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Enneking classification for benign musculoskeletal neoplasms

Enneking classification for benign musculoskeletal neoplasms
Enneking classification for benign tumors:
Enneking stage I: These tumors are not active and are not symptomatic. They are surrounded by a capsule often seen as a sclerotic rim on plain radiographs.
Enneking stage II: This is an active tumor, with slow progression and evidence of bone and soft tissue reactions (osteosclerotic rim, thinned cortex, dense soft tissue pseudocapsule).
Enneking stage III: This is often a highly vascularized, aggressive tumor with a large mass and overwhelming bone or soft tissue reaction. Cortical breakthrough is accompanied by a soft tissue mass.
Intralesional excision:
Defined as piecemeal removal of the tumor. This is further subcategorized on the basis of the capsule. The "capsule" in GCT is the reactive zone at the periphery of the tumor. It consists of a thickening of the healthy tissue akin to the pseudocapsule found in sarcomas.
  1. Intracapsular: If tumor removal is incomplete as gross or histologic remnants inside the tumor capsule can be expected.
  2. Extracapsular: If tumor removal includes the entire tumor mass as well as 3 to 5 mm of healthy tissue outside the capsule of the tumor.
En bloc resection:
Complex surgery aiming to remove the entire tumor in one piece with a cuff of healthy tissue encasing the tumor. The pathologist's evaluation of the thickness of the resected extracapsular tissue allows further subclassification of en bloc resections on the basis of the margin.
  1. Intralesional: If the tumor is violated by planned or unplanned transgression to save the relevant important neurovascular structures, causing tumor spillage.
  2. Marginal: If a very thin shell of normal tissue covers the tumor.
  3. Wide: If a thick layer of peripheral healthy tissue, a dense fibrous cover (eg, fascia), or an anatomic barrier not yet infiltrated (eg, pleura) fully covers the tumor.
GCT: giant cell tumor.
From: Boriani S, Bandiera S, Casadei R, et al. Giant cell tumor of the mobile spine: a review of 49 cases. Spine (Phila Pa 1976) 2012; 37:E37. DOI: 10.1097/BRS.0b013e3182233ccd. Copyright © 2012. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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