Letter to the Editor
Osteosarcoma in Tophaceous Gout: A Case Report and Literature Review
Osteosarcoma en gota tofácea: descripción de un caso clínico y revisión de la literatura
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A) Descripción macroscópica: placa de aspecto tumoral eritemato-violácea infiltrada de 6<span class="elsevierStyleHsp" style=""></span>cm de diámetro máximo, compuesta de nódulos tumorales duros, de consistencia ósea, petrificados, y en superficie lesiones tumorales excrecentes y de base ligeramente pediculada de unos 3<span class="elsevierStyleHsp" style=""></span>cm de diámetro. B) Descripción microscópica (hematoxilina eosina [HE]; de izquierda a derecha y de arriba a abajo: B1: H&E ×2; B2: H&E ×4; B3: H&E ×10; B4: H&E ×20). Osteosarcoma de alto grado, de tipo telangiectásico, con abundante formación de osteoide y espacios llenos de sangre sin revestimiento epitelial. A gran aumento se observan células de talla grande, con núcleos irregulares y pleomórficos, reconociéndose numerosas mitosis, muchas de ellas atípicas.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique Calvo Aranda, Irene Rodríguez Pérez, Jesús Rodríguez-Pascual, Paloma García de la Peña Lefebvre" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Enrique" "apellidos" => "Calvo Aranda" ] 1 => array:2 [ "nombre" => "Irene" "apellidos" => "Rodríguez Pérez" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Rodríguez-Pascual" ] 3 => array:2 [ "nombre" => "Paloma" "apellidos" => "García de la Peña Lefebvre" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574317300965" "doi" => "10.1016/j.reumae.2016.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300965?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1630153X?idApp=UINPBA00004M" "url" => "/1699258X/0000001300000005/v1_201708130010/S1699258X1630153X/v1_201708130010/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2173574317300941" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.11.002" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "985" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Reumatol Clin. 2017;13:306-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 769 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 600 "PDF" => 127 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Vocal cord palsy as a clinical manifestation of Behçet's disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "307" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Parálisis de cuerda vocal como manifestación clínica de enfermedad de Behçet" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 800 "Ancho" => 1600 "Tamanyo" => 113645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">On the left side, a cross-sectional slice of a cervical CT showing the paramedial position of the left vocal cord (arrow). On the right side, an axial slice showing the same position of the vocal cord (arrow), findings compatible with paralysis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elvis Amao-Ruiz, Ana María Correa-Fernández, Jesús Gallego-Gil" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elvis" "apellidos" => "Amao-Ruiz" ] 1 => array:2 [ "nombre" => "Ana María" "apellidos" => "Correa-Fernández" ] 2 => array:2 [ "nombre" => "Jesús" "apellidos" => "Gallego-Gil" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X16301541" "doi" => "10.1016/j.reuma.2016.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16301541?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300941?idApp=UINPBA00004M" "url" => "/21735743/0000001300000005/v1_201708230012/S2173574317300941/v1_201708230012/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Osteosarcoma in Tophaceous Gout: A Case Report and Literature Review" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "309" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Enrique Calvo Aranda, Irene Rodríguez Pérez, Jesús Rodríguez-Pascual, Paloma García de la Peña Lefebvre" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Enrique" "apellidos" => "Calvo Aranda" "email" => array:1 [ 0 => "ecalvoa@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Irene" "apellidos" => "Rodríguez Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jesús" "apellidos" => "Rodríguez-Pascual" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Paloma" "apellidos" => "García de la Peña Lefebvre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, HM Hospitales, Hospital Universitario HM Sanchinarro, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, HM Hospitales, Hospital Universitario HM Sanchinarro, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oncología Médica, HM Hospitales, Hospital Universitario HM Sanchinarro, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteosarcoma en gota tofácea: descripción de un caso clínico y revisión de la literatura" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2808 "Ancho" => 2502 "Tamanyo" => 836089 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High-grade