Akio Sakamoto

Presacral myelolipoma as a possible parasymptom of cancer: A case report:

Presacral myelolipomas are rare, benign, asymptomatic tumors composed of mature adipose tissue and hematopoietic elements. Presacral myelolipomas can occur in patients with a medical history of malignancy, steroid use, and/or endocrine disorders including diabetes mellitus. A 65-year-old man with no specific medical history experienced temporal abdominal pain without bowel symptoms that lasted a few hours. By the time he visited a hospital, the pain had diminished. Computed tomography failed to detect any abnormality in the abdominal or pelvic organs that would have caused the abdominal pain but revealed a lesion 4u2009cm in diameter in the frontal sacrum. Magnetic resonance imaging showed that the lesion contained fat elements with a high signal intensity on T1- and T2-weighted images, which was decreased on fat-suppression T2-weighted images. Computed tomography–guided biopsy and imaging allowed a diagnosis of presacral myelolipoma. After 3u2009months, hematochezia was observed, and follow-up examination revealed rectal carcinoma with multiple lung metastases. He died due to spread of the cancer despite chemotherapy, 6u2009months after the cancer was found. Considering the possible association between presacral myelolipoma and cancer, presacral myelolipoma might be a cancer parasymptom. Checking for possible malignancy may therefore be warranted in patients with presacral myelolipoma, especially in those without diabetes mellitus.

Florid reactive periostitis of the metacarpal bone: a case of resolution without resection

Florid reactive periostitis is a benign bone lesion characterized by a mixture of bone and fibro-connective tissue without atypia. Most patients with florid reactive periostitis are aged between 20 and 40 years, and women are more commonly affected than men. Florid reactive periostitis usually occurs in tubular bones of the hands and feet and most often in the phalanges (Riaz et al., 1996; Tomori et al., 2016). A 34-year-old, right-handed woman presented with a 4-week history of pain and an enlarging soft-tissue mass in the right hand, without a history of trauma. She was a housewife who did not participate in any regular sporting activity. There was a hard tender, 2 0.8 0.5 cm mass palpable along the ulnar side of the fifth metacarpal. The overlying skin showed no signs of redness and appeared normal. The lesion was fixed to the metacarpal bone but not associated with the tendon. The range of motion of the metacarpophalangeal joint was slightly restricted as a result of pain and swelling. Plain radiographs revealed a soft-tissue mass with erosion of the underlying bone of the fifth metacarpal without apparent periosteal bone formation. A working diagnosis of florid reactive periostitis was based on both plain radiographs and magnetic resonance images, which suggested the presence of a periosteal lesion. A biopsy was not performed initially; rather, a conservative approach involving regular observation without resection of the lesion was adopted. Seven months after the initial diagnosis, the soft-tissue lesion had enlarged and ossified (Figures 1(a) and (b)). A needle biopsy to exclude malignancy confirmed the initial working diagnosis of florid reactive periostitis. The pain disappeared 1 year after the original diagnosis. At the 2-year follow-up, a periosteal reaction in conjunction with ossification had become apparent on plain radiographs. No additional changes

Analysis of Dietary Intake during Consecutive-Day Chemotherapy for Bone and Soft-Tissue Sarcomas

Background Bone and soft tissue sarcomas are commonly treated with consecutive-day chemotherapy regimens consisting of multiple anticancer agents. Chemotherapy-induced nausea and vomiting (CINV) is a serious adverse effect of these regimens and may result in decreased energy intake during chemotherapy. Decreased energy intake may lead to undernutrition and may cause adverse effects on patient quality of life and survival. Methods Patients with bone and soft tissue sarcomas who received consecutive-day chemotherapy were retrospectively evaluated. CINV and dietary energy intake were assessed, as well as the occurrences of hiccups and constipation during chemotherapy. Results A total of 13 patients, 10 males and 3 females, with a total 16 chemotherapy courses were included in the study. All patients received antiemetic prophylaxis. The CINV control rate, defined as no emesis and no rescue therapy, gradually decreased from chemotherapy day 1 (94%) to day 5 (75%). Four patients experienced emesis, two of whom had been treated with a cisplatin-containing regimen. Decreased dietary energy intake was possibly associated with CINV during chemotherapy. Anorexia was grade 2 except for one case of grade 3. The incidences of hiccups and constipation were high on days 3–5. Conclusion Antiemetic prophylaxis treatment did not prevent emesis due to consecutive-day chemotherapy, especially with cisplatin-containing regimens, in patients with bone and soft-tissue tumors. Dietary energy intake decreased during chemotherapy, and this appeared to be associated with CINV. In addition, the incidence of hiccups and constipation increased during the course of consecutive-day chemotherapy regimens. Although these results are based on a small number of patients, it may be important to observe nutritional status during chemotherapy, as this may reflect a patient’s general condition. Nutritional counseling might be useful in supporting nutritional status in patients undergoing chemotherapy.

