RESUMEN
PURPOSE: To evaluate whether there is a mismatch between Risser staging and the proximal humerus ossification system (PHOS); and to analyze the correlation in the skeletal maturity stages between the two humeral epiphyses. METHODS: Data from patients aged 10 to 18 years with adolescent idiopathic scoliosis (AIS) seen between 2018 to 2021 were analyzed. In an anteroposterior (AP) spine radiograph the ossification process was evaluated using the Risser classification method and bilateral PHOS (if both humeral epiphyses were visualized). A mismatch between methods was defined as a Risser 0-1 (relatively skeletally immature) with a PHOS 4-5 (skeletally mature), or a Risser 2-5 (relatively skeletally mature) with a PHOS 1-3 (skeletally immature). The McNemar test was used to calculate the significance of the mismatch. RESULTS: A mismatch between Risser and PHOS stages was observed in 28.5% of 105 patients, which was statistically significant (p < 0.001). Of the 49 patients with a Risser 0-1, 55.1% (n = 27) had a PHOS 4-5. None of the patients with a Risser 2-5 had a PHOS 1-3. In the 47 patients in whom both humeri were visualized, the absolute correlation between the left and right PHOS values was 95.7%. CONCLUSION: Of AIS patients who are relatively skeletally immature according to Risser staging, more than half may be skeletally mature when measured with PHOS. In patients with a Risser 0-1, it is recommended to measure skeletal maturity in an AP spine radiograph using the PHOS method, which may more accurately guide treatment decision-making, without the need to visualize both humeral epiphyses in this radiographic projection. LEVEL OF EVIDENCE: IV.
Asunto(s)
Húmero , Osteogénesis , Escoliosis , Humanos , Escoliosis/diagnóstico por imagen , Escoliosis/patología , Adolescente , Femenino , Niño , Masculino , Osteogénesis/fisiología , Húmero/diagnóstico por imagen , Húmero/crecimiento & desarrollo , Húmero/patología , Radiografía/métodos , Estudios Retrospectivos , Epífisis/diagnóstico por imagen , Epífisis/crecimiento & desarrollo , Epífisis/patología , Índice de Severidad de la Enfermedad , Determinación de la Edad por el Esqueleto/métodosRESUMEN
La enfermedad de Erdheim-Chester (EEC) es una patología poco frecuente, caracterizada por presentar infiltración xantogranulomatosa sistémica, con afección de diversos sistemas incluido el óseo. La EEC se encuentra descripta dentro de las enfermedades osteocon-densantes (EO), las cuales se reconocen por presentar aumento de la masa ósea y compromiso tanto de huesos largos como planos. La presentación clínica de la EEC es variada: puede presentar desde un curso indolente hasta manifestaciones multisistémicas. Las características radiológicas son de gran importancia para establecer su diagnóstico. Presentamos una paciente con EEC, con esclerosis bilateral de huesos largos, que exhibe algunas características diferenciales con relación a otros casos reportados: a) afectación exclusivamente ósea a 10 años de evolución, b) compromiso bilateral y simétrico de distinta magnitud, c) esclerosis cortical endóstica y perióstica, d) signos radiológicos sugestivos de periostitis, d) ausencia de compromiso metafisario, e) ausencia de actividad metabólica de las lesiones en las imágenes de 18F-FDG PET/CT.Conclusión: la presencia de lesiones osteocondensantes bilaterales exclusivamente en huesos largos deben hacer sospechar EEC. La ausencia de compromiso metafisario y de actividad metabólica en 18F-FDG PET/CT ha sido raramente descripta. (AU)
Erdheim - Chester disease (ECD) is a rare disease, characterized by systemic xanthogranulomatous infiltration, with involvement of various organs including bone. ECD is described within the sclerosing bone disorders, which are recognized for presenting increased bone mass and involvement of both long and flat bones. The clinical presentation of ECD is diverse, ranging from an asymptomatic course to multisystemic manifestations. Radiological features are of great importance to establish the diagnosis. We describe here a patient with ECD, with bilateral sclerosis of long bones that presents some differential characteristics in relation to other reported cases: a) exclusively bone involvement at 10 years of evolution, b) bilateral and symmetric involvement of different magnitude, c) endosteal and periosteal cortical sclerosis d) radiological signs suggestive of periostitis, d) absence of metaphyseal involvement, e) absence of metabolic activity of the lesions in 18F-FDG PET/CT.Conclusion: the presence of bilateral osteosclerosis exclusively in long bones should lead to suspect ECD. The absence of metaphyseal involvement and metabolic activity in 18F-FDG PET/CT have been rarely described. (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Esclerosis/etiología , Enfermedad de Erdheim-Chester/diagnóstico por imagen , Fémur/patología , Húmero/patología , Vinblastina/efectos adversos , Biopsia con Aguja , Prednisona/uso terapéutico , Radiografía , Cintigrafía , Interferones/efectos adversos , Enfermedad de Erdheim-Chester/tratamiento farmacológico , Tomografía de Emisión de Positrones , Manejo del Dolor , Ácido Zoledrónico/administración & dosificaciónRESUMEN
The spontaneous disappearance of a segment of bone in a short period without the existence of a tumoral disease that justifies it is an exceptional event. We report the case of an older adult in whom the upper epiphysis of the right humerus and part of the acromion disappeared in a period of 3 weeks in the absence of a malignant tumor. Bone biopsy revealed osteoclasts, lymphatic vessels, and blood vessels. This disorder was first reported in 1838 and in 1955 it was established as a specific disease by Gorham and Stout. Since then, it has been named in their honor.
