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P Anract

Publications and source records attributed to P Anract.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Sacral chordoma: retrospective review of 11 surgically treated cases].

PURPOSE OF THE STUDY: Chordoma is a malignant neoplasm believed to arise from notochord remnants. It accounts for approximately 3 to 4 p. 100 of primary bone tumors and is localized along the axial skeleton, 50 p. 100 being sacrococcygeal. Clinical, radiographical and histological findings have been well established since the first description by Ribbert in 1894. Sacral chordomas are however difficult to manage and remain a challenge for surgeons and radiotherapists alike. The purpose of this study was to evaluate the long-term results of surgical treatment and patterns of failure in patients treated for chordoma of the sacrum in our department. MATERIALS AND METHODS: This retrospective study included 11 cases of sacral chordomas treated from 1973 to 1998. Patient age ranged from 36 to 77 years (mean 59 years). Six patients were female and five male. The initial treatment was surgery in all cases including intralesional removal in two cases, marginal resection in seven and complete en bloc resection in two. RESULTS: Median follow-up was 6 years (1 month to 14 years). Tumoral recurrences were observed in nine cases 5 months to 8 years after treatment. In two cases, recurrence was observed 8 years after radical sacrectomy. Treatment of recurrences was partial surgical removal with radiotherapy (40 to 70 Grays). Three patients developed metastases in lungs, liver and bone, respectively. Seven patients died, two from metastatic disease. The 5-year overall survival was 64 p. 100 but only 18 p. 100 of the patients survived 10 years. Average disease-free survival was 18 p. 100 at 5 years and 0 p. 100 at 10 years. DISCUSSION: Chordoma is a slow-growing tumor allowing survival for several years despite recurrent disease. However, only 10 to 20 p. 100 of the patients survive free of disease at 5 years. Recurrences are frequent (45 to 80 p. 100) and often multiple. Chordoma inevitably recurs and eventually leads to death after intralesional removal or marginal resection. Radical surgery should be attempted whenever technically feasible. When performed early, particularly for smaller lesions, it offers the best chance for cure. However, tumoral recurrence can occur postoperatively despite a macroscopically complete resection. Because radiation therapy seems to be more successful in controlling microscopic disease, it should be considered as a pre- or postoperative adjuvant to a macroscopically complete resection.

Adult↗
PubMed1999

Phenotypic characteristics of rabbit intervertebral disc cells. Comparison with cartilage cells from the same animals.

STUDY DESIGN: Intervertebral disc cells were extracted from the surrounding matrix, and their metabolic activities and phenotypes were studied. OBJECTIVES: To compare the metabolic activities and phenotypes of cell populations extracted from the intervertebral discs of young rabbits with those of articular and growth plate chondrocytes from the same animals. SUMMARY OF BACKGROUND DATA: The phenotype of intervertebral disc cells has been poorly studied and still is debated. METHODS: The intervertebral discs as well as articular and vertebral growth plate cartilage of rabbits were digested enzymatically. The morphology of freshly isolated cells was examined. Their contents of collagen II and X mRNAs were determined by Northern blot analysis, and their sulfation activity by 35S-sulfate incorporation as chondrocytic markers. Cells were cultured at high density or low density and grown in primary culture. The stability of their phenotype was monitored by evaluating the collagen I and II mRNA ratio. The proteoglycans newly synthesized by the cells also were quantified, and their elution profile analyzed on Sepharose 2B columns. RESULTS: The anulus fibrosus cells were morphologically undistinguishable from articular chondrocytes. The nucleus pulposus contained mainly large vacuolated cells and a few smaller cells. All freshly extracted cells expressed different levels of collagen II mRNA. Anulus fibrosus and nucleus pulposus cells contained, respectively, 22% and 8% of collagen II mRNA compared with that found in articular or growth plate chondrocytes from the same animal. Only growth plate chondrocytes expressed collagen X. When anulus fibrosus cells were incubated for 48 hours at high density, they had collagen II mRNA contents similar to those of articular and growth plate chondrocytes, but synthesized five to six times fewer sulfated proteoglycans. When seeded at low density, anulus fibrosus cells divided more slowly than articular chondrocytes and incorporated four times fewer 35S-sulfate into proteoglycans. Their collagen II mRNA content was 2.75-fold lower than that of chondrocytes, and the procollagen alpha 1II/alpha 1I mRNA ratio was 3.1 for anulus fibrosus cells and 7 for chondrocytes. No collagen X mRNA was detected. When incubated for 48 hours at high density, the nucleus pulposus giant cells had four times less collagen II mRNA content than cartilage cells but synthesized the same amounts of sulfated proteoglycans. They did not divide during 21 days in culture and still contained collagen II mRNA but no collagen X mRNA. CONCLUSIONS: Findings showed that intervertebral disc cells all express cartilage-specific matrix proteins with quantitative differences, depending on their anatomic situation. It is suggested that anulus fibrosus cells are chondrocytic cells at a different stage of differentiation than articular and growth plate chondrocytes. The phenotype of nucleus pulposus cells still is unclear. They could be chondrocytic or notochordal. A definitive answer to this important question requires differentiating markers of notochordal cells.

