<abstract><title style='display:none'>Abstract</title> Introduction. Soft Tissue Sarcomas (STS) is a group of rare malignant tumors with mesenchymal tissue origin. At present, over 50 histopathological types with typical chromosome changes are described. Treatment is multidisciplinary, centered on the surgical approach. Method. Between 2014 and 2016, 12 STS cases were treated in our clinic: 3 liposarcomas, 2 synovial sarcomas, 1 angiosarcoma, 2 rhabdomyosarcomas, 2 myxofibrosarcomas, 1 fibroblast sarcoma and 1 clear cell sarcoma. With the exception of angiosarcoma that benefited only from chemotherapy, the other cases were surgically approached, followed by radiotherapy in 7 cases, and chemotherapy in one case. Results. Patient follow-up was for a minimum of 2 years. In 3 cases (fibroblast sarcoma, clear-cell sarcoma, synovial sarcoma), a local recurrence occurred between 3 and 9 months. In 2 cases (fibroblastic sarcoma, synovial sarcoma), pulmonary metastases occurred between 6 and 18 months and the patients died at 8 months and 2 years respectively. The rest of the cases were clinically and imagistically assessed (local MRI, lung CT) at 6 months for at least 2 years and showed no signs of local recurrence or metastasis. Conclusions. The evolution of STS depends on the histological type and to the stage of diagnosis (local extension, degree of differentiation and presence of metastases). Therapeutic approach should be centered on an accurate resection, within the limits of oncological safety even with re-resection. Postoperative radiotherapy is used in most of the cases, and chemotherapy is reserved for special cases with unfavorable local evolution or metastasis.</abstract>

The Therapeutic Approach of Soft – Tissue Sarcomas. A 12 Cases Analysis

<abstract>
<title style='display:none'>Abstract</title>
Currently, Romania lacks a tradition of trade schools. This is due to the lack of awareness on the importance of this educational structure. Such multiple trades have been learned by simple observation from one individual to another. The importance of security measures has been taken for granted if not ignored. The number of traumas produced in wood processing has decreased rapidly due to the appearance of wood processing robots, the human factor being reduced only to their programming. The cases that arrive in the emergency departments are in a major percentage from the rural area, where the wood processing is done in the household without an adequate training and without going through a learning process. Hand injuries represent a great part of the Emergency Department presentations, and because of their fundamental functional use in daily life, repair of such lesions should be done with utmost care. Wounds of the hand typically have different degrees of severity depending on the mechanism of injury. Hand trauma probably represents the most frequent pathology of a plastic surgery ER and it should be handled with utmost care because of the fundamental function in the daily routine. The present article presents the therapeutic conduct of a complex case, multiple wounds with bone exposure, digital nerve sectioning and destruction of the flexor system of several fingers.
</abstract>

Complex table saw hand injury-case report

<abstract><title style='display:none'>Abstract</title> 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.</abstract>

The Prognostic Role of Immunohistochemistry in Primary Bone Tumors

<abstract><title style='display:none'>Abstract</title> 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.</abstract>

Borderline Giant Cell Tumors (GCT) of Proximal Tibial Epiphysis - Onco-Orthopedic Management Between Possibilities and Limits

<abstract><title style='display:none'>Abstract</title> A 20-year-old patient presented to the emergency service with radial distal epiphysis after a minor trauma. The radiological examination indicated a fracture at the radial distal epiphysis on the background of a tumor that occupied the radial epiphysis in its entirety, with cortical burglary in some places. When consulting the oncologist, a surgical intervention for biopsy material harvesting was performed. The anatomopathological exam showed: multiple fragments microscopically representing a tumor proliferation consisting of two cell populations, mononuclear cells, densely cellular and strobe pattern; areas of infarction, haemorrhage areas, rare intratumoral osteoid formation zones; appearance of giant cell tumor. The immunohistochemical examination confirmed the anatomopathological diagnosis adding, therefore, the aggressive character and the local relapse. The oncologist decided that it did not require oncology treatment but only orthopedic treatment. Orthopedic treatment required repeated surgery at intervals of about 5 months apart, caused by tumor recurrence. The first intervention consisted of 1/ 3 distal radius resection and replacement with a graft harvested from the peroneum. Tumor recurrence after 5 months required extirpation of tumor tissue and filling of caries caused in the graft with a fluid bone substitute. Recurrence after another 5 months required removal of the graft that was invaded by the tumor and cubitusmetacarpal arthrodesis fixed with a screw plate. Currently, the patient is undergoing complementary oncology treatment finally initiated by a medical oncologist.</abstract>

