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Category Archives: Bibliographic References

This digital library houses the book on Oncology and Orthopedic Oncosurgery.

It includes academic lectures, presentations from national and international congresses, published papers, case discussions, performed surgical procedures, and proprietary techniques developed.

The digital format was chosen because the web allows the inclusion of texts with numerous visual resources, such as images and videos, which would not be possible in a printed book.

The content is intended for students, healthcare professionals, and the general public interested in the field.

Bibliographic References

Fibroma Condromixóide

Chondromyxoid Fibroma

Chondromyxoid Fibroma

Characteristics, Diagnosis and Treatment

Chondromyxoid fibroma is a bone lesion that requires attention due to its local aggressiveness and histological peculiarities. This condition has a number of distinct characteristics that are important for proper diagnosis and treatment.

Chondromyxoid fibroma is characterized by an area of ​​bone rarefaction, generally located eccentrically in the metaphysis of long bones. One of its striking characteristics is the presence of an internal halo of bone sclerosis, which delimits the lesion from normal bone. Furthermore, it is common to observe erosion of the cortical bone, which contributes to the local aggressiveness of the lesion.

From a histological point of view, Chondromyxoid fibroma presents cellular pleomorphism, with areas of chondroid, fibrous tissue and abundant myxoid material. Often, multinucleated giant cells can also be seen, which adds complexity to the diagnosis. It is worth mentioning that this lesion can occur in association with aneurysmal bone cysts, which can influence treatment options and prognosis.

In terms of incidence, Chondromyxoid fibroma tends to occur more frequently in the proximal metaphysis of the tibia, mainly affecting adolescents and young adults. This specific distribution may be useful in the differential diagnosis with other bone lesions.

The treatment of Chondromyxoid Fibroma is mainly surgical. Generally, partial parietal resection of the lesion is performed, accompanied by local adjuvants, such as phenol, electrothermia or liquid nitrogen, and bone grafting, when indicated, in addition to filling the cavity with orthopedic cement or bone substitutes. In more advanced cases, segmental resection may be necessary. Curettage can also be used in joint regions, but must be carried out carefully to avoid recurrences.

In summary, Chondromyxoid fibroma is an uncommon bone lesion, but one that requires attention due to its local aggressiveness and potential for recurrence. Early diagnosis and appropriate treatment are essential to ensure good clinical evolution and prevent long-term complications.

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

Diagnóstico de Tumores Ósseos

Diagnosis of Bone Tumors

Diagnosis of Bone Tumors

Guide to assessment and procedures

Introduction:

When bone neoplasia is suspected, it is crucial to carry out a thorough analysis, using a multidisciplinary approach that includes clinical evaluation, laboratory tests, imaging methods and anatomopathological examination. This process is essential for an accurate diagnosis, which will guide the appropriate therapeutic approach for each case.

Analysis Parameters:

Several aspects must be considered during the analysis of the bone lesion, including the identification of the compromised bone, the number of lesions, the specific location in the bone and the limits of the lesion. Furthermore, characteristics such as the nature of the lesion (osteolytic or osteogenic), the presence of calcifications and the type of periosteal reaction are essential for the differential diagnosis.

Diagnostic Methods:

There are different study methods for pathological examination, including cytology, puncture biopsy, incisional biopsy and frozen section biopsy, ultrasound-guided biopsy or tomography. Each method has its specific indications and it is important to select the most appropriate one for each case, taking into account the location and nature of the injury.

Microscopic Study:

The fragments obtained by biopsy must be analyzed microscopically, using special stains and immunohistochemical techniques, when necessary. These analyzes allow the precise identification of the type of neoplasm and its origin, guiding appropriate treatment.

Surgical Parts:

Analysis of surgical specimens is essential to assess the extent of the neoplasia, the response to preoperative therapy and the need for adequate surgical margins. Procedures such as grading the response to chemotherapy are essential to determine the prognosis and subsequent therapeutic plan.

In summary, the diagnosis of bone tumors requires a comprehensive approach that includes careful evaluation of clinical data, imaging methods, and pathological analysis. Only through a detailed and integrated analysis is it possible to obtain an accurate diagnosis and guide the appropriate treatment for each patient.

