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Sclerotic medullary spread in diaphyseal osteosarcoma.
Dense medullary sclerosis is reported in the shafts of long bones accompanying diaphyseal osteosarcoma. Histological evidence suggests that this indicates more extensive medullary spread of tumour than is readily apparent on standard radiographic examination. It would appear that these sclerotic lesions show active radio-isotopes retention following skeletal scintigraphy. The clinical and radiological features and prognostic implications of these findings are discussed.
Chondrosarcoma in children subsequent to other malignant tumours in different locations.
During recent years the combination of surgery, radiotherapy, and multiple chemotherapy in the treatment of patients with cancer has resulted in increased survival periods and, in some cases, complete cures. In children, however, the subsequent development of other and apparently unrelated malignancies has been observed 20 times more commonly than in a control group. This paper reports the occurrence of chondrosarcoma of the femur in two children who had been treated successfully for malignant tumours of soft tissue. One of these tumours was a malignant fibrous histiocytoma in the muscles of the forearm; the other was a rhabdomyosarcoma of the cheek. The intervals between termination of treatment of these lesions and recognition of the chondrosarcoma were five years and 10 years, respectively. In addition to surgical and radiotherapeutic measures, both children had received high doses of chemotherapy.
Subtle early osteosarcoma.
Seven cases of osteosarcoma in their very early stage of development are presented. With the exception of two cases the tumors were overlooked in the first radiographic examination. Two cases demonstrated increased density, three revealed subtle erosion or lytic destruction, and one case had no definite abnormality in plain radiographs but the computed tomography was abnormal. The value of additional radiographic modalities is outlined. The necessity of a high degree of suspicion for early diagnosis of osteosarcoma is stressed.
Case report 408: Malignant fibrous histiocytoma of innominate bones and femur (multicentric).
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Case report 575. Infantile myofibromatosis.
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Problems and pitfalls in the use of computed tomography for the local evaluation of long bone osteosarcoma: report on 30 cases.
Forty-eight, computed tomography (CT) examinations undertaken in 30 patients with osteosarcoma of long bones were studied in detail, their diagnostic information being compared with that obtained from corresponding plain films. The latter were of more value in assessing peripheral bony involvement, by cortical extension and periosteal reaction, while the former, in general, permitted more accurate observation of extensions into adjacent soft tissues. Recognition of such extensions, however, was vitiated when they arose in relation to the proximal ends of the tibia, fibula, and humerus and when a haematoma had developed as a result of a biopsy. Plain films were also of more value in appreciation of response to chemotherapy. On the other hand CT is the only examination which permits a satisfactory study of intramedullary extensions of the tumour and in consequence is invaluable in determining the exact sites required for local resection. No cases of skip metastases were observed in our series, although similar appearances due to nutrient vessels or bony ridges, remote from the primary tumour, were noted on several occasions. Differentiation of these densities proved to be easy, particularly in the case of nutrient vessels when examination of the contralateral bone showed them to be symmetrical. Several authors have described the role of CT in the evaluation of local extensions. This paper reports the difficulties and errors encountered by us.
Case report 360: multifocal Ewing tumor of the skeletal system.
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Benign giant-cell tumours of bone with pulmonary metastases and favourable prognosis. Report on two cases and review of the literature.
This paper reports two giant-cell tumours of bone of low-grade malignancy, both complicated by the development of pulmonary metastases in which the histological appearances were identical to those of the primary neoplasm. Ten similar cases in the literature are reviewed.
Case report 250. Multicentric osteosarcomata (osteosarcomatosis).
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Juxtacortical osteosarcoma: a radiologic and histologic spectrum.
Radiologic and pathologic findings were analyzed in four patients with parosteal osteosarcomas, three with periosteal osteosarcomas and one with a high-grade surface osteosarcoma. Plain film and histologic findings considered together are usually distinctive and permit differentiation of these tumors from each other and from other lesions with which they are frequently confused. Prognosis and management are determined by tumor extent and histologic grade. Computed tomography is more accurate than conventional tomography, angiography, and bone scintigraphy for preoperative determination of tumor extent and for assessing tumor relationships to the bone cortex and medullary cavity. Histologically, parosteal osteosarcomas are usually low-grade, while periosteal and high-grade surface osteosarcomas are generally high-grade tumors and have worse prognoses. High-grade surface osteosarcoma, which is indistinguishable in behavior and histology from classical medullary osteosarcoma, requires more aggressive surgical management than parosteal and periosteal osteosarcomas.
