Bone and soft tissue tumors (BSTTs) are prone to metastasize to the lungs to form pulmonary nodules, which are quite different from other metastatic nodules or primary nodules, such as those from lung, breast, or colorectal cancers. Early detection of these specific lung nodules is crucial for timely intervention and treatment of BSTTs. To promote the development of BSTTs detection algorithm based on deep learning, this paper releases a Computed Tomography (CT) dataset containing 59 patients and 779 BSTTs metastatic pulmonary nodules with pixel-level annotations. We further publish benchmark lung nodule detection experiments on this dataset, achieving F1 score of 0.842, respectively, demonstrating its research potential. We release raw CT data, preprocessing codes for data conversion and coordinate extraction, to enable researchers to obtain precisely calibrated datasets for training deep learning models and promote the utilization of this clinical scientific data.

Prostate adenocarcinoma most commonly metastasizes to bone and lymph nodes; isolated soft-tissue presacral metastasis without a known primary is exceedingly rare and poorly characterized. We report a 69-year-old man presenting with hematuria and an incidental 4-cm presacral mass. MRI demonstrated a solid, heterogeneously enhancing lesion within the right mesorectal compartment without intraluminal involvement, most consistent with a primary neurogenic tumor. Serum PSA was not obtained preoperatively, as symptoms were attributed to chronic suprapubic catheter irritation and imaging did not suggest a prostatic origin. Preoperative biopsy was not pursued given the lesion's deep posterior location at the S4 level-proximity to sacral nerve roots precluded safe percutaneous access, and transrectal biopsy is contraindicated. The mass was resected via a posterior transsacral (Kraske) approach for presumed primary presacral neoplasm. Histopathology revealed metastatic prostatic adenocarcinoma with positive PSA and prostatic acid phosphatase immunostaining, identifying an occult primary tumor. This case illustrates an atypical diagnostic scenario in which resection was undertaken for a presumed primary lesion; the metastatic diagnosis was an unexpected pathologic finding that would have substantially altered management had it been established preoperatively. This case underscores the importance of including serum PSA in the standard workup of solid presacral masses in older male patients and demonstrates that the Kraske approach can provide adequate exposure for selected posteriorly situated extrarectal masses when diagnosis remains uncertain and resection is clinically indicated.

Finding an unexpected metastatic lesion in bone marrow biopsy (BMB) performed for a hematological indication can cause diagnostic issues. In a BMB performed in a patient with suspected acute leukemia evolved from a post-essential thrombocythemia myelofibrosis a group of atypical cells with E-cadherin expression was found. After careful morphological evaluation and further immunohistochemical staining, these cells were identified as a melanoma metastasis with E-cadherin expression. E-cadherin immunostain is performed frequently by hematopathologists to highlight erythroid cells but its expression can be found in a number of hematological and non-hematological neoplasms, including melanoma, which should be considered in the differential diagnosis of E-cadherin-expressing neoplasm.

Objectives: Chondrosarcoma is the most common type of primary bone sarcoma in adults with a high risk of local recurrence and metastasis. Chondrosarcomas are largely resistant to chemotherapy and radiotherapy, meaning that surgery is the mainstay of treatment for most patients. Therefore, new therapeutic targets are required. Cluster of differentiation 44 (CD44) is a transmembrane protein that has roles in cell proliferation, adhesion and migration and is shown to be overexpressed in several cancer types. Consequently, this work was undertaken to understand whether CD44 could be a potential therapeutic target in chondrosarcoma. Methods: In this study, tissue sections from chondrosarcoma patients were evaluated for CD44 expression using immunohistochemical analysis. The relationship between CD44 expression in the patient tissue and overall and event-free survival was investigated. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) gene editing was used to generate a CD44 knockout chondrosarcoma cell line which was used for a spheroid invasion assay to understand the role of CD44 in chondrosarcoma cell invasion. Results: Cox multivariate analysis of CD44 expression in chondrosarcoma patient tissue revealed that high CD44 expression was linked to decreased overall (p < 0.01) and event-free survival (p < 0.01). The observed invasion of CD44 knockout cells in the spheroid assay was less than that of the wild type cells (p < 0.001). Conclusions: The increased expression of CD44 in intermediate and high grade chondrosarcomas, as well as reduced invasion of CD44 knockout cells suggests that CD44 plays an important role in chondrosarcoma progression and metastasis. These findings support further investigation of CD44 as an imaging and/or therapeutic target for the management of chondrosarcoma.

