Fikri Oztop

Clinical and morphological characteristics of osteoid osteoma and osteoblastoma: a retrospective single-center analysis of 204 patients.

Osteoid osteoma and osteoblastoma are histologically similar, benign bone-forming tumors. In this retrospective study, we aimed to evaluate the natural history; clinical, pathologic, and radiologic findings; and treatment results in 204 patients between 1959 and 2006 in a single institution. According to the World Health Organizations definition, tumors ≤1 cm in diameter were classified as osteoid osteoma, and those ≥2 cm, as osteoblastoma. For tumors between 1 cm and 2 cm, other criteria, such as the bone involved, the site, the presence of a nidus, and presence of peripheral sclerosis, were used for diagnosis. There were 131 patients with osteoid osteoma (93 male, 38 female) and 73 patients with osteoblastoma (40 male, 33 female). The mean age in the osteoid osteoma and osteoblastoma groups was 16.4 ± 7 and 19.6 ± 9.9 years, respectively. The osteoid osteoma cases were mostly localized in the extremities, whereas the osteoblastoma cases involved the vertebral column and sacrum. The nidus size varied between 0.2 and 1.5 cm in osteoid osteoma cases, and the tumor size range was 1.3-10 cm in the osteoblastoma cases. The pain was encountered in 89% of osteoid osteoma and 45% of osteoblastoma patients. Histopathology was similar in both cases. The treatment of choice was conservative surgery for both diagnoses. In conclusion, osteoblastoma is clinically and radiologically more aggressive than osteoid osteoma.

Cystic bone lesions: histopathological spectrum and diagnostic challenges.

Abstract Objective: Bone cysts are benign lesions occurring in any bone, regardless of age. They are often asymptomatic but may cause pain, swelling, fractures, and local recurrence and may be confused with other bone lesions. Material and Method: We retrospectively re-evaluated 143 patients diagnosed with aneurysmal bone cyst (n=98, 68.5%), solitary bone cysts (n=17 11.9%), pseudocyst (n=10.7%), intraosseous ganglion (n=3, 2.1%), hydatid cyst (n=2; 1.4), epidermoid cyst (n=1, 0.7%) and cysts demonstrating “mixed” aneurysmal-solitary bone cyst histology (n=12, 8.4%), and compared them with nonparametric tests. Results: Aneurysmal bone cyst, solitary bone cysts and mixed cysts were frequently seen in the first two decades of life while the others occurred after the fourth decade. Aneurysmal bone cysts, intraosseous ganglion and pseudocysts were more common in women contrary to solitary bone cyst and mixed cysts (the female/male ratio was 1.22, 2 and 1.5 versus 0.7 and 0.5, respectively). Aneurysmal bone cyst, solitary bone cysts and “mixed” cysts were mostly seen in long bones, predominantly the femur, while epidermoid, hydatid and pseudocysts were all seen in flat bones like the vertebra, pelvis and mandible (p=0.001, chi-square). Repeat biopsies were performed in 19 cases (13.3%), 84.2% of which were aneurysmal bone cyst (5 conventional, 9 solid, 1 secondary and 1 subperiosteal) and three (15.8%) were mixed cysts (p=0.02, chi-square). Notably, some of them were located in inaccessible areas of pelvis (n=3), femur (n=3) and maxilla (n=2). Conclusion: The most common and challenging intraosseous cysts are aneurysmal bone cysts, particularly the “solid” variant. The “mixed” aneurysmal-solitary bone cyst “subgroup” requires further research with larger series to be defined more thoroughly. Öz Amaç: Kemik kistleri, her yaşta ve kemikte gorulebilen benign lezyonlardır. Sıklıkla asemptomatiktirler, ancak ağrı, şişlik, kırık ve lokal nuks yapabilir, diğer kemik lezyonlarıyla karıştırılabilirler. Gereç ve Yöntem: Calışmamızda 98’i (%68,5) anevrizmal kemik kisti; 17’si (%11,9) soliter kemik kisti; 12’si (%8,4) “mikst” anevrizmal kemik kisti-soliter kemik kisti histolojisi gosteren; 10’u (%7) psodokist, 3’u (%2,1) intraosseoz ganglion, 2’si (%1,4) kist hidatik, 1’i (%0,7) epidermoid kisti tanısı almış; toplam 143 olgu geriye donuk olarak değerlendirilmiş, klinikopatolojik veriler nonparametrik testlerle karşılaştırılmış, bulgular histopatolojik tanı guclukleri acısından tartışılmıştır. Bulgular: Anevrizmal kemik kisti, soliter kemik kisti ve mikst kistler ilk iki dekatta; diğerleri dorduncu dekaddan sonra gorulmektedir. Anevrizmal kemik kisti, intraosseoz ganglion ve psodokistler kadınlarda; soliter kemik kisti ve mikst kistler ise erkeklerde daha sık gorulmektedir (Kadın/erkek oranı sırasıyla 1,22; 2 ve 1,5’a karşı 0,7 ve 0,5’dir) Anevrizmal kemik kisti, soliter kemik kisti ve mikst kist; femur başta olmak uzere en sık uzun kemikleri tutarken (sırasıyla %24,5, %47, %33,4;epidermoid kist, kist hidatik ve psodokistler tum olgularda vertebra, pelvis, mandibula gibi yassı kemikleri secmektedir (p=0,001, ki-kare). Biyopsi tekrarı yapılan 19 olgunun (%13,3); %84,2’si anevrizmal kemik kisti (5 konvansiyonel, 9 solid, 1 sekonder, 1 subperiosteal); 3’u (%15,8) ”mikst kist” dir (p=0,02, ki-kare). Bu olguların bir kısmının pelvis (n=3), femur (n=3), maksillada (n=2) zor ulaşılan alanlarda yerleştiği dikkati cekmiştir. Sonuç: İntraosseoz kistler icerisinde en sık gorulen, aynı zamanda en cok ayırıcı tanı gucluğu yaratan lezyon solid varyantı başta olmak uzere anevrizmal kemik kistidir. Mikst anevrizmal kemik kisti-soliter kemik kisti olgu grubu iyi tanımlanmamış bir grup olup daha geniş serilerle araştırılmalıdır.