Animals↗
PubMed1999

[Palmar localization of epithelioid sarcoma mimicking Dupuytren's disease].

A case of epithelioid sarcoma localized in the palm of the left hand in a 32-year-old woman is reported. The tumor evolved for many years, clinically and microscopically simulating palmar fibromatosis. Epithelioid sarcoma is an uncommon malignant tumor, often misdiagnosed by surgeons and pathologists. It occurs in young patients and is often localized at the upper distal extremity. Microscopically, epithelioid sarcoma shows nodules manifesting fibrous hyaline cores with central necrosis. It contains epithelioid and spindle cells immunoreactive to keratin, epithelial membrane antigen and vimentin. Recurrences, lymph node metastases and lung metastases are frequent. Surgical literature tends to recommend wide "en bloc" excision or amputation, combined or not with adjuvant radiation therapy.

Adult↗
PubMed1999

[Chondrosarcoma secondary to multiple cartilage diseases. Study of 29 clinical cases and review of the literature].

PURPOSE OF THE STUDY: Several studies have demonstrated better prognosis of chondrosarcomas arising in hereditary multiple exostosis or Ollier's disease. The aim of this study was to evaluate their clinical, radiological and histological features and compare their prognosis with other chondrosarcomas. MATERIAL AND METHODS: We reviewed twenty nine secondary chondrosarcomas among seventeen patients with osteochondroma (group A), and eight with Ollier's disease (group B). These tumors represented 12 p. 100 of all chondrosarcomas treated between 1950 and 1994 in Cochin Hospital. Two group B patients successively developed three multicentric chondrosarcomas. Twenty six resections (eight intra and eighteen extra-lesional), two disarticulations and one amputation were performed as primary treatment. The average follow-up of the study was 10.5 years. The results were evaluated by means of survival curves. The significance of the difference between the curves was determined by the log-rank test. RESULTS: The mean age of malignant change was 36 years old. The most frequent tumoral site was the innominate bone for group A and the femur for group B. In three cases, radiographs showed no malignant features. All chondrosarcomas were classified as grade 1 or 2. The ten-year survival rate was 82 p. 100 with no significant difference between the two groups. The survival rates were significantly different after carcinologic surgery (extra-lesional resection or amputation) and contaminated surgery (intralesional resection), with 5 and 88 p. 100 of local recurrences respectively. DISCUSSION AND CONCLUSION: These secondary chondrosarcomas represent about 10 p. 100 of all chondrosarcomas. They appear 15 years earlier. According to O'Neal and Ackerman classification, most of the tumors are well-differentiated (60 p. 100 grade I, 39 p. 100 grade II and 1 p. 100 grade III). Carcinologic surgery is generally curative. Ten-year survival rate is 94 p. 100. With equivalent grade and surgery, their prognosis is better as compared to primary chondrosarcomas.

Adult↗
PubMed1998

[Desmoid tumor of the thoracic wall. A case manifesting as painful stiffness of the shoulder].

