Concerting magnesium implant degradation facilitates local chemotherapy in tumor-associated bone defect

Effective management of malignant tumor-induced bone defects remains challenging due to severe systemic side effects,substantial tumor recurrence,and long-lasting bone reconstruction post tumor resection.Magnesium and its alloys have recently emerged in clinics as orthopedics implantable metals but mostly restricted to mechanical devices.Here,by deposition of calcium-based bilayer coating on the surface,a Mg-based composite implant platform is developed with tailored degradation characteristics,simultaneously integrated with chemotherapeutic(Taxol)loading capacity.The delicate modulation of Mg degradation occurring in aqueous environment is observed to play dual roles,not only in eliciting desirable osteoinductivity,but allows for modification of tumor microenvironment(TME)owing to the continuous release of degradation products.Specifically,the sustainable H2 evolution and Ca2+from the implant is distinguished to cooperate with local Taxol delivery to achieve superior antineoplastic activity through activating Cyt-c pathway to induce mitochondrial dysfunction,which in turn leads to significant tumor-growth inhibition in vivo.In addition,the local chemotherapeutic delivery of the implant minimizes toxicity and side effects,but markedly fosters osteogenesis and bone repair with appropriate structure degradation in rat femoral defect model.Taken together,a promising intraosseous administration strategy with biodegradable Mg-based implants to facilitate tumor-associated bone defect is proposed.

Multimodal imaging in the diagnosis of bone giant cell tumors:A retrospective study

BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.

Diagnostic Value of GDF10 for the Tumorigenesis and Immune Infiltration in Lung Squamous Cell Carcinoma

Objective:Lung squamous cell carcinoma(LUSC)is associated with a low survival rate.Evidence suggests that bone morphogenetic proteins(BMPs)and their receptors(BMPRs)play crucial roles in tumorigenesis and progression.However,a comprehensive analysis of their role in LUSC is lacking.Our study aimed to explore the relationship between BMPs/BMPRs expression levels and the tumorigenesis and prognosis of LUSC.Methods:The“R/Limma”package was utilized to analyze the differential expression characteristics of BMPs/BMPRs in LUSC,using data from TCGA,GTEx,and GEO databases.Concurrently,the“survminer”packages were employed to investigate their prognostic value and correlation with clinical features in LUSC.The core gene associated with LUSC progression was further explored through weighted gene correlation network analysis(WGCNA).LASSO analysis was conducted to construct a prognostic risk model for LUSC.Clinical specimens were examined by immunohistochemical analysis to confirm the diagnostic value in LUSC.Furthermore,based on the tumor immune estimation resource database and tumor-immune system interaction database,the role of the core gene in the tumor microenvironment of LUSC was explored.Results:GDF10 had a significant correlation only with the pathological T stage of LUSC,and the protein expression level of GDF10 decreased with the tumorigenesis of LUSC.A prognostic risk model was constructed with GDF10 as the core gene and 5 hub genes(HRASLS,HIST1H2BH,FLRT3,CHEK2,and ALPL)for LUSC.GDF10 showed a significant positive correlation with immune cell infiltration and immune checkpoint expression.Conclusion:GDF10 might serve as a diagnostic biomarker reflecting the tumorigenesis of LUSC and regulating the tumor immune microenvironment to guide more effective treatment for LUSC.

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.

U-Net Based Dual-Pooling Segmentation of Bone Metastases in Thoracic SPECT Bone Scintigrams

In order to enhance the performance of the CNN-based segmentation models for bone metastases, this study proposes a segmentation method that integrates dual-pooling, DAC, and RMP modules. The network consists of distinct feature encoding and decoding stages, with dual-pooling modules employed in encoding stages to maintain the background information needed for bone scintigrams diagnosis. Both the DAC and RMP modules are utilized in the bottleneck layer to address the multi-scale problem of metastatic lesions. Experimental evaluations on 306 clinical SPECT data have demonstrated that the proposed method showcases a substantial improvement in both DSC and Recall scores by 3.28% and 6.55% compared the baseline. Exhaustive case studies illustrate the superiority of the methodology.