Asunto(s)
Osteólisis Esencial , Humanos , Osteólisis Esencial/patología , Osteólisis Esencial/diagnóstico por imagen , Húmero/patología , Húmero/diagnóstico por imagen , Masculino , Femenino , Anciano , Biopsia , Persona de Mediana EdadRESUMEN
La inyección con monoiodo acetato de sodio (MIA) es ampliamente utilizada para producir osteoartritis en diversas articulaciones. El objetivo fue describir los daños histológicos provocados por MIA en la articulación humeral de rata. Se inyectó 0,1 mL de mezcla de 0,5 mg de MIA disuelto en 10 mL de solución fisiológica en la articulación humeral izquierda de 21 ratas SpragueDawley. Como control se utilizó la articulación derecha de cada rata. Se realizó la eutanasia a las 4, 8 y 12 semanas post inyección en grupos de 7 ratas. Los miembros mantenidos en formalina tamponada al 10% fueron descalcificados con EDTA por tres meses. Para la evaluación histológica se realizó la inclusión en parafina y se realizaron cortes coronales de 5 µm de espesor, para posterior tinción con azul de toluidina. En el cartílago sano, se observó una superficie lisa sin fisuras, todas las células de las zonas del cartílago se observaron normales. Se observaron cambios en el cartílago articular a partir de las 4 semanas post inyección, los condrocitos de la zona radial hipertróficos con gran producción de proteoglicanos. A las 12 semanas post inyección, se observa un gran deterioro, el espacio articular se ve disminuido, La superficie del cartílago se observa con fisuras y grietas que llegan hasta la zona radial. Las células alrededor de estas fisuras han desaparecido. Se observa una pérdida prominente de proteoglicanos debido a la débil tinción con azul de toluidina. La inyección articular con MIA produce lesiones similares a la OA. La gran ventaja de la OA inducida por MIA, es la facilidad de su aplicación y la rapidez en la progresión de OA.
Injection with monoiode sodium acetate (MIA) is widely used to produce osteoarthritis in various joints. The aim of this work was to describe the histological damage caused by MIA in the rat humeral joint; 0.1 mL of 0.5 mg mixture of MIA dissolved in 10 mL of physiological solution was injected into the left humeral joint of 21 Sprague-Dawley rats. As a control, the right joint of each rat was used. Euthanasia was performed at 4, 8 and 12 weeks post injection in groups of 7 rats. The samples maintained in 10 % buffered formalin were descaled with EDTA for three months. For histological evaluation, paraffin inclusion was performed and 5 µm thick coronal cuts were made for subsequent staining with toluidine blue. In the healthy cartilage, a smooth surface was observed, all cells in the cartilage areas were normal. Changes in articular cartilage were observed after 4 weeks post injection, hypertrophic radial chondrocytes with high proteoglycan production. At 12 weeks post injection, a great deterioration was observed, the articular space was diminished. The surface of the cartilage was observed with fissures and cracks that reach the radial zone. The cells around these fissures have disappeared. A prominent loss of proteoglycans was observed due to weak toluidine blue staining. Joint injection with MIA produced lesions similar to OA. The great advantage of the OA induced by MIA, is the ease of its application and the rapidity in the progression of OA.
Asunto(s)
Animales , Femenino , Ratas , Osteoartritis/inducido químicamente , Articulación del Hombro/patología , Ácido Yodoacético/farmacología , Osteoartritis/patología , Articulación del Hombro/efectos de los fármacos , Cartílago Articular/patología , Ratas Sprague-Dawley , Modelos Animales de Enfermedad , Húmero/patologíaRESUMEN
BACKGROUND: Altered glenohumeral joint range of motion can be caused by increased humeral retroversion (HR) and/or posterior capsule tightness (PCT). To make informed clinical decisions, it is vital to understand how HR and PCT alterations, individually and in combination, affect joint range of motion measurements. PURPOSE: To evaluate the effect of experimental tissue alterations on clinical range of motion measures. STUDY DESIGN: Controlled laboratory study. METHODS: Five clinical measurements were quantified in 8 fresh-frozen cadavers under 4 experimentally created conditions: baseline (no alterations), HR condition (20° increase in HR by transecting the bone), PCT condition (20% decrease in length via thermal energy), and PCT + HR combined. Clinical measurements included bicipital forearm angle, low flexion, glenohumeral internal and external rotation, and horizontal adduction. All measurements were taken by the same blinded tester. Separate 1-factor repeated measures analyses of variance were used to evaluate the effect of the alterations on each clinical measurement. RESULTS: There was a significant main effect of condition for bicipital forearm angle ( P = .02, F = 4.03), low flexion ( P = .02, F = 3.86), internal rotation ( P = .03, F = 3.65), and external rotation ( P < .001, F = 15.15) but not for horizontal adduction ( P = .29, F = 1.33). The HR condition resulted in a decreased bicipital forearm angle of 16.1° and 15.8° as compared with the PCT and PCT + HR conditions, respectively. When compared with baseline, the PCT + HR condition decreased the low flexion test by 13.5°, and the HR condition decreased internal rotation range of motion by 14.2°. All conditions increased external rotation when compared with baseline. CONCLUSION: Greater measurement changes were noted in both HR conditions, suggesting that bony alterations influence motion to a greater extent than posterior capsule alterations. CLINICAL RELEVANCE: Clinicians should be aware that humeral retroversion will influence the measurement of posterior shoulder tightness.
