transrektální biopsie, Gleason skóre bylo 9 4,5, histologicky se jednalo o invazivní acinární adenokarcinom. Scintigrafie byla provedena 3 hodiny po aplikaci 800 MBq 99mTc-HDP na gama kameře Optima s kolimátorem LEHR. Na celotělovém a SPECT obraze byla patrná vícečetná ložiska patologicky zvýšené kostní přestavby ve skeletu. (Obr. 1A) Při zobrazení metodou SPECT/ldCT byla upřesněna lokalizace v páteři do obratle L1 v pravé polovině těla. (Obr. 2A) Na doprovodném ldCT nebyly v této lokalitě patrné žádné patologické změny kostní tkáně. (Obr. 2B) Vzhledem k celkovému klinickému stavu a generalizaci nebyla indikovaná prostatektomie, byla zahájena antiandrogenní hormonální léčba (Zoladex) a léčba bifosfonáty (Zometa). Na kontrolní scintigrafii v prosinci téhož roku byla prokázaná progrese choroby. (Obr. 1B) Při opakovaném SPECT/ldCT páteře již bylo na ldCT patrné sklerotické ložisko v místě zvýšené kostní přestavby (Obr. 3A), které se scintigraficky jevilo stejně jako v březnu. (Obr. 3B) Naše zkušenost tedy potvrzuje, že scintigraficky je možné detekovat přítomnost metastáz dříve než pomocí rentgenových metod, a to nejen při skiagrafii, ale také při CT vyšetření.
64-y-old man was sent to our department for bone scan due to a staging of a prostate cancer on March 2021. Prostate cancer was diagnosed on February. Transrectal biopsy was performed, Gleason score 9 4,5 was determined, invasive acinar adenocarcinoma was diagnosed on histology. We performed a scintigraphy 3 hours after injection of 800 MBq of 99mTc-HDP using a gamma camera Optima with a LEHR collimator. We detected multiple foci of increased bone metabolic turnover on a whole-body and SPECT bone scan. (Fig. 1A) SPECT/ldCT more precisely localized one focus to the right half of L1 vertebral body. (Fig. 2A) The bone structure was normal at this location on a corresponding ldCT scan. (Fig. 2B) No prostatectomy was indicated due to a clinical situation; antiandrogen hormonal therapy was started (Zoladex) together with treatment with phosphonates (Zometa). The patient was sent to a follow-up scan, it was performed on December of the same year. Progression was evident on this scan. (Fig. 1B) There was a new osteosclerotic lesion on the corresponding ldCT at the site of increased metabolic turnover (Fig. 3A) which was scintigraphically the same as on March. (Fig. 3B) Our experience, thus, confirm earlier detection of bone metastases in comparison to radiological procedures, not only using X-ray, but also using CT.
- MeSH
- časná detekce nádoru MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů diagnostické zobrazování MeSH
- nádory kostí * diagnostické zobrazování sekundární MeSH
- nádory prostaty diagnóza terapie MeSH
- radioisotopová scintigrafie * metody MeSH
- tomografie emisní počítačová metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The hand is an extremely rare site for giant cell tumor (GCT). There are only a few reported cases of GCT including the hand, and even fewer reporting involvement of phalanges. GCTs in small bones are typically more aggressive and have higher local recurrence and rate of metastasis in younger patients compared to long bone involvement, so the treatment is more clinically challenging in the hand. In this study, we present the management of giant cell tumors of the proximal phalanxin two patients treated with two different method; ray resection and arthrodesis using an iliac crest graft. Key words: giant cell tumor, phalanx, hand, recurrence.
