bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prognostic Role of Immunohistochemistry in Primary Bone Tumors
Authors: Pánti Z. , Ene R. , Nica M. , Popa M. , Pleniceanu M. , Cîrstoiu M. , Cîrstoiu C. 
Published: May 2018

Abstract
In the last decades, immunohistochemistry (IHC) has shown an important role in tumor differential diagnosis and has proven its prognostic role. Due to the various histological subtypes of primary malignant bone tumors, its role will be more important in the future. Based on recent studies, tumor growth, cell mobility, and metastases strongly correlate to the survival of these patients. An increased number of specific IHC markers have been used to determine the aggressiveness of the metastatic capacity of these tumors in enhancing early specific oncological therapies. This study presents 15 cases of primary malignant bone tumors, over a period of 4 years (2014-2018), from the Orthopedics and Traumatology Department of the University Emergency Hospital in Bucharest, where we evaluated the proliferation index using Ki67 IHC marker, tissue remodelation, the presence of necrosis in osteosarcoma cases in which chemotherapy was applied, and the aspect of the cytoskeleton with vimentin. Besides the histological aspect, we evaluated the tumor site, invasion and extension to the surrounding tissues (Computer Tomography, Magnetic Resonance) and vascularization with angiography, all these properties having an important prognostic role. Our findings were similar to other research papers in literature; showing that a fast growing and high proliferation index with increased cell mobility has a worse prognosis. Pulmonary metastases occurred in a relative short time in high-grade osteosarcomas, despite the chemotherapy, and multiple metastases were present at 6 months in a dedifferentiated chondrosarcoma case, in which the high-grade sarcoma was an osteosarcoma. Based on the literature, we also think that some specific markers might have multiple roles regarding the tumor growth local invasion and metastasis.
Pigmented Villonoular Synovitis of the Popliteal Fossa – Case Report
Authors: Pleniceanu M. , Popa M. , Nica M. , Panti Z. , Şerban B. , Ene R. , Cîrstoiu C. 
Published: May 2018

Abstract
Pigmented villonodular synovitis is a benign proliferative condition that causes the synovium of the joints and tendons to thicken and overgrow. The causes have not been completely discovered, with trauma and repetitive inflammation being the most incriminated. Genetic aberrations have been reported in most cases and could suggest a neoplastic origin of the disease. It appears in 2 forms: localized or diffuse. Although it can affect all joints, the most common location is the knee. The treatment options include anti-inflammatory medication, surgical removal (open or arthroscopic) and radiotherapy (mixed results). We present the case of a 31-year-old male who came to our Clinic with pain and tumefaction of the right popliteal fossa. From the patient’s medical history, it resulted that he had developed a tumoral growth in the popliteal fossa 20 months before, which was removed. After extensive investigations (X-ray, CT, and MRI), a biopsy was performed. The result was pigmented villonodular synovitis. The proliferation was removed for the second time. The immediate post-surgery evolution was good and the patient is scheduled for periodic follow-ups. Although the proliferation was removed entirely, studies show that this disease has a high chance of recurrence (46% for the diffuse form). Also, in time, repeated excisions can force the surgeon to choose more radical options (joint reconstruction or even amputation).
The Indication of Resection-Reconstruction with Tumor Prosthesis for the Young Patient with Osteosarcoma
Authors: Cursaru A. , Lupu A.G. , Anghelescu D. , Mardare G. , Ene R. , Cîrstoiu C. 
Published: May 2018