osteosarcoma on the dorsum of right foot in a patient with tophaceous gout. (A) Macroscopic description: tumor-like infiltrated erythematous violaceous plaque measuring 6<span class="elsevierStyleHsp" style=""></span>cm in maximum diameter, composed of hard tumor nodules, with the consistency of bone and petrified. The surface consisted of excrescent tumor lesions that were slightly pedicled measuring about 3<span class="elsevierStyleHsp" style=""></span>cm in diameter. (B) Microscopic description (hematoxylin and eosin [H&E]; from upper left to right and lower left to right: B1: H&E 2×; B2: H&E 4×; B3: H&E 10×; B4: H&E 20×). Telangiectatic osteosarcoma, with abundant osteoid formation and blood-filled spaces and no epithelial lining. At high magnification, it is possible to observe large cells with irregular and pleomorphic nuclei, and numerous mitoses, many atypical.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Gout is a disease that involves the deposit of monosodium urate (MSU) crystals, which mostly affects men, and constitutes the most common cause of arthritis in that gender. On occasion, it can lead to accumulations of crystals of variable size and location referred to as tophi. Considered to be a “mimicking” disease, gout can simulate, among others, infectious or neoplastic processes. We report the case of a patient with gout who developed an osteosarcoma arising at the site of a preexisting tophus.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 65-year-old man with tophaceous gout who had been followed at another center and was referred to us by way of the medical oncology department for the management an acute attack of polyarthralgia and olecranon bursitis after a transfusion while undergoing chemotherapy. He had been diagnosed a year earlier with osteosarcoma on the dorsum of his foot arising at the location of a tophus that had been removed 7 months before, after pathological confirmation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and negative findings in the study of the extension. It required infracondylar amputation and preoperative and postoperative chemotherapy with cisplatin and adriamycin. He had been taking allopurinol for 3 years (up to 300<span class="elsevierStyleHsp" style=""></span>mg/day), and employed colchicine and/or nonsteroidal anti-inflammatory drugs during attacks. He had levels of uric acid in blood of up to 8<span class="elsevierStyleHsp" style=""></span>mg/dL, and began to have symptoms at the age of 40 years with podagra, and later developed tophi in the olecranon bursa and the dorsum of his foot. The inflammatory attack was resolved with low-dose prednisone and aspiration of the olecranon bursa. Gram staining and culture of the fluid obtained were negative, and a study with polarized light microscopy revealed the presence of MSU crystals. He was discharged and began colchicine at 1<span class="elsevierStyleHsp" style=""></span>mg/day after gradual interruption of prednisone therapy. During follow-up, he changed from allopurinol to febuxostat (at a dose of 80<span class="elsevierStyleHsp" style=""></span>mg/day), which achieved optimization of his uric acid level in blood and progressive dissolution of the olecranon tophi. Several months later, colchicine was discontinued and he continued to take febuxostat at the same dose. He has not had any further attacks and maintains his level of uric acid at 5<span class="elsevierStyleHsp" style=""></span>mg/dL. In May of 2016, he developed an “in-transit” recurrence of the neoplastic disease, with a superficial mass in ipsilateral thigh that required local resection and chemotherapy (ifosfamide).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Gout is the most common cause of arthritis in men, and is originated by deposits of MSU crystals in tissues. Some patients develop tophi (subcutaneous, periarticular or intraarticular crystal accumulations) which can have a marked inflammatory activity and present calcifications or ossifications as they increase in size.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–3</span></a> Moreover, tophi can mimic infectious or neoplastic processes and become superinfected or undergo malignant transformation, having an adverse effect on the prognosis of the patient.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A number of publications have reported tumors that arise at the sites of tophi.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–9</span></a> All occurred in extremities of middle-aged or elderly men and involved recurrences or metastasis. There are descriptions of benign neoplasms such as giant cell tumors or malignant diseases such as different sarcomas (undifferentiated pleomorphic sarcoma, cutaneous angiosarcoma or fibrosarcoma).