Background/Objective: Anti-tumor effects of plasma-activated medium (PAM) were demonstrated using various malignant tumors. However, the anti-tumor effect of PAM on synovial sarcoma remains unclear. Therefore, we aimed to investigate the anti-tumor effects of PAM on synovial sarcoma and its underlying mechanisms, focusing on the quantitative analyses of both intracellular reactive oxygen species (ROS) and cell apoptosis. Methods: The human synovial sarcoma cell line HS-SY-II was used to investigate the cell viability after PAM treatment. We investigated the anti-tumor effects and side effects of local PAM injection in a synovial sarcoma xenograft murine model. Moreover, we observed PAM-induced intracellular ROS accumulation and cell apoptosis and assessed the involvement of intracellular ROS in the anti-tumor effects of PAM using an intracellular ROS scavenger. Results: PAM significantly decreased the viability of synovial sarcoma cells compared with untreated Dulbecco’s modified Eagle medium. Local PAM injection into a synovial sarcoma xenograft murine model significantly suppressed tumor growth, including tumor volume (p < 0.001) and weight (p = 0.031), without side effects. Regarding anti-tumor mechanisms, PAM induced significant cell apoptosis and intracellular ROS accumulation (p < 0.001). The intracellular ROS scavenger significantly inhibited the anti-tumor effect of PAM (p < 0.001). Conclusions: We confirmed the anti-tumor effects of PAM on synovial sarcoma in vitro and in vivo, as well as the absence of side effects. The underlying mechanism was suggested to involve cell apoptosis induced by intracellular ROS accumulation. Considering the various clinical issues associated with the existing treatments of synovial sarcoma, PAM is a promising new option.

This study aimed to investigate the awareness levels of primary physicians regarding non-ossifying fibromas (NOFs)/fibrous cortical defects (FCDs) using patient referral documents. Referral documents of 62 male and 46 female patients (mean age: 11 [5–32] years) who were diagnosed with NOFs/FCDs based on radiological findings were retrospectively reviewed. The suspected diagnoses by primary physicians were classified as “NOF/FCD,” “Benign,” “Intermediate,” “Malignant,” and “No description.” The Ritschl radiological classification of NOFs/FCDs and the relationship between the stages and suspected diagnoses were examined. NOFs/FCDs were diagnosed in 40 patients. The classifications were “Benign,” “Intermediate,” “Malignant,” and “No description’’ in 12, 3, 5, and 48 patients. Osteosarcoma was suspected in 4 patients. Among 63 patients with stage A Ritschl classification, NOFs/FCDs were diagnosed in 24 and osteosarcoma was suspected in 3. In 30 patients with stage B, NOFs/FCDs were diagnosed in 11 and osteosarcoma was suspected in one. Among patients with stages C and D, 3/10 and 2/5 patients, respectively, were diagnosed with NOFs/FCDs and a malignant bone tumor was suspected in 1 case with stage D. The suspected diagnosis was ``No description’’ in 46%, 43.3%, 40%, and 40% of patients with stages A, B, C, and D, respectively. The ``primary physicians” awareness levels of NOF/FCD seemed insufficient, owing to a high rate of “No description.” Plain radiography is a diagnostic technique for NOFs/FCDs, and NOF/FCD lesions commonly develop in children and young adults. Primary physicians need to be educated about the typical NOF/FCD radiological findings.

Background/Aim: Angiomatoid fibrous histiocytoma (AFH) is a rare soft-tissue tumor that typically occurs in young individuals and often mimics hematomas or sarcomas. Its diagnosis is difficult due to nonspecific histological features, and identification of gene fusions such as EWSR1–CREB1 is crucial. We report a case definitively diagnosed using GenMineTOP, a dual DNA/RNA genomic profiling panel. Case Report: A 61-year-old woman presented with acute onset of pain and swelling in the right popliteal fossa, initially diagnosed as a hematoma. MRI revealed a 10-cm intramuscular mass with heterogeneous signal intensity and fluid-fluid levels. Needle biopsy showed no tumor cells. Despite transient improvement, the mass persisted and anemia worsened, prompting surgical excision. The tumor was resected with marginal margins, and histology revealed large atypical cells with unclear differentiation. Postoperative radiotherapy (60 Gy in 30 fractions) was administered under suspicion of sarcoma. GenMineTOP testing identified an EWSR1–CREB1 fusion gene. Reevaluation confirmed AFH with characteristic lymphoid cuffs and CD68 positivity. One year postoperatively, the patient remains free of recurrence and metastasis. Conclusion: This case underscores the diagnostic challenges of AFH, particularly in older patients with deep-seated lesions mimicking hematomas. Dual DNA/RNA genomic profiling enabled definitive diagnosis and demonstrated its clinical utility in evaluating soft-tissue tumors with ambiguous histopathological features.

A referral from a primary physician is a crucial initial diagnostic intervention for the management of osteosarcoma. We reviewed the awareness of primary physicians regarding the radiological findings of osteosarcoma through their referral documents. Referral documents of 40 patients (27 male and 13 female; median age, 19 [8–81] years) with osteosarcoma were retrospectively investigated. The documents were examined for suggested supplementary radiological procedures, presence or absence of a descriptive keyword for the radiological findings of osteosarcoma, periosteal reaction, matrix, soft tissue mass, type of border of the lesion, and type of bone destruction, followed by an assessment of the diagnostic radiologists’ findings. The keywords “periosteal reaction,” “matrix,” “soft tissue extension,” “border of the lesion,” and “type of bone destruction” were described in 5 (7.5%), 5 (15%), 4 (10%), 0 (0%), and 7 (17.5%) cases by the primary physicians, respectively. Records with “periosteal reaction,” “matrix,” “soft tissue mass,” “type of border of the lesion,” and “type of bone destruction” were described in 5 (31.25%), 5 (31.25%), 10 (62.5%), 3 (18.8%), and 3 (18.8%) radiologic findings of the diagnostic radiologists, respectively. The descriptions of keywords for radiological findings suggesting osteosarcoma in referral documents from primary physicians seemed generally insufficient. More enhanced and comprehensive awareness of the typical radiological findings of osteosarcoma is necessary to prevent diagnostic delays.