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en: Atypical femoral fracture in a multiple myeloma patient undergoing treatment with denosumab: A case report and literature review.

en: Atypical femoral fracture may occur in patients with multiple myeloma who receive denosumab, even for a short period. Attending physicians should be cognizant of the early symptoms and signs of this fracture.

ja: A 71-year-old woman with multiple myeloma developed dull pain in her right thigh 8 months after restarting high-dose denosumab following its initial administration for 4 months and subsequent withdrawal for 2 years. Fourteen months later, complete atypical femoral fracture occurred. Osteosynthesis was achieved using an intramedullary nail and she was switched to oral bisphosphonate 7 months after cessation of denosumab. There was no exacerbation of the multiple myeloma. Bone union was achieved and she recovered to her pre-injury level of activities. The oncological outcome was alive with disease at 2 years after surgery.

en: International Journal of Surgery Case Reports


en: Blue light induces apoptosis and autophagy by promoting ROS-mediated mitochondrial dysfunction in synovial sarcoma.

en: Taken together, our results revealed that BL induced apoptosis via the ROS-mitochondrial signaling pathway, and autophagy was activated in response to the production of ROS, which protected SS cells from apoptosis. Therefore, BL is a promising candidate for the development of an antitumor therapeutic strategy targeting SS.

en: Cancer Medicine

ja: Cancer Medicine


en: 四肢機能温存のために筋肉移植と関節包再建を行った症例の検討:最善の Orthoplastic Surgery を考える

en: 第49回日本マイクロサージャリー学会学術集会

ja: 第49回日本マイクロサージャリー学会学術集会


en: Combination chemotherapy of doxorubicin and ifosfamide with proton beam therapy for myoepithelial carcinoma originating in the paraspinal region: A case report and literature review.

en: Soft tissue myoepithelial carcinoma (MEC) is an extremely rare mesenchymal tumor that has a poor prognosis unless complete surgical resection is achieved. The present study reported a case of a 38-year-old woman with a tumor in the left paraspinal region at L2 to L3 with vertebral destruction. MEC was diagnosed based on molecular pathological examination of a biopsy specimen. Because curative surgery was expected to be difficult, a combination of chemotherapy with doxorubicin and ifosfamide and proton beam therapy as local therapy was performed, resulting in long-term survival for at least 7.8 years. To the best of our knowledge, this is the first case of soft tissue MEC for which classical cytotoxic chemotherapy and proton beam therapy were effective. Although surgical resection with negative margins is the mainstay of treatment for MEC, adequate doxorubicin-based systemic therapy and high-dose radiation therapy may be a feasible alternative in patients with unresectable or advanced MEC. Future studies on the relationship between molecular pathological features, including biomarkers, and the selection of therapeutic agents are warranted.

en: Molecular and Clinical Oncology

ja: Molecular and Clinical Oncology


en: ZFTA::RELA fusion in a distinct liposarcoma morphologically overlapping with chondroid lipoma.

en: Chondroid lipoma is a rare benign adipose tumor characterized by a recurrent ZFTA::MRTFB fusion. Herein, we report an unusual liposarcoma that partly exhibited overlapping features with those of chondroid lipoma and harbored a ZFTA::RELA fusion. A 59-year-old man presented with a shoulder mass that had existed for approximately 8 years and with increasing pain due to a pelvic mass. The 5.8-cm resected shoulder tumor partly consisted of nests and strands of variably lipogenic epithelioid cells within a hyalinized or focally chondromyxoid stroma, indistinguishable from chondroid lipoma. The histological pattern gradually transitioned to highly cellular, stroma-poor, diffuse sheets of cells with greater nuclear atypia and mitotic activity. Vascular invasion and necrosis were present. The metastatic pelvic tumor revealed a similar histology. Despite multimodal treatment, the patient developed multiple bone metastases and succumbed to the disease 14 months after presentation. Targeted RNA sequencing identified an in-frame ZFTA (exon 3)::RELA (exon 2) fusion, which was confirmed by reverse transcription-polymerase chain reaction, Sanger sequencing, and break-apart fluorescent in situ hybridization assays. The tumor showed a different histology from that of ependymoma, no brain involvement, and no match with any sarcoma types or ZFTA::RELA-positive ependymomas according to DNA methylation analysis. p65 and L1CAM were diffusely expressed, and a CDKN2A/B deletion was present. This is the first report of an extra-central nervous system tumor with a ZFTA::RELA fusion. The tumor partly displayed an overlapping histology with that of chondroid lipoma, suggesting that it may represent a hitherto undescribed malignant chondroid lipoma with an alternative ZFTA fusion.

en: Genes, Chromosomes & Cancer

ja: Genes, Chromosomes & Cancer


en: Clinical Outcome of Patients with Pelvic and Retroperitoneal Bone and Soft Tissue Sarcoma: A Retrospective Multicenter Study in Japan.

