Isolated dorsal vertebral Chondroblastoma: A rare case report with review of literature

Accounting for approximately 1-2% of all bone tumors, chondroblastoma is a benign bone tumor that is locally aggressive too typically affects the epiphyses or apophyses of long bones. Less commonly affected sites include the talus and calcaneus of the foot and flat bones.Vertebral involvement by chondroblastoma is very rare, with advance pubmed search we could find only 30 cases, reported in literature of vertebral chondroblastoma.We are presenting one such rare case with review of available literature to evaluate clinical radiological and pathological characteristics of vertebral chondroblastoma

A Study of Agreement between Clinicoradiological and Histopathological Diagnosis of Bone Tumours and Tumour: Like Lesions with FNAC Study in Selected Cases

BACKGROUND: Bone tumours and tumour-like lesions are rare. However, they cause significant morbidity and mortality. Histopathological examination of bone tumours is considered to be a challenging field in pathology and final diagnosis should be given only after review of clinical and radiological findings. FNAC (Fine Needle Aspiration Cytology) evaluation of bone tumours is a safe, simple and cost-effective procedure that is minimally disruptive to bone. In this era of neoadjuvant chemotherapy and limb salvage surgeries, FNAC is proving to be a valuable tool in preliminary diagnosis of bone tumours. This study aims at elaborating the various bone tumours and analysing the age and gender distribution of these tumours. The agreement between clinico-radiological and histopathological diagnosis of bone tumours has been studied. An attempt has been made to study the FNAC findings of bone tumours. Immunohistochemical markers have been used to confirm diagnosis in challenging bone tumours. METHODS: The study was carried out in the Department of Pathology, Madurai Medical College, Madurai, during the period from May 2012 to July 2014 on 90 specimens of bone tumours and tumour-like lesions received in the department after exclusion of specimens with leukaemic infiltration of marrow. After adequate fixation and decalcification, representative bits were taken, processed and stained with Haematoxlyin and Eosin. The cases were classified based on WHO classification, 2002. Cohen’s Kappa value was calculated to test the strength of agreement between clinico-radiological and histopathological diagnosis. FNAC was performed on 15 bone tumours and slides stained with H&E after fixation. The observations were compared with other studies and inferences drawn. The provisional histopathological diagnosis of two bone tumours was confirmed by immunohistochemical markers. RESULTS: Bone tumours and tumour-like lesions formed only 1.03% of all diagnosed neoplasms received in the department during the study period. Benign bone tumours formed 58.9% of the study material and 36.7% were malignant bone tumours. Among the malignant tumours, 66.7% were primary bone malignancies and 33.3% cases were metastatic deposits. Cartilage tumours formed the major category constituting 43.3%. Osteosarcoma was the most common primary bone malignancy (50%) while osteochondroma was the commonest benign tumour (66%). The incidence of tumours was maximum during second decade of life (45.6%). Osteosarcoma and osteoid osteoma showed predilection for males. Bone tumours were most commonly encountered around the knee joint (23.3%). Metastasis occurred most commonly in the femur (36.4%). 85 cases showed agreement between clinicoradiological and histopathological diagnosis. In 5 cases, the histopathological diagnosis was not in agreement with clinicoradiological diagnosis. Cohen’s Kappa value was 0.943 which showed excellent agreement between clinicoradiological and histopathological diagnosis. Out of the 12 adequate FNAC smears, categorisation was correctly done in 10 cases. However, in 2 cases of suspected osteosarcoma, a cytological diagnosis of sarcoma, not otherwise specified was given due to lack of osteiod. These two cases were later confirmed by histopathology to be osteosarcoma. IHC was used to confirm a provisional histopathological diagnosis of primary bone lymphoma using CD 45 immunostain. Also, a provisional histopathological diagnosis of metastatic deposits of follicular thyroid carcinoma to skull with occult primary was confirmed by TTF -1 and Thyroglobulin immunomarkers. CONCLUSION: There is very good agreement between clinico – radiological and histopathological diagnosis in bone tumours. However, many benign bone tumours and tumour - like lesions mimic malignant lesions radiologically. Hence, histopathological confirmation of radiological diagnosis should always be done before definitive treatment. A close co – ordination between the orthopaedician, radiologist and pathologist is the best approach to treat a patient with bone tumours. Cytology can serve as a good tool for rendering quick and cost effective diagnosis for further management. However, the results of FNAC should be cautiously interpreted and when in doubt, histopathological confirmation should be obtained before treatment. Immunohistochemistry has its own role in bone tumour diagnosis. It can be a valuable tool in categorising small round cell tumours and determining sites of occult primary in case of metastasis to bone

Various Tumor-Mimicking Lesions in the Musculoskeletal System: Causes and Diagnostic Approach

Tumor-mimicking lesions in the musculoskeletal system can be defined as lesions mistaken as tumors due to the presence of palpation upon physical examination or a tumor-like appearance upon radiological examination. Moreover, tumor-mimicking lesions show diverse etiologies and anatomic locations. We illustrated the various tumor-mimicking lesions involving bone and soft tissue. In this review, the tumor-mimicking lesions were classified into those based on clinical examination and those based on radiological examination in musculoskeletal radiology. Awareness of the various causes of tumor-mimicking lesions, correctly obtaining clinical information, and the proper selection of imaging modality are important for the differentiation of tumor-mimicking lesions from true neoplasms

A Study in Paleo-Oncology: On the Identification of Neoplastic Disease in Archaeological Bone