Tumor with Aggregate Cells at the Level of Radial Distance Pipe - Treatment and Evolution

<abstract><title style='display:none'>Abstract</title> Introduction. Breast cancer is the main cause of mortality for neoplastic diseases in women worldwide. Since the incidence is increasing every year, the need for reconstructive techniques increases and autologous tissue reconstruction procedures are also gaining ground over the more popular expander/ implant techniques. A hypertensive and obese patient is admitted by SCUCPRA’s Chronic Diseases Service, with a postmastectomy scar on the left breast, with normal aspect. A TRAM Flap is performed through an oblique tunnel for transposing the tissue over the defect. The abdominal defect was covered with polypropylene mesh. Three days post-operatory, the patient presented an umbilical necrotic scar of 6/ 3 cm and a 4/ 3 cm necrotic scar in the medial zone of the TRAM Flap. Materials and method. Four days post-operatory, the patient presented a 10/ 5 cm brown-black colored dehiscent umbilical scar and 2 dehiscent areas of 4/ 1 cm and 5/ 1 cm inferior and superior, on the TRAM Flap. Excisional debridement of the ulceration was performed, and the abdominal defect was covered with a split-thickness skin graft. The TRAM Flap was also debrided and immediate suture was performed. Conclusions and results. Necrosis is an important complication that can occur both at the abdominal level, as well as on the TRAM Flap, after a breast reconstruction, affecting both the general state of the patient and the long-term results of the reconstructive method.</abstract>

Post-Operative Complications in Tram Flap Breast Reconstruction after Mastectomy

<abstract>
<title style='display:none'>Abstract</title>
Pelvic lymphadenectomy with radical hysterectomy is the basic treatment in locally advanced cervical cancer, but, for carefully selected cases, this intervention can be extended and high Para-Aortic lymphadenectomy can be performed to the site of emergence of the renal arteries. The mortality of the procedure has decreased significantly since the 1900s when it was introduced by Wertheim, while the 5-year DFS reached rates of over 90%.
</abstract>

Radical hysterectomy for locally advanced cervical cancer with Para-Aortic lymphadenectomy: case presentation

<abstract>
<title style='display:none'>Abstract</title>
The purpose of this article was to analyze bone metastases as being the most common site of recurrence of breast cancer. Bone metastases secondary to breast cancer have a negative impact on patient survival, mobility and quality of life. In addition, the clinical complications of bone cancer metastases of breast cancer are associated with a significant financial burden for the individual and society.
This article summarized the implications of breast cancer musculoskeletal metastases based on clinical application in an emergency hospital, including patient workup, procedural strategy and techniques.
</abstract>

Breast cancer and musculoskeletal implications - potential mechanism of dissemination

<abstract>
<title style='display:none'>Abstract</title>
Gonarthrosis is one of the main causes of pain and limitation of physical activity in elderly patients. The diagnosis is established based on the clinical and radiological examination, and the treatment consists of non-surgical measures. The final stage of gonarthrosis is treated surgically and consists of total knee arthroplasty.
The molecular study in gonarthrosis aims to identify patients with early stages of arthrosis, with reversible potential, who can benefit from etiological treatment and non-pharmacological measures to slow down the evolution of the disease or even reversibility. Total knee arthroplasty is a surgical intervention with the role of reducing the symptoms and restoring the functionality of the affected joint.
Total knee arthroplasty remains the surgical intervention of choice in the case of patients in the final stage of the evolution of the disease with very good functional outcome.
</abstract>

Gene expression and molecular aspects in osteoarthritis of the knee - review of literature

<abstract>
<title style='display:none'>Abstract</title>
Introduction: Breast cancer continues to be the most frequent malignancy in women worldwide. Considerable advances in oncology over the years have led to decreased mortality in early stage (EBC) and locally advanced (ABC) breast cancer, but this has raised concerns about possible long-term effects of anticancer treatment nonetheless.
Purpose: The present paper aims to describe the efficacy and safety of osteoclast inhibitors, both as antiresorptive agents, reducing osteoporosis and fracture risk, and as adjuvant anticancer agents, potentially improving disease-related outcomes in patients with early stage and locally advanced breast cancer.
Materials and methods: In this article, literature sources were selected and evaluated using the PRISMA 2020 guideline.
Conclusions: Bisphosphonates are recommended for early stage and advanced breast cancer patients, either premenopausal or postmenopausal, with osteoporosis. Denosumab may also be used for postmenopausal women. Bisphosphonates also showed a statistically significant benefit for overall survival in postmenopausal women only. However, denosumab is not presently used for indications other than prevention or treatment of osteoporosis.
</abstract>

How to choose the bone modifying treatment for early stage and locally advanced breast cancer?