en: This study aimed to retrospectively analyze the clinical outcomes of patients with pelvic and retroperitoneal bone and soft tissue sarcoma (BSTS). Overall, 187 patients with BSTS in the pelvis and retroperitoneal region treated at 19 specialized sarcoma centers in Japan were included. The prognostic factors related to overall survival (OS), local control (LC), and progression-free survival (PFS) were evaluated. The 3-year OS and LC rates in the 187 patients were 71.7% and 79.1%, respectively. The 3-year PFS in 166 patients without any distant metastases at the time of primary tumor diagnosis was 48.6%. Osteosarcoma showed significantly worse OS and PFS than other sarcomas of the pelvis and retroperitoneum. In the univariate analyses, larger primary tumor size, soft tissue tumor, distant metastasis at the time of primary tumor diagnosis, P2 location, chemotherapy, and osteosarcoma were poor prognostic factors correlated with OS. Larger primary tumor size, higher age, soft tissue tumor, chemotherapy, and osteosarcoma were poor prognostic factors correlated with PFS in patients without any metastasis at the initial presentation. Larger primary tumor size was the only poor prognostic factor correlation with LC. This study has clarified the epidemiology and prognosis of patients with pelvic and retroperitoneal BSTS in Japan.

en: Cancers

ja: Cancers


en: Hemangioblastoma of the Cauda Equina : A Case Report and Review of the Literature.

en: Introduction : Hemangioblastoma in the spine mainly occurs at the cervical and thoracic levels and is often associated with von Hippel-Lindau (VHL) syndrome. Here, we reported a quite rare case of spinal sporadic hemangioblastoma arising from the cauda equina. Case presentation : A 66-year-old woman presented with a 5-year history of low back and leg pain. Imaging revealed a hypervascular intradural extramedullary tumor in the lumbar region. Preoperative angiography helped to identify the feeding arteries and draining vein, and so facilitated subsequent tumor resection. The pain was dramatically improved but weakness of the left tibialis anterior and left extensor hallucis longus muscles persisted. Discussion : We reported a rare case of spinal hemangioblastoma arising from the cauda equina. Preoperative angiography may be useful for diagnosis and understanding of the anatomy of feeding veins. J. Med. Invest. 69 : 312-315, August, 2022.

en: The Journal of Medical Investigation : JMI


en: The survival and proliferation of osteosarcoma cells are dependent on the mitochondrial BIG3-PHB2 complex formation.

en: Previous studies reported the critical role of the brefeldin A-inhibited guanine nucleotide exchange protein 3-prohibitin 2 (BIG3-PHB2) complex in modulating estrogen signaling activation in breast cancer cells, yet its pathophysiological roles in osteosarcoma (OS) cells remain elusive. Here, we report a novel function of BIG3-PHB2 in OS malignancy. BIG3-PHB2 complexes were localized mainly in mitochondria in OS cells, unlike in estrogen-dependent breast cancer cells. Depletion of endogenous BIG3 expression by small interfering RNA (siRNA) treatment led to significant inhibition of OS cell growth. Disruption of BIG3-PHB2 complex formation by treatment with specific peptide inhibitor also resulted in significant dose-dependent suppression of OS cell growth, migration, and invasion resulting from G2/M-phase arrest and in PARP cleavage, ultimately leading to PARP-1/apoptosis-inducing factor (AIF) pathway activation-dependent apoptosis in OS cells. Subsequent proteomic and bioinformatic pathway analyses revealed that disruption of the BIG3-PHB2 complex might lead to downregulation of inner mitochondrial membrane protein complex activity. Our findings indicate that the mitochondrial BIG3-PHB2 complex might regulate PARP-1/AIF pathway-dependent apoptosis during OS cell proliferation and progression and that disruption of this complex may be a promising therapeutic strategy for OS.

en: Cancer Science

ja: Cancer Science


en: Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography

en: Intertrochanteric fractures are common fragility fractures in elderly patients. The importance of a reliable classification system for these fractures has been increasingly recognized. The aim of this study was to test the hypothesis that three-dimensional classification by CT has better intra- and inter-observer reliability than conventional two-dimensional classification. Two hundred and three consecutive patients (39 male, 164 female; mean age 84.5 years) with intertrochanteric fracture were included in the study. In each case, the fracture was classified using the two-dimensional Evans-Jensen and AO/OTA systems that rely on plain radiographs and using a three-dimensional fragment-based CT system. The second evaluation was performed 1 month after the first evaluation by the same examiner to determine intra-observer reliability. Another blinded examiner also classified each case to assess inter-observer reliability. The kappa coefficient was used for determination of intra- and inter-observer reliability. The kappa values for the two-dimensional Evans-Jensen and AO/OTA classification systems showed moderate intra-observer reliability (κ=0.65 and κ=0.61, respectively) and slight inter-observer reliability (κ=0.20 and κ=0.19). The intra-observer kappa value for the three-dimensional classification system was 0.88, indicating almost perfect reliability; the inter-observer kappa value was 0.70, indicating substantial reliability. The findings of this study confirm that the fragment-based classification system has high reliability. Surgeons should be aware that the three-dimensional fragment-based CT system for classification of intertrochanteric fractures has better intra-observer and inter-observer reliability than the conventional two-dimensional systems.

