Search Results (233)

Background and Clinical Significance: Malignant transformation of giant cell tumor of bone (GCTB) is a rare but clinically significant event, most commonly associated with radiotherapy, denosumab therapy, or recurrent disease. Secondary malignant transformation occurring in the absence of recognized risk factors is exceptionally uncommon. We report a rare case of high-grade sarcomatous transformation of proximal humeral GCTB after a prolonged latency period without prior radiotherapy, denosumab exposure, or documented recurrence; Case Presentation: A 27-year-old female initially presented with right shoulder pain and was diagnosed with proximal humeral GCTB. She underwent intralesional curettage and bone grafting, with histopathological confirmation of benign GCTB. Nine years later, she developed progressive shoulder pain, functional limitation, and systemic symptoms. Imaging demonstrated an aggressive lytic lesion with cortical destruction and soft-tissue extension involving the proximal humerus. Repeat curettage and histopathological evaluation revealed high-grade spindle cell sarcoma consistent with malignant transformation of GCTB. The patient received neoadjuvant chemotherapy followed by wide resection and endoprosthetic reconstruction of the proximal humerus, with additional adjuvant chemotherapy postoperatively. At two-year follow-up, she remained disease-free with excellent functional recovery and satisfactory quality of life; Conclusions: This case highlights the potential for delayed malignant transformation of GCTB even in the absence of established predisposing factors. Clinicians should maintain long-term vigilance in patients treated for GCTB, particularly when new pain, functional decline, or aggressive radiologic features develop years after initial treatment. Early recognition and multidisciplinary management are essential to optimize oncologic and functional outcomes. Full article

Background/Objectives: Sacral giant cell tumor of bone (GCTB) is a rare, mostly benign but locally aggressive neoplasm that carries significant diagnostic and treatment challenges due to its anatomic complexity, proximity to sacral nerve roots as well as the blood vessels, and potential impact on bowel, bladder, sexual, and lumbopelvic function and stability. This narrative review aimed to synthesize current evidence on the epidemiology, clinical presentation, diagnostic evaluation, classification, management strategies, outcomes, and surveillance of sacral GCTB. Methods: A focused literature search of PubMed/MEDLINE and Google Scholar was conducted for studies published between January 2000 and January 2026, with additional manual review of reference lists. Given the rarity of the tumor and the observed heterogeneity in study designs, treatment strategies, and outcomes, the evidence was synthesized narratively. Results: Sacral GCTB mainly affects young adults with an indolent nature, often presenting late with progressive low back or buttock pain, radiculopathy, or neurological deficits. Magnetic resonance imaging is the preferred modality for determining local extent, whereas histopathologic biopsy and molecular testing remain essential for definitive diagnosis. Conventional grading systems, such as Enneking and Campanacci, have limited value in sacral disease, as anatomical extent and anticipated neurological morbidity are more relevant for treatment planning. Surgery remains the cornerstone for resectable disease, yet management plans should balance local tumor control against preservation of sacral nerve roots and mechanical stability. Denosumab, selective arterial embolization, and radiotherapy may play important roles in selected unresectable or high-morbidity cases. Local recurrence remains a major concern, and long-term surveillance is recommended because tumor relapse, treatment-related morbidity, and distant metastasis may occur late. Conclusions: Current evidence supports a multidisciplinary, individualized approach to sacral GCTB, guided by tumor extent, expected neurological morbidity, and patient-centered functional outcomes. Prospective multicenter studies are needed to refine treatment algorithms and improve risk stratification. Full article