<abstract>
<title style='display:none'>Abstract</title>
Myositis ossificans (MO) is a rare group of diseases in which heterotopic ossification occurs in muscles, tendons, nerves, or even subcutaneous fat. MO can occur in patients of all ages, but usually appears in young adults who practice sports or have a history of mechanical trauma, burns, infections or drug abuse.
The article highlights the case of a 29-year-old athletic female who noticed, by random palpation, a small lump in her left biceps, near the radial insertion. The lump was not painful and noticeable with the naked eye.
Rest and NSAIDs were recommended and all went well for about 3 months.
However, after almost a week from that moment, the pain was excruciating, inflammation extend on the arm and forearm, she could not extend her arm anymore and its circumference was 30 cm from 24 initially.
A biopsy was performed and the result was calcified fibrous tissue with suggestive aspect of myositis ossificans. Surgery was planned with reconstruction of the biceps tendon in mind.
After surgery, the elbow was splinted at 90 degrees for two weeks, then dynamic splinting was performed with increasingly wider range of motion until full recovery was achieved.
MO is a rare disease that involves many differential diagnoses, some of which are deadly and each with its own particularities, different imaging aspects and different treatments.
</abstract>

Myositis ossificans in a 29 years old athletic female

Bone and soft tissue pathology, the importance of the systematic approach

<abstract><title style='display:none'>Abstract</title>Epidermoid bone inclusion cysts are pathological structures bordered by a layer of stratified squamous epithelium containing keratin debris. They are also called epidermal bone cysts. Intraosseous epidermoid cysts are rare entities; these lesions may occur as a result of trauma (puncture wound or pressure erosion).They appear to be well defined, translucent lytic lesions with sclerotic margins on imaging studies. The most frequent sites affected are: the distal phalanx and the calvaria - intradiploic, but a few cases of larger bone involvement have been reported. The imagistic differential diagnosis of this lesion includes intraosseous extension of a glomus tumor, enchondroma, osteoid osteoma, acral metastases, some primary vascular bone tumors, giant cell reparative granuloma, subungual nodular melanoma or other lytic non-neoplastic lesions such as osteomyelitis. We present the case of a 70-year-old man experiencing anxiety and pain due to distal phalanx expansion of the IV digit, following hand trauma. An X-ray was performed, showing a radiotransparent lesion located in the distal phalanx. An intramedullary inclusion cyst must be taken into account as a clinical differential diagnosis. Due to the extensive destruction of the distal phalanx, amputation was necessary. Gross examination of the surgical specimen revealed a cystic lesion that contained whitish, creamy material with extensive necrotic areas. Microscopic examination revealed a ruptured intraosseous epidermoid inclusion cyst, which was successfully excised.</abstract>

Posttraumatic intraosseous epidermoid inclusion cyst. A case report and short literature review

<abstract><title style='display:none'>Abstract</title>Due to its anatomical position, traumatic lesions of the pancreas are rare and difficult to diagnose. Diagnosis time is paramount as an increase in duration translates into an increase in morbidity and mortality. Duct lesions are hard to identify on CT, ERCP being the investigation of choice but it is difficult to obtain as it requires highly specialized staff and equipment. Intraoperative macroscopic and palpatory evaluation of the pancreas in a trauma patient should be elective no matter what other lesions are present. The treatment is mainly dictated by this evaluation and is defined as it follows: stage I and II usually require a conservative approach; stage III, IV, and V usually imply resection of the pancreas although recent advances in conservative management have been made through ERCP and pancreatic duct stenting. In these stages, intraoperative evaluation should ensure the ampulla is intact if the head of the pancreas is not resected. Serum amylase and lipase levels do not offer a concrete direction towards a pancreatic lesion. Currently, there is no standard surgical treatment for these stages thus making intraoperative evaluation mandatory. One must remember that post-traumatic pancreatitis exists, which becomes apparent days after the accident.</abstract>