Asunto(s)
Húmero/patología , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiopatología , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Antebrazo , Humanos , Cápsula Articular , Masculino , Examen Físico , RotaciónRESUMEN
Solitary fibrous tumor (SFT) is a spindle-shaped cell neoplasm originally described in the pleura, but subsequently found in many anatomic sites. Only few cases of primary SFTs in the bone have been previously described in the literature. We present the case of an 86-year-old man with a 1-week history of pain in his left arm. Imaging studies demonstrated a well-defined osteolytic lesion in the proximal humerus measuring 6.1 cm in diameter. Sections showed a round to spindle-shaped cell neoplasm with prominent mitotic activity (28 mitoses per 10 high-power fields) and areas of necrosis, focally surrounding staghorn-shaped vessels. The tumor cells were positive for CD34, CD99, Bcl-2, and STAT6 and negative for smooth muscle actin, epithelial membrane antigen, and cytokeratin AE1/AE3. These findings were consistent with a malignant SFT involving the left humerus. Although extremely rare, SFT should be considered in the differential diagnosis of primary bone tumors. This is the first case report of a primary SFT in a long bone with malignant histological features.
Asunto(s)
Biomarcadores de Tumor/análisis , Neoplasias Óseas/patología , Húmero/patología , Enfermedades Raras/patología , Tumores Fibrosos Solitarios/patología , Anciano de 80 o más Años , Biopsia , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Legrado , Diagnóstico Diferencial , Humanos , Húmero/diagnóstico por imagen , Húmero/cirugía , Imagen por Resonancia Magnética , Masculino , Enfermedades Raras/diagnóstico , Enfermedades Raras/cirugía , Tumores Fibrosos Solitarios/diagnóstico , Tumores Fibrosos Solitarios/cirugíaRESUMEN
We present a rare case of primary bone cancer principally affecting the right humerus of a skeleton from the pre-Columbian site of Cerro Brujo (1265-1380 CE) in Bocas del Toro, on the Caribbean coast of Panamá, excavated in the early 1970s. The humerus contains a dense, calcified sclerotic mass with associated lytic lesions localized around the midshaft of the diaphysis. Evidence of systemic inflammation and anemia, likely caused by the cancer, are visible in the form of severe porotic hyperostosis of the cranial vault and bilateral periosteal reactions in the tibiae. Differential diagnosis and future probes of the tumor are discussed. A tooth from the individual yielded a radiocarbon date 150 years later than those of the domestic occupation at the site. Given that it was the only formal burial recovered from the site, and as the individual had such a visible, painful, and rare pathology, this likely constitutes a ritual burial.
Asunto(s)
Neoplasias Óseas/historia , Neoplasias Óseas/patología , Húmero/patología , Adolescente , Historia Antigua , Humanos , PanamáRESUMEN
Resumen El cáncer es la segunda causa de muerte en Costa Rica y un alto porcentaje de pacientes con cáncer tiene dolor producto de su enfermedad. Diferentes estrategias permiten ofrecer alivio del dolor en aquellos casos de alta complejidad en los que el manejo médico no cumpla las metas de tratamiento. Se presenta un caso de un paciente con cáncer de esófago y dolor severo por cáncer refractario a manejo médico comprehensivo, por lo cual se ofreció tratamiento con terapia combinada (morfina, ziconotide, ropivacaína), mediante un sistema implantable de analgesia intratecal. Esta estrategia permitió obtener rápidamente un adecuado y sostenido control del dolor asociado a una mejoría de la funcionalidad del paciente. Se discuten los hallazgos clínicos y los estudios de imagen. En este caso la analgesia intratecal demostró ser una opción eficaz para tratar adecuadamente el dolor, en el contexto de un paciente con dolor severo por cáncer refractario a manejo médico comprehensivo. Es necesaria una aproximación multimodal del tratamiento del dolor y considerar esta técnica mínimamente invasiva en casos complejos de dolor por cáncer.
