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The most common soft tissue sarcomas of hand are epitheloid sarcomas, synovial sarcomas and malignant fibrous histiocytomas which are high grade, aggressive tumors. Liposarcomas of the hand are extremely rare and to the best of our knowledge less than 20 cases have been reported so far in the literature. Well differentiated spindle cell liposarcoma is an extremely rare subtype of well differentiated liposarcoma/atypical lipomatous tumor which is different from the other subtypes clinicopathologically, genetically and prognostically. Palmar localization of this rare variant of liposarcoma at this site makes ours only the second case reported in the world literature so far. This recently described entity is low grade lesion and the hand surgeons need to adopt a less aggressive approach in the treatment of this subtype.

It is well known that the coagulation factor XIII (FXIII) is deeply involved in wound healing and tissue regeneration. We measured the plasma levels of FXIII (FXIII levels) before and after surgery in 80 patients with bone tumors [benign tumors in 30 patients (BT group), malignant tumors in 30 patients (MT group), and carcinoma metastasis in 20 patients (CM group)] and in the control group which consisted of 30 patients with osteoarthritis of the hip joint who had underwent total hip arthroplasty (THA). The numbers of patients whose preoperative FXIII level was below the lower limit of normal were as follows: 0 (0%) among 30 patients in the control group; 7 (23%) among 30 patients in the BT group; 12 (40%) among 30 patients in the MT group; and 9 (45%) among 20 patients in the CM group. Among patients with bone tumors examined in this study, patients with osteosarcoma who underwent chemotherapy showed a significant decrease in FXIII levels (p < 0.01). We indicated not only FXIII levels in patients with bone tumors, but also the natural time-course of FXIII levels in patients who underwent orthpaedic surgery of THA at the first time.

Purpose: We compared the expression of microRNAs (miRNAs) in rat chondrosarcoma relative to normal rat cartilage with miRNA expression in human chondrosarcoma relative to normal human cartilage. We did this in order to answer the question: Are the miRNA profiles of chondrosarcoma in humans and rats similar enough to allow for the rat model to be valid for study of chondrosarcoma in humans? Methods: Twenty rats were sacrificed, cartilage was collected, RNA extracted and 233 miRNAs analyzed. The expression of these miRNAs was then compared to their expression in normal human tissue and chondrosarcoma. Integrative correlation coefficients were applied to the data in whole to measure the similarity between the rat and human miRNA. Results: For normal human versus normal rat cartilage the integrative correlation coefficient was 0.84 (95% CI: 0.82–0.87). The integrative correlation coefficient for chondrosarcoma in human versus rat tissue was 0.70 (95% CI: 0.65–0.74). Conclusions: Our findings suggest that human and rat normal cartilage, as well as chondrosarcoma genetics, are sufficiently similar for use of rat models to study chondrosarcoma (integrative correlation coefficient $\mathrm{\text{values}}>0.50$). We also revealed similarities between specific miRNA, especially those with the most similar fold-change (miR26b, 126, 145, 195, and 320).

Background: Surgical techniques for resection of tumors at proximal humerus and scapula has been described in literature along with different classification systems, however, these techniques have not been revised for a while and the classification systems which are currently in use neither respect the difference between bone and soft tissue tumors nor the anatomical location humeral vs scapular. Material and Methods: The author operated on 32 patients with shoulder girdle tumors, all are bone tumors, Ewings sarcoma ($n=14$), Osteosarcoma ($n=6$), Metastatic tumors ($n=6$), GCT ($n=3$), Chondrosarcoma ($n=3$). We assigned two separate classifications to humerus and scapula resection, since surgical approaches, techniques, and reconstruction options are totally different for the both sites. Resection of the humerus is classified into: Type I to Type IV, A: is added to the type when the majority of Deltoid is preserved, and B: when it is sacrificed. And we classify the scapula resection into: Type I to Type III, A: is added to the type when the majority of Deltoid is preserved, and B: when it is sacrificed. In extra articular humerus resection, we found that sacrificing the acromion and coracoid process is not necessary as part of routine resection. Preservation of these structures can improve the cosmetic appearance of the shoulder with at least equal functional outcome. Endoprosthesis was used in 26 patients for reconstruction, osteoarticular allograft was used in 2 patients, and Tichoff Lindberg technique for 4 patients. Results: At 30 month mean follow up period, 2 patients developed local recurrence (osteosarcoma $n=1$, Ewing Sarcoma $n=1$), 2 patients had wound infection, and one patient developed stem loosening. The average MSTS functional score for all patients was 83%. Conclusion: The modification of surgical techniques saved structures which were unnecessarily resected, and kept the integrity of muscles and their attachments which were sacrificed in previously described techniques. This might lead to fewer restrictions during the rehabilitation process and resulted in preservation of the shoulder contour. The new classification system is realistic, separates the humeral resection from the scapular one, easy to be recalled and applicable to all patients.

Background: Soft tissue sarcomas (STS) are rare, and little is known about the factors that affect the delays in the initial treatment. The aim of this study is to quantify the period between onset of symptoms and start of treatment of STS and determine the factors affecting delays in initial treatment.

Methods: This is a retrospective study of all STS treated in our institution between October 2009 and March 2019. We analysed patient record to determine the period from onset of symptoms to start of initial treatment. We also collected data with regard to patient characteristics and features of the tumour. Tumours were classified into upper extremity, lower extremity, trunk and others based on location of the tumour. Statistical tests were done to identify factors that affected delay in initial treatment.

Results: The study included 134 patients (76 male and 58 female) with STS with an average age of 56.6 years. The tumours involved the upper extremity in 20 patients, lower extremity and trunk in 50 patients each and other areas in 14 patients. The most frequent histological subtypes were liposarcomas (n = 31, 23.5%) and undifferentiated pleomorphic sarcomas (n = 24, 18.2%). Initial treatment was delayed by an average of 9.9 months for all groups. The period of treatment delay for tumours involving the upper extremity was shorter (7.9 months) and these tumours were smaller at initial presentation (57.6 mm) compared to tumours in other locations (p < 0.05). Other factors that were positively associated with treatment delays were a history of diabetes mellitus (p = 0.037) and smoking (p = 0.026).

Conclusion: Patients with upper-extremity STS may have the benefit of a relatively better prognosis as they present earlier and with a smaller tumour. In addition, factors, such as diabetes and smoking, which indicate a low interest in health also influenced the delay in the initial treatment.

Level of Evidence: Level III (Therapeutic)

Management of liver neoplasia is a multidisciplinary endeavour. In the non-cirrhotic liver resectional surgery has a well-defined place in the management of primary liver tumours. In the cirrhotic liver, the approach to treatment of hepatocellular carcinoma depends on the severity of underlying liver disease and the size of the tumour. The best long term results are achieved with transplantation regardless of severity of liver failure, but the number and size of lesions is important. Liver resection can be used in any size lesion, but the extent of resection possible is dependent on the severity of liver disease. As with ablative methods, the tumour volume is an important prognostic factor. Colorectal cancer is the most common secondary liver cancer with a chance of cure following surgical resection. Surgical resection is becoming more aggressive, as more sophisticated techniques and increasing chemotherapeutic options allow removal of more advanced tumours. The role and timing of surgery, local ablation, chemotherapy and adjuvant chemotherapy are explored in the setting of both synchronous and metachronous disease. Surgical resection and the chance of cure is possible in a subset of patients with neuroendocrine liver metastases, but pharmacological and chemotherapeutic therapies are available if resection is not possible. Surgery is less applicable in non-colorectal, non-neuroendocrine tumours, but in some circumstances, it may be of benefit.