Objectives: Thoracic sarcomas are a heterogeneous group of rare mesenchymal tumors. This study aimed to identify prognostic factors for overall survival (OS) and progression-free survival (PFS) in patients undergoing resection of primary thoracic soft tissue and bone sarcomas. Methods: We retrospectively reviewed patients with primary intrathoracic or chest wall sarcomas who underwent surgical resection between 2005 and 2020. Eighty-four patients were included: 60 with soft tissue sarcoma and 24 with bone sarcoma. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors for PFS and OS. Results: The most common histological subtypes were chondrosarcoma (19%) and undifferentiated pleomorphic sarcoma (17.8%). Overall, 54.8% of patients were female, and the mean age was 55.7 years (SD 17.9). Neoadjuvant and adjuvant therapies were primarily administered in intermediate- (G2) and high-grade (G3) tumors. Median OS was 28.4 months. On multivariate analysis, high tumor grade (G3 vs. G1-2) independently predicted worse PFS (HR 3.21, 95% CI 1.34-7.68; p = 0.01) and OS (HR 4.40, 95% CI 1.56-12.41; p = 0.01). Larger tumor size (HR 1.09, 95% CI 1.03-1.15; p = 0.001) and incomplete resection (HR 12.21, 95% CI 2.56-58.34; p = 0.002) were independently associated with worse OS, while lung metastases at diagnosis independently predicted worse PFS (HR 4.89, 95% CI 1.21-19.69; p = 0.03). Conclusions: Histological grade is the strongest independent predictor of survival in resected thoracic sarcoma. Surgery alone appears adequate for low-grade sarcomas, whereas multimodal treatment strategies seem particularly relevant for patients with higher-grade sarcomas.

Background/Objectives: Secondary malignant neoplasms of the bone are a major concern for cancer patients, with significant morbidity and mortality despite advancements in cancer care. The current literature reports demographic variability, but population-level trends and survivor-specific risk factors remain poorly characterized for bone metastasis. This study aims to provide a comprehensive temporal analysis of the trends and disparities of secondary malignant neoplasms of the bone. Methods: Deidentified death certificate data from the United States as reported in the CDC WONDER database (1999-2023) were analyzed for secondary malignant bone neoplasms (ICD-10 C79.5). Age-adjusted mortality rates per 100,000 were calculated and stratified by gender, age, and race. Temporal trends were assessed using Joinpoint Regression, yielding APCs, AAPCs, and 95% CIs. Results: Between 1999 and 2023, there were 424,811 deaths in U.S. adults over the age of 25 years related to secondary malignant bone neoplasms. The overall age-adjusted mortality rate (AAMR) increased from 5.77 (95% CI 5.67 to 5.87) in 1999 to 11.92 (95% CI 11.79 to 12.05) in 2023. The average annual percentage change (AAPC) over this period was 3.28 (95% CI 2.63 to 3.94). From 1999 to 2009, mortality decreased with an annual percentage change (APC) in AAMR of -3.62 (95% CI -4.92 to -2.30), followed by a sharp increase in mortality between 2009 and 2023 with an APC of 8.52 (95% CI 7.83 to 9.19). Certain populations had greater increases in AAMR over the study period. The population aged 85 years and older had the largest increase in mortality from secondary malignant bone neoplasms with an AAPC of 4.77 (95% CI 3.38 to 4.77). Over the study period, Black individuals had an overall AAPC of 1.53 (95% CI 0.11 to 2.97), White individuals had an AAPC of 2.60 (95% CI 1.61 to 3.60), and Asian or Pacific Islanders had an AAPC of 3.74 (95% CI 1.17 to 6.38). Rural areas had overall higher AAMRs compared to urban areas, with an AAPC of 2.27 (95% CI 1.52 to 3.02). Conclusions: Overall, AAMR increased from 1999 to 2023, though there was a period of decreasing AAMR from 1999 to 2009. We suggest that due to increased rates of screening, it is possible that rates of secondary metastases of the bone have been constant over the years, but they were not diagnosed, leading to a false increase in AAMR. Mortality rates were highest in Black individuals in our study, possibly pointing towards discrepancies in cancer screening and treatment between races. Additionally, the AAMR was higher in rural than in urban areas, which we hypothesize may be due to limited access to treatment, such as surgery. Our study was limited by its nature as a database study, but future studies should focus on the prevention of primary malignancies and minimizing risk factors for the development of secondary malignancies.

Background/Objectives: Although the Spinal Instability Neoplastic Score (SINS) is widely used to estimate spinal metastases fracture risk and guide decisions on stabilisation procedures, prior studies have demonstrated mixed results. Patients with the same score exhibit clinically heterogeneous outcomes, with some SINS criteria correlating less well with the estimated fracture risk than others. There are also barriers to implementation such as the time burden required for manual calculation and interobserver variability associated with qualitative morphological criteria. SINS also lacks sensitivity for detecting latent structural compromise in treatment-naive patients and those susceptible to the iatrogenic effects of stereotactic body radiation therapy. This review aims to evaluate emerging imaging, biomechanical, and microstructural markers with the potential to improve fracture risk stratification and prognostication for spinal oncology patients. Methods: We synthesise evidence across three innovative frontiers: (1) biomechanical modelling, including CT-derived finite element analysis and failure-load pattern models; (2) radiomics, utilizing radiomics features from radiological imaging to develop a predictive model; and (3) microstructural MRI biomarkers, exploring the translatability of the Vertebral Bone Quality score, fat fraction, and paraspinal muscle atrophy from osteoporosis to the metastatic spine. Results: Emerging biomechanical, radiomic and microstructural imaging markers show potential in addressing some limitations of traditional SINS criteria for fracture risk stratification across the spinal oncology treatment continuum, from initial diagnosis to post-radiation surveillance, thereby facilitating more precise risk assessment. However, current evidence remains largely retrospective and heterogeneous, and further validation is required before clinical adoption. Conclusions: We propose a framework that shifts the paradigm from conventional morphological scoring toward a multiparametric assessment of spinal stability.