- MeSH
- artrodéza MeSH
- kosti prstů ruky * diagnostické zobrazování chirurgie patologie MeSH
- lidé MeSH
- nádory kostí * diagnostické zobrazování chirurgie MeSH
- obrovskobuněčný nádor kosti * diagnostické zobrazování chirurgie patologie MeSH
- ruka MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
INTRODUCTION: Temporal bone chondroblastoma is a rare, locally aggressive tumour originating from immature cartilage, which recurs to a high degree. Treatment is surgical. Radiotherapy is reserved for recurrence. We describe a case of a 15-year-old-boy choosing a conservative surgical approach with reconstruction of the posterior canal wall. This study aims to report a rare pediatric case. METHODS: A literature review was performed to better understand temporal bone chondroblastomas, to describe their histopathological and radiological characteristics and to establish the optimal surgical and non-surgical treatments. The research of previous published data was done using PubMed with keywords mentioned below. RESULTS: Authors present a case of a 15-year-old boy with hearing impairment and facial nerve palsy. Conservative surgery with reconstruction of the tympanic membrane and posterior wall of the external auditory canal, restoring the hearing has been performed. We did not administer any adjuvant therapies. No sign of recurrence was observed 1 year after primary surgery. Facial nerve function is normal, and hearing is satisfactory. CONCLUSION: Chondroblastomas account for less than 1% of primary bone tumours. Temporal bone chondroblastoma is rare, locally aggressive, with a high prevalence of recurrence. This study describes specific histopathological and radiological findings, the chosen surgical approach and follow-up to improve the management and the prognosis of patients affected with this particular clinical entity.
- MeSH
- chondroblastom * diagnostické zobrazování chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mladiství MeSH
- nádory kostí * diagnostické zobrazování chirurgie MeSH
- radiografie MeSH
- spánková kost diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
BACKGROUND: Chondrosarcomas of the small bones of the hands and feet are uncommon and account for less than 2% of all chondrosarcomas in the skeleton; a 4.2% rate of malignant degeneration of enchondromas to secondary chondrosarcomas has been reported. We performed this study to assess the outcome of the patients with chondrosarcomas of the small bones. We hypothesized that the presumed better prognosis of chondrosarcomas in these locations could be biased as the majority of these tumors tend to be of lower grades and are removed when still small sized, and that less aggressive surgery has an adverse effect on local control MATERIALS AND METHODS: We retrospectively studied the files of 44 patients with chondrosarcomas of the small bones of the hands and feet. There were 23 female and 21 male patients with a mean age of 50.9 years (range, 6-86 years). The mean follow-up was 13 years (range, 5-40 years). We recorded the patients' details including gender and age at diagnosis, type and duration of symptoms, tumor location and histology, type of surgery and complications, and outcome (local recurrences and metastases). RESULTS: The most common anatomical location for chondrosarcomas of the hands was the metacarpals and proximal phalanges. The most common presenting symptom was a slowly enlarging palpable mass. Overall, 36 chondrosarcomas were secondary to a pre-existing cartilaginous tumor. Patients with syndromes were affected in younger age compared to the others. The mean age at diagnosis was higher for higher grade chondrosarcomas. Overall, 13 patients (29.5%) experienced a local recurrence; the rate of local recurrence was higher after curettage regardless the histological grade of the tumors. After wide resection of the first local recurrence, five patients experienced local re-recurrence. Five patients (11.4%) experienced lung metastases, two patients at presentation. All these patients had a high grade chondrosarcomas. At the last follow-up, one patient with lung metastases died from disease, and another patient died from unrelated cause. CONCLUSIONS: The patients with chondrosarcomas of the small bones of the hands and feet may have a dismal outcome if treated improperly. A careful treatment planning is required to avoid unnecessary amputations. Curettage is associated with a high rate for local recurrence that should be treated with a more aggressive surgical resection to avoid re-recurrences. Although the risk is low, the patients may develop lung metastases, especially those with higher grade chondrosarcomas, therefore, they should be staged and followed closely.