Abstract Cancer is the second cause of death in Costa Rica and a high percentage of cancer patients have pain due to their illness. Different strategies allow offering pain relief in high complexity cases in which medical management does not meet treatment goals. We present an illustrative case of a patient with esophageal cancer and severe cancer related pain refractory to comprehensive medical management. Intrathecal combination therapy (morphine, ziconotide, ropivacaine) was offered through an implantable intrathecal analgesia system. This strategy allowed obtaining quickly an adequate and sustained pain control with an improvement in patient's functional status. Clinical findings and imaging studies are discussed. In this case, intrathecal analgesia proved to be an effective option to adequately treat pain in a patient with severe cancer pain refractory to comprehensive medical management. A multimodal approach to cancer pain management is necessary and this minimally invasive technique should be considered in complex cases of cancer pain.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Prótesis e Implantes/estadística & datos numéricos , Carcinoma de Células Escamosas/complicaciones , Húmero/patología , Costa Rica , QuimioterapiaRESUMEN
The aim of this case report is to describe an uncommon hemorrhagic cerebrovascular accident (CVA) associated with an osteosarcoma (OSA) metastasis. Cerebrovascular accident (CVA) is the acute onset of a neurological deficit from any change in blood supply resulting from a pathological process, characterizing a stroke and among all the causes, the neoplastic thrombus of osteosarcoma, specifically, is the most infrequent in clinical practice. A seven-year-old female midsize mixed-breed dog was submitted to a forelimb amputation for showing an osteoblastic OSA in proximal humerus. Three weeks later, the patient presented uninterruptible seizure and coma, resulting in death. At necropsy, it was observed afriable and reddish mass in the left frontal cortex which, microscopically was constituted by OSA metastasis in association with multiple ruptures of blood vessels and focally extensive severe bleeding, which caused a CVA. At immunohistochemistry, neoplastic cells of the humerus and the brain metastasis were positive for vimentin and osteonectin, confirming the diagnosis of osteoblastic OSA. The reports about OSA metastasis on the brain are rare in animals and humans, what could be related to the low frequency and few diagnosis ante and post-mortem. As uncommon as the description of OSA metastasis to the brain, is the CVA associated to them, demonstrating that reporting cases related to these clinical and anatomopathological lesions are important for the scientific community.(AU)
Asunto(s)
Animales , Femenino , Perros , Osteosarcoma/complicaciones , Osteosarcoma/veterinaria , Accidente Cerebrovascular/veterinaria , Hemorragias Intracraneales/veterinaria , Metástasis de la Neoplasia , Húmero/patologíaRESUMEN
BACKGROUND: Chondroblastoma is an uncommon, benign, but locally aggressive bone tumor that occurs in the apophyses or epiphyses of long bones, primarily in young patients. Although some are treated with large resections, aggressive curettage and bone grafting are more commonly performed to preserve the involved joint. Such intralesional resection may result in damage to the growth plate and articular cartilage, which can result in painful arthritis. Prior studies have focused primarily on oncologic outcomes rather than long-term joint status and functional outcomes. QUESTIONS/PURPOSES: (1) What local complications can be expected after aggressive intralesional curettage of epiphyseal chondroblastoma? (2) What is the joint survival of a joint treated in this way for chondroblastoma? (3) What additional procedures are used in treating symptomatic joint osteoarthritis after treatment of the chondroblastoma? (4) What are the functional outcomes in this group of patients? METHODS: A retrospective study of our prospectively collected database between 1975 and 2013 was done. We found 64 patients with a diagnosis of chondroblastoma of bone. After applying our selection criteria, 53 patients were involved in this study. We excluded seven patients with tumors initially treated with en bloc resection (five located in the extremities and two in the axial skeleton) and two patients with apophyseal tumors. One patient who underwent nonsurgical treatment and one patient lost to followup were also excluded. The mean age was 18 years (range, 11-39 years); the minimum followup was 2 years with a mean followup 77 months (range, 24-213 months). We analyzed all patients with a diagnosis of epiphyseal chondroblastoma of the limb treated with aggressive curettage and joint preservation surgery. During the period in question, our general indications for curettage were patients with active, painful tumors and those with more aggressive ones that remained intracompartmental, whereas initial wide en bloc resection was indicated in patients who had tumors with an extracompartmental extension breaching the adjacent joint cartilage and massive articular destruction. The tumor location was the distal femur in 14 patients, proximal tibia in 11, proximal humerus in 10, proximal femur in eight, the talus in seven, and elsewhere in the lower extremity in three. Local complications including joint degeneration and tumor recurrence were evaluated. Based on radiographic analysis, secondary osteoarthritis was classified by using the Kellgren-Lawrence grading system from Grade 0 to Grade IV. Patients who underwent joint replacement resulting from advanced symptomatic osteoarthritis were considered to have had joint failure for purposes of survivorship analysis, which was estimated using the Kaplan-Meier method. Functional results were evaluated with the Musculoskeletal Tumor Society functional score by the treating surgeon, who transcribed the results on the digital records every 6 months of followup. RESULTS: Twenty-two