Background and Clinical Significance: Osteoblastomas are rare, benign but locally aggressive bone tumors with a predilection for the posterior elements of the spine. Their clinical, radiological and histopathological presentation often overlaps with that of osteoid osteomas, leading to diagnostic and therapeutic challenges—particularly in atypical locations such as the anterior thoracic spine. Case Presentation: We report two cases of young female patients (aged 35 and 30 years) presenting with persistent thoracic back pain unresponsive to NSAIDs. In the first case, imaging revealed a lesion at the right T7 pedicle initially attributed to osteoid osteoma; CT-guided thermoablation was declined due to proximity to neural structures. At this stage, we chose percutaneous transpedicular ablation by drilling through the centrum of the lesion (Nidus) surgically. After this transpedicular resection with initial symptom improvement, the patient developed recurrence with lesion progression into both anterior and posterior columns, requiring a second, open, surgical intervention. In the second case, a lesion at the left T11 pedicle and transverse process was identified directly as osteoblastoma due to size and radiological morphology; initial biopsy was non-diagnostic due to specimen fragmentation. In both cases, histopathology was inconclusive or misleading, while clinical and radiological features—including NSAID unresponsiveness, lesion size, and anatomical extent—favored osteoblastoma. Both patients underwent surgical resection via posterior costotransversectomy, partial hemivertebrectomy, expandable cage placement, and posterior instrumentation (T5–T8 and T10–T12, respectively). The postoperative courses were complicated by thoracic events—hemothorax in the first case and pulmonary embolism in the second—both of which were managed successfully. At follow-up, both patients were neurologically intact and pain-free. Conclusions: These cases emphasize the diagnostic overlap between osteoid osteoma and osteoblastoma and highlight the importance of clinical and radiographic correlation when histopathology is inconclusive. A posterior-only approach with costotransversectomy may be a valid strategy in selected cases of thoracic spinal tumors, although specific complications such as hemothorax must be considered. Full article

Background and Objectives: Frontal bone osteomas are benign tumors characterized by the abnormal proliferation of bone. Though typically asymptomatic, these masses often produce visible forehead deformity and may cause localized discomfort. Endoscopic resection has emerged as an optimal technique for appropriately selected frontal osteomas because it enables complete excision while minimizing visible scarring and risk of neurovascular injury. This case series reviews the senior author’s patient outcomes and complications using a scalp-based, endoscopic-assisted surgical approach for frontal bone osteoma excision. Materials and Methods: A review was conducted of all patients (n = 22) who underwent endoscopic-assisted frontal bone osteoma excision performed by a single surgeon between February 2019 and December 2025. All procedures involved endoscopic visualization through remote scalp incisions, osteoma excision, and frontal bone contouring. Patient demographics, presenting symptoms, CT imaging findings, operative details, histopathology results, and postoperative outcomes were recorded. Results: Twenty-two patients underwent endoscopic-assisted excision of frontal bone osteomas performed by the senior author (NT). The primary concern prompting surgical intervention was aesthetic deformity, with localized pain reported in some cases. For all patients, CT imaging was obtained preoperatively to evaluate lesion size and anatomical relationships to nearby facial structures. Histopathology confirmed cortical bone consistent with osteoma in all cases. Postoperative swelling and ecchymosis were common in the first week but resolved spontaneously. No contour irregularities, fluid collections, residual bone, or sensory deficits were observed. Some alopecia was noted in the first three patients, prompting the senior author to modify the technique. All patients healed with small, flat, well-concealed scars adjacent to the hairline. Conclusions: This single-surgeon experience demonstrates that endoscopic-assisted excision of frontal bone osteomas is a safe and effective technique that permits complete excision with excellent aesthetic outcomes and minimal morbidity. The operative framework presented in this study, including surgical planning, technique steps, and postoperative management, supports endoscopic resection as an ideal alternative to traditional direct approaches for frontal bone osteomas. Full article

