Bone Tumors

Scapula and proximal humerus are the most frequent site of primary bone tumors of upper limb. Surgical reconstruction after resection, aimed to obtain a stable painless limb and active motion of the shoulder. Three major key-points can affect functional results: intra- or extra-articular resection, ability to offer a strength fixation of rotator cuff tendons, and remaining function of the deltoid muscle after resection. When most of the deltoid muscle is active associated with an intra-articular resection, recent results of reversed prosthesis are very promising in terms of active motion. For other cases, conventional or tumor prosthesis can be proposed, but inefficience of rotator cuff tendons fixation on a prosthesis leads to very poor restoration of active motion. Arthrodesis is an attractive option in this situation for young patients. In all cases, impairment of the shoulder function is the rule after resection, complication rate is high, and long-term deterioration of the reconstruction is frequent. Moreover, cosmetic results are always poor.

KEYWORDS:
allograft; arthrodesis; bone tumor; humerus; reconstruction; reversed prosthesis; scapula

Objective: The aim of this study was to evaluate the ability of diffusion-weighted magnetic resonance imaging (MRI) and its corresponding apparent diffusion coefficient (ADC) values in the detection, characterization, and discrimination between different types of bony lesions. Materials and Methods: Patients were evaluated by conventional and diffusion-weighted MR images. Diffusion was carried out using the b values of 0, 500, and 1000, and then the ADCs were generated. Results: The average ADC value of benign lesions was approximately 1.84×10-3 mm 2 /s±0.33, while that of malignant lesions was approximately 1.17×10-3 mm 2 /s±0.44; p<0.001. The receiver operating characteristic (ROC) curve analysis produced a cutoff value for the detection of malignancy of 1.47×10-3 mm 2 /s with 89.5% specificity and 79.5% sensitivity. Conclusion: Diffusion-weighted imaging combined with ADC values is considered a useful tool that can be added to the conventional MRI sequences for detection, differentiation, and characterization of different bony lesions.

Gastrointestinal duplications are an uncommon congenital
abnormality that manifest before the age of two in 80% of
cases. Ileal duplication is the most common while colonic
duplication, either cystic or tubular, occurs in 10%-15%
of cases and remains asymptomatic and undiagnosed in
most cases. Mostly occurring in pediatric patients, colonic
duplication is encountered in adults in only a few cases.
The most common clinical manifestations are abdominal
pain and intestinal obstruction. Rarely, duplications
present with signs of acute abdomen or acute bleeding.
This study reports a case of colonic duplication in an
adult who presented with chronic constipation. Complete
diagnostic workup was made on several occasions during the previous eight year period, but no pathology was found and chronic constipation was attributed to hypothyroidism caused by long standing Hashimoto thyroiditis. Multislice CT, performed because of abdominal distension, defined colonic pathology but the definite diagnosis of duplication of the transversal colon was made at operation. The cystic duplication and the adjacent part of the ascending and transversal colon were excised enblock. This study implies that colonic duplication, though uncommon, should be included in the differential diagnosis of chronic constipation even when precipitating factors for constipation, such as hypothyroidism are present.

Osteoid osteoma is a rare occurrence in the hand, especially in children. We report here a rare case of a 12-year-old boy complaining of growing painful swelling of the middle phalanx of the third finger that had started 3 months earlier and had not responded to anti-inflammatory medication. Based on the clinical findings and plain radiographs, osteomyelitis or Ewing’s sarcoma was suspected. However,
MRI revealed the typical characteristics of osteoid osteoma. The lesion was excised, and the histological examination confirmed the diagnosis. We make a brief review of the literature concerning this uncommon localization and discuss the differential diagnosis and treatment modalities.

Introduction Surgery is the cornerstone for the management of giant cell tumors (GCTs). There are no definite guidelines for the management. The purpose of this series was to study the patient demography and results of the surgical intervention for skeletal GCTs in our population. Methods All the histologically diagnosed cases of GCT of bone from year 2012 to 2018 were retrospectively analyzed for patient demographics, site, and grade of the lesion, type of biopsy taken (if any), nature of surgical intervention, and final outcome with respect to complications. Results Seventeen cases of skeletal GCT were diagnosed on histopathology. The mean age at presentation was 31.5 ± 10.9 years with females affected 1.4 times more. Proximal tibia was the most common site (29.4%) followed by distal radius and dis-tal femur in that order. About 58.8% of the lesions were of Campanacci grade 2 and remaining were grade 3 lesions. Ten patients had extended curettage, five had en bloc resection, and one had amputation as the primary treatment. Twenty percent patients (n = 3) had local recurrence of the pathology and one patient developed distant recurrence (lung metastasis). Conclusion Proximal tibia followed by distal radius was the most common site of GCT in our population. The tumor behavior and recurrence cannot be predicted with any grading system. The goal should be salvage of the joint by intralesional curettage, with resection reserved for distal radius GCTs, cases with extensive soft tissue extension or those with destruction of the articular cartilage and joint involvement.

Aneurysmal bone cyst (ABC) infrequently occurs within the upper cervical vertebrae. Various therapeutic options have been reported in the literature. We would like to share our experience in managing a case of a 16-year-old girl diagnosed with ABC at the body of axis (C2) vertebra. Serious attention had to be given on the stability of the cervical spine following tumour resection, which can be affected by the mode of treatment chosen. Instability can have a detrimental effect on the cervical spine, in which case may necessitate further surgery. We performed a single-staged intra-lesional curettage via a transoral approach and temporary non-fusion posterior stabilization of C1 lateral mass screw and C2 pedicle screw. The implants were removed after six months once ossification of C2 has taken place to regain full motion of the neck. There was no evidence of recurrence or instability of the cervical spine three years following surgery.

A study of the skeletal remains recovered from the late Neolithic dolmen of Yermenonville (Eure-et-Loir, France) revealed an unusual swelling of the distal diaphysis of a right radius.  Radiographic examination showed the presence of an oval lacuna within the bone. The location and morphology of the lesion are consistent with the diagnosis of unicameral bone cyst. This pseudo-tumoral manifestation has rarely been described in the anthropological literature, and the present case appears to be the oldest one identified to date. This finding gives proof that this condition, whose aetiology is still debated, does go back to very ancient times.