Introduction

Epithelioid osteoblastomas are an extremely rare entity infrequently seen in the resection of benign bone tumors. First described in the early 20thcentury, it has only been reported a handful of times throughout literature. Although these tumors can present similarly to malignant bone lesions, it is important for an experienced pathologist to differentiate epithelioid osteoblastoma from osteosarcoma. We present the case and treatment of a young female who was discovered to have an epithelioid osteoblastoma of the femur.

Case report

We describe the case of a 19-year-old healthy female who presented with 3 weeks of progressive right-sided groin pain. After biopsy demonstrated, epithelioid osteoblastoma extensive curettage of the lesion followed by insertion of a short cephalomedullary intramedullary nail was performed. At 1-year follow-up,the patient was full weight-bearing without pain or recurrence.

Conclusion

Epithelioidosteoblastomas are a very rare entity in the diagnosis of benign bone tumors and are characterized as having aggressive features clinically, radiographically, and histologically. It is imperative that an experienced pathologist differentiates this lesion from osteosarcoma to guide treatment and to ensure the best possible outcomes.

Background

Clinical workup and treatment guidelines have been published by the National Comprehensive Cancer Network (NCCN) to ensure patients are treated uniformly and appropriately. This study sought to retrospectively review patients with a new diagnosis of sarcoma who were treated in a National Cancer Institute (NCI) designated center and determine compliance rates with guidelines for sarcoma.

Aim

To evaluate our compliance of NCCN sarcoma guidelines at a major NCI designated center and to report instances of deviation that could be used for future studies to improve patient care.

Methods

Data was collected retrospectively as an internal review and quality assessment of 35 newly diagnosed and treated patients. Demographic data were recorded and information concerning whether patients had appropriate imaging, biopsy and management. Variables of interest were expressed as raw numbers and percentages.

Results

Primary site imaging was obtained in 100% of cases. Chest and full-body imaging were obtained in 97% and 100% of indicated cases, respectively. Tissue was obtained preoperatively in 97% of cases. Imaging was reviewed at multidisciplinary Treatment Planning Conference (TPC) in 97% of cases. Pathology was reviewed in 94% of cases in TPC. Both tumor, node, metastasis staging and plan of care were reviewed in 100% of cases in TPC. Treatment guidelines were followed in 94% of cases reviewed.

Conclusion

This study evaluated the workup and treatment provided by a single NCI designated sarcoma service to a series of patients with pathologies defined with the NCCN sarcoma treatment guidelines. Although adherence to NCCN was reported to be very high future prospective studies are required to investigate whether NCCN guidelines impact patient outcomes.

BACKGROUND:Patient satisfaction and reported outcomes are becoming increasingly important in determining the efficacy of clinical care. To date no study has evaluated the patient experience in the orthopedic oncology outpatient setting to determine which factors of the encounter are priorities to the patient. AIM:To evaluate what factors impact patient experience and report satisfaction in an outpatient orthopedic oncology clinic. METHODS:Press Ganey® patient surveys from a single outpatient orthopedic oncology clinic at a tertiary care setting were prospectively collected per routine medical care. All orthopedic oncology patients who were seen in clinic and received electronic survey were included. All survey responses were submitted within one month of clinic appointment. IRB approval was obtained to retrospectively collect survey responses from 2015 to 2016. Basic demographic data along with survey category responses were collected and statistically analyzed. RESULTS:One hundred sixty-two patient surveys were collected. Average patient age was 54.4 years (SD = 16.2 years) and were comprised of 51.2% female and 48.4% male. 64.2% of patients were from in-state. Out of state residents were more likely to recommend both the practice and attending physician. The likelihood to recommend attending physician was positively associated with MD friendliness/courtesy (OR = 14.4, 95%CI: 2.5-84.3), MD confidence (OR = 48.2, 95%CI: 6.2-376.5), MD instructions follow-up care (OR = 2.5, 95%CI: 0.4-17.4), and sensitivity to needs (OR = 16.1, 95%CI: 1-262.5). Clinic operations performed well in the categories of courtesy of staff (76%) and cleanliness (75%) and less well in ease of getting on the phone (49%), information about delays (36%), and wait time (37%). CONCLUSION:Orthopedic specialties can utilize information from this study to improve care from the patient perspective. Future studies may be directed at how to improve these areas of care which are most valued by the patient.