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— (A) A graph showing the overall survival to death of patients with haematologic neoplasms of bone. (B) A graph showing the survival to death of patients with primary bone lymphoma, myeloma and plasmacytoma.
Source publication
We report on 205 patients with haematologic neoplasms of bone treated from 1985 to 2009. There were 77 patients with primary bone lymphoma, 77 with myeloma and 51 with plasmacytoma. All patients had medical treatments; 43 patients had wide and 162 intralesional surgery. Mean follow-up was 5 years (median, 3.5 years); 11 patients were lost to follow...
Contexts in source publication
Context 1
... survival to death of patients with hema- tologic neoplasms of bone was 67%, 49% and 37% at 5, 10 and 15 years, respectively (Fig. 1A). At the last follow-up, 99 patients (51%) were nED, 20 patients (10.3%) were AWD, and 75 patients (38.6%) were DWD ; 12 patients with plasmacy- toma (24%) progressed to multiple myeloma at a mean of 2 years (range, 5 months to 5 years) after diagnosis. The 15-year survival to death of patients with primary bone lymphoma was 45%, ...
Context 2
... (10.3%) were AWD, and 75 patients (38.6%) were DWD ; 12 patients with plasmacy- toma (24%) progressed to multiple myeloma at a mean of 2 years (range, 5 months to 5 years) after diagnosis. The 15-year survival to death of patients with primary bone lymphoma was 45%, compared to 35% of patients with myeloma, and 23% of patients with plasmacytoma (Fig. 1B). Overall sur- vival to local recurrence of patients with hemato- logic neoplasms of bone was 91% and 87% at 5 and 10 to 15 years, respectively ( Fig. 2A). Thirteen patients (6.7%) had local recurrence at a mean of 4 years (range, 2 months to 15.5 years) after surgi- cal treatment ; initially, 12 of these patients had intralesional ...
Citations
... Moreover, multiple myeloma (MM), which is the most frequent type of primary bone malignant tumor, can be another rare cause of VP ( Figure 5). Greenleaf et al. described an adolescent patient with VP as the initial presentation of a MM [56], whereas VP is usually observed during follow-up or in diffuse bone involvement ( Figure 6) [58][59][60][61]. Greenleaf et al. described an adolescent patient with VP as the initial presentation of a MM [56], whereas VP is usually observed during follow-up or in diffuse bone involvement ( Figure 6) [58][59][60][61]. ...
... Greenleaf et al. described an adolescent patient with VP as the initial presentation of a MM [56], whereas VP is usually observed during follow-up or in diffuse bone involvement ( Figure 6) [58][59][60][61]. Greenleaf et al. described an adolescent patient with VP as the initial presentation of a MM [56], whereas VP is usually observed during follow-up or in diffuse bone involvement ( Figure 6) [58][59][60][61]. ...
Vertebra plana is a rare radiologic condition characterized by a uniform loss of height of a vertebral body that represents a diagnostic challenge for surgeons. The purpose of this study was to review all possible differential diagnoses that may present with a vertebra plana (VP) described in the current literature. For that purpose, we performed a narrative literature review in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, analyzing 602 articles. Patient demographics, clinical presentation, imaging characteristics and diagnoses were investigated. VP is not a pathognomonic feature of Langerhans cell histiocytosis, but other oncologic and non-oncologic conditions should be considered. The list of differential diagnoses, based on our literature review, can be recalled with the mnemonic HEIGHT OF HOMO: H—Histiocytosis; E—Ewing’s sarcoma; I—Infection; G—Giant cell tumor; H—Hematologic neoplasms; T—Tuberculosis; O—Osteogenesis imperfecta; F—Fracture; H—Hemangioma; O—Osteoblastoma; M—Metastasis; O—Osteomyelitis, chronic.
... In metastatic patients, the diagnoses of the primary tumor were: breast cancer (13), lung cancer (9), multiple myeloma (6), renal cancer (6), urothelial cancer (3), hepatocarcinoma (2), gastrointestinal cancer (2), and endometrial cancer, prostate cancer, pancreas cancer, Merkel's cells carcinoma, and cholangiocarcinoma in one each. We decided to include patients with multiple myeloma because they can be comparable to metastatic bone patients regarding treatment strategies and outcomes (24). The patient with post-radiation fracture was treated 3 years before with excision and two cycles of adjuvant radiotherapy for a liposarcoma of the thigh. ...
Purpose
The aim of this study is to compare titanium vs carbon fiber intramedullary (IM) nailing in terms of response to radiotherapy, local control of the disease, time of surgery, fluoroscopy exposure, and complications.