BACKGROUND: Desmoid tumors are uncommon fibromatous tumors arising from musculoaponeurotic tissue characterized by spindle cell fibroblast and myofibroblast proliferation. The cause is unknown (trauma, hormonal factors, genetic anomaly...). Locally invasive, they tend to recur increasing morbidity or even mortality. CASE REPORT: Stiff shoulder resulting from blockage of the scapulothoracic articulation was the inaugural sign. Three-phase bone scintigraphy demonstrated early uptake in the soft tissue in contact with the scapula. Magnetic resonance imaging and biopsy confirmed the diagnosis of desmoid tumor. Complete resection was performed. No adjuvant radiotherapy nor hormone treatment were given since no antiestrogen receptor antibodies were identified on the surgical specimen. DISCUSSION: The clinical manifestation (stiff shoulder) and the scapular localization observed in this case are unusual for desmoid tumors. Initially tendinopathy of the shoulder, acromio-clavicular arthropathy and capsular retraction of the shoulder joint had been entertained. Early diagnosis and wide surgical resection are indicated in desmoid tumors.

Adult↗
PubMed1998

Malignant giant-cell tumours of bone. Clinico-pathological types and prognosis: a review of 29 cases.

Twenty-nine patients with malignant giant-cell tumours of bone (GCT) were followed-up for between 6 months and 18 years. Seventeen of the tumours were primary and 12 were due to malignant degeneration of initially benign lesions. The clinical features did not differ from those of benign GCT, except for a higher incidence in the distal tibia and sacrum. Anaplastic GCTs were included in the study because their clinical and radiographic features and prognosis were no different from those of the GCT grade III of Jaffe. Eighteen of the tumours were grade III, and 11 were anaplastic. This retrospective study was intended to assess the effects of chemotherapy and surgery for malignant GCT. Three treatment groups were selected, in which treatment was either by surgery alone, surgery plus chemotherapy, or radiotherapy alone.--The prognosis was poor and the 5 year tumour-free survival rate in the series was 50%. The prognosis was the same for primary as for secondarily malignant tumours. There was no statistical difference in survival between malignant grade III and anaplastic malignant tumours. The one-year survival rate for patients treated by chemotherapy and surgery was statistically higher (chi2 test) than for persons treated by surgery alone. However, the five-year survival rate and the actuarial survival curves were not statistically different in the two groups (log rank test).--Chemotherapy appears to be of some value in the treatment of these malignant tumours but a larger series is required to confirm the efficacy of this approach.

Adult↗
PubMed1998

Psychological management, prevention and treatment of phantom pain after amputations for tumours.

Amputation for tumours is rarely carried out nowadays and has few specific technical features, apart from the rare cases where ingenuity is required to gain a few centimetres in length of a stump. As far as possible, the decision for amputation should not be imposed; it is better that the patient himself should take the initiative. The prosthesis and its constraints should be described honestly to avoid subsequent disappointment. Prevention of a painful phantom limb must always be undertaken, and based on certain operative and perioperative precautions. The most important factors are treatment by psychotropic agents and the quality of the human relationships between patient and surgeon.

Amputation, Surgical↗
PubMed1998

[A case of hyalinizing spindle cell tumor with giant rosettes in the presacral region. Immunohistochemical and ultrastructural study].

Hyalinizing spindle cell tumor with giant rosettes is a slowly growing tumor with a risk of local recurrence in case of incomplete surgical excision that could be regarded as a distinctive type of low-grade fibroblastic tumor. We report a case involving the presacral area. This tumor was composed of areas of bland spindle cell proliferation with a fascicular pattern in a fibrous or myxoid stroma, intermixed with giant rosettes consisting of rounded cells surrounding a central collagen core. The tumor expressed vimentin, and, for cells comprising the rosettes, S-100 protein, NSE and CD-57. These latter cells exhibited ultrastructural features of Schwann cells, the tumoral cells of fascicular area exhibiting features of fibroblastic cells. Flow cytometry showed DNA-aneuploidy and a very low S-phase fraction. This tumor appeared to be composed of two cellular components, fibroblastic and Schwann cells, located, at the opposite of neurofibroma, in two distinct areas.

Aneuploidy↗
PubMed1998

Heterotopic ossification after total hip arthroplasty: risk factors and prevention.