Background/Objectives: Large language models (LLMs) are increasingly applied to medical image interpretation; however, their diagnostic accuracy and reliability in musculoskeletal radiology remain uncertain. This study evaluates the diagnostic performance and confidence calibration of LLMs in detecting and classifying bone tumors on radiographs. Methods: This retrospective observational study analyzed a dataset of 257 radiographs with confirmed diagnoses obtained from Radiopaedia, including normal studies and a spectrum of benign and malignant bone tumors. Cases were selected to ensure representation across multiple tumor types. Three LLMs (ChatGPT 5.3, X-ray Interpreter GPT-4.1, and X-ray Interpreter Gemini) evaluated each image using a standardized prompt assessing abnormality detection, tumor detection, classification, and confidence. Outcomes included diagnostic accuracy, false positive abnormality rates, false negative rates, tumor hallucination rates, and confidence calibration. Results: Abnormality detection was high across models, with Gemini demonstrating the highest sensitivity (up to 100%). Tumor detection was strongest in lesions with characteristic features, including osteosarcoma and osteochondroma. False negative rates varied substantially, with GPT-4.1 demonstrating the highest rate (29.9%), followed by ChatGPT (24.8%) and Gemini (6.6%). Primary diagnostic accuracy was highest for osteosarcoma in GPT-4.1 (80%), while ChatGPT 5.3 performed best in benign lesions, including osteochondroma (84.6%) and non-ossifying fibroma (76.9%). Tumor subtype classification remained limited across all models and was poorest for Ewing sarcoma (0% in ChatGPT and GPT-4.1; 10.3% in Gemini). False positive abnormality rates were highest in GPT-4.1 (40.7%), followed by Gemini (25.9%) and ChatGPT (13.5%). Tumor hallucination occurred only in Gemini (12.3%). All models demonstrated confidence miscalibration, with higher confidence observed in incorrect predictions and in tumor-negative cases. Conclusions: LLMs demonstrate strong performance in detecting radiographic abnormalities but remain limited in tumor subtype classification, particularly for diagnostically challenging lesions such as Ewing sarcoma. Elevated false positive and false negative rates, along with systematic overconfidence—especially in GPT-4.1—highlight important limitations for clinical use. These findings support the role of LLMs as adjunctive tools rather than independent diagnostic systems. Full article

Background and Clinical Significance: Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive vascular tumor, classically affecting adolescent males. Diagnosis in adulthood is exceptionally uncommon and may mimic other vascular or malignant nasopharyngeal lesions. This patient also had chronic hypocalcemia with Fahr-like intracranial calcifications secondary to long-standing postoperative hypoparathyroidism after thyroid carcinoma treatment. To our knowledge, this coexistence has not been previously reported. Case Presentation: A 34-year-old Caucasian male with papillary thyroid carcinoma treated with total thyroidectomy developed postoperative hypoparathyroidism with chronic hypocalcemia and Fahr-like intracranial calcifications. During admission for acute respiratory insufficiency due to tracheostomy dysfunction, imaging revealed a 37 × 33 × 32 mm heterogeneous, hypervascular nasopharyngeal mass extending into the right pterygopalatine fossa (PPF) with bone remodeling and focal bony dehiscence. Digital subtraction angiography demonstrated a markedly hypervascular tumor, predominantly supplied by branches of the right internal maxillary artery (via the sphenopalatine artery). Endoscopic resection was performed, and histopathology confirmed JNA. Most JNA cases occur between 7 and 19 years of age; presentations in men older than 30 years are rare and often generate diagnostic uncertainty, particularly when differentiating from nasopharyngeal carcinoma or other lesions. In adults, magnetic resonance imaging/computed tomography for assessment of local extent and angiography for vascular mapping are key to minimizing hemorrhagic risk. The concurrent endocrine disorder emphasizes the need for multidisciplinary perioperative metabolic optimization, without implying a pathophysiological link. Conclusions: This report illustrates JNA diagnosed in adulthood in a male with Fahr-like intracranial calcifications secondary to chronic hypoparathyroidism. It highlights the necessity of considering JNA in the differential diagnosis of hypervascular nasopharyngeal masses in adults, especially in patients with complex comorbidities. Full article

Ossification of the vascular pedicle following fibula free flap (FFF) reconstruction is an uncommon and typically asymptomatic complication. Symptomatic cases requiring intervention are rare. We report a 29-year-old man with anterior maxillary osteosarcoma who underwent tumor resection followed by reconstruction with an osteocutaneous FFF. Calcification within the surgical site region was noted on imaging at two months after fibular reconstruction. By five months, he developed progressive trismus and pain with mastication. Computed tomography demonstrated a calcified structure extending from the mandible to the reconstructed maxilla along the flap pedicle, raising concern for tumor recurrence. Surgical excision was performed, and histopathology revealed benign woven bone without evidence of malignancy. Postoperatively, trismus improved, and flap viability was preserved. Retained periosteum during FFF harvest maintains osteogenic potential and may result in pedicle ossification. In symptomatic patients, particularly when recurrence is suspected, surgical resection is both diagnostic and therapeutic. Full article