Methods
From 2015 to 2021, 52 impending or pathologic fractures were treated with IM nailing in 47 patients: 18 males and 29 females with a mean age of 73. Titanium nails were used in 27 cases: femur (17 cases), humerus (8 cases), and tibia (2 cases). Carbon fiber nails were used in 25 cases: femur (17 cases), humerus (7 cases), and tibia (1 case).
Results
At a mean follow-up of 8.4 months, most patients died from the disease (63.4%). Fracture healing without osteolysis progression was present in 52% of titanium nailing at a mean time of 6 months and in 53% of carbon fiber nails at a mean time of 4.6 months. No statistically significant difference has been shown in terms of healing ( P = 0.5), intraoperative fluoroscopy ( P = 0.7), and time of surgery in femoral nailing ( P = 0.6), while a significantly lower surgical time for carbon fiber humeral nailing ( P = 0.01) was found. Two breakages of carbon fiber femoral nails were observed, and both were treated with revision with modular tumor megaprosthesis.
Conclusions
Our results suggest that surgical time and fluoroscopy exposure are not longer for carbon fiber nails compared to titanium ones. Healing seems to be faster in carbon fiber nails. Further clinical studies are needed to clarify the long-term outcomes of these implants.
... Kom pli ka cje po ope ra cyj ne do ty czy ły 11% cho rych i wszyst kie udało się roz wią zać. Wy ni ki le cze nia ope ra cyj ne go są zna mien ne lep sze niż le cze nia wy łącz nie z uży ciem ra dio te ra pii i che mio te ra pii, gdzie 5 i 10-let nie przeży cia ob ser wu je się u 47-88% cho rych [36]. ...
... Postoperative complications occurred in 11% of the patients and were all resolved. Surgical outcomes are significantly better than the outcomes of radio therapy and chemotherapy alone, where 5-and 10-year survival rates were 47-88% [36]. Dosoretz points out that relapse in the form of generalized disease occurs in 50% of patients after bone lymphoma radiotherapy. ...
Background:
Primary bone lymphomas are very rare. The diagnosis is based on a histopathological examination and imaging studies where other disease foci should be excluded. The lymphomas are most often found in the axial skeleton, pelvis, femur and humerus. The tumour causes extensive lytic bone destruction with soft tissue infiltration. Surgical treatment is currently not used routinely. The aim of this study was to present five clinical cases and their most characteristic imaging features.
Material and methods:
Over the last three years, 1327 patients with bone tumours have been hospitalized in the Oncological Orthopaedics Department in Brzozów, and most of these tumours (1184) were metastatic cancers. A total of 57 primary malignant bone tumours were diagnosed, of which five fulfilled the diagnostic criteria of primary bone lymphomas. Patient age and tumour sites varied. All the tumours were large, infiltrated soft tissues and caused osteolysis. No periosteal reactions or sequesters were observed. Two patients were treated surgically by radical resection and implantation of a prosthesis. The indication for surgery was tumour location enabling R0 resection. All patients received chemotherapy and radiotherapy. They have been followed up at the haematological and orthopaedic clinics. There is currently no evidence of generalized disease.
Results:
The most characteristic feature of bone lymphomas is extensive osteolysis with soft tissue infiltration. The absence of false capsules helps distinguish lymphomas from sarcomas. No bone sequesters or osteosclerotic lesions described in the literature were observed in imaging examinations at our centre. Discussion. Diagnosis of a primary bone lymphoma is difficult as the tumour often resembles metastatic lesions. Secondary bone involvement is particularly difficult to differentiate from multifocal lymphoma. The Coley criteria are useful in diagnosis. If radical resection is possible, surgical treatment significantly improves prognosis. Radiotherapy has been associated with frequent recurrences of generalized disease and it is postulated that it should only be employed in palliative patients.
Conclusions:
1. Primary bone lymphomas are rare tumours. 2. Imaging studies characteristically show extensive lytic bone destruction with soft tissue infiltration. 3. No sclerotic lesions or periosteal reactions were observed. 4. Surgical treatment should be performed when radical tumour resection is possible.
... Marshall et al. [9] state that surgery in patients with primary lymphoma of bone is indicated for biopsy, prophylactic fixation of impending fractures, treatment of fractures before or after radiotherapy and systemic therapy, and theoretically in patients with disease unresponsive to conventional therapy (radiotherapy and chemotherapy). A recent paper by Mavrogenis et al. [22] emphasises data that could contradict this statement: they report better survival in patients affected by primary bone lymphoma who were surgically treated with a wide-margin excision in comparison with intralesional surgery, but among patients affected by this disease, the authors's review addressed only those who underwent surgery and not the entire population. Nonetheless, their report is to be considered and warrants further investigation. ...