patients (42%) developed 26 local complications. The most common local complication was osteoarthritis in 20 patients (77% [20 of 26 complications]); tumor recurrence was observed in four patients; an intraarticular fracture and superficial infection treated with surgical débridement and antibiotics developed in one patient each. Joint survival was 90% at 5 years (95% confidence interval [CI], 76%-100%) and 74% at 10 years (95% CI, 48%-100%). Proximal femoral tumor location was associated with lower survivorship of the joint than other locations showing a 5-year survival rate of 44% (95% CI, 0%-88%; p = 0.000). Of the 20 patients with osteoarthritis, four were symptomatic enough to undergo joint replacement, all of which were for tumors in the proximal femur. The mean Musculoskeletal Tumor Society functional score was 28 of 30 points (93%). CONCLUSIONS: Osteoarthritis was a frequent complication of aggressive curettage of epiphyseal chondroblastoma, and tumors located in the proximal femur appeared to be at particular risk of secondary osteoarthritis and prosthetic replacement. Because chondroblastoma is a tumor that disproportionately affects younger patients, the patient and surgeon should be aware that arthroplasty at a young age is a potential outcome for treatment of proximal femoral chondroblastomas. LEVEL OF EVIDENCE: Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Condrosarcoma/cirugía , Legrado/efectos adversos , Neoplasias Femorales/cirugía , Húmero/cirugía , Procedimientos Ortopédicos/efectos adversos , Osteoartritis de la Cadera/cirugía , Astrágalo/cirugía , Tibia/cirugía , Adolescente , Adulto , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/instrumentación , Niño , Condrosarcoma/diagnóstico por imagen , Condrosarcoma/patología , Bases de Datos Factuales , Epífisis/patología , Epífisis/cirugía , Femenino , Neoplasias Femorales/diagnóstico por imagen , Neoplasias Femorales/patología , Prótesis de Cadera , Humanos , Húmero/patología , Estimación de Kaplan-Meier , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia , Procedimientos Ortopédicos/métodos , Osteoartritis de la Cadera/diagnóstico , Osteoartritis de la Cadera/etiología , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Astrágalo/patología , Tibia/diagnóstico por imagen , Tibia/patología , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Central chondrosarcoma of bone is graded on a scale of 1 to 3 according to histological criteria. Clinically, these tumors can be divided into low-grade (Grade 1) and high-grade (Grade 2, Grade 3, and dedifferentiated) chondrosarcomas. Although en bloc resection has been the most widely used treatment, it has become generally accepted that in selected patients with low-grade chondrosarcomas of long bones, curettage is safe and effective. This approach requires an accurate preoperative estimation of grade to avoid under- or overtreatment, but prior reports have indicated that both imaging and biopsy do not always give an accurate prediction of grade. QUESTIONS/PURPOSES: (1) What is the concordance of image-guided needle preoperative biopsy and postoperative grading in central (intramedullary) chondrosarcomas of long bones, and how does this compare with the concordance of image-guided needle preoperative biopsy and postoperative grading in central pelvic chondrosarcomas? (2) What is the concordance of preoperative image-guided needle biopsy and postoperative findings in differentiating low-grade from high-grade central chondrosarcomas of long bones, and how does this compare with the concordance in central pelvic chondrosarcomas? METHODS: Between 1997 and 2014, in our institution, we treated 126 patients for central chondrosarcomas located in long bones and the pelvis. Of these 126 cases, 41 were located in the pelvis and the remaining 85 cases were located in long bones. This study considers 39 (95%) and 40 (47%) of them, respectively. We included all cases in which histological information was complete regarding preoperative and postoperative tumor grading. We excluded all cases with incomplete data sets or nondiagnostic preoperative biopsies. To evaluate the needle biopsy accuracy, we compared the histological tumor grade, obtained from the preoperative biopsy, with the final histological grade obtained from the postoperative surgical specimen. The weighted and nonweighted kappa statistics were used to evaluate the agreement. RESULTS: Concordance between the preoperative biopsy and the final pathological analysis in terms of histological grade was much higher in long-bone chondrosarcoma than in pelvic chondrosarcoma (83% [33 of 40] versus 36% [14 of 39]; odds ratio, 8, 48). Likewise, the weighted kappa coefficients were higher in long-bone chondrosarcoma than in pelvic chondrosarcoma for the determination of histological grade (0.63; 95% confidence interval [CI], 0.34-0.91 versus 0.12; -0.32 to 0.57; p < 0.001). When categorizing the lesions as low grade or high grade, concordance between the preoperative biopsy and the final pathological analysis was much higher in long-bone chondrosarcoma than in pelvic chondrosarcoma (90% [36 of 40] versus 67% [26 of 39]; odds ratio, 4, 5). Likewise, the weighted kappa coefficients were higher in long-bone chondrosarcoma than in pelvic chondrosarcoma (0.73; 95% CI, 0.51-0.94 versus 0.26; 0.04-0.48; p < 0.001). CONCLUSIONS: Image-guided needle biopsy, when performed by a specialist radiologist and evaluated by an experienced bone pathologist, is a useful tool in determining the histological grade of long-bone chondrosarcomas allowing identification of true low-grade tumors. The histological grade should be correlated with imaging and the clinical presentation, but under these circumstances, experienced tumor surgeons may use this information in planning surgical treatment. The same appears not to be true for pelvic lesions, in which histological grade established by needle biopsy should be interpreted with caution. LEVEL OF EVIDENCE: Level III, diagnostic study.