Osteochondromas are the most common benign bone tumors; however, they are rarely found in the foot. To date, only three cases involving the sesamoid bone have been reported in the literature. We report the case of a 14-year-old female who presented with a 1.5-year history of foot pain and impaired gait. Clinical evaluation and imaging—including plain radiography and magnetic resonance imaging—identified a lesion in the medial sesamoid bone. The diagnosis of osteochondroma was confirmed histologically, and the lesion was excised with preservation of the sesamoid bone. Postoperatively, the patient’s pain resolved completely, and her gait returned to normal within two months. We recommend surgical excision of symptomatic osteochondromas of the sesamoid bone to alleviate pain and restore functional gait. Full article

Background/Objectives: Chondromyxoid fibroma (CMF) is a rare benign cartilaginous bone tumor, accounting for less than 1% of all primary bone tumors. Although CMF most commonly arises in the metaphysis of long bones, involvement of the phalanges of the toes is uncommon. We report a pediatric case of CMF arising in the distal phalanx of the second toe that recurred four years after initial surgical treatment and discuss its management. Methods: A 10-year-old girl presented with a painless mass in the distal phalanx of the second toe. Imaging studies demonstrated an expansile osteolytic lesion with cortical thinning, showing a somewhat aggressive radiologic appearance. Intralesional curettage and debridement were performed to preserve the digit, and the bone defect was reconstructed using allogenic cancellous bone graft and demineralized bone matrix. Histopathological examination confirmed the diagnosis of CMF. Results: Four years later, the patient returned with progressive enlargement of the lesion, indicating tumor recurrence. Because of the recurrent nature of the tumor and progressive cosmetic deformity and recurrence-related anxiety, distal phalangectomy was performed. At the one-year follow-up, the patient showed no evidence of recurrence and maintained satisfactory functional and cosmetic outcomes. Conclusions: CMF of the toe phalanx may show delayed recurrence after curettage, requiring prolonged radiologic surveillance. In recurrent cases, definitive resection should be considered based on a combination of oncologic, anatomic, and patient-centered factors, with distal phalangectomy providing reliable local control in anatomically expendable digits. Full article

Background/Objectives: Phyllodes tumors are rare fibroepithelial neoplasms of the breast, accounting for less than 1% of all breast tumors and approximately 2–3% of breast fibroepithelial tumors. They can be benign, borderline, or malignant, depending on cellular atypia and stromal invasion. Although most display local behavior, malignant forms can metastasize hematogenously, most frequently to the lungs, bones, and liver, with lymph node metastases being exceptional. Case Presentation: We analyzed the case of a 47-year-old woman with a phyllodes breast tumor weighing approximately 5 kg. The tumor evolved slowly over five years, followed by accelerated growth, cutaneous necrosis, superinfection, and severe anemia. Total mastectomy was performed, and histopathological examination confirmed the diagnosis of a malignant phyllodes tumor. Five months after surgery and adjuvant radiotherapy, the patient developed laterocervical metastases with thyroid invasion and life-threatening tracheal compression, an extremely rare presentation for this type of tumor in adults. Discussion/Conclusions: This case illustrates the aggressive and unpredictable behavior of malignant phyllodes tumors and underscores the necessity of careful oncological monitoring and a multidisciplinary approach, given their potential for dissemination to unusual locations. Full article

Background/Objectives: An Aneurysmal Bone Cyst (ABC) is a rare benign osteolytic bone lesion with locally destroying growth. It occurs mostly in the first two decades of life, rarely in older patients, and commonly affects the metaphysis. Clinical presentation includes pain and pathologic fractures. While most ABCs occur as primary lesions, there is an entity of secondary (reactive) ABC following osseous lesions such as fractures. We report a rare case of a secondary aneurysmal bone cyst of the distal radius following a distal radius fracture 4 years prior, with subsequent treatment and reconstruction. Methods: A 67-year-old female patient presented with a pathologic distal forearm fracture with radiologically expansive lytic bone lesion of the metaphysis of the distal radius, suspicious of an ABC. A biopsy and primary fracture management with an external fixator were performed due to the unclear dignity of the lesion. The diagnosis of an ABC was confirmed in the biopsy. The tumor resection and reconstruction were performed with a vascularized free fibula graft (ipsilateral, double barrel), using patient-specific 3D-printed osteotomy templates. Results: Follow-up radiographs showed excellent bone union with progressive remodeling. The functional outcome was very good with almost the same range of motion and grip strength as the contralateral side. No limitation in everyday life and no donor site morbidity was reported. Conclusions: ABC is a rare benign bone tumor the treatment of which consists of complete resection and reconstruction. Reconstruction of the distal radius can be achieved with a fibula graft. In our case, an excellent result was achieved with patient-specific osteotomy templates. Only a few cases of ABC in the distal radius and at this age have been reported; nevertheless, it should be considered as a differential diagnosis for osteolytic bone lesions Full article