Subcutaneous lipomas: A minimally invasive method for resection of subcutaneous lipomas preserving retaining ligaments

BackgroundLipomas are common benign tumors usually located in the subcutaneous tissues. Resection of lipomas frequently requires incisions equal to the diameter of the tumor. The “squeeze technique” with a small incision is well-described, but is frequently not successful, particularly for lipomas in the shoulder region. We report a method for resection of subcutaneous lipomas that preserves retaining ligaments.MethodsLipomas are characterized by high signal intensity on T1- and T2-weighted images on magnetic resonance imaging. Retaining ligaments demonstrate low signal intensity on T1-weighted images and high signal intensity on T2-weighted images with fat-suppression. Through a 1xa0in. incision, lipomas were detached from the retaining ligaments bluntly with a finger. Tumors were then extracted either in a piecemeal fashion or with the “squeeze technique.” Complete lipoma resection was visually confirmed through the incisions. For the current report, we analyzed 18 large lipomas resected by this method, with “large” defined as equal to or greater than 5xa0cm in diameter.ResultsThe 18 patients included four males and 14 females with a mean age of 53.4 (26–72). The mean lipoma size was 6.6 cm (5–12). Locations included the shoulder in nine cases (50%), the upper arm in five cases (28%), the back in two cases (11%), and the thigh in two cases (11%). Retaining ligaments were identified by MRI in all cases. Lipomas were located between retaining ligaments at the periphery of the tumor. All three lipomas larger than 10xa0cm were located in the shoulder. There was no difference in the technical difficulty of resection of these compared with lipomas less than 10xa0cm in diameter. There were no cases of chronic pain or residual hypoesthesia at the incision sites.ConclusionsThe method is an easy and minimally invasive way to achieve complete resection, even for large lipomas, regardless of anatomical location. The method may contribute to reduction of side effects including residual hypoesthesia and chronic pain at the incision site, due to the small incision and preservation of retaining ligaments, which may contain cutaneous nerves.Level of Evidence: Level IV, therapeutic study.

Unsintered hydroxyapatite and poly-L-lactide composite screws/plates for stabilizing β-tricalcium phosphate bone implants

Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.

Osteoid Osteoma Can Occur at the Pars Interarticularis of the Lumbar Spine, Leading to Misdiagnosis of Lumbar Spondylolysis

Patient: Male, 18 Final Diagnosis: Osteoid osteoma Symptoms: Low back pain Medication: — Clinical Procedure: Operation Specialty: Orthopedics and Traumatology Objective: Rare disease Background: Osteoid osteomas are benign bone-forming tumors characterized by local inflammation and pain. They are also characterized by a small osteolytic lesion (nidus). Spondylolysis is a defect of the pars interarticularis, which may lead to stress fractures, and is a common cause of low back pain in adolescence. Osteoid osteoma occurs predominantly in the posterior elements of the spine. Magnetic resonance imaging (MRI) signal abnormality suggesting bone marrow edema is a common finding in osteoid osteoma and early-stage spondylolysis without prominent defect. Case Report: An 18-year-old male was suffering from low back pain. He was diagnosed with lumbar spondylolysis on initial MRI and computed tomography (CT). Subsequent thin-slice CT demonstrated a nidus at the pars interarticularis, and variously-sliced MRI could detect widespread bone marrow edema. On the diagnosis of an osteoid osteoma, the nidus and surrounding osteosclerosis were resected. The patient’s pain disappeared after surgery. Conclusions: Osteoid osteoma in the pars interarticularis can be difficult to diagnosis, because MRI and CT findings for osteoid osteoma at the pars interarticularis are similar to those of the lumbar spondylolysis. The possibility of osteoid osteoma should be kept in mind when examining adolescents with low back pain.

Distal defect of the humerus, a possible normal variant: a case report

BackgroundMany normal variants of bones on plain radiographs have been reported.Case presentationIn the current report, a 14-year-old Asian girl noticed an occasional slight elbow pain. She had no traumatic episode. Plain radiographs showed a well-defined osteolytic lesion with a sclerotic rim, which was continuous with the normal subarticular bone in the distal humerus. Magnetic resonance imaging revealed that the defect area seen on the plain radiograph showed low-signal to iso-signal intensity on T1-weighted images and slightly high-signal intensity on T2-weighted fat suppression images. Bone edema was not observed. The association between her elbow pain and the lesion was not conclusive.ConclusionsThe findings from the images suggested that the lesion was a normal variant rather than osteochondritis dissecans or a neoplastic lesion, and possibly an anatomical counterpart of a dorsal defect of the patella.

Oxycodone Resistance Due to Rifampin Use in an Osteosarcoma Patient with Tuberculosis

Patient: Male, 30 Final Diagnosis: Osteosarcoma Symptoms: Pain Medication: Rifampin • Oxycodone Clinical Procedure: Oxycodone usage Specialty: Oncology Objective: Unusual clinical course Background: Oxycodone is a semisynthetic opioid receptor agonist, and is frequently used for pain control in patients with cancer. Most oxycodone is metabolized by N-demethylation to noroxycodone by CYP3A. Rifampin is a strong inducer of several drug-metabolizing enzymes, including CYP3A. Hence, rifampin-induced CYP3A activity may decrease the effect of oxycodone. Case Report: Osteosarcoma is a highly aggressive primary bone tumor of childhood and adolescence. Here, we report a 30-year-old male with osteosarcoma of the femur with lung metastases in the upper lobe. The lung also contained small, scattered nodular lesions that were identified as tuberculosis. Multi-drug therapy, including rifampin, was administered. The upper-lobe metastatic lesion extended to the brachial plexus and caused severe pain. Over 1000 mg per day of oxycodone was ineffective for pain control. However, morphine was able to control his pain at about one-third the equivalent dose. Conclusions: Our patient demonstrated oxycodone resistance due to rifampin. Chemotherapy may have compromised the patient’s immune system, thus theoretically increasing the risk of tuberculosis. Recognition of the interactions between rifampin and oxycodone is important in this and other cancers. Notably, for patients using high doses of oxycodone to manage severe pain, stopping rifampin may lead to oxycodone overdose.