Asunto(s)
Biopsia con Aguja , Condrosarcoma/patología , Neoplasias Femorales/patología , Peroné/cirugía , Húmero/cirugía , Biopsia Guiada por Imagen , Neoplasias Pélvicas/patología , Tibia/cirugía , Adolescente , Adulto , Anciano , Argentina , Diferenciación Celular , Condrosarcoma/cirugía , Legrado , Femenino , Neoplasias Femorales/cirugía , Peroné/patología , Humanos , Húmero/patología , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Oportunidad Relativa , Osteotomía , Neoplasias Pélvicas/cirugía , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tibia/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
The aim of this case report is to describe an uncommon hemorrhagic cerebrovascular accident (CVA) associated with an osteosarcoma (OSA) metastasis. Cerebrovascular accident (CVA) is the acute onset of a neurological deficit from any change in blood supply resulting from a pathological process, characterizing a stroke and among all the causes, the neoplastic thrombus of osteosarcoma, specifically, is the most infrequent in clinical practice. A seven-year-old female midsize mixed-breed dog was submitted to a forelimb amputation for showing an osteoblastic OSA in proximal humerus. Three weeks later, the patient presented uninterruptible seizure and coma, resulting in death. At necropsy, it was observed afriable and reddish mass in the left frontal cortex which, microscopically was constituted by OSA metastasis in association with multiple ruptures of blood vessels and focally extensive severe bleeding, which caused a CVA. At immunohistochemistry, neoplastic cells of the humerus and the brain metastasis were positive for vimentin and osteonectin, confirming the diagnosis of osteoblastic OSA. The reports about OSA metastasis on the brain are rare in animals and humans, what could be related to the low frequency and few diagnosis ante and post-mortem. As uncommon as the description of OSA metastasis to the brain, is the CVA associated to them, demonstrating that reporting cases related to these clinical and anatomopathological lesions are important for the scientific community.
Asunto(s)
Femenino , Animales , Perros , Accidente Cerebrovascular/veterinaria , Hemorragias Intracraneales/veterinaria , Osteosarcoma/complicaciones , Osteosarcoma/veterinaria , Metástasis de la Neoplasia , Húmero/patologíaRESUMEN
It was attended in the Veterinarian Hospital University of Piauí a dog, German Shepherd, male, 8 months of age, weighing 26.45 kg, presenting pain and lameness on the left forelimb. On the clinical examination showed an sensitivity increase to palpation the scapular humeral articulation left. The radiographic showed panosteitis in the left humerus. Instituted if a symptomatic therapy with carprofen (NSAIDs) 2.2 mg/kg/BID during 10 days which allowed the successful treatment.
Asunto(s)
Animales , Perros , Perros/anomalías , Osteítis/clasificación , Osteítis/diagnóstico , Osteítis/patología , Osteítis/veterinaria , Húmero/patologíaRESUMEN
A casuística de cães diagnosticados com neoplasias vem aumentando consideravelmente. O hemangiopericitoma canino é uma neoplasia mesenquimal que geralmente apresenta-se como nódulo único, multilobular, de consistência firme, localizado preferencialmente em região de articulação úmero-radio-ulnar e fêmuro-tibio-patelar. Os retalhos axiais geniculares são utilizados para recobrir defeitos na tíbia lateral e medial e na articulação tibiotársica. O objetivo deste trabalho é descrever um caso atendido no Hospital Veterinário da Universidade de Marília - UNIMAR de um cão com diagnóstico de hemangiopericitoma em que foi realizada cirurgia reconstrutiva com a técnica de flap axial genicular. O domínio de técnicas de cirurgia reconstrutiva permite a realização do procedimento adequado, proporcionando recuperação rápida, de baixo custo, com excelente resultado estético e funcional.
The casuistry of dogs diagnosed with neoplastic has increased considerably. Canine hemangiopericytoma is a mesenchyme neoplasm that usually presents itself as a single nodule, multilobular, firm consistency, preferentially located in the region of the umero-radio-ulna joint and femur-tibia-patellar. The genicular axial flaps are used to cover defects in the lateral and medial tibia and tibiotarsal joints. The objective of this study is to describe a case in the Veterinary Hospital of the University of Marilia - UNIMAR of a dog diagnosed withhemangiopericytoma, it was performed reconstructive surgery with genicular axial flap technique. The domain of reconstructive surgery techniques allows performing the appropriate procedure, providing fast recovery, low cost, with excellent aesthetic and functional result.
La serie de los perros diagnosticados con cáncer ha aumentado considerablemente. Hemangiopericitoma canina es una neoplasia mesenquimal que por lo general se presenta como un nódulo único, multilobular, consistencia firme, preferiblemente ubicado en la región del húmero-radio-cubital y la articulación femoro-tibio-rotuliana. Las aletas axiales geniculares se utilizan para cubrir defectos de la tibia y el corvejón conjunta lateral y medial. El objetivo de este estudio es describir un caso el Hospital Veterinario de la Universidad de Marilia - UNIMAR un perro diagnosticado con hemangiopericitoma que se realizó la cirugía reconstructiva con técnica de colgajo axial genicular. Las técnicas de cirugía reconstructiva de dominio permite llevar a cabo el procedimiento adecuado, proporcionando una rápida recuperación, de bajo costo, con un excelente resultado estético y funcional.