A retrospective review of 168 consecutive total hip arthroplasty procedures done in 1983 at the Cochin Teaching Hospital, Paris, France, was conducted to determine the rate of occurrence of heterotopic paraarticular ossification and to look for risk factors for this complication. None of the patients received preventive therapy for heterotopic ossification. Mean age was 66.2 years. The reason for arthroplasty was hip osteoarthritis in every case. The index operation was the first arthroplasty procedure. Heterotopic ossification was noted in 61.3% of patients and was high-grade in 8.3%. The rate of occurrence of heterotopic ossification was not influenced by age, gender, joint destruction, preoperative osteophytosis, duration of the arthroplasty or the occurrence of complications during or after the arthroplasty. However, severe ossification was more common in men that in women (12.7% men versus 5.7% women had grade III ossification) and in patients operated on by relatively inexperienced surgeons (28/8% grade II and III ossifications, versus 14.7% in patients operated on by experienced surgeons). The rate of occurrence of heterotopic ossification in the patients who had no risk factors (60.9%) was not significantly different from that in the overall study population. These data suggest that preventive strategies targeted to specific patient subgroups would probably be ineffective, and that routine preventive therapy of all total hip arthroplasty patients is warranted.

Adult↗
PubMed1998

[Giants schwannoma of the sacrum. Apropos of 3 cases and review of the literature].

Giant sacral schwannoma is a very rare tumor (25 cases reported). The authors report 3 cases of giant sacral schwannoma treated by curettage through posterior approach and discuss symptoms and treatment. These tumors were characterized by their minimal symptoms compared to radiographic findings. Magnetic resonance imaging must be performed in order to detect extraosseous tissue component and intradural invasion. A biopsy was performed to confirm the diagnosis before definitive treatment. Wide resection was proposed by many authors because of the high recurrence rate. We believe that a wide resection is too sever as it causes neurologic sacrifices. A curettage through posterior approach preserves nerve function, and if a local recurrence occurs it remains possible to perform a wide resection. When sacroiliac joint instability is detected, a lumboiliac arthrodesis is indicated. Osteosynthesis could be performed with spine device (using pedicular and iliac screws).

Adult↗
PubMed1998

[Transfer of posterior tibial muscle to the back of the foot: an original procedure for fixing the transplant].

PURPOSE OF THE STUDY: The purpose of the study was to adjust a palliative transfer using the Tibialis Posterior (TP) tendon in case of foot dorsiflexion palsy. The surgical procedure emphasized some functional features, in an attempt to lessen parasitical motion of the foot in abduction or in adduction when patients bear the ankle joint in dorsiflexion, and to strengthen the transfer. MATERIAL AND METHODS: The surgical technique was carried out four times in patients, with a follow-up of six to eighteen months. One 20 cm long leg incision, on the antero-lateral part of tibia, up to the retinaculum of extensors tendons, allowed a section of Tibialis Anterior (TA) tendon as proximal as possible, and an aperture through the tibiofibular fascia in its lower third. One 15 cm long leg incision, along the postero-medial edge of the tibia, toward medial malleolus, allowed a release of the TP tendon after distal section. The tendon was rerouted across the former fascia aperture. One 6 cm foot medial incision face to navicular bone, where the TA tendon was thoroughly extracted and diverted, close to the sole side of the medial cuneiforme, and the two medial metatarsal bones. One 5 cm foot dorsal incision was performed, opposite to the 2d intermetatarsal space, where the diverted TA tendon end was recovered and pulled along a tunnel beneath the retinaculum of extensors. It was thus sutured, with a satisfactory tension to the TP tendon transferred across the tibiofibular fascia. Weight bearing in a short leg cast was allowed. RESULTS, DISCUSSION, CONCLUSION: In the four cases, the results fulfilled the goal, with a satisfactory evaluation of the efficacy of the transfer, even the TA tendon was once intentionally diverted through the 1st metatarsal space instead of the second one, without any damage for the vessels pedicle. Among the widespread use of TP tendon, we think that a more neutral position of the tendon should be adopted with a curse coming along the extension of the leg axis, to the 2d intermetatarsal space. The more distally the transfer may be bound, the much efficient it will be. Obviously, there is no change in a correct automatic use of the transfer in gait. Even though it requires more experience and much longer follow-up time, this technique ensure a reliable and comfortable attachment of the transferred tendon, by a tendon-to-tendon suture, and secure a better restored foot dorsiflexion.

Follow-Up Studies↗
PubMed1998

[Complications from the hinged GUEPAR prosthesis after resection of knee tumor. 102 cases].