Nasal Dermoid Cyst with Sinus Tract Intranasal Bone: A Case Report

Dermoid cysts are benign tumors originating from germ cells, which can form in various locations, including the nasal area in rare cases. They are of unknown exact etiology, but it is suggested that it is due to abnormal tissue migration during early embryonic development. Nasal dermoid cysts albeit rare, can present in various forms such as sinuses, fistulas, or intracranially extending tracts. They can be asymptomatic and incidentally discovered or present with a visible external mass or sinus that is either painful, infected or cosmetically concerning. If nasal dermoid cysts with an intra-nasal bone sinus tract are left untreated, they can lead to life-threatening complications. This report describes the case of a 6-year-old girl with a nasal dermoid cyst connected to a superficial punctum by an intra-nasal tract. She had undergone surgical excision of a nasal swelling previously diagnosed as a dermoid cyst. One year later, she returned to our clinic with a recurrence of the nasal swelling. Imaging tests revealed a nasal dermoid cyst with a tract extending to the nasal tip, without intracranial expansion. The cyst, along with the entire tract, was successfully removed surgically, and the postoperative follow-up indicated no complications. Histopathology confirmed the diagnosis of a dermoid cyst. This case underscores the significance of considering the dermoid tract in nasal cyst cases and the necessity of its complete removal to prevent recurrence.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts:A single-center experience

BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.

High circulating tumor cell concentrations in a specific subtype of gastric cancer with diffuse bone metastasis at diagnosis

AIM: To clarify the biological feature contributing to gastric cancer with diffuse bone metastases at diagnosis.METHODS: The participants visited the Department of Clinical Oncology, Akita University Hospital, from January 2014 to August 2015. The selection criterion for gastric cancer with diffuse bone metastases at diagnosis includes over 29 hot spots of bone scintigraphy. Circulating tumor cell were collected from 20 m L of peripheral venous blood drawn using a Cell Search kit and a Cell Tracks Auto Prep system by SRL, a clinical laboratory. The endpoints of this study were correlations between circulating tumor cells(CTC) count and therapeutic outcomes. RESULTS: Among 39 patients with gastric cancer, 5 patients met the criterion. The incidence of this subtype was 12.8%. CTC counts ranged from 235 to 6440 cells/7.5 m L of peripheral blood(median of 1724). These values were much higher than common gastric cancers(2 cells). In chemo-sensitive cases, CTC counts decreased within 14 d(median) from 275, 235 and 1724 to 2, 7 and 66, respectively. On the other hand, CTC counts increased after treatment failure or insensitive case from 2, 7 and 6440 to 787, 513 and 7885, respectively. The correlation between CTC count and survival time showed a trend, but did not reach significance(Y = 234.6- 0.03 X, P = 0.085).CONCLUSION: High CTC count is a biological hallmark of this subtype, and can be used as a direct and definitive indicator of therapeutic outcome.

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.

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.

Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica

AIM To study the clinical findings and characteristic features in sciatic notch dumbbell tumors(SNDTs).METHODS We retrospectively reviewed the clinical outcomes and characteristic features of consecutive cases of SNDTs(n = 8). RESULTS Buttock masses occurred in three patients with SNDT(37.5%). Severe buttock tenderness and pain at rest were observed in seven patients with SNDTs(87.5%). Remarkably, none of the patients with SNDTs experienced back pain. Mean tumor size was 8.4 ± 2.0 cm(range, 3.9 to 10.6 cm) and part of the tumor mass was detected in 2 patients in the sagittal view of lumbar magnetic resonance imaging(MRI).CONCLUSION The clinical information regarding to SNDTs is scarce. The authors consider that above mentioned characteristic findings may facilitate the suspicion of pelvic pathology and a search for SNDT by MRI or computed tomography should be considered in patients presenting with sciatica without evidence of spinal diseases.

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.