[The malignant fibrous histiocytoma of bone (author's transl)].
The primary malignant fibrous histiocytoma of bone (Stout) is a rare and autonomous sarcoma of the bone which has to be separated from the osseous sarcoma and the osseous fibrosarcoma. The malignant histiocytoma is morphologically characterized by the storiform pattern of interlacing spindle cell bundles and functionally by the phagocytosis of lipids, glycogen, hemosiderin and hematoidin. Contrary to the osteosarcomas, the main age of osseous histiocytomas are the fifth and sixth decade. Location of predilection are the metaphyses of the long tubular bones. The X-rays show moth-eaten spongiolysis, endosteal erosion and perforation of the cortex. Early metastases in the lungs are frequent. The primary treatment is a surgical one. Case record of a typical malignant osseous histiocytoma from the proximal metaphysis of the left femur with metastases in the lung of a female child, aged 14 years.
Management of pathologic fractures of long bones in malignant disease.
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[Experiences with arthroplasty for tumors and metastases of the proximal femur and humerus (author's transl)].
This report describes the results of 17 arthroplasties of the hip joint for tumors or metastases in the proximal part of the femur and 3 arthroplasties of the shoulder joint because of tumors in the proximal humerus. Based on case reports the paper discusses the indication in the case of malignant, potentially malignant and benign primary bone tumors and in the case of metastases. In addition principles for the construction of suitable hip and shoulder prostheses are cited, whereby the partial joint replacement continues to retain its justification beside total replacement. While the results of the hip arthroplasty proved satisfactory, the results of the corresponding operation on the shoulder are less satisfactory and urge to exercise more restraint in the operative indication.
[Treatment of malignant fractures of the femur with total hip-femur-knee joint alloplastics (author's transl)].
This is to report as an example of 2 such cases, the indications and operative procedures of total hip-femur-knee joint alloplastics for malignant fractures of the femur. This is an alternative to the exarticulation of the femur in the case of impossibility to fix the osteosynthesis material on the remaining femur. The higher radicality of this method in comparison to the common femur-saving way might lead to a wider usage.
Solitary skeletal lesions as primary manifestations of non-Hodgkin's lymphoma. Report of two cases and review of the literature.
Two patients with solitary skeletal lesions of the lower extremity were eventually diagnosed as having high-grade malignant B-cell non-Hodgkin's lymphoma. In both cases staging revealed no other nodal or extranodal involvement. One patient had been symptomatic for more than 2 years, presenting originally as a case of chronic synovitis. The second patient presented with slight exertional pain in his left knee of relatively recent history. In his case the initial plain X-ray showed little evidence of bony destruction, while magnetic resonance imaging revealed an extensive lesion in the left tibial plateau. Orthopedic surgeons should be aware of the differential diagnosis of primary lymphoma of bone. Early use of magnetic resonance imaging, in addition to plain X-ray and scintigraphic imaging, can be helpful in leading to an early biopsy and consequently early treatment. Magnetic resonance imaging should be regarded as the method of choice for follow-up examinations of lymphoma lesions.
Late recurrence of giant-cell tumor of bone: pharmacoangiographic evaluation.
Late recurrence (more than five years) of benign giant-cell tumor of bone is uncommon. Two patients were evaluated by angiography, including injection of vasoactive drugs, because of osteolytic lesions developing six and seven years after primary operation for benign giant-cell tumor. Angiography established a probable recurrence in both cases. Angiography also permitted accurate evaluation of tumor extension, facilitating pre-operative planning. Giant-cell tumors are predominantly hypervascular lesions. Angiographic evaluation is therefore recommended when a recurrent lesion is suspected.
Vascularized free fibula transfer in the treatment of bone tumours. Report of three cases.
The surgical treatment of two cases of bone tumours and one case of a tumour-like lesion are reported in this article. The tumours were resected radically and the massive bone defect or bone cavity were substituted by vascularized free fibula transfer. All of them were cured by early union. Neither atrophy nor non-union between the graft and the recipient bone occurred. Early restoration of function was observed. Our experiences of isolating the graft and the operative procedure are discussed. We believe that this method has prospects not only in the field of treatment of bone tumours but also in the management of bone defects or non-union due to various other causes.