Trauma of the pancreas. A hidden disaster

<abstract><title style='display:none'>Abstract</title> Introduction. Among the cases of malignant tumors, gathering 30% of them, the most frequent is the osteosarcoma. It occurs especially in children and young adults, the mean age being 14 years old. The treatment consists initially in neoadjuvant chemotherapy, followed by the surgical removal of the tumor. Due to aggressive malignant features (rapid increase in size, tendency to invade surrounding tissues, variable location), in multiple cases, the surgical treatment of osteosarcoma becomes a true challenge. Materials and methods. Nowadays, it is possible to create 3D printed models, by using CT and MRI, which are superior to the 3D graphical reconstructions. The 3D printing technique facilitates the production of these 1:1 scale printed models that faithfully embody the patient’s particular features concerning the anatomic pathology. The benefits gained from using such a modern tool allow the orthopedic surgeons to establish the measurements of a precise resection and to simulate the surgical maneuvers, as part of an elaborated modern surgical planning. Results. In this article, we presented the case of a 10-year-old patient diagnosed with femoral osteosarcoma and treated with neoadjuvant chemotherapy followed by GMRS surgical approach based on a preoperative planning involving a 3D printed model. This piece was used to provide precise information regarding the tumor, to allow preoperative measurements and a surgical simulation. Conclusion. The surgical accuracy can be increased by using a personalized preoperative planning based on a 3D printed model, leading to a lower rate of long/ short-term complications, recurrences, or metastases.</abstract>

Personalized Surgical Planning – The Use of 3D Printing in Oncological Pathology

Orthopaedic marketing strategies in Romania

<abstract><title style='display:none'>Abstract</title>This report represents an analysis of 19 confirmed cases of breast cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence and sites of osseous metastases, in correlation with their histopathologic classification. This retrospective analysis is based on medical imaging techniques (X-ray radiography and nuclear medicine functional imaging).</abstract>

Incidence and location of bone metastases in breast cancer

<abstract><title style='display:none'>Abstract</title> Although most soft tissue tumors are benign, with a high healing rate after surgical excision, there is a variety of malignant tumors with differences in progression and prognosis. The study aimed to assess the survival rate in patients diagnosed with this pathology, based on the patient’s characteristics (age, gender, race), as well as the tumor’s histological type, differentiation degree, location and size. The retrospective study included a group of 103 patients diagnosed during 2010 and 2017 in our department. Considering the high healing rate of benign tumors, only the group of neoplastic patients (45 cases) was involved in the survival rate estimation, assessing tumor characteristics and individual comorbidities. Within this lot, we emphasized a predominance of neoplasm in patients aged over 50 years (32 cases), men (29 cases), and localization of the neoplasm in the thigh (23 cases). The predominant histopathological type, liposarcoma, was diagnosed in 67% of the cases, with dimensions over 6 cm and with local extension. There have been significant variations in mortality between the different histological subtypes (liposarcoma vs. synovial sarcoma). Local recurrences were showed in 18 cases of liposarcoma in the first 2 years after the surgical excision, with an increased aggressiveness of this neoplasm in men over 50 years. 12 cases developed distant metastasis, and until the end of the study, 7 deaths were reported in 3 cases involving associated comorbidities. The five-year survival is inversely proportional to the extent of the tumor and the local invasion, as well as to the age of the patient. An overall survival rate is difficult to appreciate in the context of a heterogeneous group of tumors so it must be evaluated for every histological subtype taking into account the patient’s particularities.</abstract>

Statistically based survival rate estimation in patients with soft tissue tumors

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Romanian Journal of Orthopaedic Surgery and Traumatology

Official publication of Societatea Română de Oncologie Musculo-Scheletală and Societatea Română de Artroplastie

 Romanian Journal of Orthopaedic Surgery and Traumatology (ROJOST) is an international, bi-annual newly established journal of the Romanian Society of Musculoskeletal Oncology...

 Romanian Journal of Orthopaedic Surgery and Traumatology (ROJOST) is an international, bi-annual newly established journal of the Romanian...

Romanian Journal of Orthopaedic Surgery and Traumatology

Official publication of Societatea Română de Oncologie Musculo-Scheletală and Societatea Română de Artroplastie

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