OBJECTIVES:To study the role of angiogenesis and cyclooxygenase-2 expression in cartilaginous tumors and correlate these factors with prognosis.INTRODUCTION:For chondrosarcoma, the histological grade is the current standard for predicting tumor outcome. However, a low-grade chondrosarcoma can follow an aggressive course—as monitored by sequential imaging techniques—even when it is histologically indistinguishable from an enchondroma. Therefore, additional tools are needed to help identify the biological potential of these tumors. The degree of angiogenesis that is induced by the tumor could assist in this task. Angiogenesis can be quantified by measuring the expression of vascular endothelial growth factor and CD34, and cyclooxygenase-2 can induce angiogenesis by stimulating the production of pro-angiogenic factors.METHODS:In total, 21 enchondromas and 58 conventional chondrosarcomas were studied by examining the clinical and histopathological findings in conjunction with the immunostaining markers of angiogenesis and cyclooxygenase-2 expression.RESULTS:The significant variables that were associated with poor outcome were 1) higher-grade chondrosarcomas, 2) tumors that developed in flat bones, and 3) over-expression of CD34 (with a median count that was higher than 5.9 vessels in 5 high power fields). Moreover, CD34 expression (measured using the Chalkley method) revealed significantly higher microvessel density in flat bone chondrosarcomas.DISCUSSION:Previous studies have shown a positive correlation between Chalkley microvessel density and histological grade; however, in our sample, we found that the former is predictive of the outcome. Chondrosarcomas in flat bones have been shown to correlate with a poor prognosis. We also found that CD34 microvessel density values were significantly higher in flat-bone chondrosarcomas. This could explain—at least in part—the more aggressive biological course that is taken by these tumors.CONCLUSIONS:These results provide evidence that CD34 microvessel density in chondrosarcomas can be helpful in predicting patient outcome and may add to our understanding of chondrosarcoma pathogenesis.

The results point to the use of the vascular pattern classification as a prognostic tool in CSs and to differentiate low-grade from moderate-grade/high-grade CSs. Vascular pattern might be also used to complement histologic grade, VEGF immunostaining, and microvascular density, for indicating a patient's prognosis. Low-grade CSs develop under low neoangiogenesis, which conforms to the slow growth rate of these tumors.

Objective: To evaluate the results of percutaneous vertebroplasty (PV) in spinal fragility fractures (osteoporosis/tumor), analyzing possible complications. Method: We evaluated 33 patients with spinal fractures (FXV) due to osteoporosis or tumor who underwent PV between January and November 2021. A physical examination was performed, obtaining the history and risk factors for bone fragility/tumor and a radiological evaluation of the spine to verify FXV. Genant’s semiquantitative method was used for postoperative classification, the VAS score, and a disability questionnaire (ODI). A radiologist evaluated tomographic control to quantify vertebral filling and extravasation, determining where they occurred. Results: 46 vertebrae of 33 patients were operated on, with a mean age of 71 years, and 11 patients with more than one level of surgery. Of the total, 13 patients had tumor fractures, and 20 had fractures due to insufficiency. PMMA extravasation was observed in 31 vertebrae, most frequently in the External Vertebral Venous Plexus (23), Discal Body (9), Anterior Epidural Recess (4), Pulmonary Vessels (4), Internal Vertebral Venous Plexus (3), Inferior Cava (2), Adipose Plane (2) and Azygos Vein (1). No patient had clinical complications. Furthermore, the mean preoperative VAS was eight, the postoperative one was 3, the mean preoperative ODI was 56, and the postoperative one was 30. Conclusion: PMMA extravasation was frequent in several locations and levels without any clinical complications. VP proved to be effective in improving pain and function. Level III; Longitudinal Retrospective Cohort Study.