Patterns and Distribution of Bone Tumors among Patients at Kumi Orthopaedic Center: A Retrospective Study

Introduction: Primary bone tumors, although rare, are an important rising cause of morbidity and mortality in Africa. Late presentation, delayed diagnosis, and failure to obtain proper management are important causes of loss of limbs and lives especially in Sub-Saharan Africa. Existing data on primary bone tumors in Uganda for the various regional levels is limited. This study aimed to determine the patterns and distributions of primary bone tumors especially in rural Uganda. Methods: This was a retrospective study carried out at Kumi Orthopaedic Center from 2012 to 2023. Patients’ information regarding the histological type of bone tumor, age, sex, and tumor site was obtained from their files. Results: A total of 115 bone tumors were seen over the study period. The mean age of patients was 30 years ± 20.1 years (range: 1 to 80 years). The majority of the patients were males 67 (58.3%) and females were 48 (42.6%). Benign tumors accounted for 66 (57.4%) of the tumors while malignant tumors were 49 (42.6%). Most tumors (both benign and malignant) were found in patients between the ages of 11 to 20 years 46 (40.1%) followed by those between 21 to 30 years 15 (13.2%) and the least were in the elderly aged 71 to 80 years 4 (3.5%). The commonest benign tumors were osteochondroma 14 (21.2%), cysts 11 (16.7%), hemangiomas 9 (13.6%), and fibrous dysplasia of the bone 8 (12.1%). The commonest malignant tumors were plasmacytoma 10 (20.4%) followed by metastases 8 (16.3%), osteosarcomas 7 (14.3%), lymphoma 5 (10.2%), and fibrosarcoma 4 (8.2%). Conclusion: Uganda shares some similar epidemiological characteristics of primary bone tumors with other countries;however, this study identified some peculiar differences. Population-based studies are required to obtain more accurate epidemiological data to improve patient diagnosis and treatment.

Ultrasonographic Diagnosis of Bone Tumor of the Knee and Its Clinical Implication

In order to evaluate the value of the ultrasonography in the diagnosis of tumor of the knee and its clinical implication, 67 patients with clinically suspected bone tumor of the knee were examined by ultrasound. The ultrasonographic characteristics of different bone tumors were studied and compared with the results of pathologic characters after operation. Ultrasonography can readily visualize the bony destruction and the pathologic change of the periosteum and the soft tissue related to bone tumor. Fifty-two cases of malignant bone tumors and 15 cases of giant cell tumors were diagnosed by ultrasonography. Pathologically, there were 54 cases of malignant bone tumor and 13 cases of giant cell tumor. It was concluded that ultrasonographic examination might be a useful method for the diagnoses of bone tumor of the knee and play an important role in guiding needle biopsy and electing operative method and approach.

PREPARATION OF BONE TUMOR THERAPEUTIC RADIOPHARMACEUTICALS ^(153)Sm-EDTMP

Samarium-153- EDTMP (ethylene diamine tetramethylene phosphonate), for its promising biological properties, has been proved as a palliating therapeutic agent for bone tumor in human beings. 153Sin with high radionuclear purity and specific activity of 5.18 GBq (140 mCi)/mg Sm2O3 was prepared by irradiating naturalSm2O3(152Sm, 26.7%) sample, replacing costly enriched samarium oxide target, at a flux of 4x 1013n.cm-2.s-1 for 110 h. The yield of 153Sm complexing with EDTMP is greater than 98% at PH 8￣10 in boiling water bath for 30 min, and not significantly decreases within one week after 153Sm-EDTMP complex formation.

MR perfusion and diffusion imaging for the diagnosis of benign and malignant bone tumors