PURPOSE: The purpose of this study was to present the complications which occurred in knee replacement with the GUEPAR prosthesis, after bone tumor resection. We tried to point out complications in relation to prosthetic design and surgical technique. MATERIAL AND METHOD: Between 1972 and 1993, 90 patients had a knee resection, for 80 malignant and 10 benign tumors. There were 51 males and 49 females, aged 12 to 75 years (mean age 35). Fifty-six distal femur resections and 34 proximal tibial resections were performed. Length of resection averaged 16 cm (9 to 30). The reconstruction was always achieved with a cemented, custom-made GUEPAR prosthesis. Including revisions, there was a total of 102 prostheses in 90 patients. A patellar resurfacing was performed in 64 cases. An allograft reconstruction was associated in 39 knees. In all tibial resections and in two extra-articular femoral resections, the extensor mechanism had to be reconstructed. Several reconstruction techniques were associated, in which 19 medial gastrocnemius transfers. The prosthesis design was slightly modified with time. Ten patients received radiotherapy, and 55 had chemotherapy. RESULTS: Results and complications were retrospectively assessed, with an average follow-up of 4.3 years (1 to 22). Six patients were lost for follow-up, 62 patients were alive, with no evolutive disease, 13 had an evolutive disease and 10 were deceased from disease. Nineteen patients had distant metastasis and 17 had local recurrences. Apart from intraoperative complications, late mechanical complications included: 13 aseptic loosening, 2 femoral shaft fractures, 18 knee contractures, 5 femoral stem fractures and, 18 intra-articular instabilities related to wear of the hinge-axis. In the 39 allograft-composite prostheses, only 15 had a favorable evolution. There were 15 extensor mechanism failures and 13 knees had persistent infection. There was a total of 94 reoperations in the 90 patients. In 28 cases, the initially implanted prosthesis was removed. There were also 18 revisions, 7 amputations and 3 arthrodeses. Survivorship analysis showed a 60 per cent probability for the initial prosthesis not to be revised at 10 year-follow-up, apart from oncologic complications. DISCUSSION: Results with allograft-composite reconstruction were not better than with massive prosthesis. When needed, soft tissue coverage and patellar tendon augmentation would better be performed with gastrocnemius plasty. Polyethylene and steel bushes were not solution for hinge axis wear.

Actuarial Analysis↗
PubMed1997

Subacute osteomyelitis presenting as a bone tumour. A review of 21 cases.

Twenty-one patients with subacute osteomyelitis who were initially considered to have bone tumours were reviewed, with an average follow up of 3 years. The clinical symptoms were not specific and laboratory investigations were normal. The radiographic findings were limited osteolysis surrounded by bone sclerosis in 14 cases, osteolysis without definite borders in 6, and onion-layer periosteal bone formation in one. The preoperative diagnoses included osteoid osteoma, osteosarcoma, chondroblastoma, Ewing's sarcoma, giant cell tumour, fibrosarcoma, eosinophilic granuloma, and bone tumour of unknown aetiology. The definitive diagnosis was made by surgical biopsy, histology and cultures which grew staphylococcus in 9 cases. The gross specimens all showed lymphocytes, plasma cells and granulation tissue with osteogenesis. All the patients recovered completely; 17 were treated with antibiotics and immobilisation, and 4 did not need an antibiotic. There was no recurrence of infection after curettage and excision of the infected tissues.

Adolescent↗
PubMed1997

[Long-term results of condylar reconstruction using patella as vascularized graft].

PURPOSE OF THE STUDY: In 1966, R. Merle d'Aubigné published 4 cases of unicondylar destructions (due to trauma or tumor) reconstructed with the patella replacing the joint surface. Since this time the same technique has been used in 6 other cases. The results of these 10 patients are studied. MATERIAL AND METHOD: Six of the examined patients were treated initially for a giant cell tumor, 1 for a low-grade osteosarcoma, and 3 for post traumatic arthritis. The patellar transplant remains vascularized by it's supero-medial vascular bundle. The femoral condyle was affected in 9 cases, the tibial plateau in one. RESULTS: The long term follow-up of these 10 patients revealed unexpected satisfactory results. None of the operated knees was clinically "excellent", due to instability or axial deterioration, but function remained correct, with a good range of motion, active professional possibilities, and, often, regular practice of some sports, like skiing or tracking. Function was not correlated with radiological aspect. The arthritic remodeling of the knee was obvious in all of the cases, and regularly increasing. Five of the 10 knees had to be reoperated (one or several times): 3 during the first months of follow-up (1 for sepsis, 2 for supracondylar fractures), 5 during the first years, to improve function (2 arthrolysis, 2 valgus osteotomies, 1 loose bodies removal). Three patellar plasties had to be converted into a total knee prosthesis, after 8, 27 and 40 years. The follow-up of the 7 patients still walking on their patellar plasty is of 2, 4, 17, 19, 24, 24 and 25 years. DISCUSSION AND CONCLUSION: Condylar reconstruction using a vascularized patellar transplant is mechanically speaking an approximative, obsolete and rather rough procedure. Nowadays one would prefer a knee prosthesis, with or without auto or allografts, preserving the patella. The immediate functional result would certainly be better, but the future remains uncertain. The patellar plasty can delay for 10, 20 years or even more the time of a prosthesis. This technique might also be useful in countries where prosthetic implants are not easily available.