Malignant peripheral nerve sheath tumor with hemophilic syndrome and bone marrow fibrosis:A rare case report

BACKGROUND Malignant schwannoma is a rare tumor in the peripheral nervous system,accounting for approximately 5%to 10%of systemic soft tissue sarcomas.Especially,malignant schwannoma occurring in the broad ligament of the uterus with hemophilic syndrome and bone marrow fibrosis is extremely rare in clinical practice.Here,we report the first case of an patient diagnosed with malignant peripheral nerve sheath tumor(MPNST)of the broad ligament of the uterus with hemophilic syndrome and bone marrow fibrosis,and share our reference clinical diagnosis and treatment experience.CASE SUMMARY A patient was diagnosed with MPNST of the uterus harboring hemophilic syndrome and bone marrow fibrosis.She received combination,and repeated imaging revealed further encountered rare complications(hemophilia syndrome and bone marrow fibrosis)after two cycles of chemotherapy.Thereafter,combined treatment with pazopanib,gemcitabine,and dacarbazine was initiated.Unfortunately,the patient succumbed to death at hospital after two weeks.CONCLUSION This report firstly provided reference clinical practice for a patient with MPNST of the uterus harboring hemophilic syndrome and bone marrow fibrosis.Our case raises a reminder about the tolerance and safety of combination therapy,especially in young women.

The surgical Treatment and Outcome of Pathological Fracture in Patients with Giant Cell Tumor of Bone

Between 1992 and 2008, we treated 35 patients with giant cell tumor (GCT) of bone, seven of the 35 pre-sented with a pathological fracture. The fractures were located in the femur in five, and in the humerus and radius in one patient each. The surgical treatments were curettage in six cases and wide resection in the distal radius case. Two of the seven patients developed local recurrence, giving a local recurrence rate of 29%. The local recurrence rate in GCT patients without a pathological fracture was 21%. There was a tendency for there to be a higher recurrence rate associated with fractured GCT, but no statistically significant difference was observed between the two groups. Therefore, it was considered that a pathological fracture was not a risk factor for local recurrence in GCT.

Surgical treatment of giant cell tumors of long bone combined with inserted microwave antennas induced hyperthermia

AIM：To evaluate the surgical treatment methods of giant cell tumors(GCT) of long bone in conjunction with inserted microwave antennas induced hyperthermia.METHODS:46patients,included the surgical procedures,the oncology results,the functions of the limbs and the complications were analyzed.RESULTS:Follow-up 3.5 to 9 years(mean 5.5years).All patients were evaluated according to oncological and orthopaedic criteria.Two tumors were recurred.Orthopaedic furction were perfect in 44 patients and were fair in 2.Infection was found in 2 patients.CONCLUSION:The surgical procedure to treat the giant cell tumors of long bone by inserted microwave antennas induced hyperthermia is a definitive surgical method which is safe and confident.

A Huge Metastatic Liver of a Neuroendocrin Tumor Explored by SPECT/CT with 99mTc-Tektrotyd: A Case Report

Background: Colorectal neuroendocrine tumors are rare and have a heterogeneous clinical representation and variable prognosis. High grade neuroendocrine tumors (NETs) are characterized by destructive and aggressive growth, followed by rapid spread. For this purpose, SPECT/CT with 99mTc-Tektrotyd is very useful for imaging and staging of NETs. Case Report: A 50-year-old man with a huge metastatic liver from an unknown neuroendocrine tumor (NET). SPECT/CT with 99mTc-Tektrotyd was performed in this patient, it showed a huge metastatic hepatomegaly compressing neighboring organs with bone metastases, and also revealed the primary colon tumor. Discussion and Conclusion: In recent decades, the incidence and prevalence of neuroendocrine tumors (NETs), especially those of the colorectal segments, have been increasing. 99mTc-EDDA/HYNIC-TOC (Tektrotyd?) was introduced into the market and its use has been approved for scintigraphic imaging of patients with NETs and other SSTR-positive tumors. It provides in vivo metabolic data related to the over-expression of Somatostatin Receptors (SSTRs) and also predicts response to peptide receptor radionuclide therapy (PRRT).

Expect the unexpected:Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism

Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.

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.

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.

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.