Objective： MR-PWI and MR-DWI were supplementary functional methods to differentiate benign from malignant bone tumors. The aim of this study was to assess the diagnostic potential of MR-PWI conjunction with MR-DWI in differentiating benign from malignant bone tumors. Methods： MR-PWI and MR-DWI were performed on 39 patients by using a 1.5 T MR imager. Perfusion imaging was started with GRE-EPI sequence as soon as the bolus administration commenced. With b value as 300 s/mm^2, diffusion imaging was performed with SE-EPI sequence. Type of TIC, peak enhancement, steepest slope, signal difference between 2 baselines and ADC were compared between benign and malignant bone tumors. The data were analyzed with soft-ware （SPSS, version 13.0）. Subjective overall performance of two techniques was evaluated with Receiver Operating Characteristic （ROC） analysis. Results： 1. MR-PWI： （1） The Patterns of TIC of most benign bone tumors （17/21） were type Ⅰ and Ⅱ, and all malignant bone tumors were type Ⅲ and Ⅳ. （2） There were significant differences in peak enhancement （17.52 ± 2.37 vs. 52.42 ± 5.74） %, steepest slope （4.69 ± 2.84 vs. 9.63 ± 4.05）%/s and signal difference between 2 baselines （6.87 ±3.34 vs. 31.75 ± 11.09） % between benign and malignant groups. And their diagnosis accuracy was 82.1%, 79.5% and 87.2%, respectively. （3）. 4 highly vascularized benign bone tumors were mistaken in diagnosis as malignant ones according to their perfusion characteristics. 2. MR-DWI： There was significant difference between ADC of benign and malignant groups [（1.86 ± 0.38） vs. （1.44± 0.26）] ×10^-3 mm^2/s when b value was 300 s/mm^2. The diagnosis accuracy was 79.5% when ADC value less than 1.63 × 10^-3 mm^2/s was considered as malignant ones. 3. The diagnosis accuracy of M R-PWI and MR-DWI were 89.7% and 79.5%, respectively. Conclusion： MR-PWI is the better valuable technique than MR-DWI in differentiation benign from malignant bone tumors. To suspicious highly vascularized bone tumors, MR-PWI combining with MR-DWI lead to higher diagnosis accuracy.

Sonographic Diagnosis of Bone Tumors

This paper presents the results of sonographic and radiographic exami nations in 48 patients clinically diagnosed as having bone tumors. Sonography revealed bone destruction in all 48 cases, elevated periosteum in 26 cases and soft tissue mass in 34 cases. The results obtained in this series demonstrate that mostbone tumors have their characteristic sonographic features such as giant cell tu-mors, malignant bone tumors, bone cysts, as well as metastatic lesions. Studyshowed that sonography has equally high accuracy in the diagnosis of these tumorscompared with radiography.

Analysis of therapeutic efficacy of Aredia in treating pain caused by advanced malignant metastatic bone tumors

Objective To study therapeutic efficacy of Aredia in treating malignant metastatic bone tumors. Method 60～90 mg Aredia was administrated iv in 31 cases with malignant metastatic tumors,once each week. Results Pain in 12 cases was significantly relieved.14 cases acquired relif.Total effective rate was 83.9%.Activity ability was improved by 80.6%.No apparent toxicological and adverse effects as well as fever and cold symptoms were observed.Conclusion Aredia is a kind of ideal drugs for treatment of pain caused by malignant metastatic bone tumors.It is convenient in use and could be endured by patients.

Limb salvage surgery for malignant bone tumors of the extremities in children and adolescents

Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods： Between December 1995 and January 2003, 33 cases of preserving epiphysis procedure had been done. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing＇s sarcomas, 2 chondrosarcomas, and 2 aggressive osteoblastomas. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. The modified protocol T10 was taken. Radiography and MRI were used to determine the margins of the tumors preoperatively and histological examination was used to corroborate the evidence intraoperatively. The tumors were staged clinically. Among them, there were 2 cases in ⅠA, 2 cases in ⅠB, 17 cases in ⅡA, and 12 cases in liB. According to the MRI analysis, the metaphyseal tumors in children were classified into 3 types. Type Ⅰ, with the tumor close to but not contacting epiphyseal plate, and the distance between the two over 2 cm, was taken as absolute indication for the technique. Type Ⅱ, with the tumor near or contacting epiphysis plate, and the distance between the two less than 1 cm, was taken as relative indication for the surgery. For type Ⅲ, the tumor contacted the epiphyseal plate partially, and was over 2 cm beyond the joint. In the cohort, 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The size of the residual epiphyseal bone segment differed after different excision protocols which were taken according to the clinical classifications. Bone defects after tumor resections were repaired with massive intercalary allograft bone, followed by internal fixation by intramedullary nails and cancellous screws. Results： Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clinical data. Postoperative follow-up was 12-72 months. Recurrences were seen in 3 cases, with one local recurrence in type Ⅲ cases one year post tumor resection, other 2 recurrences around the femoral vessels in type Ⅱ cases 15 months and 30 months after the tumor resection respectively. The recurrence rate accounted for 10.34%. Amputation was performed for the cases with recurrences. But pulmonary metastasis developed and the patients died. In this cohort, 9 cases died. Five-year survival rate constituted 57.94% demonstrated by Kaplan-Meier survival analysis. The median survival time for male patients was 64.36 months, and that for female patients was 56.00 months （P = 0.0403）. The sites, stages and types were not associated with the survival time. Four cases reported 5 complications （17.24%）. The complications included fracture of the allograft, limb length discrepancy, nerve injury, breakage of nails, and loosening of the screws. No patient reported skin necrosis, hematoma, infection, rejection to the allograft, and nonunion at the end of the follow-up. According to the functional evaluation criteria after surgical treatment of malignant tumors of the extremities introduced by Enneking, excellent functional results were reported in 11 cases, good in 13 cases, fair in 3 cases, and poor in 2 cases. The excellent or good result rate was 83%. The excision interface involved partial epiphysis in 4 cases, involved the epiphyseal plate in 8 cases. Intact epiphysis was preserved in 17 cases. Five cases with poor postoperative functional results were in types II and III. Average time of bone union was 2.5 months for epiphyseal end and 3.8 months for diaphyseal end. According to the International Society of Limb Salvage （ISOLS） radiological implants evaluation system, excellent reconstruction was observed in 23 cases, good reconstruction in 4 cases, fair reconstruction in 1 case, and poor reconstruction in 1 case. All patients in the group had satisfactory joint stability. No patient reported joint dislocation, valgus or varus deformity, and osteoarthritis. The average limb length discrepancy was 3.2 cm, ranging 2-6 cm. Conclusion： The limb salvage surgery with preservation of epiphysis for malignant bone tumors in children and adolescents guarantees the patient＇s satisfactory postoperative limb functional results. Preoperative effective adjuvant chemotherapy and prevention of postoperative complications deserve great attention.