Abstract
Introduction. The osteosarcoma represents the most frequently encountered primitive malignant bone tumor, representing 30% of the malignant bone tumors with an unpredictable evolution. Materials and methods. A retrospective study realized over a period of 3 years (Jan. 2016-Jan. 2018), which included 6 patients diagnosed with osteosarcoma and treated through the reconstruction with tumor prosthesis technique in the Orthopaedics and Traumatology Clinic of the University Emergency Hospital in Bucharest. Results. Of the total 6 patients, 5 were male and 1 was a female with ages between 20 and 61 years old, with an average of 30.6 years. The localization of the tumor was at the distal femur (3 cases) and at the proximal tibia (3 cases). In 3 cases, the reattachment of the extensor apparatus of the knee to the prosthesis was needed, while for 3 of the cases, a musculocutaneous flap was created for the coverage of the implant. All the 6 patients were monitored and had postoperative follow-ups at 3, 6 and 12 months by having clinical and imagistic evaluations in search of the eventual local recurrences or metastases in other tissues and organs. The postoperative evaluation of the function of the joint was realized with the Knee Society Score Questionnaire and recorded very good results (76-91) with an average of 82 points. Conclusions. The short-term results of this study about the treatment of the knee osteosarcoma with modular prostheses show that this treatment has a low tumoral recurrence rate and restores the joint function.
Surgical Treatment of Giant-Cell Tumors of the Distal Epiphysis of the Radius
Authors: Rădulescu D. , Bădilă A. , Nuțiu O. , Manolescu R. , Ciobanu T. , Japie I. , Rădulescu R. 
Published: May 2018

Abstract
Introduction. Giant-cell tumor of the bone is a benign tumor, but with high local aggressiveness, even with risk of remote metastasis. Material and methods. We present the case of a 57-year-old woman, without significant pathological history, who, after clinical, imagistic and anatomopathological investigations, was diagnosed with giant cell tumor of the right distal radius. The patient underwent surgery and due to the size of the tumor and destruction of the surrounding cortical bone, segmental resection of the tumor in oncological limits was performed. The bone defect was filled with the proximal one third of the ipsilateral fibula, fixed to the remaining radius diaphysis with a plate and screws. Also, the autograft was stabilized to the proximal row of the carpal bones with 2 k-wires for 6 weeks. Postoperatively, clinical and X-ray check-ups were performed at 6, 12, 24 weeks and 1 year after surgery. Results. According to Mayo functional assessment score, the results were good. At 1 year after surgery, the patient gained 85 points, representing a good functional outcome of the surgery. This way, the wrist joint mobility and the carpal cartilage were preserved, providing a barrier against distal migration of any remaining tumoral cells, as well. Conclusions. It can be stated that in aggressive giant cell tumors located at the distal radius, the best therapeutic option is a segmental resection of the lesion followed by the replacement of the bone defect with a proximal fibular autograft. This method provides the best postoperative functional results with a lower risk of local recurrence and does not require microvascular surgery or access to a bone bank.
Dealing with Bone Metastases from Breast Cancer - A Pathological and Clinical Overview
Authors: Munteanu O. , Dumitru A. , Bodean O. , Arsene L. , Voicu D. , Bratilă E. , Mehedinţu C. , Sajin M. , Cîrstoiu M.M. 
Published: May 2018

Abstract
From breast malignant tumors, bone is the most frequent site of metastasis. Bone metastases from breast cancer are correlated with pathological fractures, spinal cord compression and other skeletal-related events as well as bone pain and hypercalcemia. These lead to impaired mobility, decreased quality of life, and overall decrease in survival. Clarification of mechanisms regulating bone metastasis has advanced greatly in the last years and this has translated into plentiful unused therapeutic options. Greater understanding of the pathophysiology of bone metastases has led to the detection and clinical efficiency of bone-targeted agents. This review summarizes the key evidence for current clinical practice and future directions.
Interdisciplinary Approach in Bone Metastases of Ovarian Cancer
Authors: Bodean O. , Georgescu T. , Arsene L. , Voicu D. , Munteanu O. , Berceanu C. , Sajin M. , Cîrstoiu M.M. 
Published: May 2018

Abstract
Ovarian carcinoma is a deadly disease, with one of the highest case-to-fatality ratio amongst all gynecological malignancies. The high mortality of these tumors can be explained by the fact that most patients present at an advanced stage, with widely spread metastatic disease, especially within the peritoneal cavity. Extraperitoneal, occult metastases are usually rare in cancer surviving patients. Bone metastases are not a common finding, but their incidence seems to be higher than expected, as proven by autopsy studies. Because most clinicians are not very familiar with bone metastases of ovarian carcinoma, in this article we intended to discuss the most controversial aspects concerning the diagnosis of this type of disease.
Multiple Metastases Gestational Choriocarcinoma - A Case Report
Authors: Mehedințu C. , Cîrstoiu M.M. , Brătilă E. , Plotogea M. , Antonovici M. , Cazachevici A. , Berceanu C. 
Published: May 2018