- MeSH
- chondrosarkom * diagnostické zobrazování chirurgie MeSH
- kyretáž MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory kostí * diagnostické zobrazování chirurgie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Local treatment of pelvic Ewing's sarcoma may be challenging, and intergroup studies have focused on improving systemic treatments rather than prospectively evaluating aspects of local tumor control. The Euro-EWING99 trial provided a substantial number of patients with localized pelvic tumors treated with the same chemotherapy protocol. Because local control included surgical resection, radiation therapy, or a combination of both, we wanted to investigate local control and survival with respect to the local modality in this study cohort. QUESTIONS/PURPOSES: (1) Do patients with localized sacral tumors have a lower risk of local recurrence and higher survival compared with patients with localized tumors of the innominate bones? (2) Is the local treatment modality associated with local control and survival in patients with sacral and nonsacral tumors? (3) Which local tumor- and treatment-related factors, such as response to neoadjuvant chemotherapy, institution where the biopsy was performed, and surgical complications, are associated with local recurrence and patient survival in nonsacral tumors? (4) Which factors, such as persistent extraosseous tumor growth after chemotherapy or extent of bony resection, are independently associated with overall survival in patients with bone tumors undergoing surgical treatment? METHODS: Between 1998 and 2009, 1411 patients with previously untreated, histologically confirmed Ewing's sarcoma were registered in the German Society for Pediatric Oncology and Hematology Ewing's sarcoma database and treated in the Euro-EWING99 trial. In all, 24% (339 of 1411) of these patients presented with a pelvic primary sarcoma, 47% (159 of 339) of which had macroscopic metastases at diagnosis and were excluded from this analysis. The data from the remaining 180 patients were reviewed retrospectively, based on follow-up data as of July 2016. The median (range) follow-up was 54 months (5 to 191) for all patients and 84 months (11 to 191) for surviving patients. The study endpoints were overall survival, local recurrence and event-free survival probability, which were calculated with the Kaplan-Meier method and compared using the log-rank test. Hazard ratios (HRs) with their respective 95% CIs were estimated in a multivariate Cox regression model. RESULTS: Sacral tumors were associated with a reduced probability of local recurrence (12% [95% CI 1 to 22] versus 28% [95% CI 20 to 36] at 5 years, p = 0.032), a higher event-free survival probability (66% [95% CI 51 to 81] versus 50% [95% CI 41 to 58] at 5 years, p = 0.026) and a higher overall survival probability (72% [95% CI 57 to 87] versus 56% [95% CI 47 to 64] at 5 years, p = 0.025) compared with nonsacral tumors. With the numbers available, we found no differences between patients with sacral tumors who underwent definitive radiotherapy and those who underwent combined surgery and radiotherapy in terms of local recurrence (17% [95% CI 0 to 34] versus 0% [95% CI 0 to 20] at 5 years, p = 0.125) and overall survival probability (73% [95% CI 52 to 94] versus 78% [95% CI 56 to 99] at 5 years, p = 0.764). In nonsacral tumors, combined local treatment was associated with a lower local recurrence probability (14% [95% CI 5 to 23] versus 33% [95% CI 19 to 47] at 5 years, p = 0.015) and a higher overall survival probability (72% [95% CI 61 to 83] versus 47% [95% CI 33 to 62] at 5 years, p = 0.024) compared with surgery alone. Even in a subgroup of patients with wide surgical margins and a good histologic response to induction treatment, the combined local treatment was associated with a higher overall survival probability (87% [95% CI 74 to 100] versus 51% [95% CI 33 to 69] at 5 years, p = 0.009), compared with surgery alone.A poor histologic response to induction chemotherapy in nonsacral tumors (39% [95% CI 19 to 59] versus 64% [95% CI 52 to 76] at 5 years, p = 0.014) and the development of surgical complications after tumor resection (35% [95% CI 11 to 59] versus 68% [95% CI 58 to 78] at 5 years, p = 0.004) were associated with a lower overall survival probability in nonsacral tumors, while a tumor biopsy performed at the same institution where the tumor resection was performed was associated with lower local recurrence probability (14% [95% CI 4 to 24] versus 32% [95% CI 16 to 48] at 5 years, p = 0.035), respectively.In patients with bone tumors who underwent surgical treatment, we found that after controlling for tumor localization in the pelvis, tumor volume, and surgical margin status, patients who did not undergo complete (defined as a Type I/II resection for iliac bone tumors, a Type II/III resection for pubic bone and