Efficacy of DR, CT and MRI in bone tumors

Objective: The aim of the study was to investigate the efficacy of digital radiography(DR), computed tomography(CT) and magnetic resonance imaging(MRI) in bone tumors. Methods: Fifty-five patients with histologically confirmed bone tumors underwent imaging examinations. Fifty-five patients were performed DR, 21 CT and 20 MRI. Results: DR of 51 patients clearly revealed bone changes. DR of 40 patients well showed marginal. Twenty tumors appeared periosteal reaction on DR and 19 calcification on DR. CT scan of 21 patients clearly depicted bone changes, marginal and calcification and CT scan of 8 revealed periosteal reaction. MRI scan of 20 patients all showed marginal and soft-tissue mass and bone marrow edema was prominent in 8 patients. Conclusion: DR is the first imaging approach for born tumors. CT well reveal the extent and minute structure of the bone tumors, the extent, soft-tissue mass and bone marrow edema are more dramatically demonstrated on MRI imaging. DR integrates with CT and MRI, is helpful in diagnosis of bone tumors.

Profile of Malignant Bone Tumors among Rheumatology Inpatients in Lome (Togo)

Background: The reel impact of malignant bone tumors in adults seems unclear in Black Africa. Aim: The aim of this study is to determine the epidemiological and the semiological profile of malignant bone tumors in rheumatology inpatients at Hospital University Center Sylvanus Olympio in Lome. Methods: It was a retrospective study of recorded cases conducted over a period of 19 years in the rheumatology department at Hospital University center Sylvanus Olympio in Lome, Togo. Results: One hundred and sixty-six patients (68 women and 98 men) suffered from a bone tumor. The average age of patients was 55 years old with some extremes cases of 14 and 98 years old. The most affected age group was the one between 46 and 55 years old (40 cases, 24.1%). The disease’s average duration was 17 months. These tumors were primary in 43 cases (26%) and secondary in 123 (74%). Metastases were those of prostate (44 cases, 35.7%), breast (12 cases, 9.7%), bronchus (7 cases, 5.7%), cervix (5.7%), and liver (2 cases, 1.6%). Myeloma (34 cases;79.0%) and osteosarcoma (9 cases;20.9%) were the main primary malignant bone tumors. However, 41 cases (33.3%) of malignant bone tumors had not been able to label. The spine was the predilection part for all above-mentioned tumors. Conclusion: This study shows the significant part occupied by malignant bone tumors in musculoskeletal diseases within the sub-Saharan population in general and Togo in particular.

Clinical Outcomes of Artificial Total Hip Arthroplasty for Proximal Femoral Bone Tumors

Objective:To investigate the clinical outcome of artificial hip replacement for proximal femoral bone tumors.Methods:One hundred patients with proximal femur bone tumors admitted to the hospital for treatment from June 2018 to May 2020 were selected and divided into a control group and an experimental group of 50 patients each using central randomization.The control group received conventional treatment and the experimental group underwent artificial total hip arthroplasty,and the results of treatment were compared between the two groups.Results:The operative time and hospitalization time of the experimental group were shorter than that of the control group,and the blood loss was less than that of the control group;after the replacement surgery,the range of flexion and extension,internal and external rotation activity and abduction activity scores were better than those of the control group;and the total incidence of adverse reactions in the experimental group was 6.0%,which was significantly lower than that of the control group(14.0%).By comparing the treatment effects of the two groups,the differentiation was significant,and P<0.05 was statistically significant.Conclusion:Artificial hip arthroplasty can effectively treat proximal femoral tumors,shorten operative time,hospitalization time and intraoperative bleeding,and alleviate patients’therapeutic pain,which has good promotion value in clinical practice.