Abstract
Introduction. Gestational choriocarcinoma (GC) is a malignant condition that develops from trophoblastic cells originating from a previous pregnancy, eutopic or ectopic. Metastatic choriocarcinoma is often diagnosed in the absence of a primary uterine or ovarian tumor, presumably because the latter has undergone complete necrosis. GC rapidly metastasizes spreading to lungs, brain, bones, bone marrow, liver, and other organs, but responds well to chemotherapy. Material and methods. We presented the case of a 25-year-old woman with critical evolution after being diagnosed with choriocarcinoma following a complete hydatidiform mole pregnancy. Even though the patient initially received proper treatment, due to poor follow-up compliance, the condition led to invasive metastases. When it spread to the musculoskeletal system and other organs, doctors were able to link symptoms to the choriocarcinoma diagnosis and chemotherapy was initiated. Unfortunately, the patient succumbed due to intracranial hemorrhage. Discussions. GC is a highly and fast invasive malignancy, with rapidly growing tumors. It is often associated with hemorrhage, ischemic necrosis, and secondary inflammation. Often, by the time the tumor is discovered, X-rays of the chest and bones have already shown metastatic lesions. Chemotherapy success depends on the early detection and diagnosis of tumors after pregnancy. Conclusions. Even though the initial diagnosis and treatment should have led to a favorable outcome, the patient’s poor compliance was followed by rapid progression of the disease and, finally, exitus.
Transarterial Embolization Treatment of Sacral Tumors
Authors: Anghelescu D. , Popescu E. , Cursaru A. , Dimitriu A. , Ene R. , Cîrstoiu C. 
Published: May 2018

Abstract
Objectives. Sacral tumors represent about 1-4,3% of all bone tumors. They typically present with an abundance of blood vessels. Due to their anatomical localization, they are hard to approach surgically. Thus, a presurgical neoadjuvant therapy is indicated. The preoperative angiography with the embolization of the nutritive arteries decreases the perioperative blood loss and the symptomatology, and even decreases the volume of the tumors that cannot be surgically approached. Materials and methods. The principle of embolization consists in the targeting of the nutritive tumoral artery and in obturating it with embolic agents (polyvinyl alcohol, embospheres, etc.) through selective catheterization under angiographic control. The biopsy of the tumor is essential for certain diagnosis. The histological type of the tumor and the degree of differentiation influence the tumor’s physiopathology and often influence the therapeutic decision regarding its degree or recurrence. In some cases in which the tumor’s degree of extension increases the surgical risk, serial embolization can be used as a primary method of treatment. Because of the late onset symptomatology, when they are discovered they are extended and the degree of invasion in adjacent tissues is so high that it requires en bloc resection with nerve root sacrifice to assert complete excision and low recurrence rates. Results. The patients who undergo surgical treatment usually bleed, and the perioperative blood loss and the need for blood transfusion volumes were halved in the cases in which presurgical transarterial embolization was performed. Conclusions. Transarterial embolization of sacral tumors is a procedure indicated as a neoadjuvant presurgical therapy to decrease the blood loss risks and for the tumors that cannot be surgically removed it is used in the palliative treatment to reduce symptomatology.
Giant Cell Tumours of the Tendon Sheath – Particular MRI Aspect
Authors: Bratu A.M. , Sălcianu I.A. , Nicula A.I. , Zaharia C. , Marinescu A.N. 
Published: May 2018

