Surface-type chondromyxoid fibroma in an elderly patient: a case report and literature review
Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm that typically occurs in young adults. Juxtacortical or surface-type CMF are rarer still and we present the case of a surface-type CMF in a 78-year-old woman, with only one other case described in a patient of a similar age previously. This patient was an otherwise healthy woman who presented for evaluation of a palpable lump in the anterior proximal tibia. Initial radiographs obtained demonstrated a focal soft tissue fullness immediately anterior to the anterior cortex of the proximal tibia, which contained faint chondroid-like matrix internally. There was associated scalloping of the anterior tibial cortex. MRI confirmed the presence of a juxtacortical, enhancing lesion. Subsequent excisional biopsy was performed and histopathology demonstrated features, which was consistent with surface-type CMF. At a 6-month follow-up the patient remained free of recurrence. In a patient of this age, paraosteal chondrosarcoma should be excluded. Surface-type CMF, although rare, has been described in older patients and while it is unlikely to feature in a list of differential considerations on initial imaging, awareness of the entity is important.
The impact of obesity on knee osteoarthritis symptoms and related biomarker profiles in a bariatric surgery cohort [Meeting Abstract]
Background/Purpose: Obesity is a common risk factor for knee osteoarthritis (KOA). While it is intuitive that bariatric weight loss improves knee pain, it is not clear how much is due to decreased mechanical load vs metabolic changes. Methods: Patients were screened for knee pain prior to sleeve gastrectomy, gastric bypass, or laparoscopic gastric banding. We required pain for >15 days/month and VAS pain > 30, excluding lupus, inflammatory arthritis, crystal disease, psoriasis, and bilateral knee replacement. Enrolled patients took standing knee xrays for Kellgren-Lawrence (KL) grading. We measured BMI and used the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire at baseline and 1, 3, 6 and 12 months, calculating % excess weight loss (%EWL) and deltaKOOS. We collected blood at baseline and followup to study biomarkers for predicting KOOS scores. Results: Of 536 patients considering bariatric surgery, we found 308 with knee pain and enrolled 176 (91.5% female; BMI 43.6 kg/m2+/-7, 32-61; age 42 +/-11, 18-73) well distributed in xray severity (KL0-4). For the 150 patients who had surgery, knee improvement paralleled weight loss at the followups. At 1 year, %EWL correlated well with deltaKOOS pain (R = .262, n = 114, p = 0.005), similar to other intervals and to other KOOS measures. The sleeve and bypass (n=72 and 27) vs banding (n=15) resulted in higher deltaKOOS pain at 1 year: 32.9 +/-21.3 and 30.7 +/-22.6 vs 10.2 +/-21.4, p=0.001. Sleeve and bypass patients also achieved a higher % of their potential deltaKOOS pain improvement than did banding (65.2% and 60.1% vs 16.8% of remaining KOOS points to 100), and a higher % of patients improved to any degree (93.1% and 88.9% vs 66.7%). Radiographic severity did not predict deltaKOOS at 1 year, nor did the presence of key comorbidities. Patients lost weight in a near-linear fashion through 1 year (Fig. 1), but their KOOS improvements plateaued at 1 month. This held true in sleeve and bypass subgroups (with altered anatomy), while banding showed less consistent deltaKOOS despite a similar trend in %EWL. Baseline leptin levels in obese KOA were higher than non-obese KOA and non-obese/non-OA controls from other cohorts (100.2 +/-61.9 vs 26.2 +/-16.7 and 15.4+/-13.8, p<0.001). Similarly, IL-1Ra, a potential marker of OA progression, was much higher than non-obese KOA or controls (1123+/-940 vs 324.0+/-145.6 and 272+/-130.0, p<0.001). Within obese KOA, higher leptin levels predicted worse xrays (KL0/1 vs KL2/3/4, p = 0.037). After 1 year, mean leptin and IL1-Ra from obese KOA patients had decreased (p<0.001). Conclusion: Bariatric surgery improves knee OA symptoms proportionally to %EWL. Most relief occurs during the 1st month before much weight loss, suggesting a metabolic impact beyond mechanical load reduction on joints - at least with the sleeve and bypass that alter digestive anatomy. Leptin and IL-1Ra serum levels are elevated in obese KOA vs non-obese KOA and controls - and fall after bariatric surgery which could contribute to knee pain relief
Assessing sirtuin expression in endometrial carcinoma and non-neoplastic endometrium
Sirtuins participate in hormone imbalance, metabolism and aging, which are important processes for endometrial cancer (EC) development. Sirtuins mRNA expression (SIRT1 to 7) was determined in 76 ECs (63 Type I, 12 Type II and one mixed EC), and 30 non-neoplastic endometria (NNE) by quantitative real-time PCR. SIRT1 and SIRT7 protein expression was evaluated by immunohistochemistry using Allred score. Compared to NNE, ECs showed SIRT7 (p < 0.001) mRNA overexpression, whereas SIRT1 (p < 0.001), SIRT2 (p < 0.001), SIRT4 (p < 0.001) and SIRT5 (p < 0.001) were underexpressed. No significant differences were observed for SIRT3 and SIRT6. Type II ECs displayed lower SIRT1 (p = 0.032) and SIRT3 (p = 0.016) transcript levels than Type I ECs. Concerning protein expression, SIRT1 immunostaining median score was higher in ECs compared to NNE epithelium (EC = 5 vs. NNE = 2, p < 0.001), while SIRT7 was lower in ECs (EC = 6 vs. NNE = 7, p < 0.001). No significant associations were found between SIRT1/7 immunoexpression and histological subtype, grade, lymphovascular invasion or stage. Our data shows that sirtuins are deregulated in EC. The diversity of expression patterns observed suggests that sirtuins may have distinctive roles in endometrial cancer similarly to what has been described in other cancer models.