en: Injury

ja: Injury


en: Morphometric Analysis of Subaxial Cervical Spine with Myelopathy: A Comparison with the Normal Population.

en: The morphometry of the sagittal diameter of the spinal canal, sagittal-transverse ratio, and canal-body ratio on axial reconstructive CT images appears useful for distinguishing cervical spinal canal stenosis involving myelopathy.

en: Spine Surgery and Related Research

ja: Spine Surgery and Related Research


en: Intracanalicular Osteochondroma in the Lumbar Spine.

en: resection of the osteochondroma with the ligamentum flavum relieved the symptoms. Spinal osteochondroma occurs relatively frequently in elderly individuals compared with peripheral lesions and mimics a degenerative spinal disorder. Careful physical examination and imaging evaluation can reveal this tumor and surgery is effective for relieving the symptoms.

en: NMC Case Report Journal

ja: NMC Case Report Journal


en: A Rare Case of Acute-Onset Spastic Quadriparesis Caused by a Chondroma of the Cervical Spine.

en: Chondromas are benign cartilaginous tumors that occur very rarely in the spine. Moreover, chondromas of the extraskeletal origin are also very rare. In this case report, we describe an extremely rare case of chondroma arising from the ligamentum flavum in the cervical spine. A 67-year-old man presented to our clinic with acute-onset spastic quadriparesis. We performed emergent magnetic resonance imaging and found an epidural mass in the right ligamentum flavum at C4-C5. The acute-onset presentation was suspicious for intraligamentous hematoma in the ligamentum flavum at this level. We performed emergency decompression surgery and en bloc removal of the epidural mass with the right C4 and C5 lamina. The lesion had the appearance of cartilaginous tissue rather than hematoma. Based on the histological investigation, the final diagnosis was intraligamentous chondroma of the cervical spine. The quadriparesis improved postoperatively, as did the results of manual muscle testing in the affected area, and he was able to resume walking independently with a cane. At the one-year follow-up, the manual muscle testing results were almost normal. Surgeons should keep in mind the possibility of benign tumors including chondroma of the cervical spine when a patient presents with acute-onset quadriparesis.

en: Case Reports in Orthopedics

ja: Case Reports in Orthopedics


en: A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings.

en: A novel three-dimensional fragment-based classification system based on computed tomography findings was established to characterize femoral intertrochanteric fractures. The intertrochanteric bone fragments were defined as follows : neck, posterior portion of the greater trochanter, anterior portion of the greater trochanter, lesser trochanter, and shaft. Each type of fracture was classified as 2-, 3-, 4-, or 5-fragment according to the number of floating bone fragments. Following the description of the fracture type, each floating bone fragment was appended, with the exception of a fragment involving the shaft. Ninety-five intertrochanteric fractures were classified by the same surgeon. The fractures occurred in 14 men and 81 women with a mean age of 84.7 years. The frequency of each type of fracture was investigated. Thirty-one fractures (32.6%) were 2-fragment and 64 (67.4%) were ≥ 3-fragment. A fragment of the anterior portion of the greater trochanter, which cannot be classified using conventional systems, was included in 29 cases (30.5%). A 5-fragment fracture was detected in two cases (2.1%). Using this fragment-based classification system, intertrochanteric fractures can be evaluated in more detail than is possible using conventional classification systems. J. Med. Invest. 66 : 362-366, August, 2019.

ja: The Journal of Medical Investigation : JMI


en: Intimal sarcoma arising from the common iliac artery presenting with artery occlusion : a case report and literature review.

en: We present a rare case of intimal sarcoma arising from the common iliac artery in an 82-year-old man who presented with intermittent claudication. He had undergone endovascular therapy with self-expanding stents to both iliac arteries that had occluded soon after placement. After salvage bypass grafting, a diagnosis of intimal sarcoma with angiosarcoma phenotype from the iliac artery was made. Further bypass graft surgery relieved symptoms temporarily. However, the tumor progressed and the left limb became ischemic. The chemotherapy of eribulin did not prevent tumor progression. The patient died of the disease 20 months after the first surgery. J. Med. Invest. 66 : 205-208, February, 2019.

en: The Journal of Medical Investigation : JMI