Muhammad Umar Jawad

Primary lymphoma of bone in adult patients.

The low incidence of primary lymphoma of bone (PLB) has led to discrepancies in classification as well as difficulty in prognostication. The authors of this report used the Surveillance, Epidemiology, and End Results (SEER) database to analyze a large, population‐based cohort of adult patients with this disease. The database provides a standardized classification and documentation of outcomes and enables a meaningful evaluation of prognostic factors.

Surgery Significantly Improves Survival in Patients With Chordoma

Study Design. Retrospective database review using Surveillance, Epidemiology, and End Results database, National Cancer Institute. Objective. To determine current treatment outcomes and demographic characteristics and to define the prognostic factors and impact of surgery on survival. Summary of the Background Data. Rarity of the disease has limited the number of population-based studies addressing the issues of prognostic factors and the current treatment outcomes. Methods. A total of 962 patients with chordoma, diagnosed between1973 and 2005, were identified in the Surveillance, Epidemiology, and End Results database. Patient demographics and clinical characteristics, incidence, year of diagnosis, location, size and stage at diagnosis, treatment(s), and survival were extracted. Kaplan-Meier, log-rank, and Cox regression were used to analyze the significance of prognostic factors. Results. Race specific incidence per 100,000 persons in 2005 shows whites to have the highest (0.473) incidence, followed by Asians/Pacific Islanders (0.091), and Afro-Americans (zero), respectively. The incidence difference between whites and Afro-Americans over time is statistically significant (P < 0.001). The age adjusted incidence reveals a peak in eighth decade of life. Survival was not impacted by race. Age category <59, Hispanic ethnicity, size <8 cm, and surgical resection were all independent predictors of better overall survival. Analysis revealed that survival outcomes were very similar in patients with “in-operable disease” and those in which “surgery was recommended but not performed” suggesting that benefits of resection cannot be solely attributed to selection bias. Conclusion. With high local recurrence rates and the significant functional morbidity associated with surgical resections, clinicians are left wondering if surgery constitutes an appropriate treatment option. Our study clearly demonstrates that surgery significantly improves the overall survival for patients with chordoma. We have further identified age <59 and size of primary tumor <8 cm as important prognostic factors determining the outcome with substantial statistical significance.

In Brief: Classifications in Brief: Mirels’ Classification: Metastatic Disease in Long Bones and Impending Pathologic Fracture

The earliest efforts to predict the risk of an impending fracture in the presence of tumor dates to the 1960s [1–3, 10, 11]. Although some of the earlier studies made positive contributions, they lacked supportive statistical evidence. Later, several larger and well-documented studies were designed to identify the features of an impending pathologic fracture [4, 7, 8]. Although the statistical power of the later studies was improved, they failed to reach an agreement regarding specific criteria on which to base the decision of prophylactic fixation. It was not until 1989 when Hilton Mirels proposed a rating system to classify pathologic fracture risk [12].

In Brief: Classifications in Brief: Enneking Classification: Benign and Malignant Tumors of the Musculoskeletal System

Since its establishment in 1959, the American Joint Committee for Cancer (AJCC) has undertaken the responsibility for developing clinically useful staging systems for various types of cancer. The task force on malignant bone tumors of the AJCC could not agree on a satisfactory system and recommended institutions with access to large numbers of patients, consistency in management, and long-term followups undertake this task [2]. In 1980, a system for surgical staging of musculoskeletal sarcoma was proposed, studied, and adopted by the Musculoskeletal Tumor Society and subsequently by the AJCC [4]. This system was established initially at the University of Florida in 1977 based on the data collected from 1968 through 1976 by Dr. William Enneking.

Matrix Metalloproteinase 1: Role in Sarcoma Biology

In carcinomas stromal cells participate in cancer progression by producing proteases such as MMPs. The expression MMP1 is a prognostic factor in human chondrosarcoma, however the role in tumor progression is unknown. Laser capture microdissection and In Situ hybridization were used to determine cellular origin of MMP1 in human sarcomas. A xenogenic model of tumor progression was then used and mice were divided in two groups: each harboring either the control or a stably MMP1 silenced cell line. Animals were sacrificed; the neovascularization, primary tumor volumes, and metastatic burden were assessed. LCM and RNA-ISH analysis revealed MMP1 expression was predominantly localized to the tumor cells in all samples of sarcoma (p = 0.05). The percentage lung metastatic volume at 5 weeks (p = 0.08) and number of spontaneous deaths secondary to systemic tumor burden were lower in MMP1 silenced cell bearing mice. Interestingly, this group also demonstrated a larger primary tumor size (p<0.04) and increased angiogenesis (p<0.01). These findings were found to be consistent when experiment was repeated using a second independent MMP1 silencing sequence. Prior clinical trials employing MMP1 inhibitors failed because of a poor understanding of the role of MMPs in tumor progression. The current findings indicating tumor cell production of MMP1 by sarcoma cells is novel and highlights the fundamental differences in MMP biology between carcinomas and sarcomas. The results also emphasize the complex roles of MMP in tumor progression of sarcomas. Not only does metastasis seem to be affected by MMP1 silencing, but also local tumor growth and angiogenesis are affected inversely.

