US-guided CNB is safe and effective. US contrast medium depicts tumour vascular supply and identifies the representative area(s) for sampling. Sensitivity and specificity are also high in subgrouping and grading, including myxoid types. Discussion about biopsy is part of the essential multidisciplinary strategy for these tumours.
Introduction. Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results. After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient’s quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion. Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.
Operative intervention is indicated for lesions involving the periacetabular area and is reserved to patients who fail to respond adequately to non operative treatment. Though merely palliative in most of the cases, in few selected patients, Capanna class I, surgery may achieve a curative role just as in primary tumours of the bone. Staging procedures and different surgical techniques are described Introduzione Nell'ambito delle localizzazioni secondarie scheletriche, il bacino rappresenta, dopo la colonna, la sede più frequente di coinvolgimento metastatico. I tumori del seno (32%), della prostata (36%) e del polmone (10%) sono le neoplasie più frequentemente coinvolte. La localizzazione scheletrica costituisce la prima manifestazione della malattia neoplastica nel 23% dei pazienti e quindi l'ortopedico può essere il primo medico coinvolto nel processo diagnostico [1]. Il dolore è il sintomo più frequente, spesso sordo, talora esacerbato dal carico, occasionalmente più intenso nelle ore notturne. La sua eziologia è multifattoriale e va dalla stimolazione delle terminazioni nervose dell'endostio da parte di sostanze liberate in seno all'osso eroso o dalla stessa neoplasia, alla distensione del periostio per aumento di volume della massa neoplastica o da una sopraggiunta frattura che causa infiammazione dei tessuti circostanti [2][3][4][5]. L'incidenza di fratture patologiche oscilla dal 9 al 29% dei casi a seconda degli Autori ed è correlata alla localizzazione e al tipo di neoplasia [6][7][8]. Cinque tipi di carcinoma sono responsabili dell'80% delle fratture patologiche: carcinoma della mammella per il 50%, del polmone per il 10%, del rene per il 10%, della tiroide per il 5% [9]. Si tratta di neoplasie che inducono lesioni di tipo osteolitico, per le quali il rischio di frattura risulta nettamente elevato rispetto a lesioni di carattere osteoblastico. In effetti Marcove, in uno studio condotto su 150 casi di fratture patologiche, ha rilevato che solo il 3% si era verificato su lesioni tipicamente osteoblastiche da carcinoma prostatico [6]. Iter diagnostico-terapeuticoA fronte di una localizzazione metastatica ossea, una corretta indicazione terapeutica non può prescindere dalla valutazione di tutta una serie di fattori che vanno dal comportamento biologico della neoplasia primitiva, alle condizioni generali del paziente, alle implicazioni meccaniche della lesione scheletrica.
UpdAte in diAgnosis And mAnAgement of mUscUloskeletAl tUmoUrs Musculoskeletal tumours are rare, with a wide variety of presentations. Three "up to date" topics are focused, two in imaging, one in management. Contrast Enhanced UltraSound is promising also as a guidance for tru-cut biopsy and magnetic resonance with functional imaging studies (DCE, DWI, MRI-spectroscopy) could help in diagnosis and treatment. Piedmont and Valle d'Aosta Oncological Network could be an organizational model for musculoskeletal tumours in an interdisciplinary organization.
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