Osteosarcomas of jaw: Experience of a single centre

Abstract Although osteosarcoma is the most common primary malignant tumour of bone, osteosarcomas of jaw are rare. In osteosarcomas of jaw, evaluating the clinicopathological factors affecting the prognosis is not easy because of different approaches to diagnosis, treatment, and follow-up. This study reviewed 14 cases of JOS that were diagnosed between 1990–2010, in terms of age, gender, site, clinical history, histopathologic type and histopathologic grade, treatment, and prognosis. Median age was 35 years, while male:female ratio was 1.8:1. Eight tumours were located in the mandible. Osteoblastic differentiation was the predominant feature in seven cases followed by chondroid osteosarcoma (four cases), fibroblastic osteosarcoma, low-grade (parosteal) osteosarcoma associated with fibrous dysplasia, and postradiation osteosarcoma (one cases each). During follow-up, recurrence was seen in four patients at least once and they all died. In conclusion, early diagnosis and complete resection seems to be effective in prognosis. Therefore, clinicians and pathologists should be aware of its characteristics and main differential diagnosis to avoid late recognition.

Subperiosteal aneurysmal bone cyst

Aneurysmal bone cyst of long bones in a subperiosteal location is unusual. We report such a case, and the importance of radiological and pathological examination is emphasized. The diagnosis of subperiosteal aneurysmal bone cyst should be considered in the presence of subperiosteal lytic lesions of the long bones.RésuméLa localisation sous-périostée du kyste anévrismal des os longs est peu fréquente.. Nous rapportons un tel cas. L’importance de l’examen radiologique et pathologique est soulignée. Le diagnostic du kyste anévrismal osseux sous-périosté devrait être suspecté en présence des lésions lytiques sous-périostées des longs os.

The value of touch imprint cytology of core needle biopsy in the diagnosis of spinal lesions.

AIM We aimed to investigate the contribution of the touch imprint cytology (TIC) of core needle biopsies (CNBs) to the diagnosis in spinal lesions. MATERIAL AND METHODS Sixty cases with spinal CNB and TIC were included in the study. Hematoxylin and Eosin (H&E) and May-Grunwald- Giemsa (MGG) stained TIC slides and CNB of each case were blindly reevaluated by two pathologists. TIC and CNB findings were categorized as follows: 1-Nondiagnostic 2- Benign nonneoplastic 3- Benign neoplastic 4- Malignant 5-Malignant lesions that can be typed. RESULTS TIC and CNBs were nondiagnostic in 62% and 45% of all cases, respectively. Malignancy could be identified and typed in 23% of imprint preparations and 35% of CNBs. When TIC and CNB diagnosis were compared, it was seen that diagnostic categories were just the same in 70% of the cases. In 37% of the cases benign and malignant groups could be distinguished. In 20% of the cases diagnostic categories were totally different. CONCLUSION The percentage of the nondiagnostic material in CNBs can reach up to 45%. The findings in TIC and CNBs were compatible with each other. We observed that TIC was diagnostic on its own especially in carcinoma metastasis and contributed to the assessment of cytologic detail in hematologic malignancies.

Recurrence of an atrial myxoma

A 22-year-old man had an operation 14 years ago for removal of a left atrial myxoma. He was admitted to our hospital because of acute femoral arterial embolism. Echocardiographic examination revealed a mobile pedunculated echodense atrial mass attached to the atrial septum. At operation, the left atrium was found to be occupied with a gelatinous pale mass attached by a stalk to the atrial septum. The tumour was extirpated along with a part of atrial septum, which was assumed to be involved in the tumour. The atrial septal defect created was closed with patch. Histopathological examination of excised material revealed typical features of a myxoma.

Pigmented villonodular synovitis of the lumbosacral spine

Pigmented villonodular synovitis commonly occurs in synovial joints of the appendicular skeleton but rarely affects the synovial joint of the spine, and thus information regarding its natural history, treatment and prognosis remains limited. This case report illustrates a male patient with lumbosacral spinal pigmented villonodular synovitis who presented with lower back pain. It was treated by radical surgical excision and posterior instrumentation. Surgical decompression and follow-up of a patient with magnetic resonance imaging (MRI) constitute a satisfactory treatment of pigmented villonodular synovitis.RésuméLa synovite villo-nodulaire pigmentée se produit généralement dans les articulations synoviales du squelette locomoteur, mais affecte rarement les articulations synoviales du rachis et ainsi les publications concernant son histoire naturelle, son traitement et son pronostic sont peu nombreuses. Ce cas clinique concerne un patient masculin de synovite villo-nodulaire pigmentée du rachis lombo-sacré se traduisant par des lombalgies. Il a été traité par excision chirurgicale radicale et ostéosynthèse postérieure. La décompression et le suivi IRM de ce patient atteint de synovite villo-nodulaire pigmentée ont été satisfaisants.