Giant cell tumor of bone (GCTB) is a distinctive, intermediate-grade primary bone neoplasm defined by a neoplastic mesenchymal stromal compartment and a prominent osteoclast-rich microenvironment. Although histologically benign, GCTB is clinically consequential due to its locally destructive behavior, propensity for recurrence, and rare capacity for metastasis and malignant transformation. Over the past decade, the identification of recurrent H3F3A p.G34 mutations has fundamentally reshaped the understanding of GCTB pathogenesis, establishing the stromal cell as the true neoplastic driver and positioning the tumor as a paradigmatic epigenetically driven osteolytic disease. This narrative review focus on biology, pathophysiology, and histopathology in the era of H3F3A. H3F3A-mutant stromal cells orchestrate pathological osteoclastogenesis through dysregulated RANKL signaling and chromatin reprogramming, giving rise to the characteristic cellular admixture of osteoclast-type giant cells, mononuclear histiocytic cells, and neoplastic stromal elements. The targeted inhibition of osteoclast activity with denosumab has transformed clinical management, inducing profound morphological changes and bone formation. However, its long-term impact on local control, recurrence patterns, and malignant progression remains unclear. Collectively, GCTB exemplifies a molecularly defined bone tumor in which advances in epigenetic biology and tumor–microenvironment interactions have directly influenced diagnostic practice and therapeutic strategy. Ongoing challenges include refining risk stratification, optimizing treatment sequencing, and clarifying the biological consequences of sustained osteoclast suppression. Full article

The sacrum is a common site for a wide range of pathological processes, including benign and malignant tumors as well as non-neoplastic conditions. Accurate diagnosis of sacral lesions remains challenging due to overlapping imaging features and the anatomical complexity of the region. This review provides a comprehensive overview of sacral lesions, with emphasis on imaging characteristics, diagnostic challenges, and clinical implications. Key imaging findings are highlighted to help narrow the differential diagnosis. While certain imaging patterns may suggest specific etiologies, image-guided biopsy is often necessary for definitive diagnosis. Familiarity with the spectrum of sacral pathologies is essential for radiologists to effectively contribute to diagnosis, patient management, and multidisciplinary care. Full article

Pediatric odontogenic tumors are rare but are frequently overlooked because they often mimic simple cysts on routine radiographic examinations. The radiographic appearance on panoramic imaging and cone-beam computed tomography (CBCT) frequently does not correlate with the true biological nature of these lesions. On CBCT, classic odontogenic tumors often demonstrate mixed radiolucent–radiopaque patterns with ill-defined borders, internal calcifications, septations, or other structural features. The diagnostic challenge arises when an odontogenic tumor mimics a unilateral, well-defined radiolucent area or a cystic lesion with clear borders and no associated tooth displacement, erosion, root resorption, or cortical bone dehiscence. Panoramic radiography has inherent diagnostic limitations but remains widely used for routine dental screening. CBCT provides enhanced three-dimensional assessment and improves diagnostic accuracy in the evaluation of jaw lesions. A marked increase in dental follicle diameter necessitates differentiation between cystic transformation, inflammatory processes, and other odontogenic pathologies. Cortical swelling and bone asymmetry warrant careful evaluation. In this context, an atypical cyst-like lesion detected on routine panoramic radiography prompted a needle aspiration biopsy, which revealed a dry tap and suggested a solid lesion. This prompted CBCT evaluation. Two juvenile cases are presented in which clinical findings, panoramic radiography, and CBCT provided discordant diagnostic impressions of cystic-appearing lesions with well-defined borders and bone expansion. These cases illustrate a diagnostic pathway in which imaging demonstrates a cyst-like appearance with benign radiological features, fine-needle aspiration biopsy reveals the absence of cystic fluid, and histopathology confirms that radiology alone cannot reliably distinguish true cysts from solid odontogenic tumors in pediatric patients. Full article