Biomedical subjects

P Anract

Publications and source records attributed to P Anract.

42 records · Page 3Linked to original sources

PubMed1996

[Synovial chondromatosis and chondrosarcoma. A study of the relationship between these two diseases].

PURPOSE OF THE STUDY: This retrospective study concerns six patients in whom chondrosarcoma was suspected to develop in synovial chondromatosis. We discuss for these cases different diagnosis. The authors expose the clinical signs and radiological aspects which suggest malignant transformation. We report the indispensable criteria for established diagnosis of malignant transformation of synovial chondromatosis and appropriated forms of therapeutic management were suggested. MATERIALS AND METHODS: Six patients, 3 males and 3 females from 36 to 58 years of age were included in this study. Three patients presented 6 months, 3 years and 25 years history of synovial chondromatosis of the knee joint. When the malignant transformation appeared, a surgical biopsy was performed and the pathologist diagnosed a chondrosarcoma in all cases. For the other three patients, the chondrosarcoma and synovial chondromatosis were diagnosed at the same time. The localization was shoulder, hip and knee. A surgical biopsy was performed and the pathologist diagnosed chondrosarcoma. Synovial chondromatosis was diagnosed by histologic examination of the resection or amputation specimen. TREATMENT AND RESULTS: Four patients had thigh amputation, one patient had "en bloc resection" of the hip-joint and the last patient had resection of the shoulder joint. In all cases, the histologic examination diagnosed chondrosarcoma and synovial chondromatosis. All patients were free of disease. DISCUSSION: The malignant transformation of synovial chondromatosis is rare but this diagnosis must be established to perform appropriate treatment. Other possible diagnosis are: low grade synovial chondrosarcoma initially diagnosed as a synovial chondromatosis. Bertoni believes that all cases of malignant transformation of synovial chondromatosis are initially low grade chondrosarcoma. We believe that his criteria are too strict for diagnosed chondrosarcoma. coexistence of synovial chondromatosis and synovial chondrosarcoma. These 2 diagnosis are extremely rare and their coexistence are unlikely. secondary synovial chondromatosis developed into chondrosarcoma. We don't have histologic criteria to confirm this diagnosis in all our cases. The symptoms that should suggest a malignant transformation of synovial chondromatosis were: rapid late deterioration of clinical conditions, bone invasion diagnosed by X-ray films and medullar invasion discovered by MRI. According to us, the indispensable criteria to diagnose malignant transformation were: 1.) histologic diagnosis of synovial chondromatosis established before diagnosis of chondrosarcoma, 2.) histologic diagnosis of chondrosarcoma on the same anatomic site as the synovial chondromatosis, 3.) diagnosis of chondrosarcoma and synovial chondromatosis on the same resection specimen. Only the three first cases were in accordance with these criteria. The treatment must be a "en bloc resection" of the joint or an amputation. CONCLUSION: Malignant transformation is rare, but this diagnosis should be established to perform adequate treatment. This diagnosis should be suspected when a rapid deterioration of the clinical status appeared and when bone involvement was detected by MRI. However, the danger still lies in the misinterpretation of the synovial chondromatosis as chondrosarcoma. This diagnosis can be made with clinical, radiological and pathological criteria. The treatment must be a wide resection or an amputation.

Adult↗

PubMed1996

[Clear cell chondrosarcoma. Study of 13 clinical cases and review of the literature].

PURPOSE OF THE STUDY: Clear cell chondrosarcoma is a variant of bone chondrosarcoma. These unusual tumors are peculiar by their epiphyseal location in long bones, by their cytology and by their cytology and by their protracted course. Clinical, radiographical and histological features are described before therapeutic approach. MATERIAL AND METHODS: We report a series of thirteen cases of clear cell chondrosarcoma identified and treated between 1965 and 1995 in Cochin Hospital. RESULTS: Clear cell chondrosarcoma represented 5.4 per cent of the whole chondrosarcomas registered in the same period. There was a male prevalence (8 cases). Most patients were in their third decade (8 cases). Clinical course was usually of long duration ranging from three months to nine years. Roentgenographically, the lesion was often indistinguishable from chondroblastoma; this tumor involved the proximal part of the femur in 8 cases, located in the epiphysis. Histologically, cells with clear cytoplasm were always present, and areas of conventional chondrosarcoma were seen in half of cases. All patients underwent surgical treatment: "en bloc" resection was performed in 12 cases, after a curettage with bone grafting in 2 cases; a simple curettage with bone grafting was performed in one case. Two recurrences occurred: a local recurrence after a bone grafting treated by resection with good result, and another recurrence with pulmonary metastasis leading to death within 8 years. DISCUSSION: Clinical, radiographical and histological features are the same in our series and in the series published by Unni et al. in 1976 and by Bjornsson et al. in 1984. Treatment consists in "en bloc" resection because the lesion may recur after curettage. Rarely the tumor may metastasize. Prognosis is good with a five year survival rate similar to grade 1 chondrosarcoma (O'Neal and Ackerman classification). CONCLUSION: These rare bone tumors are characterized by their good prognosis when the treatment is an "en bloc" resection.