Abstract
Giant cell tumor of soft tissue (GCTST) is usually of synovial origin. It affects synovial membrane, serous bursae, and tendinous tunnels. The most common localizations are in the hands and forearms. Anatomopathological, GCTST is considered as being composed of a cellular fibroblastic stroma in which the tumor cells are distributed. This type of tumor is composed of a mononuclear complex and osteoclast-like giant multinucleated cells, similar to those found in the giant cell tumor at the bone level. Histologically, some authors consider that GCTST is a strictly benign tumor, consisting of welldefined multinucleated histiocytes admixed with eosinophils, lymphocytes and scattered spindleshaped cells, or hemosiderin deposits in its structure, and tumor cells do not have mitosis or atypia. Other authors consider that GCTST is a type of low-grade sarcoma; this entity was named “malignant fibrous histiocytoma, giant cell type” due to the histological similarity with malignant fibrous histiocytoma. The case of a female patient, suspected of giant cell tumor of the brachioradialis tendon sheath was presented. The MRI aspect of this tumor is not the typical one. The MRI examination consisted of a series of sequences, with T1 and T2 weighted images, fat suppression sequence, performed in all three planes, axial, sagittal, and coronal. Also, the examination was performed native, after the administration of intravenous contrast substance, when the 3D multiplanar sequences were performed. The final diagnosis was the post-operative anatomopathological examination, which confirmed that it was a giant cell tumor. We present this case for its less frequent localization - forearm, and the interest it might have in surgical treatment.
Differential Diagnosis of Benign Tumors of Bone Rich in Giant Cells, Based on Immunohistochemistry
Authors: Ali L. , Pop D.M. , Stoica C.I. 
Published: May 2018

Abstract
Introduction. The aim of this study was to investigate several cases of giant cell tumor of bone (TCG), chondroblastoma and aneurysmal bone cyst (ABC) by immunohistochemistry (IHC) with a panel of markers: p63, S-100, CD68, CD56, DOG1, Galectin-1, D2-40, CD34, CD45 and ki-67, some of which proved to be specific for a certain entity. Material and methods. The cases were retrospectively selected from cases processed in our facility where the surgical excision material was histopathologically analyzed in optical microscopy using the usual staining hematoxylin and eosin. The immunohistochemistry exam was performed at INCDVB by indirect method avidin-biotin-peroxidase complex (C-DAB) with polyclonal antibodies (Dako) for S100; CD56, p63, DOG1, CD34, D2-40, CD45, ki67, and Galectin1 were performed in 14 cases out of which 10 were TGC, 3 chondroblastomas, and one primary ABC. Results. Five out of ten TGC investigated showed p63 diff use nuclear expression in the mononuclear cell. None of the 3 cases of chondroblastoma or ABC-primary or secondary (associated with the above mentioned tumors), expressed p63. Other variables, non-specifically encountered in all of the tumors, were emphasized by CD34 (vascular network), ki-67 (index of proliferation), CD45 (inflammatory infi ltrate). DOG1 expression was found positive in all chondroblastoma cases. Conclusions. p63 proved to be a useful biomarker in differentiating giant cell tumor of bone from central giant cell granuloma and other giant cell-rich tumors, especially chondroblastoma and ABC. Chondroblastoma was particularly rewarding in this investigation by demonstrating the dual immunohistochemical phenotype of the neoplastic cells, both chondroblastic (S-100, D2-40) and osteoblastic (CD56 and Galectin -1). DOG1, which is mainly used for the diagnostic of GIST, was found by many to be also specific, in the proper morphopathological context, for chondroblastoma.
Borderline Giant Cell Tumors (GCT) of Proximal Tibial Epiphysis - Onco-Orthopedic Management Between Possibilities and Limits
Authors: Cismașiu R.S. , Bîrluțiu R.M. , Tudor A. , Pop D. , Stoica C.I. 
Published: May 2018