Prototyping: Major Advance in Surgical Planning and Customizing Prostheses in Patients with Bone Tumors of the Head and Neck

Major resections of bone tumors of the head and neck, owing to their small dimensions and their proximity to the organs in this region, cause important functional and aesthetic problems that significantly compromise patients’ quality of life. Therefore, therapeutic planning should always extend beyond the resection to include functional and aesthetic reconstruction, preferably immediately. Microsurgical reconstruction represents a significant advance, but has not yet been perfected. Rapid prototyping (RP) comes as a new technology for the purpose of assisting the surgeon in the visual and tactile aspects of surgery, providing diagnostic accuracy and increasing the success of surgical planning. The authors demonstrate the technological advances in the manufacture of customized mandibular prostheses with the assistance of RP and practical applications of these methods.

Digital measurement of bone tumor volume by CT three-dimensional reconstruction technology

Objective To discuss the measurement of bone tumor volume on the basis of three dimensional images segmentation technology. Methods Twenty patients with lacunar bone tumor from Tianjin Hospital and Tongji Hospital were included in the

Preoperative transarterial Embolisation in bone tumors

Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications.

Preoperative embolization of primary bone tumors:A case control study

AIM:To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss,intraoperative blood transfusion volume and surgical time.METHODS:Thirty-three patients underwent preoperative embolization of primary tumors of extremities,hip or vertebrae before resection and stabilization.The primary osseous tumors included giant cell tumors,aneurysmal bone cyst,osteoblastoma,chondroblastoma and chondrosarcoma.Twenty-six patients were included for the statistical analysis(embolization group)as they were operated within 0-48 h within preoperative embolization.A control group(non-embolization group,n = 28)with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.RESULTS:The mean intraoperative blood loss was 1300 mL(250-2900 mL),the mean intraoperative blood transfusion was 700 m L(0-1400 m L)and the mean surgical time was 221 ± 76.7 min for embolization group(group Ⅰ,n = 26).Non-embolization group(group Ⅱ,n = 28),the mean intraoperative blood loss was 1800 m L(800-6000 m L),the mean intraoperative blood transfusion was 1400 mL(700-8400 mL)and the meansurgical time was 250 ± 69.7 min.On comparison,statistically significant(P < 0.001)difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion.There was no statistical difference between the two groups for the surgical time.No patients developed any angiography or embolization related complications.CONCLUSION:Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.

Preparation and bio-distribution of bone tumor therapeutic agent (188)~Re-TCTMP

TCTMP ( 1,4,8,11-tetraaza cyclotetradecyl- 1,4,8,11-tetramethylene phosphonate) was synthesized and coupled with 188Re. The 188Re-TCTMP's coupling condition, stability and bio-distribution in mice were investigated.The results showed that satisfactory yield of 188Re could be obtained under the conditions of media pH=2.0, 0.8～1.6 mg of SnCl2 and 50 mg of ligand. 188Re-TCTMP was stable (complexation yield ＞95%) in 8 d without protection of N2. The result of bio-distribution indicated that 188Re-TCTMP had a strong affinity to skeleton and very low non-target tissue's uptake, and the amount of 188Re-TCTMP in blood was (0.06±0.02)%ID/g 6 h after injection,whereas the concentration of 188Re-HEDP (1-hydroxy-ethylidene diphosphonate) in blood was (0.28±0.05)%ID/g 6 hafter injection. Compared with 188Re-HEDP, 188Re-TCTMP exhibits better potential for the treatment of metastases.

