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Natural History of Kids’ Benign Bone Tumors; Sarcoma Staging; Pathologic Fractures

Almost 20% of asymptomatic children and adolescents had benign bone tumors of the extremities, a review of a longitudinal radiographic collection showed.

Overall, 35 benign tumors were identified in 33 pediatric patients whose median age was 8. The most commonly identified tumor types were non-ossifying fibromas (NOF, 7.5%), enostoses (5.2%), osteochondromas (4.5%), and enchondromas (1.8%).

The findings came from a review of the Brush Inquiry, a collection of 25,555 radiographs and 262 healthy children. The x-rays were all left-sided views of each patient’s upper and lower extremities. The overall incidence of benign tumors in the asymptomatic population was 18.9%, and the median age at detection after a previous negative radiograph was 9 years. NOFs were the only tumor type that resolved over time, Christopher D. Collier, MD, of the University of Chicago, reported during the Musculoskeletal Tumor Society (MSTS) virtual meeting.

“The goal of this study was to give us more accurate information on the overall incidence of these [tumors] and the natural history,” MSTS program co-chair Thomas J. Scharschmidt, MD, of Ohio State University in Columbus, said during a review of selected abstracts. “The impetus for the study is that those of us in the oncology world have a lot of consults for NOFs, osteochondromas, and other things that can cause a lot of anxiety for families. This information provides us with some numbers to be able to counsel families when they are sent to us.”

Following are summaries of two other abstracts from the meeting.

Skeletal Staging in Bone Sarcomas

As many as 35% of patients with bone sarcomas and bony metastases at diagnosis would have gone undetected if staging had included only a CT scan of the lungs, a separate review of 9,855 patients showed.

The analysis of the National Cancer Database included patients with newly diagnosed bone sarcomas during 2010-2015: 4,013 patients with chondrosarcoma, 4,105 with osteosarcoma, and 1,737 with Ewing sarcoma. The data showed that 11.7% of patients had lung metastases and 4.8% had bone metastases at diagnosis. The presence of bone metastases was associated with worse survival in each of the three histologies and in all histologies combined (P<0.01).

The study had its origin in the growing interest in modified staging protocols that challenge the value of skeletal staging, Collier and colleagues noted in a poster presentation. The data showed that lung-only staging would have missed metastatic disease in 16% of patients with osteosarcoma, 25% of those with chondrosarcoma, and 35% of patients with Ewing sarcoma.

“I think we probably routinely get bone staging, more so in our bone sarcomas and soft-tissue sarcomas, but I think this study really highlighted the importance of that as well as the poor outcomes with bone metastases overall across all of these bone sarcomas,” said Scharschmidt.

Pathologic Fracture and Limb Salvage Outcomes

Pathologic fracture did not adversely affect patient or implant survival following limb salvage surgery for osteosarcoma, a review of 304 cases showed.

During a median follow-up of 13 years, 17 (5.6%) patients had a

Surgery for benign breast conditions unlikely to harm breastfeeding ability

Having surgery for benign breast conditions won’t harm a woman’s future ability to breastfeed, new research suggests.

The study included 85 women, aged 18 to 45. Fifteen had a prior history of benign breast conditions, including cysts, benign tumors and enlarged breasts. Sixteen had had breast surgery, including breast augmentation, reduction mammoplasty and biopsy.

Whether they’d had surgery or not, 80% were able to breastfeed or obtain breast milk for bottle-feeding, according to findings presented Saturday at a virtual meeting of the American College of Surgeons. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

Each year, nearly one million women in the United States are diagnosed with benign breast conditions. About half of women will have a benign breast lesion in their lifetime.

Many of these conditions are managed with surgery. Other common breast procedures include surgery to reduce enlarged breast tissue or augmentation for asymmetry or developmental breast conditions.

“Pediatricians and obstetrician-gynecologists who refer teenage patients for treatment of breast conditions, as well as parents, are concerned that surgery may impact breast development and eventual lactation,” said study co-author Laura Nuzzi, clinical research manager at Boston Children’s Hospital.

There is limited research on how surgery for benign breast conditions may affect later breastfeeding. The authors are continuing their research in this area, they noted in an ACS news release.

Study co-author Shannon Malloy is a clinical research associate in the hospital’s Adolescent Breast Clinic.

Malloy said, “We hope to augment the conclusions from this study that suggest plastic reconstructive surgeons, primary care practitioners, and any provider who comes in contact with women who have a benign breast condition can reassure them that an operation for a benign breast condition is safe and should not preclude them from enjoying the benefits of surgery for fear of impairing future breastfeeding satisfaction and lactation.”

More information

The American Academy of Pediatrics has more on breastfeeding.

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