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors of these articles provide interesting hypotheses such as the role of prolonged hyperuricemia and the severity of the MSU deposit as factors leading to secondary cell transformation toward inflammation,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> or the theory of sarcoma associated with a foreign body, similar to those originated by other materials.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Sarcomas are mesenchymal tumors originating from connective tissue (fibrosarcoma), cartilage (chondrosarcoma), bone (osteosarcoma), endothelium (angiosarcoma), etc. Although there may be a certain underestimation of the incidence of these neoplasms in gout, sarcomas seem to be uncommon, but occasionally are aggressive. Thus, they should be included in the differential diagnosis in the case of a subcutaneous or periarticular mass in a patient with gout or with the atypical complication of a preexisting tophus.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Calvo Aranda E, Rodríguez Pérez I, Rodríguez-Pascual J, García de la Peña Lefebvre P. Osteosarcoma en gota tofácea: descripción de un caso clínico y revisión de la literatura. Reumatol Clin. 2017;13:307–309.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2808 "Ancho" => 2502 "Tamanyo" => 836089 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High-grade osteosarcoma on the dorsum of right foot in a patient with tophaceous gout. (A) Macroscopic description: tumor-like infiltrated erythematous violaceous plaque measuring 6<span class="elsevierStyleHsp" style=""></span>cm in maximum diameter, composed of hard tumor nodules, with the consistency of bone and petrified. The surface consisted of excrescent tumor lesions that were slightly pedicled measuring about 3<span class="elsevierStyleHsp" style=""></span>cm in diameter. (B) Microscopic description (hematoxylin and eosin [H&E]; from upper left to right and lower left to right: B1: H&E 2×; B2: H&E 4×; B3: H&E 10×; B4: H&E 20×). Telangiectatic osteosarcoma, with abundant osteoid formation and blood-filled spaces and no epithelial lining. At high magnification, it is possible to observe large cells with irregular and pleomorphic nuclei, and numerous mitoses, many atypical.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validation of the measurement of tophi with magnetic resonance imaging as an outcome measure for chronic gout" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Pérez-Ruiz" 1 => "A. Urresola" 2 => "D. Gorostiza" 3 => "B. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 11 | 23 |
| 2024 October | 118 | 36 | 154 |
| 2024 September | 126 | 17 | 143 |
| 2024 August | 141 | 36 | 177 |
| 2024 July | 93 | 32 | 125 |
| 2024 June | 126 | 31 | 157 |
| 2024 May | 184 | 36 | 220 |
| 2024 April | 118 | 16 | 134 |
| 2024 March | 123 | 29 | 152 |
| 2024 February | 94 | 19 | 113 |
| 2024 January | 79 | 19 | 98 |
| 2023 December | 74 | 17 | 91 |
| 2023 November | 95 | 16 | 111 |
| 2023 October | 76 | 24 | 100 |
| 2023 September | 67 | 30 | 97 |
| 2023 August | 42 | 15 | 57 |
| 2023 July | 56 | 30 | 86 |
| 2023 June | 64 | 20 | 84 |
| 2023 May | 68 | 23 | 91 |
| 2023 April | 36 | 10 | 46 |
| 2023 March | 114 | 30 | 144 |
| 2023 February | 67 | 21 | 88 |
| 2023 January | 57 | 22 | 79 |
| 2022 December | 83 | 41 | 124 |
| 2022 November | 91 | 28 | 119 |
| 2022 October | 81 | 31 | 112 |
| 2022 September | 74 | 46 | 120 |
| 2022 August | 95 | 51 | 146 |
| 2022 July | 67 | 63 | 130 |
| 2022 June | 61 | 21 | 82 |
| 2022 May | 56 | 41 | 97 |
| 2022 April | 70 | 58 | 128 |
| 2022 March | 71 | 41 | 112 |
| 2022 February | 73 | 36 | 109 |
| 2022 January | 72 | 49 | 121 |
| 2021 December | 43 | 42 | 85 |
| 2021 November | 38 | 52 | 90 |
| 2021 October | 72 | 51 | 123 |
| 2021 September | 50 | 43 | 93 |
| 2021 August | 39 | 47 | 86 |
| 2021 July | 34 | 36 | 70 |
| 2021 June | 66 | 24 | 90 |
| 2021 May | 56 | 36 | 92 |
| 2021 April | 114 | 101 | 215 |
| 2021 March | 62 | 35 | 97 |
| 2021 February | 45 | 26 | 71 |
| 2021 January | 46 | 22 | 68 |
| 2020 December | 35 | 29 | 64 |
| 2020 November | 41 | 24 | 65 |
| 2020 October | 48 | 10 | 58 |
| 2020 September | 59 | 25 | 84 |
| 2020 August | 33 | 26 | 59 |
| 2020 July | 28 | 16 | 44 |
| 2020 June | 30 | 18 | 48 |
| 2020 May | 24 | 25 | 49 |
| 2020 April | 31 | 12 | 43 |
| 2020 March | 14 | 6 | 20 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 2 | 0 | 2 |
| 2019 December | 1 | 0 | 1 |
| 2019 November | 3 | 0 | 3 |
| 2019 October | 2 | 0 | 2 |
| 2019 August | 1 | 0 | 1 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 3 | 0 | 3 |
| 2019 May | 5 | 0 | 5 |
| 2019 April | 1 | 0 | 1 |
| 2019 March | 5 | 0 | 5 |
| 2019 February | 1 | 0 | 1 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 69 | 9 | 78 |
| 2018 March | 94 | 5 | 99 |
| 2018 February | 31 | 9 | 40 |
| 2018 January | 65 | 6 | 71 |
| 2017 December | 30 | 10 | 40 |
| 2017 November | 37 | 8 | 45 |
| 2017 October | 57 | 30 | 87 |
| 2017 September | 57 | 27 | 84 |
| 2017 August | 26 | 21 | 47 |
| 2017 July | 4 | 7 | 11 |
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