Humans have experienced neoplastic disease since antiquity as evidenced by its frequent mentions in numerous ancient medical texts from diverse cultures. However, the skeletal record does not always corroborate this fact, as archaeological cases of neoplasms are not found as often as other more recognizable diseases. Numerous reasons have been given for this disparity ranging from cancer killing the individual before skeletal lesions could form to the idea that tumours simply do not survive in the archaeological record. As such neoplasms are not often considered when constructing a differential diagnosis and to a larger extent the disease is considered to be a product of the modern age. This thesis examines the identification of neoplasms in archaeological bone using clinical data and comparison to medically diagnosed cancer cases from the University of Athens Human Skeletal Reference Collection. I also developed diagnostic criteria and data forms specifically designed to record and describe neoplastic lesions. This enabled me to develop differential diagnoses for suspected cancer cases in skeletons from the Athenian Agora, ancient Corinth, the Wiener Laboratory at the American School of Classical Studies in Athens and the Anthropology Department of the University of Waterloo. Using the comparative collection, I worked toward identifying characteristics that would make it possible to identify neoplastic lesions and distinguish between primary and secondary malignancies. An unexpected finding was demonstrating that lesions associated with leukemia are similar to those of scurvy, a metabolic disease, and must be considered in differential diagnoses. The methods I employed may be applied elsewhere to other suspected cases of cancer and thus enable more research in cancer’s prevalence in antiquity. This will support the public issue that cancer is not a disease of modernity and that attempts to treat and understand this disease has always been a part of medical history

BONE AND JOINT SURGERY

Total hip arthroplasty with cemented Lubinus SP II prosthesis is well analyzed in the Sweden National Hip Arthroplasty Register. There are only few reports from the other countries concerning survival analysis of this implant in short and mid-term follow-up. Eesti Arst 2007; 86(8):533-60

Musculoskeletal Diseases 2021-2024

This open access book focuses on imaging of the musculoskeletal diseases. Over the last few years, there have been considerable advances in this area, driven by clinical as well as technological developments. The authors are all internationally renowned experts in their field. They are also excellent teachers, and provide didactically outstanding chapters. The book is disease-oriented and covers all relevant imaging modalities, with particular emphasis on magnetic resonance imaging. Important aspects of pediatric imaging are also included. IDKD books are completely re-written every four years. As a result, they offer a comprehensive review of the state of the art in imaging. The book is clearly structured with learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers easily navigate through the text. As an IDKD book, it is particularly valuable for general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic knowledge, and for clinicians interested in imaging as it relates to their specialty

Musculoskeletal Diseases 2021-2024

This open access book focuses on imaging of the musculoskeletal diseases. Over the last few years, there have been considerable advances in this area, driven by clinical as well as technological developments. The authors are all internationally renowned experts in their field. They are also excellent teachers, and provide didactically outstanding chapters. The book is disease-oriented and covers all relevant imaging modalities, with particular emphasis on magnetic resonance imaging. Important aspects of pediatric imaging are also included. IDKD books are completely re-written every four years. As a result, they offer a comprehensive review of the state of the art in imaging. The book is clearly structured with learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers easily navigate through the text. As an IDKD book, it is particularly valuable for general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic knowledge, and for clinicians interested in imaging as it relates to their specialty

The recognition, frequency, and taxonomic association of skeletal pathology from selected Plio-Pleistocene-aged sites from the Cradle of Humankind, Witwatersrand, South Africa

Skeletal pathology has been largely unexplored from South African Plio-Pleistocene cave contexts. As a result, there is little known about the types of pathology present in these assemblages or the frequencies at which they occur. This study was designed to identify and analyze skeletal pathology from two sites in the Cradle of Humankind, South Africa. Over 7000 postcranial fossils, representing the broad range of macromammalian taxa from the early hominid sites of Cooper‟s D and Swartkrans (Members 1-3), were examined for evidence of gross skeletal pathology. Frequencies of pathology were recorded at order and family levels and the elements were categorized to skeletal section to identify possible trends in the anatomical location of lesions. Chi-square and randomization tests for goodness-of-fit were conducted at family level and by skeletal section to note any significant disagreement between observed and expected frequencies of pathology. Pathological fossils were described and lesions were identified to broad diagnostic categories. In total, twenty-four pathological fossils were identified from Cooper‟s D and forty from Swartkrans. Joint disease, trauma and enthesopathy are the most common disease types from both sites. For the Swartkrans fauna there is the additional presence of neoplasia. The frequency of pathology at order level is similar for both sites, with artiodactyls showing the lowest frequency, followed by carnivores and primates. Pathology by family occurs at frequencies of between 0 and 6%. Hominids fall outside of this range, occurring at a frequency of 100% for Cooper‟s D and 16% for Swartkrans. For both sites there is a significant disagreement between the observed and expected frequencies of pathology for bovids, felids and hominids. This indicates that pathology does not occur in equal proportion throughout the assemblage, but rather occurs at high frequency for felids and hominids and low frequency for bovids, possibly correlated to the trophic roles of the different taxa. It was, however, found that pathology predominantly occurred on the same elements for all families, specifically the vertebrae and distal-limb. Chi-square and randomization tests by skeletal section revealed a non-significant result for Cooper‟s D (P = 0.07) and a significant result for Swartkrans (P = 0.03). For Swartkrans there is a significant disagreement between the observed and expected frequencies of pathology for distal-limb and hindlimb elements. This result may be due to the high frequency of pathology on hominid distal elements, explained, in part, by a mechanical stress aetiology involving activity related to hominid grip and grasping