Primary bone lymphoma is a rare disease. Little is reported about surgical procedures in these patients. We evaluated a single-centre consecutive series of 21 patients for results, prognostic factors and surgical treatment.
Patient ages ranged from 19 to 82 years. The most frequently affected site was the spine (six cases), followed by the ileum, femur and mandible (three cases each). Four patients were treated with chemotherapy and 17 with chemotherapy and radiation therapy. Six patients were affected by a pathological fracture. Surgery was performed in four patients (19 %), in two cases before chemotherapy, in one case during chemotherapy and in one case after chemotherapy and radiotherapy. Five patients died within the range of three to 36 months after diagnosis. Average follow-up of the remaining patients was 62.8 (19-145) months.
Overall survival was 74.2 % at five years. The only positive prognostic factor was complete remission after chemotherapy. A trend for better survival was present for International Prognostic Index (IPI) score (P = 0.051), under 40 years of age (P = 0.10) and abnormal lactate dehydrogenase (LDH) values (P = 0.10), but it did not reach statistical significance.
Surgical treatment should be aimed at restoring function and eliminating pain while minimising delays in the chemotherapy schedule. When feasible, postponing surgery until after chemotherapy is advisable.
... Local radiation is recommended, and additional systemic chemotherapy seems to be effective [6]. Recently, Mavrogenis and al [7], reported the role of surgery for heamatologic neoplasms of bone about 205 patients treated from 1985 to 2009, the survival to death was improved after wild resection for lymphoma and plasmacytoma. But no statistical difference was noted in survival to local recurrence between wide and intralesional surgery. ...
Tumors of chest wall represent a variant entity. Most of them arise from metastasis of malignant tumors or from local invasion by contiguity. However, non-Hodgkin's lymphomas of the chest wall are extremely rare; only a few cases have been reported in the literature. We report a case about a Moroccan woman, with non-Hodgkin null phenotype lymphoma of the chest, treated successfully with CHOP (cyclophosphamide, Doxorubicin, Vincristin and prednisone) followed by local radiotherapy.
Pelvic tumors are rare entities. Metastases are the most common malignant tumors and can derive mainly from breast, lung, prostate, kidney, and thyroid cancers. Primary benign and malignant tumors may arise from bone or bone marrow in cases of hematological malignancies. There is a broad spectrum of pathology involving the pelvis and differential diagnosis could be a challenge. However, with the proper analysis of the imaging workup for a patient with a suspected tumor, the diagnosis can be narrowed. Evaluation should always begin with a conventional plain radiographs and cross-sectional imaging (CT and MRI), up to a biopsy as final step of the staging.
Background
More than 90% of patients with multiple myeloma (MM) develop lytic bone lesions that can be surgically treated for symptomatic relief and functional improvement.Methods
This was a retrospective observational analytic study conducted between 2009 and 2018, including 58 patients with MM bone disease who underwent 77 orthopedic surgical procedures and were co-managed by internal medicine. Analysis of data related to MM bone disease, different modalities of surgical treatment, perioperative complications, and survival was performed.ResultsMedian age was 72 years (66.5–77 years) and 56.9% of patients were males; 54.43% of injuries were located in the spine, 27.85% in the pelvis or lower limbs, 15.19% in the upper limbs, and 75.32% of patients had pathologic fractures. In 29.31% of the cases, the bone lesion was the debut of MM. Surgical procedures performed were mainly kyphoplasty (48.05%) and intramedullary nailing (29.87%). The overall complication rate following surgery was 74.03%. Only 20.78% of cases had a surgical complication. Among medical complications, we registered 28.57% transfusion requirements, 25.97% acute renal failures, 24.68% developed an infection, and 10.39% developed hypercalcemia. Patients were followed-up for a mean of 6.13 years and 37.93% suffered a new fracture. The median overall survival time for patients after surgery was 32.9 months (11.6–49). The estimated overall survival at 1, 3, and 5 years after surgery was 81.17%, 57%, and 34.11%, respectively.Conclusions
The orthopedic surgical treatment of MM bone disease aims to improve symptomatology and patient quality of life; however, these patients have a high risk of perioperative complications and considerable early mortality, making multidisciplinary management with medical specialties essential.
Neoplasms of the sacrum are relatively uncommon, representing 1–2% of all musculoskeletal tumors [1]. They can be classified as primary or metastatic, the former being either benign or malignant. The most common malignancy of the sacrum is metastatic disease, whereas the most common primary sacral tumor is chordoma; more rare sacral malignancies include hematologic neoplasms, Ewing’s sarcoma, chondrosarcoma, and osteosarcoma [2].