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

Condroma

Chondroma

Chondroma

Chondroma is a benign tumor that develops from cartilage cells, with the short bones of the hands and feet as its main sites of occurrence. Generally, it can present as a solitary lesion or, in some cases, affect multiple bones, characterizing what is known as enchondromatosis.

Unilateral enchondromatosis, in turn, is a form of dyschondroplasia that is called Ollier’s disease. Maffucci Syndrome is characterized by the presence of multiple enchondromas associated with hemangiomas.

Although chondroma has a predilection for short bones, it can occasionally be found in long bones, such as the distal femur, proximal humerus and tibia. In these locations, it is important to make a differential diagnosis with other conditions, such as bone infarction, which is generally asymptomatic and can be identified by radiographic findings, and grade I central chondrosarcoma, which is symptomatic and evolves slowly over time and causes cortical erosion. inside the bone, getting bigger and bigger. 

Differentiating histologically between chondroma and grade I chondrosarcoma can be challenging, and a clinical and radiographic observation approach is preferable to determine the appropriate management, since grade I chondrosarcoma is slow to evolve, which allows observation in short periods of time, three to six months, performing imaging exams. If changes occur, with worsening of the images, the lesion should be considered as grade I chondrosarcoma and treated as such. The histological diagnosis of this neoplasm is controversial. 

Radiographically, chondroma is characterized by a rarefaction lesion, occasionally with foci of calcification, which may result in bone deformities.

The treatment of asymptomatic chondroma, discovered by chance, can only be observation, as it generally does not evolve and behaves like a scar, being just an examination finding. Curettage of a “chondroma”, which in reality was a grade I chondrosarcoma, can lead to the spread of the tumor, making it difficult to perform correct resection surgery with an oncological margin.

When the chondroma affects the outer surface of the bones, it is called juxtacortical chondroma and usually requires surgical treatment through partial parietal resection.

Chondroma is a benign cartilage tumor, generally harmless, but requires monitoring and, in a few cases, if it progresses, with an increase in the lesion, there is a need for surgical intervention, with resection of the tumor with an oncological margin, to guarantee the better outcome for the patient, avoiding recurrences.

Clinical monitoring of the patient without symptoms should be carried out with images at 3 months, 6 months and every year thereafter for early diagnosis and adequate treatment in time for a possible grade I chondrosarcoma, allowing this lesion to be treated appropriately. correctly and in good time. 

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

Condroblastoma

Chondroblastoma

Chondroblastoma

Chondroblastoma is a rare benign neoplasm that accounts for approximately 1.8% of all bone tumors. This type of tumor prefers the epiphysis of long bones and generally manifests as a lesion of bone rarefaction, with foci of calcification. It is more common in male patients, typically occurring during the first and second decades of life, when the growth plate is still open.

First described by Codman in 1931, chondroblastoma was initially associated with the “calcified giant cell tumor” of the proximal humerus. However, subsequent studies showed that it was a tumor entity distinct from the gigantocellular tumor (GCT).

Due to its intra-articular location, chondroblastoma can present symptoms similar to arthritis. Furthermore, it can demonstrate local aggressiveness, causing erosion of the cortical bone, growth plate and joint invasion. Often, areas of aneurysmal bone cysts may be associated with radiographic manifestations of local aggressiveness.

Treatment of chondroblastoma generally involves intralesional curettage followed by local adjuvants, such as phenol, electrothermia or liquid nitrogen, in addition to the placement of an autologous bone graft or polymethyl methacrylate cement. In more advanced cases, segmental resection followed by reconstruction with a prosthesis or arthrodesis may be necessary in recurrent or very advanced cases.

The prognosis for chondroblastoma may be poor due to the risk of local recurrence and possible orthopedic complications, including joint degeneration and growth failure.

Although rarely, chondroblastoma can lead to lung metastases with histology similar to that of a benign tumor, without presenting atypia. The treatment for these metastases may be clinical and imaging monitoring and if observation indicates progress, surgical excision may be necessary.

In summary, chondroblastoma is a benign bone neoplasm that, although rare, requires careful attention due to its potential for local aggressiveness and possible long-term complications. Early diagnosis and appropriate treatment are essential to ensure the best possible prognosis for affected patients.

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

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