Abstract
Intralesional tumoral procedures in giant cell tumor (GCT) are quoted as having a recurrence rate of up to 60%. Thus, a number of studies suggest that broad resection is associated with a lower local recurrence risk compared to intralesional curettage, increasing the free recurrence interval from 84% to 100%. The TCG involvement of the proximal tibia occupies a particular place through the relationship with the articular line, but especially through the frequent, direct, or indirect interest of the extensor mechanism of the knee. Purpose of the paper. Based on the unique tumor registry of “Foişor” Orthopedic Clinic, we proposed to follow all the cases of TCG with proximal tibial localized operation, beneficiaries of an “en bloc” resection and modular tumor prosthesis reconstructions - registering a number of 5 cases between 2009 and 2017. Material and method. The initial evaluation was performed by radiography, CT-scan and MRI investigations and recurrence cases in which histopathological reassessment became mandatory after post-intralesional techniques were also included in the study. The surgical technique followed tumor resection, tumor reconstruction, and the reconstruction procedure of the extensor of the knee, which involved the modulation of the modular tumor prosthesis with a rotary reversible flap of the medial gastrocnemius with the ankle of the patellar tendon to the prosthesis and flap. Quantification of functional outcomes required the use of the revised Muscle-Skeletal Society Score (rMTS) and postoperative complications were centralized; the most commonly reported being the peroneal nerve palsy. Results and discussions. The results obtained were compared to the orthopedic oncology literature data for such a procedure, following their superposition and discrepancy. The challenge of such an orthopedic oncology intervention is the reconstruction of the extensor, with definite functional implications of limiting the knee extension, as well as avoiding the peroneal nerve palsy. However, the results can be reproducible, with an absent relapse rate.
Interdisciplinary Approach in Cervical Neoplasm with Secondary Determinations – A Case Report
Authors: Voicu D.I. , Bodean O.M. , Pauleț F. , Munteanu O. , Arsene L.V. , Cîrstoiu M.M. 
Published: May 2018

Abstract
Introduction. Cervical cancer is the third most common malignancy in women with gynecological pathology. Most of the times, patients are admitted to hospital in advanced stages, with multiple secondary metastases. Case report. We report the case of a 70-year-old patient initially admitted in the Orthopedic Department of University Emergency Hospital in Bucharest with suspicion of pubis fracture. After clinical, imagistic and paraclinical evaluation, cervical cancer was suspected and the patient was transferred to the Obstetrics and Gynecology Department of University Emergency Hospital in Bucharest in order to identify etiology of the multiple secondary metastases. CT examination revealed liver determinations as well as pelvic lymphadenopathy, accompanied by suggestive neoplastic transformation of the cervix and invasion of the uterine body, parameters, and bladder; inferior branch of the pubis, and bilateral pubis, with a suggestive side-by-side aspect, were also distinguished from osteolysis. Histopathological examination following a cervical biopsy revealed non-keratinized squamous carcinoma with secondary imagistic findings, placing this case in FIGO IVB stage. Conclusions. Due to the insidious evolution, cervical cancer can reach advanced stages. The prognosis of patients with advanced stage cervical cancer and bone secondary determinations is reserved.
Denosumab Treatment in a Rare, Neglected Giant Cell Tumor (GCT) of the Femoral Neck: Case Report and Literature Review
Authors: Marinescu R. , Lăptoiu D. , Botezatu I. , Ciumeica S. , Bunea A. , Ştefan G. 
Published: May 2018

Abstract
Introduction. GCT resembles an aggressive benign tumor of bone and its evolution based on the histological features is unpredictable. About 50% of the cases are located around the knee (proximal femur and distal tibia), with the proximal humerus and distal radius representing the third and fourth most common sites. Femoral neck location is unusual. We report a case of GCT located at the femoral neck level, in a 19-year-old female. Case presentation. Onset was hidden by pathologic femoral neck fracture and, due to insidious symptoms, proper diagnosis and treatment were neglected for almost six months. After 6 months, the case was referred to our clinic and re-evaluated with complete examination and biopsy. Wide resection and tumoral arthroplasty of the hip was performed. Postoperative complete recovery was achieved and the patient returned to previous activities. After 2 years of normal clinical evolution, a neurological severe issue appeared; at this time, a cerebral metastasis was diagnosed. Once the positive diagnosis was achieved, 120 mg Denosumab treatment was initiated monthly. At 16 months follow-up, the patient was symptom free and continued Denosumab treatment. Discussion. Denosumab is a human monoclonal IGG2 antibody inhibiting osteoclast differentiation, activation, and survival with applicable suppression of bone turnover in patients with multiple myeloma, osteolytic bone disease, and bone metastases from breast and prostate cancer. It is also a useful drug for managing the GCT of bone and one excellent option in metastatic GCT. The long time safety and complications, especially in young female patients, are to be proven. Conclusions. Early diagnosis and accurate management of GCT are mandatory in order to achieve good long-term clinical results. Denosumab treatment may be necessary in order to avoid secondary metastasis or local recurrence.