Arthroplasty, Replacement, Knee↗
PubMed1996

[Medical environment of total hip prosthesis].

Total hip replacement is an extremely frequent operation for the treatment of degenerative joint disease. Indication for surgery must take into account the patient's general status, associated diseases, multiple joint involvement, and the efficacy and tolerance to medical treatments. The decision to operate is taken together by the physician and the patient. The degree of functional impairment and the patient's age are important factors. The patient must be informed that the period of hospitalization will be approximately 15 days and that good results are obtained in approximately 98% of the cases. Preoperative consultation with the anesthesist will focus on associated diseases with special attention to possible infectious foyers. Early post operative care includes a 48 hour antibiotic reginien, thromboprophylaxy with low molecular weight heparin for 3 days followed by anti-vitamin K for 6 weeks, and non-steroid antiinflammatory drugs for 5 days of up to 6 weeks in case of suspected risk of ossification. At mid-term, complications may include hematomas, infection and luxation. The fixation may also fail in certain cases where transtrochanter access was used. Long-term follow-up monitors for possible late onset infection and late luxations which usually result from prosthesis wear and more rarely from muscular causes.

Hip Prosthesis↗
PubMed1996

[Low grade intramedullary osteosarcoma. Apropos of 8 cases].

PURPOSE OF THE STUDY: The authors reviewed eight patients treated for Low Grade Intramedullary Osteosarcoma (LGIO). They analyzed the radiographical and histological features and evaluated the prognosis of this disease. MATERIALS: Eight cases of LGIO were studied. The mean follow-up period was 3.9 years. LGIO is defined as a Broders classification grade I osteosarcoma. The study involved 3 males and 5 females. Mean age at the time of diagnosis was 28. METHODS: Clinical records, radiographs and C.T. Scan were available and reviewed in all cases. Five patients had had MRI. In addition to the conventional histological study, ultrastructural studies were conducted in three of the cases. On their last examination, all patients received a clinical and X-ray assessment. RESULTS: The tumor was localized around the knee in six cases on the humerus and on the proximal femur in one case. The tumor was situated in the metaphysis and was most often lytic. A malignant tumor was suspected at the outset for only two of the patients. The scanner and the MRI revealed a cortical discontinuity and extraosseous involvement in five cases. Seven patients had a wide resection, which was intra-tumoral once. The histological examination of two of those resections revealed limited areas of anaplasia; complementary chemotherapy was then conducted. We did not observe any local recurrence in this group. We observed, however, an iliac metastasis, for which another wide resection was performed. This last patient remained free of disease three years later. One patient had radiotherapy and chemotherapy; he died from pulmonary metastasis after his LGIO turned into high grade osteosarcoma. DISCUSSION: LGIO are rare, they represent 1.8 per cent of all Osteosarcomas in the Cochin file. The mean age of patients contracting LGIO is higher than that of conventional osteosarcoma patients. Observation of the radiographs and histological examination could lead to think the tumor is benign, and mistake it with a fibrous displasia. The C.T. Scan and the MRI have the advantage of showing soft tissue invasion and help the histological examination. The wide resection is the only treatment able to cure the patient. Chemotherapy would be useful for LGIO cases containing limited arcas of anaplasia. CONCLUSION: LGIO is a slowly-evolving tumor. It remains localized for a long period of time. The histological diagnosis is difficult and requires a pathologist familiar with bone tumors. Its treatment requires surgery. LGIO must be distinguished from conventional osteosarcomas because of its better prognosis.

Adult↗