Adult↗

PubMed1994

[Dedifferentiated chondrosarcoma. A study of 13 clinical cases and review of the literature].

PURPOSE OF STUDY: Dedifferentiated chondrosarcoma is a variant of chondrosarcoma of bone consisting in a highly anaplasic sarcoma associated with low grade chondrosarcoma. The histopathology and the poor prognosis characterize these tumors. The clinical, radiographical and histological features are described before proposing a therapeutic approach to improve prognosis. MATERIAL AND METHODS: Thirteen cases of dedifferentiated chondrosarcoma having the histological requirements described by Dahlin and Beabout were identified and treated between 1977 and 1992 at the Cochin Hospital. These tumors represented 10 per cent of all chondrosarcomas registered in the same period. Eleven cases were primary and in two cases the dedifferentiated chondrosarcomas were first found in recurrent tumors. The average of age was 53 years. This was a retrospective study. The clinical reports, radiograms and histological reports were reevaluated. In doubtful cases the histological sections were reviewed. RESULTS: The clinical features were no different from chondrosarcoma except for the high incidence of pathological fractures. The histology was associated in all cases with a grade 1 or 2 chondrosarcoma and a grade 3 or 4 anaplasic component. The anaplasic components were: 5 osteosarcomas, 5 fibrosarcomas, 2 fibrous histiocytomas, 1 rhabdomyosarcoma. All the patients underwent surgical treatment. Only one patient was treated by adjuvant chemotherapy. Among the eleven primary chondrosarcomas: two disarticulations were performed. En bloc resection was performed in nine patients: one wide margin, six marginal and two intralesional. The two secondary dedifferentiated chondrosarcomas were treated by disarticulation. No local recurrences were observed after disarticulation or wide resection. All patients presented pulmonary metastasis leading to death except one patient with only three months follow up. The average survival time was nine months (1 to 36 months). DISCUSSION: Prognosis is uniformly poor. The five years survival rate is 0 per cent in our series and 10.5 per cent in the series published by Unni and Frassica. The physiopathologic hypothesis which prevails is that the two histologic components originate from two different primitive cell clones, one of which differentiates into a low grade chondrosarcoma while the others fails to differentiate and remains a high grade sarcoma expressing different morphologic features. Treatment was not always adequate, because the diagnosis was missed at time of biopsy in five cases. The biopsies showed the two histological components in only six cases. All our patients presented pulmonary metastasis excepted one patient. This feature was also noted in other series (70 to 100 per cent). Those metastasis originate from the anaplasic component. Chemotherapy has not been well evaluated for these tumors but its effectiveness is evident for treatment of osteosarcoma. CONCLUSION: These tumors, which are characterized by their histology and their poor prognosis, are frequently inadequately treated. It is necessary to improve the prognosis: by performing a large biopsy adjusted on the lytic bone. by performing a wide resection or amputation. We believe that it is necessary to associate a chemotherapy to surgical treatment. We have decided to treat our patients with an osteosarcoma protocol.

Adult↗

PubMed1991

[Prostheses in recent and old complex injuries of the shoulder].

Eighty prostheses, including 46 humeral prostheses and 34 total ones, have been laid for complex injuries of the shoulder. In 56 cases, these were recent fractures, mainly of the head and tubercle of the humerus, in subject ages 65 in average. In 34 cases, the injuries were older and comprised malunion or epiphyseal necrosis. Five cases of subluxation and six of secondary displacement of the tubercles were noted. Pain was suppressed in most cases, but mobility was less satisfactory (37% exceeding 90 degrees active elevation). The humeral sealing evolved in a reassuring way, but a poorly evolutive glenoid rim was often observed. Finally, upper subluxation may occur during the evolution, which suggests the possibility of secondary ruptures in the rotator cuff.

