Introduction To evaluate the response and the correlation between survival and prognostic factors in 32 patients with multiple myeloma. Method We recruited 32 patients (18 men and 14 women) with mean age 59 years old who were diagnosed with multiple myeloma that were treated with surgery (n = 21) and without surgery (n = 11). 9 patients underwent hemiarthroplasty, 14 patients underwent open reduction and internal fixation and 4 patients underwent spinal decompression and posterior pedicular instrumentation from January 2012 to December 2017. In this group, there were 6 patients who underwent more than one surgeries. Patients were classified using the International Staging System (ISS) for multiple myeloma by evaluated albumin and β 2 -microglobulin level. Results The mean follow up period for 32 patients was 30.2 months (range, 3–65 months) with 7 patients in ISS stage I, 22 patients in ISS stage II and 3 patients in ISS stage III. The median survival duration was 28 months (95% CI). We documented the median survival for ISS stage II disease was 29 months, stage III disease 6 months and stage I disease 16 months with the median age of ISS stage I, II, and III disease was 65, 59, 60 years respectively. Survival correlation with ISS stage (p = 0.009), the hemoglobin level (p = 0.772), and the calcium level (p = 0.926). Conclusions The survival rate was lower in patients with higher ISS stage for this disease. Survival rate seems to be better among younger patients than in older ones even with lower ISS stage of this disease.

Introduction Myelolipomas are very rare benign tumours consisting of hematopoietic cells and mature adipose tissues. They are most commonly found in the adrenal glands. However, there have been several reported cases of extra-adrenal myelolipomas, most commonly in the presacral region. Nearly all presacral lesions are small and asymptomatic; thus, most are discovered incidentally on imaging studies. Presentation of case We report two cases of presacral myelolipomas. The first is a 48-year-old female presenting with atypical back pain, found to have a mass in her presacral region with a size of 3,3 cm. The second case is a 59-year-old female, who presented for evaluation of a hip fracture, found to have a 4,7 cm presacral lesion. Both presacral myelolipomas were discovered incidentally and were confirmed by percutaneous guided fine-needle aspiration biopsy. Both were treated conservatively. Discussion Accepted indications for the surgical excision of myelolipomas are symptomatic tumour, size >4 cm, metabolically active tumour, and a suspicion of malignancy on an imaging study. However, previous reports have documented that nearly half of the conservatively managed myelolipomas with a mean initial size of 5,1 cm, has increased in size or became symptomatic over a 3-years period. Conclusion We conclude that symptomatic presacral myelolipomas or lesions larger than 4 cm should be en-bloc resected, and we present an intuitive decision-making algorithm.

Fibrous dysplasia represents a dysplastic disorder of bone characterized by solitary or multifocal polyostotic intramedullary lesions composed of proliferations of fibroblast-like spindle cells with a characteristic whorled pattern in which trabeculae of immature woven bone. A 20 years old female with pain and limping on his left hip has been suffered for about 1 month. The pain was localized on the left hip with dull characteristics, and worsen when she moves and walks. The pain intensity also decreased with rest. Then she came to hospital and performed X-ray with shepherd crook deformity on her left hip and performed ipsilateral non-vascularized fibular strut graft on her left hip. Right after postoperative wound has been healed the chief complain was marked decrease. For about 2 years after the surgery follow up by X-ray and also MRI examination with contrast the condition of the fibular strut graft was viable, the complaint was gone and the progression of the disease has been stopped.

Objective- To assess osteosarcoma epidemiology in Haji Adam Malik General Hospital. Material and Methods- This study is a retrospective descriptive study with a crosssectional approach. Patient with musculoskeletal tumour (especially osteosarcoma) in Haji Adam Malik Hospital from January 2012 to Desember 2017 period, got their age, gender, musculoskeletal tumour type, biopsy result, tumour sites, treatment completion, metastasis and amputation status recorded from their medical record. Result-Primary bone tumors is the most cases and found in 50% of musculoskeletal tumors followed by soft tissue tumors and metastatic bone disease. Male (60%) have slightly higher prevalence than female in (40%). The incidence of primary bone tumors shows osteosarcoma, GCT, and osteochondroma are in the top three with 63%, 13%, and 6% respectively. Specifically for osteosarcoma, male and female have 1.9 : 1 prevalence ratio. The most common sites for osteosarcoma is distal the femur (45%) and proximal tibia (29%). About 63% of patients undergo complete treatment and with 55% recorded with metastasis in the first diagnosis and amputation was performed in 89% of patients. Conclusion- Primary bone tumors dominate the data with 50% for musculoskeletal tumors followed by 31% soft tissue tumors and 19% metastatic bone disease. The incidence of musculoskeletal tumors shows that men are slightly higher than women in 60% and 40%. The incidence of primary bone tumors shows osteosarcoma, giant cell tumor, and osteochondroma are in the top three with 63%, 13%, and 6% respectively.

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