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    • br Discussion Furthermore most of the previously described c

    2019-04-18


    Discussion Furthermore most of the previously described cases with a solitary lesion affecting bone involved the craniofacial bones [2–7], and only a few cases affected the appendicular skeleton. Several affected extra-craniofacial sites have been sporadically reported, for example: femur [8], tibia [9–11], humerus [1], ulna [12,1], and BMS-754807 [13]. The age of the patients was usually less than 2 years [3], and no adult case has been reported, to our knowledge. Konishi et al. reported the only known adult case of a solitary myofibroma affecting a lumbar vertebrae in a 33 years old male [14]. They described an expansile lytic lesion with a sclerotic rim located in the right pedicle of L1 vertebrae. As in our case, their patient sough medical attention due to severe pain in his lower back and abdomen and was pain free after excising the tumor. Other cases described in adult patients were confined to non-osseous sites, like subcutaneus or intramuscular tumors [15–18]. The differential diagnosis of myofibroma is extensive. Microscopically, the lesion may bear a resemblance to nodular fasciitis, neurofibroma, fibrous histiocytoma, desmoid tumor, lipofibromatosis, other fibromatoses, inflammatory myofibroblastic tumor, congenital infantile fibrosarcoma, and various types of sarcoma [5]. Radiologically, the differential diagnosis may include non-ossifying fibroma, fibrous dysplasia and histiocytosis X [8]. Given the patient׳s age and the lesion location, this lesion could be easily confused with a non-ossifying fibroma. Nevertheless our primary concern was the patient׳s worsening pain, which led us to offer her a surgical treatment. As observed in previously reported cases, the plain radiograph and CT for our case showed a sharply demarcated, non-specific lytic mass with a sclerotic margin [1,14]. Radiological examinations can outline the tumor extent but are not sufficiently specific to allow definitive diagnosis, which requires histopathologic examination. Our case revealed the typical pathological features of myofibroma as described above. In the majority of cases the histology of myofibroma is distinctive, and additional studies are not needed [5]. However, immunostaining and clinical signs can support the diagnosis and differentiate it from the aforementioned pathologies. Surgical excision of solitary bone lesions usually results in cure [14]. Spontaneous regression may occur in soft tissue lesions as well as is solitary bone lesions [14].
    Conflict of interest statement
    Introduction Bone metastases are exceedingly common among advanced cancer patients, especially in those with breast, prostate, and lung carcinomas [1,2]. They are a cause of great morbidity and result in significant pain in 50–75% of patients at some point throughout the course of their illness [2–4]. Bone metastases can also lead to hypercalcemia, skeletal complications including pathological fractures and spinal cord compression, and have a negative impact on quality of life (QOL) [1,5,6]. External beam radiation therapy (EBRT) is recommended for the relief of symptomatic bone metastases [1,5,6]. Studies have proven it to be both cost-effective and efficacious, with up to 80% of treated patients experiencing at least some pain relief [3,6]. Moreover, it has few associated toxicities, many of which are temporary and minor in nature [6]. Recent technological developments have led to an increased use of stereotactic body radiation therapy (SBRT) for the treatment of select tumors, most commonly to the liver, lung, or bone [7,8]. This technique is employed with a locally curative intent and delivers more radical doses of radiation with great accuracy [9]. For spinal metastases, SBRT allows for locally ablative doses of radiation to the target and limits the spinal cord or cauda to thresholds below the dose of myelopathy [6]. SBRT to the spine delays tumor progression and provides long-term pain control and maintenance or even improvement in QOL [7]. Long term complications of spine SBRT, unique from conventional EBRT, include vertebral compression fractures and, much less likely, radiation myelopathy. Acute adverse events are similar to conventional radiotherapy and are usually self-limiting [8].