Reduction of Treatment Needed for Knee Osteoarthritis after Bariatric Surgery [Meeting Abstract]
Reduction of Knee Osteoarthritis Symptoms in a Cohort of Bariatric Surgery Patients. [Meeting Abstract]
Relationship between knee alignment and T1rho values of articular cartilage and menisci in patients with knee osteoarthritis
OBJECTIVE: To assess the relationship between knee alignment and subregional T1rho values of the femorotibial cartilage and menisci in patients with mild (Kellgren-Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3T. MATERIALS AND METHODS: 26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3T MR scanner. Mann-Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1rho values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. RESULTS: Medial femoral anterior cartilage subregion in varus group had significantly higher (p<0.05) T1rho values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1rho values (p<0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1rho values (p<0.0029) than all meniscus subregions in valgus group. CONCLUSION: There exists some degree of association between knee alignment and subregional T1rho values of femorotibial cartilage and menisci in patients with clinical OA.
Underdiagnosis and Undertreatment Of Knee Osteoarthritis In The Obese Population: The Need For Physician Education and Advocacy [Meeting Abstract]
Atypical incomplete femoral fractures in asymptomatic patients on long term bisphosphonate therapy
OBJECTIVES: Progression of an incomplete atypical femoral fracture (IF) to a complete fracture in patients on long term bisphosphonate (BP) therapy can be catastrophic. We aimed to determine the frequency and imaging features of IF in asymptomatic patients on long-term BP therapy and to identify distinguishing clinical and laboratory markers in the subset of patients who develop these fractures. MATERIAL AND METHODS: From August 2009 to March 2011, 220 femoral radiographs in 110 asymptomatic patients (101 women, 9 men, age 47-94) were reviewed by 2 radiologists. All patients were on BP therapy for at least 3years and had no history of hip/thigh pain or recent trauma. MRI was performed when a fracture was suspected on radiographs. Bone mineral density, serum calcium, 25-hydroxy vitamin D, intact parathyroid hormone, serum c-telopeptide and urine n-telopeptide were obtained in all patients. RESULTS: Two of 110 patients (1.82%, confidence interval of 0.6% to 6.3%) had 3 IFs. Both patients, age 50 and 57, were Caucasian, active and on BP for 8years. MRI confirmed radiographic findings in both patients. Both women had T-scores in the osteopenic range at 2 sites and osteoporotic range at 1 site. CONCLUSION: The 1.82% frequency of IF in asymptomatic patients on long term BP therapy is higher than that suggested in the literature. Statistical differences between fracture and non-fracture groups were not presented as the patient population was too small to draw any significant conclusions.
A Retrospective Review of Patients with Atypical Femoral Fractures While on Long-Term Bisphosphonates: Including Pertinent Biochemical and Imaging Studies
Objectives: To elucidate the effects of prolonged bisphosphonate (BP) exposure on the development of atypical fragility fractures and to define risk factors.Methods: Approval was obtained from the IRB. A retrospective chart analysis was performed on 51 patients with complete subtrochanteric or diaphyseal femoral fracture(s) from January 2005 to April 2011 while on BP for at least 3 years; 25 patients (mean age 67.52) had all available data. All fractures included in the study were low or no energy fractures. Relevant clinical and demographic data including age, gender, ethnicity, height, weight, comorbid medical conditions, and medications were collected. Imaging and laboratory data including calcium, alkaline phosphatase, 25-hydroxy vitamin D(25-OHD), intact parathyroid hormone(PTH), serum c-telopeptide(CTX), urine n-telopeptide(NTX), bone mineral density, radiography and MRI were obtained in all patients.Results: The majority of patients were Caucasian, on alendronate, had bilateral findings, and almost half had prodromal symptoms. 45.8% had a 25-OHD level that was suboptimal (less than 30 ng/ml). Mean BP duration was 9.84 years and mean bone densities were in the osteopenic, not osteoporotic, range.Conclusion: Certain characteristics in patients with atypical BP-related fracture include relatively young age, long duration of BP use, suboptimal 25-OHD and bone densities in non-osteoporotic ranges. All of these may be significant risk factors for insufficiency fracture development.
Comparison of Atypical Femoral Fracture Patients on Long term Bisphosphonates with Controls matched for age and duration of bisphosphonate therapy [Meeting Abstract]