In Brief: Crowe’s Classification: Arthroplasty in Developmental Dysplasia of the Hip

THA was described as ‘‘The operation of the century’’ [13]. Despite success of the procedure for patients with idiopathic or traumatic degenerative arthritis, hip replacement for congenital dislocation or subluxation was controversial as late as the 1970s [3, 6, 8, 13]. Different anatomic characteristics observed on AP radiographs of the pelvis historically were used to assess the degree of acetabular dysplasia. These included acetabular angle of Sharp, center edge angle of Wiberg, acetabular index of depth to width as described by Heyman and Herndon [11], acetabular roof obliquity described by Massie and Howorth [14], femoral head extrusion index, lateral subluxation, and peak to edge distance [15]. Crowe et al. described a relatively simple method to determine degree of hip dysplasia in 1979 [4].

Skeletal Plasmacytoma: Progression of disease and impact of local treatment; an analysis of SEER database

BackgroundPrevious reports suggest an as yet unidentifiable subset of patients with plasmacytoma will progress to myeloma. The current study sought to establish the risk of developing myeloma and determine the prognostic factors affecting the progression of disease.MethodsPatients with plasmacytoma diagnosed between 1973 and 2005 were identified in the SEER database(1164 patients). Patient demographics and clinical characteristics, treatment(s), cause of death, and survival were extracted. Kaplan-Meier, log-rank, and Cox regression were used to analyze prognostic factors.ResultsThe five year survival among patients initially diagnosed with plasmacytoma that later progressed to multiple myeloma and those initially diagnosed with multiple myeloma were almost identical (25% and 23%; respectively). Five year survival for patients with plasmacytoma that did not progress to multiple myeloma was significantly better (72%). Age > 60 years was the only factor that correlated with progression of disease (p = 0.027).DiscussionPlasmacytoma consists of two cohorts of patients with different overall survival; those patients that do not progress to systemic disease and those that develop myeloma. Age > 60 years is associated with disease progression. Identifying patients with systemic disease early in the treatment will permit aggressive and novel treatment strategies to be implemented.

Morphology of the proximal femur in a Pakistani population

Purpose. To measure the morphology of the proximal femur in a Pakistani population. Methods. Standardised anteroposterior pelvic radiographs of 116 male and 20 female healthy volunteers aged 20 to 50 (mean, 33) years were taken. Morphologic dimensions of the proximal femur were measured, including canal flare index (CFI), morphological cortical index (MCI), femoral head offset, femoral head diameter, and femoral head position. Results. Based on the CFI, 67% of the subjects had normal canal shapes (CFI, 3.0–4.7), whereas 1% and 33% of the subjects had stovepipe shapes (CFI, <3) and champagne-flute shapes (CFI, 4.7–6.5), respectively. Based on the MCI, 29% of the subjects had cylindrical shapes (MCI, <2.7) and 71% had trumpet shapes (MCI, >2.7). Conclusion. Morphology of the proximal femur in our study population differed significantly from those in western populations, indicating regional variation. It could also be due to the younger age of our population.

Acetabular morphometry and prevalence of hip dysplasia in the South Asian population

We carried out a cross-sectional study to measure the association of the seven acetabular parameters with pelvic morphometry and prevalence of hip dysplasia in our population. Convenience sampling was carried out and 250 consecutive patients who came to AKUH for intravenous pyelogram and had no complaints in the region of the hip joint were enrolled in the study. Post-micturition standardized plain antero-posterior pelvic radiographs of 250 asymptomatic adults (500 hip joints) was studied. There were 136 males (54.4%) and 114 females (45.6%). Mean age of our study population was 38 years (15–78 years). The average center edge angle was 35.5±6.6° standard deviation (SD), acetabular angle was 37.76±4.37°, depth to width ratio was 0.31±4.6°, roof obliquity was 10.6±6.2°, extrusion index was 0.1±5.8, lateral subluxation 8.9±2.7 mm, and peak to edge distance 17±3.98 mm. There was significant influence (p<0.05) of age in all angles except depth to width ratio. A total of seven hip joints (1.4%) were dysplastic with CE angle <25° while four of the seven hips were severely dysplastic with CE angle <20°. In the dysplastic group there was significant correlation (p<0.05) of CE angle with acetabular angle, depth to width ratio, extrusion index and peak to edge distance. Prevalence of hip dysplasia was found to be very low in our population. These results are consistent with the findings of studies carried out in other Asian countries.