We present a case of adamantinoma that originated from the fibula and had a large soft tissue component measuring approximately 6 cm. Clinical, radiological, and pathological investigations initially suggested that the tumor might be a bone-invading synovial sarcoma. To the best of our knowledge, no other case of fibular adamantinoma with such a large soft tissue component has been reported in the literature.

Background: Nowadays, limb-sparing procedures are the gold standard in the treatment of soft-tissue sarcomas of the limbs. Wide tumor resection with appropriate oncological margins, reconstruction, and stabilization of the involved bone and joint and restoration of the soft tissue lost are essential in order to obtain good clinical and functional outcomes. Tumor excision and soft-tissue reconstruction performed in one-step surgery is chosen by many centers as the preferred approach; however, according to our experience in some selected patients, two-step surgery performed using a dermal regeneration template first and then a margin revision, taking into account the definitive results of the anatomopathological exam conducted over the surgical specimen from the previous surgery, associated with definitive reconstruction surgery over a healthy bed of granulated tissue, showed many potential benefits. Methods: A retrospective observational study was conducted on thirteen patients who underwent a two-step reconstruction procedure using dermal substitution after soft-tissue sarcoma excision. Results: Clinically, the enrolled patients achieved excellent contour and cosmesis of their surgical wounds, with a mean VSS value of 3.07. During the follow-up period, no local recurrences were observed in any patient. Conclusions: Two-step surgery represents the most suitable solution to allow surgical radicality with minimal recurrency and adequate soft-tissue reconstruction, avoiding the possibility of wasting autologous tissue. Our patients generally embraced this approach and the management that followed.

Walking ability may be fairly well maintained after sciatic nerve resection combined with wide resection of soft tissue sarcoma, therefore, surgeons should not hesitate to perform sciatic nerve resection to achieve an adequate surgical margin.

Low-grade myofibroblastic sarcoma (LGMS) is a rare soft-tissue malignant neoplasm originating from the stromal cells that is predominantly comprised of atypical myofibroblasts. The present study reports the case of a patient with low-grade myofibroblastic sarcoma in the soft tissue of the knee. The patient exhibited a soft, painless mass on the medial side of the left knee. During surgery, a yellow-white mass above the posterior margin of the sartorius muscle was identified. This mass, which was irregular and adherent to surrounding tissues, had a blurry boundary, indicative of invasive growth. The morphology of the mass significantly differed from conventional lipomas and was lacking typical features. Immunohistochemical staining confirmed the diagnosis of a malignant LGMS. The patient experienced no recurrence over 1 year of follow-up and reported complete recovery of knee range of motion. The present study suggests that an incisional biopsy may be performed if LGMS is suspected based on patient symptoms and imaging results. In addition, long-term follow-up is crucial for the timely detection and management of any recurrence, playing a key role in the patient\'s ongoing care and treatment.

Malignant peripheral nerve sheath tumors are soft tissue sarcomas originating from peripheral nerves. They are more frequently diagnosed in individuals with neurofibromatosis and tend to affect young men more often than women. The most common sites for these tumors within the peripheral nerve sheath are in the pelvis and the distal femur. Although chemotherapy and radiotherapy are not frequently used, it should be noted that in some cases, postoperative radiotherapy and chemotherapy may be beneficial. The primary treatment approach typically involves the complete surgical removal of the tumor. Here, we discuss the case of our patient whom we successfully treated with extensive resection and followed up with postoperative radiotherapy at our clinic.

BACKGROUND: Details of improved gait ability after wide resection of soft tissue sarcomas that necessitate removal of portions of the quadricep muscle have not yet been reported. We describe a patient with improved gait ability following a rehabilitation program after wide resection of a soft tissue sarcoma that included four components of the quadricep muscle.
METHODS: An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°-30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications.
CONCLUSIONS: Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris.

Giant cell tumor (GCT) of the bone is a benign, locally aggressive neoplasm of epiphyseal origin. Most common sites for GCTs include the distal femur, proximal tibia, and the distal end of radius with the distal humerus being involved rarely. GCT is predominantly managed by extended curettage followed by adjuvant therapy to reduce recurrence. Juxta-articular GCTs are difficult to manage due to the destruction of the articular cartilage and subchondral bone which necessitates the need for joint reconstruction or fusion to salvage the joint. Aggressive and recurrent GCTs can be managed by wide resection of the tumor to reduce local recurrence followed by joint reconstruction or fusion. Joint reconstruction using a total elbow arthroplasty has been described for limb salvage as it provides a good functional outcome. We present a case of an aggressive GCT of the distal humerus that was treated using wide resection with humero-ulnar arthrodesis as an alternative in situations where joint reconstruction is not possible due to the unavailability of the prosthesis or socio-economic factors. The patient was asymptomatic after two years of follow-up, had no signs of recurrence, and had good hand functions.

UNASSIGNED: Bone metastases in thyroid cancer impair the patient\'s quality of life and prognosis. Interestingly, wide margins resection as the surgical treatment of bone metastases might improve the overall survival (OS). Nonetheless, data are lacking regarding the potential benefits of this strategy.
UNASSIGNED: In order to assess the OS of patients with thyroid cancer after a bone metastases carcinologic resection, a retrospective multicentric study was performed, evaluating the 1, 5, 10 and 15 years-OS along with the potential prognosis associated factors.
UNASSIGNED: 40 patients have been included in this multicentric study, with a mean follow-up after surgery of 46.6 ± 58 months. We observed 25 (62.5%) unimestastatic patients and 15 multimetastatic patients (37.5%). The median overall survival after resection was 48 ± 57.3 months. OS at 1, 5, 10, and 15 years was respectively 76.2%, 63.6%, 63.6%, and 31.8%. Survival for patients with a single bone metastasis at 15 year was 82.3%, compared with 0.0% (Log Rank, p = 0.022) for multi-metastatic bone patients.
UNASSIGNED: This study advocates for an increased long term 10-year OS in patients with thyroid cancer, after resection of a single bone metastasis, suggesting the benefits of this strategy in this population.

Desmoplastic fibroma is an extremely rare primary bone tumor that can mimic the presentation of other bone lesions. We describe the case of a middle-aged male with a mass on the left distal femur initially diagnosed as fibrous dysplasia that underwent a wide margin excision followed by a distal femoral replacement to restore anatomy and functionality. Histologic examination of the complete surgical specimen was consistent with a desmoplastic fibroma. This case is the first report of a successful application of endoprosthetic reconstruction after desmoplastic fibroma resection.

UNASSIGNED: We determined the impact of sarcopenia on the treatment outcomes of malignant bone and soft tissue tumors in elderly patients.
UNASSIGNED: We retrospectively reviewed 76 patients (age ≥65 years) who were treated for malignant bone and soft tissue tumors. Sarcopenia was assessed by measuring the cross-sectional area of the psoas muscles at the L3 vertebra from preoperative computed tomography images and categorized using the total psoas area/m 2 (TPA/m 2 ) ≤5.0 cm 2 /m 2 . The patients\' clinical data were then evaluated.
UNASSIGNED: The operation time, length of hospital stay, and median overall survival were not different between the sarcopenia (n=41) and no-sarcopenia (n=35) groups. The local recurrence rate (p=0.01) and incidence of postoperative complications (p=0.02) significantly differed between both groups. The TPA/m 2  of both groups significantly decreased at the final follow-up.
UNASSIGNED: Sarcopenia negatively influenced wound healing and local recurrence, and was significantly exacerbated postoperatively in all elderly patients.