ischium tumors and a Type I/II/III resection for tumors involving the acetabulum, according to the Enneking classification) removal of the affected bone (HR 5.04 [95% CI 2.07 to 12.24]; p < 0.001), patients with a poor histologic response to induction chemotherapy (HR 3.72 [95% CI 1.51 to 9.21]; p = 0.004), and patients who did not receive additional radiotherapy (HR 4.34 [95% CI 1.71 to 11.05]; p = 0.002) had a higher risk of death. The analysis suggested that the same might be the case in patients with a persistent extraosseous tumor extension after induction chemotherapy (HR 4.61 [95% CI 1.03 to 20.67]; p = 0.046), although the wide CIs pointing at a possible sparse-data bias precluded any definitive conclusions. CONCLUSION: Patients with sacral Ewing's sarcoma appear to have a lower probability for local recurrence and a higher overall survival probability compared with patients with tumors of the innominate bones. Our results seem to support a recent recommendation of the Scandinavian Sarcoma Group to locally treat most sacral Ewing's sarcomas with definitive radiotherapy. Combined surgical resection and radiotherapy appear to be associated with a higher overall survival probability in nonsacral tumors compared with surgery alone, even in patients with a wide resection and a good histologic response to neoadjuvant chemotherapy. Complete removal of the involved bone, as defined above, in patients with nonsacral tumors may be associated with a decreased likelihood of local recurrence and improved overall survival. Persistent extraosseous tumor growth after induction treatment in patients with nonsacral bone tumors undergoing surgical treatment might be an important indicator of poorer overall survival probability, but the possibility of sparse-data bias in our cohort means that this factor should first be validated in future studies. LEVEL OF EVIDENCE: Level III, therapeutic study.
- MeSH
- adjuvantní chemoterapie MeSH
- adjuvantní radioterapie MeSH
- časové faktory MeSH
- dítě MeSH
- doba přežití bez progrese choroby MeSH
- dospělí MeSH
- Ewingův sarkom diagnostické zobrazování mortalita patologie terapie MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory kostí diagnostické zobrazování mortalita patologie terapie MeSH
- nádory pánve diagnostické zobrazování mortalita patologie terapie MeSH
- neoadjuvantní terapie MeSH
- novorozenec MeSH
- osteotomie * škodlivé účinky mortalita MeSH
- předškolní dítě MeSH
- randomizované kontrolované studie jako téma MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
- Geografické názvy
- Evropa MeSH
PURPOSE OF THE STUDY Osteoid osteoma is a benign tumor that forms in bone, which accounts for 3% of all primary bone tumors. The classical clinical finding is substantial nocturnal pain and imaging findings. The management of osteoid osteomas include open surgical excision or minimally invasive percutaneous interventions. Why and which treatment modality should be considered between CT-guided radiofrequency ablation and open surgical excision for osteoid osteomas in unusual locations? MATERIAL AND METHODS We retrospectively reviewed 17 patients with osteoid osteomas in unusual locations included cuboid, triquetrum, coronoid process, and proximal phalanx. We evaluated the duration from symptoms to diagnosis, activity related pain, clinical findings, and possible recurrence or complications. The minimum clinical follow-up was 51 ± 34.8 months. RESULTS CT-guided radiofrequency ablation was applied to 3 patients and open surgical excision procedures to 14. All the complaints of patients gone after treatment. No major complications were observed following CT-guided radiofrequency ablation or surgical excision. Transient weakness/paresthesia was determined in 1 patient in the treated shoulder after CT-guided radiofrequency ablation, which resolved spontaneously in the 6th week. There was only recurrence seen in 1 patient, who had 2nd proximal phalangeal osteoid osteoma. Proximal interphalangeal joint arthrodesis was performed after recurred lesion. DISCUSSION The main challenge in management of the osteoid osteomas of the unusual locations are the diagnosis. When we examined the literature, the interval from the beginning of the symptoms to accurate diagnosis did not change over the past decades. Techniques for management of these lesions should be chosen with consideration of the location of the lesion. CONCLUSIONS If there is long-term complaint of undiagnosed limb pain, the physician should suspect osteoid osteoma. However, the selection of treatment modality should be considered according to the location of the lesion. Which management modality is superior may change depending on the location of the lesion between CT-guided radiofrequency ablation and surgical excision. Key words: osteoid osteoma, unusual locations, CT guided, radiofrequency ablation, benign bone tumor.