Flow Cytometric Analysis of DNA in Bone Tumors Using NucIear Suspension

The types of DNA content ean be divided into four groups:(1)diploids andnera-diploids;(2)triploids;(3)tetraploidy and hyperploidy aneuploids;(4)biclonal DHAcontent.Recent studies show that measuring DNA content by flow cytometry(FCM) can beapplied to most primary bone lumors in pointing out clinicatly relevant informattons.Ii thisstudy,cellular DHA content of 33 primary bone tvenors was analysed by FCM Isolated ratcle-ar suspensions were prepared by a simple,rapid and effective method using 10％ formatin-fctedand paraffin-embeuded bone tumor specimens.The results showed that 10 benign(inchtding 5Grade I giant cell tumors of bone) and 5 histologically questionable tumors had nornufl DNAcontent (diploids or near-diploids)and the other 7 questionable and of the 11 malignanttumors had abnormul DNA content(aneuploids).The cell cycle distribution analysis showedthat the aneuploidy tumors had higher proponion of S-phase and G2+M-phase cells than the nor-mal ploidy tumors,indicating there were differences in proliferative activity.The method alsoshowed that beniga and low-malignant primary bone tumors were diploids or near-diptoids,andhigh-malignant cnes were aneuploids Compared with typically pathological grading,the flowDNA analysis of bone tumors can more objectively point out their biological behavior andprognosis.

Preparation and bio-distribution of bone tumor therapeutic radiopharmaceutical ^(153)Sm-TTHMP

TTHMP (triethylenetetraaminehexamethylenephosphonic acid) was labeled with 153Sm. The labeling condition, stability, mole ratio of 153Sm to TTHMP, rabbit bone imaging and bio-distribution of 153Sm-TTHMP in mice were investigated. The results showed that weak basic media and high concentration ligands were favorable to form 153Sm-TTHMP; labeling compounds were stable at pH 7 in 7 days. The results also indicated that the chemical mole ratio of 153Sm-TTHMP is n(153Sm)﹕n(TTHMP) = 1﹕1 and skeleton uptake of 153Sm-TTHMP is high((13.96(3.51)%/g at 1h post injection and (13.54(2.98)%/g at 48h post injection), while the non-target tissue uptake is relatively low, so 153Sm-TTHMP is a promising bone tumor therapeutic agent.

DNA gel electrophoretic and microaut oradiographic studies on apoptosis in bone tumor cells after exposure with ^(153)Sm-EDTMP

The apoptosis in bone tumor cells is studied after 153Sm-EDTMP irradiation. Fragmented DNA is analyzed by agarose gel electrophoresis. Experimental observations show that 153Sm-EDTMP exposure induces the internucleosomal DNA damage in bone tumor cells the DNA ladder pattern formation in bone tumor cells is shown. At the same time, the microautoradiographic study indicates that 153Sm-EDTMP could permeate through cell membrane and displays membrane-seeking condensation in bone tumor cells. Soon afterwards 153Sm-EDTMP could be phagocytized by the tumor cells and distributed ill cytoplasm as well as nucleus in the form of phagosome. With the prolongation of observing time, the membrane-bounded apoptotic bodies are observed.

Clinicopathological Correlation of Primary Malignant Bone Tumors—An Observational Study

Background: Primary malignant tumors arising from bone are uncommon but important malignant neoplasms which account for 0.2% of all primary cancers in adults and approximately 5% of all childhood malignancies. Aim: No comprehensive surveillance data about primary malignant bone tumors is available from this region of West Bengal in the literature. An attempt is undertaken to correlate clinicopathological findings, both histological & cytological features of primary bone tumours. Method: This observational study of clinical presentation was corroborated with cytology and histopathology of 67 cases of primary malignant bone tumors in 2005-2007 in a tertiary health care centre. Results: Among the primary malignant tumors, 39 cases (58.20%) were male and 28 (41.80%) were female. Sixty one lesions (91%) were located in the long bones and 6 (9%) involving flat and short bones. Osteosarcomas are found to be the predominant primary malignant bone tumors (44.77%), followed by Ewing’s sarcomas (20.89%), chondrosarcomas (13.43%), high grade giant cell tumor, and plasmacytoma (5.97%). Predilection for male (M: F 2:1) found in both osteosarcoma and chondrosarcoma, but it was reverse in cases of Ewing’s sarcomas. Conclusion: Osteosarcoma is the most common around knee joint and chondrosarcoma is frequent in long bones in this region. We made an attempt to correlate FNAC findings with the histopathology and it was seen that overall sensitivity of FNAC of primary malignant bone tumors was 56.71%.

Imaging appearance of bone tumors of the maxillofacial region

This paper reviews the imaging appearance of benign and malignant bone tumors of the maxillofacial region.A benign bone tumor commonly appears as a well circumscribed lesion.The matrix of the tumor may be calcified or sclerotic.Malignancies often display aggressive characteristics such as cortical breakthrough, bone destruction,a permeative pattern and associated soft-tissue masses.Computed tomography scan is an excellent imaging modality for accurate localization of the lesion,characterization of the tumor matrix and detection of associated osseous changes such as bone remodeling,destruction or periosteal reaction.Magnetic resonance imaging is of limited value in the evaluation of maxillofacial bone tumors.