Asunto(s)
Animales , Perros , Fémur/patología , Hemangiopericitoma/cirugía , Hemangiopericitoma/rehabilitación , Hemangiopericitoma/veterinaria , Procedimientos de Cirugía Plástica/veterinaria , Radio (Anatomía)/patología , Húmero/patología , Huesos de la Pierna/cirugía , Huesos de la Pierna/patologíaRESUMEN
It was attended in the Veterinarian Hospital University of Piauí a dog, German Shepherd, male, 8 months of age, weighing 26.45 kg, presenting pain and lameness on the left forelimb. On the clinical examination showed an sensitivity increase to palpation the scapular humeral articulation left. The radiographic showed panosteitis in the left humerus. Instituted if a symptomatic therapy with carprofen (NSAIDs) 2.2 mg/kg/BID during 10 days which allowed the successful treatment.(AU)
Asunto(s)
Animales , Perros , Perros/anomalías , Osteítis/clasificación , Osteítis/diagnóstico , Osteítis/veterinaria , Osteítis/patología , Húmero/patologíaRESUMEN
A casuística de cães diagnosticados com neoplasias vem aumentando consideravelmente. O hemangiopericitoma canino é uma neoplasia mesenquimal que geralmente apresenta-se como nódulo único, multilobular, de consistência firme, localizado preferencialmente em região de articulação úmero-radio-ulnar e fêmuro-tibio-patelar. Os retalhos axiais geniculares são utilizados para recobrir defeitos na tíbia lateral e medial e na articulação tibiotársica. O objetivo deste trabalho é descrever um caso atendido no Hospital Veterinário da Universidade de Marília - UNIMAR de um cão com diagnóstico de hemangiopericitoma em que foi realizada cirurgia reconstrutiva com a técnica de flap axial genicular. O domínio de técnicas de cirurgia reconstrutiva permite a realização do procedimento adequado, proporcionando recuperação rápida, de baixo custo, com excelente resultado estético e funcional.(AU)
The casuistry of dogs diagnosed with neoplastic has increased considerably. Canine hemangiopericytoma is a mesenchyme neoplasm that usually presents itself as a single nodule, multilobular, firm consistency, preferentially located in the region of the umero-radio-ulna joint and femur-tibia-patellar. The genicular axial flaps are used to cover defects in the lateral and medial tibia and tibiotarsal joints. The objective of this study is to describe a case in the Veterinary Hospital of the University of Marilia - UNIMAR of a dog diagnosed withhemangiopericytoma, it was performed reconstructive surgery with genicular axial flap technique. The domain of reconstructive surgery techniques allows performing the appropriate procedure, providing fast recovery, low cost, with excellent aesthetic and functional result. (AU)
La serie de los perros diagnosticados con cáncer ha aumentado considerablemente. Hemangiopericitoma canina es una neoplasia mesenquimal que por lo general se presenta como un nódulo único, multilobular, consistencia firme, preferiblemente ubicado en la región del húmero-radio-cubital y la articulación femoro-tibio-rotuliana. Las aletas axiales geniculares se utilizan para cubrir defectos de la tibia y el corvejón conjunta lateral y medial. El objetivo de este estudio es describir un caso el Hospital Veterinario de la Universidad de Marilia - UNIMAR un perro diagnosticado con hemangiopericitoma que se realizó la cirugía reconstructiva con técnica de colgajo axial genicular. Las técnicas de cirugía reconstructiva de dominio permite llevar a cabo el procedimiento adecuado, proporcionando una rápida recuperación, de bajo costo, con un excelente resultado estético y funcional.(AU)
Asunto(s)
Animales , Perros , Hemangiopericitoma/rehabilitación , Hemangiopericitoma/cirugía , Hemangiopericitoma/veterinaria , Procedimientos de Cirugía Plástica/veterinaria , Húmero/patología , Radio (Anatomía)/patología , Fémur/patología , Huesos de la Pierna/patología , Huesos de la Pierna/cirugíaRESUMEN
The purpose of this research is to investigate the morphometric effects of short term usage of testosterone enanthate among the anabolic androgenic steroids used as doping by athletes on humerus bones of male rats. 30 rats (35 days) were utilized in this research. The rats were divided into three equal groups. For the experimental group (n= 10), testosterone enanthate at 10 mg/kg dose in 100 µl peanut oil diluents, for the peanut oil group (n= 10), peanut oil of testosterone enanthate' diluent (100 µl) was executed intraperitoneally 5 days in a week for 3 weeks. The control group (n= 10) was nourished without any practice for 3 weeks. All rats were euthanized end of the research. Humerus bones were exposed by the dissection of rats' front extremite bones and measurements and the averages were taken. When the length of rats' humerus bones were analyzed, the growth of humerus bones of rats testosterone enanthate applied in the experimental group stopped significantly and the difference was significant (p<0.05). It was observed that among anabolic androgenic steroids, testosterone enathate's usage on male rats in puberty period caused early epiphyseal closure and stopped the growth of humerus bones significantly.
El objetivo de esta investigación fue estudiar en el húmero de ratas macho, los efectos morfométricos del uso a corto plazo de Enantato de testosterona entre los esteroides anabólicos usados como dopaje por atletas. En esta investigación se utilizaron 30 ratas divididas en tres grupos iguales. Un grupo experimental (n= 10), que se le administró Enantato de testosterona en dosis de 10 mg/kg en 100 µl diluido en aceite de maní, a otro grupo sólo se le administró aceite de maní (n= 10). La administración fue realizada por vía intraperitoneal 5 días a la semana durante 3 semanas. El grupo control (n= 10) fue alimentado durante 3 semanas. Todas las ratas fueron sacrificadas al término de la investigación. Los húmeros fueron expuestos por disección, se realizaron las mediciones y se tomaron los promedios. Cuando se analizó la longitud de los húmeros se observó que su crecimiento en las ratas del grupo experimental que recibieron Enantato de testosterona, se detuvo de manera significativa (p<0,05). Se observó que entre los esteroides anabólicos androgénicos, el uso de testosterona en ratas macho en el periodo de la pubertad causó el cierre epifisario temprano y detuvo el crecimiento del húmero de manera significativa.