Spinal bone metastases often lead to vertebral fractures and other skeletal events that severely affect patients' quality of life. Predicting structural failure is essential for guiding treatment and preventing complications. However, conventional assessment tools have limited predictive power, highlighting the need for computational methods capable of simulating disease progression and its mechanical consequences. This study aimed to develop a fully automated, patient-specific methodology to predict vertebral structural behavior from computed tomography (CT) data, supporting clinical decision-making and treatment planning. The proposed pipeline integrates three main components: a deep neural network for semantic segmentation of vertebrae and metastatic regions from CT scans, the Coherent Point Drift (CPD) algorithm to ensure consistent alignment and automated definition of boundary conditions across datasets, and the Cartesian Grid Finite Element Method (cgFEM) to simulate the vertebral mechanical response under metastatic involvement. Model performance was evaluated by comparing the predicted outcomes with reference data, using precision, sensitivity, and specificity to assess reliability. The proposed workflow achieved full automation from CT imaging to fracture risk estimation. The segmentation module showed high accuracy across multiple metrics, enabling robust model generation. Geometric normalization and CPD-based boundary condition assignment standardized vertebral geometries across studies, while cgFEM simulations provided clinically interpretable metrics such as safety factors and stability variations associated with tumor size, location, and density. These analyses enabled the identification of scenarios linked to a higher fracture risk. The main limitations include the use of fixed boundary conditions and a predefined voxel threshold, which may reduce physiological realism and generate false positives. Overall, this work presents an end-to-end, patient-specific framework for automated fracture risk evaluation in metastatic vertebrae. By combining deep-learning-based segmentation, geometric normalization, CPD alignment, and cgFEM simulations, the method produces clinically relevant outputs that can guide therapeutic strategies. Future developments will focus on integrating patient-specific loading data and predictive modeling to support incorporation into clinical decision support systems.

Background and Clinical Significance: Thyroid cancer is increasing, particularly the differentiated type, with decreasing incidence of the anaplastic type. Anaplastic thyroid carcinoma (ATC) is a rare, aggressive, and often lethal form. It frequently presents with metastatic disease, regional and systemic, with common distant metastasis to the lung, bone, brain, and adrenal, and rarely to other places; Case presentation: A 74-year-old Arab male presented with symptomatic anemia and melena and was admitted for investigation of the cause. The patient was found to have a large retrosternal goiter and gastric tumor. CT scan showed a pedunculated, nonobstructive mass, suggestive of a GIST or leiomyoma. The neck mass presented with compressive symptoms. He underwent a combined neck and abdominal surgical resection based on a multidisciplinary team decision, as prior biopsies were not conclusive. The final pathology report identified similar tumors in the two specimens and suggested an anaplastic thyroid carcinoma as the primary tumor with metastasis to the stomach. Furthermore, the workup, including a PET scan 2 weeks post-surgery, revealed widespread metastases in the bone, lung, and liver, and the treatment was palliative. He was followed up in the outpatient clinic for 4 and a half months post-operatively. The patient developed sepsis and cardiopulmonary arrest and died; Conclusions: ATC can metastasize to many places in the body, including the stomach (as shown in our case), which can cause significant upper gastrointestinal bleeding and anemia. Metastatic ATC carries a poor prognosis; thus, physicians need to keep a high index of suspicion in approaching similar cases. A multidisciplinary approach for the management is of utmost importance for appropriate treatment. This disease's pathology, behavior, and targeted new treatment modalities must be explored further.

Background and Clinical Significance: Bone involvement is a common and debilitating manifestation of advanced malignancies, with a substantial negative impact on patients' functional status, quality of life, and overall prognosis. Management is primarily palliative and may include several locoregional approaches such as radiotherapy, surgical stabilization, cementoplasty, thermal or cryoablation, and high-intensity focused ultrasound. Electrochemotherapy (ECT) is an emerging non-thermal ablative technique that combines limited invasiveness with short procedural times and a favorable safety profile. Case Presentation: We report the case of a patient with oligometastatic lung cancer presenting with a painful rib metastasis refractory to radiotherapy. The patient had previously undergone radiotherapy to the right femoral head and the eighth rib, followed by cryoablation combined with cementoplasty for the femoral lesion and cryoablation of the rib. At one-year follow-up after cryoablation combined with bone cementoplasty, computed tomography demonstrated progression with the appearance of a new symptomatic rib lesion unresponsive to further radiotherapy. Percutaneous ECT was therefore performed under general anesthesia, supplemented with an erector spinae plane block. A total of twelve 18-gauge needle electrodes were accurately positioned under fluoroscopic guidance. Follow-up imaging at three months showed complete local tumor resolution, accompanied by marked and sustained pain relief. Conclusions: This experience supports the role of ECT as an effective salvage locoregional treatment option in selected patients with bone metastases resistant to conventional therapies.