Adult↗

PubMedDate not supplied

Prognostic value of cytokeratin 19 fragment (CYFRA 21-1) and cytokeratin-positive cells in bone marrow samples of breast cancer patients.

The aim of this study was to investigate the relationship between the detection of micrometastatic cells by immunocytochemistry (ICC) with an anticytokeratin antibody and cytokeratin fragment (CYFRA 21-1) expression detected by an immunofluorescent assay in bone marrow of breast cancer patients. Micrometastatic CK+ cells were screened with a pancytokeratin antibody A45 B/B3 from bone marrow aspiration samples of 102 breast cancer patients (65 primary tumors, 10 local recurrences and 27 distant metastases). CYFRA 21-1 levels were assessed in bone marrow supernatant of these patients before collection of the mononucleated interface cells on a Ficoll-Hypaque density gradient and in 20 control patients. CYFRA 21-1 and CK+ cell detection by ICC were both correlated with clinical stage. CYFRA 21-1 was significantly elevated in patients with micrometastatic disease detected by ICC: 4.77 ng/mL (+/- 10.87 SD) versus 1.00 ng/mL (+/-1.36 SD) in patients with negative ICC (p=0.01). In univariate analysis, a CYFRA 21-1 value > or =1 ng/mL and the presence of CK+ cells were associated with a poorer survival for patients with stage I to III breast cancer (n=65). On multivariate analysis, only pathological nodal status and presence of CK+ cells in bone marrow were independent prognostic factors for overall survival. In conclusion, in this series CYFRA 21-1 was correlated with detection of CK+ cells by ICC in bone marrow, but cannot replace ICC. The presence of CK+ cells in bone marrow remains a strong independent prognostic factor in primary breast cancer.

Antigens, Neoplasm↗

PubMedDate not supplied

[Psychopathological factors of surgical biopsy within the scope of bone tumors].

Some particularities of cancerous conditions in bone surgery have profound psychological implications for the patients involved: their angst of death is compounded by the fear of mutilation or physical impairment. All medical treatment is undertaken to save the patient's life, but at what cost? The reactions of some patients at different stages of the process, before the diagnosis is established--during a brief stay at the hospital, when biopsy is performed--, when the diagnosis is disclosed and later, during the period of treatment, affect the medical team and are apt to seriously undermine the relationship between doctors and patients. The emergence of a tumor is a major event in a patient's life, even if this tumor eventually turns out to be of the non-malicious kind. Psychological counseling and even the prescription of psychotropic medication may prove necessary: the patient must be helped to cope with a newly acquired sense of powerlessness and the awareness of his or her own mortality. At every step of this personal experience, whether before, during or after the performance of the biopsy, the patient is likely to need help to cope with a sense of anxiety, uncertainty, loneliness, or the consequences of a brutal disclosure of his or her medical condition. Some psychic reactions may take us by surprise. In the first place, we have been puzzled by the discrepancy between the simplicity of the biopsy in operative, surgical terms and the highly emotional reaction it elicited among some patients. To the surgeon, biopsy often amounts to a quick surgical gesture. During their brief stay at the hospital, patients whose condition commands no particular attention are likely to suffer a sense of loneliness while they expect the verdict of the biopsy, and these emotions may be harder to cope with than the implications of serious surgery, should the preliminary analysis require it. Even if it turns out that surgery is not necessary, the anxiety just won't go away and a reactive depression may settle in, oddly enough, one could think. Occasionally, some patients may become aggressive in their dealings with the surgeon, who must remain calm and amenable to have them accept the terms of the treatment. Once the treatment options are reviewed (most of which are stereotypical and codified, a fact that is barely belied by the detailed explanations patiently provided by the medical staff), the patient is left alone to ponder the course and the meaning of life. At this point, life cannot go on under the best possible terms if patients are not offered the opportunity to discuss their physical and moral suffering and if no one is there to listen to complaints that transcend the scope their physical condition.

Adaptation, Psychological↗