Asunto(s)
Animales , Masculino , Ratas , Anabolizantes/administración & dosificación , Húmero/efectos de los fármacos , Testosterona/administración & dosificación , Doping en los Deportes , Húmero/patología , Ratas WistarRESUMEN
El quiste óseo aneurismático es una lesión benigna que afecta la médula de huesos largos, supone 6% de las lesiones óseas primarias y puede surgir secundariamente con otros tumores óseos benignos o malignos. Presentamos el caso de una mujer de siete años de edad con un quiste óseo aneurismático, diagnosticado por clínica, radiología, tomografía axial computarizada y confirmado por histopatología. Se le realizó resección con técnica eggshell e injerto óseo no vascularizado de peroné izquierdo, su evolución fue satisfactoria hasta los cuatro años de operada, lo que concuerda con lo descrito en la literatura mundial.
An aneurysmal bone cyst is a benign lesion involving the marrow of long bones; it accounts for 6% of primary bone lesions and may occur as a secondary lesion with other benign or malignant bone tumors. We describe herein the case of a seven year-old female with an aneurysmal bone cyst which was diagnosed clinically, radiographically and with a CAT scan, and confirmed with histopathology. Resection was performed using the eggshell technique and a non-vascularized left fibular bone graft. The patient did well up to the fourth postoperative year, which is consistent with what has been reported in world literature.
Asunto(s)
Niño , Femenino , Humanos , Quistes Óseos Aneurismáticos/cirugía , Peroné/trasplante , Húmero/cirugía , Quistes Óseos Aneurismáticos/patología , Trasplante Óseo/métodos , Estudios de Seguimiento , Húmero/patología , Tomografía Computarizada por Rayos XRESUMEN
An aneurysmal bone cyst is a benign lesion involving the marrow of long bones; it accounts for 6% of primary bone lesions and may occur as a secondary lesion with other benign or malignant bone tumors. We describe herein the case of a seven year-old female with an aneurysmal bone cyst which was diagnosed clinically, radiographically and with a CAT scan, and confirmed with histopathology. Resection was performed using the eggshell technique and a non-vascularized left fibular bone graft. The patient did well up to the fourth postoperative year, which is consistent with what has been reported in world literature.
Asunto(s)
Quistes Óseos Aneurismáticos/cirugía , Peroné/trasplante , Húmero/cirugía , Quistes Óseos Aneurismáticos/patología , Trasplante Óseo/métodos , Niño , Femenino , Estudios de Seguimiento , Humanos , Húmero/patología , Tomografía Computarizada por Rayos XRESUMEN
Objetivo: Determinar cuál es el tratamiento quirúrgico de las diferentes patologías de tercio proximal de húmero en el Hospital Nacional Dos de Mayo. Diseño: Estudio descriptivo, retrospectivo y transversal. Se incluyeron 30 pacientes que presentaban lesiones de húmero proximal con indicación quirúrgica, atendidos en el Hospital Nacional Dos de Mayo entre abril 2009 hasta mayo 2015. Resultados: Fueron 30 casos (15 varones 15 mujeres), operándose 32 húmeros, edad promedio 50,6 años (12 hasta 77 años) causa de lesión más frecuente: accidentes de tránsito (53,4 por ciento). El procedimiento más común fue reducción abierta y fijación interna con placa (40 por ciento usó placa bloqueada), evidenciándose sobre indicación de este material. Además se encontró que los días entre la lesión hasta la operación es prolongado (promedio 19,1 días) afectando el tiempo operatorio (promedio 2,5 horas), prolongando la hospitalización (promedio 8,1 días postquirúrgicos). Adicionalmente se halló un 76,7 por ciento de pacientes con hemoglobina <12mg/dL no consignado como comorbilidad. Conclusiones: Hace falta establecer protocolos de manejo en este tipo de lesiones que permitan un mejor tratamiento con el material de osteosíntesis adecuado y que ayude a intervenir prontamente con buen resultado.
Objective: To determine the surgical treatment of the different pathologies of proximal third of the humerus in the National Hospital Dos de Mayo. Design: A descriptive, retrospective and cross-sectional study. 30 patients with lesions proximal humerus with surgical indication treated at the Dos de Mayo National Hospital from April 2009 to May 2015 were inc1uded. Results: There were 30 cases (15 men 15 women), 32 being operated humerus, mean age 50.6 years (12 to 77) most common cause of injury: traffic accidents (53.4 per cent). The most common procedure was open reduction and internal fixation with plate (40 per cent used plate blocked), showing on display of this material. It was also found that the days between the injury until the operation is long (average 19.1 days) affecting the (average 2.5 hours) operative time, prolonging hospitalization (average 8.1 days post-surgery). Additionally it was found 76.7 per cent of patients with hemoglobin <12 mg/dL not recorded as comorbidity. Conclusions: It is necessary to establish protocols for handling such injuries that enable better treatment with appropriate osteosynthesis material and help intervene early with good results.