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PubMed1975

Solitary bony metastasis as the first sign of malignant gastric tumor or of its recurrence.

Symptomatic solitary bony metastasis as the First sign of asymptomatic gastric carcinoma is very infrequent. Only 8 cases reported by 7 authors have been found in the literature. Furthermore, solitary bony metastasis as the sole sign of recurrence after hopefully curative resections are so rare that none has been previously reported in the literature. Three additional instances of solitary and histologically proven osseous metastasis of malignant gastric neoplasms have been observed and treated at Memorial Hospital during the years 1949 through 1969, and are herewith reported.

Adenocarcinoma↗
PubMed2003

The role of the pediatric plastic surgeon in limb salvage surgery for osteosarcoma of the lower extremity.

Limb salvage for management of osteosarcoma of the lower extremity has become the mainstay of treatment for patients with malignant bony and soft tissue tumors. The knee has become a special area of concern for the reconstructive surgeon due to the high rate of wound complications and difficulties of soft tissue reconstruction. With the availability of new prosthetic implants, the advancement of surgical soft tissue techniques and introduction of adjuvant and neoadjuvant chemotherapy, resection and reconstruction has become the standard approach for patients presenting to St. Jude Children's Research Hospital. The pediatric plastic surgeon's role usually requires handling of wound complications in these reconstructive procedures. This article will discuss the authors' approach to dealing with wound complications in this difficult patient population and their interaction with the orthopedic oncologic service in obtaining primary resection and soft tissue coverage.

Adolescent↗
PubMed2000

Tc-99m MIBI to evaluate children with Ewing's sarcoma.

PURPOSE: Tc-99m MIBI has been used increasingly to evaluate benign and malignant tumors because of its tumor-seeking properties and ability to provide an imaging assessment of multiple-drug resistance. This study investigated the clinical utility of Tc-99m MIBI in the management of Ewing's sarcoma in children. METHODS: Thirteen Tc-99m MIBI studies in nine (six male, three female) patients ages 6.5 to 20 years (mean, 13.4 years) with Ewing's sarcoma were reviewed. All patients had imaging studies at diagnosis, and four had follow-up studies during or after therapy. Scintigraphy was evaluated for Tc-99m MIBI uptake within the tumor and in metastases, which other imaging modalities had shown to be present in four patients. Scintigraphic results were correlated with the clinical course in all patients and with tumor P-glycoprotein status in six patients. RESULTS: Tc-99m MIBI accumulated in 6 of 9 primary tumors and did not accumulate in one recurrent tumor. No metastases showed Tc-99m MIBI uptake. The presence or absence of Tc-99m MIBI uptake at diagnosis or after therapy carried no prognostic significance. Tc-99m MIBI was present in the two tumors that were P-glycoprotein positive and in only one of four tumors that were P-glycoprotein negative. CONCLUSION: Tc-99m MIBI imaging does not appear to be useful in Ewing's sarcoma.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1996

Giant cell tumor of bone.

Giant cell tumor is a locally aggressive tumor with a high recurrence rate if not completely excised. The condition is more common among Asians than whites. During a 10-year period 44 patients, ranging in age from 12 to 51 years, were treated. The most common sites were the proximal femur and the distal radius. The aim of treatment was to excise the tumor completely. Because the tumor usually occurred at the juxtaarticular region of the bone, difficult reconstruction was expected. The authors' method of choice for filling large defects resulting from resection was to use a large vascularized bone graft from the iliac crest to enhance bone to bone corporation. The recurrence rate was low (4.5%), with only 2 recurrences: 1 at the proximal femur and the other at the proximal tibia. The functional results were highly satisfactory, with excellent stability of the joint, although in the case of the distal radius there was some degree of subluxation of the wrist joint. By applying microsurgical technique for the reconstruction, one was able to be more aggressive with excision of this locally aggressive tumor while maintaining excellent functional results. In the case of the knee, as long as 1 tibial condyle was intact, reconstruction of the other condyle using a vascularized iliac crest block maintained the joint integrity perfectly or created a pseudojoint component that was perfectly stable.

Adolescent↗
PubMedDate not supplied

Giant cell tumors of bone containing large amounts of hemosiderin: MR-pathologic correlation.

We present three giant cell tumors of bone that contained large amounts of hemosiderin and compare their MR appearance with intraoperative findings and histological characterization. Histologically, hemosiderin was found in multinucleated giant cells, mononuclear stromal cells, and xanthoma cells. All cases showed markedly decreased signal areas on both T1- and T2-weighted MR imaging due to hemosiderin deposition; this made evaluation of the integrity of the adjacent cortices difficult. In one case, extraosseous tumor extension appeared as a signal void area on MR imaging. Findings on immunohistochemical studies suggested the giant cells may have a histiocytic nature. Because the tumor cells themselves have a phagocytic nature, the decreased signal areas in and around giant cell tumors should be regarded as active tumor tissues in delineating the tumor on MR imaging.

Adult↗
PubMedDate not supplied

Combined MRI and MRA for limb salvage planning.

Magnetic resonance angiography (MRA) was performed in two patients with primary bone neoplasms being staged for differing types of limb-salvage procedures. A gated two-dimensional (2D) phase contrast MRA sequence that is capable of variable velocity encoding throughout the cardiac cycle was used to acquire the MRA images. The resulting cardiac phase images were added with a matched filter algorithm to create a single high signal-to-noise ratio image. An SE MR image in the same plane and field of view was then added to the MRA image. This displayed the relationship of vascular and stationary tissues within a composite picture: a "2D combined angiographic-stationary tissue" image. The anatomy represented gave information equivalent to conventional angiography. While this technique is not an ideal 3D rendering, it is easier to use. Along with other SE sequences acquired as needed for staging, it provides a complete preoperative evaluation of a tumor bed or donor site for a vascularized graft harvest.

Adolescent↗
PubMed1984

Physical approach for the reduction of dual radionuclide image subtraction artefacts in immunoscintigraphy.

Investigations have been undertaken into methods for reducing the artefacts resulting from the subtraction of images during immunoscintigraphy. The image subtraction techniques have been assessed using simple phantoms and the results applied to the image processing of clinical studies. Subtraction images were viewed for artefacts and the changes in target-to-nontarget ratios measured. Subtraction artefacts were reduced considerably using a combination of radionuclides with similar photopeak energies. In the case of 131I-labelled antibodies a blood pool subtraction with 113Inm was applied. When the images of radionuclides having very different photopeak energies were subtracted as in the case of 131I and 99Tcm, a preliminary background thresholding of the iodine image prior to 99Tcm subtraction reduced the artefacts due to the differential septal penetration and scatter components.

Antibodies, Monoclonal↗
PubMed2002

High-grade osteosarcoma of the extremity: differences between localized and metastatic tumors at presentation.

BACKGROUND: In osteosarcoma, as in other tumors, the presence of metastases at presentation is generally considered a consequence of late diagnosis. To verify this, the authors investigated whether there was a relationship between the stage of the disease at presentation and several clinical and pathologic characteristics, including the interval between the onset of first symptoms or signs and the final diagnosis. PATIENTS AND METHODS: One thousand seventy-one patients with high-grade osteosarcoma of the extremity were observed between 1980 and 1999. Of these, 891 had a localized tumor and 180 had metastases at the time of diagnosis. RESULTS: Compared with patients with localized disease, patients with detectable metastases at the time of diagnosis had higher serum levels of alkaline phosphatase, larger primary lesions, and tumors often located in the femur and humerus. In terms of time to diagnosis, the interval between the onset of first symptoms and the final diagnosis was significantly shorter in patients with metastases than in patients with localized tumor. This surprising finding probably reflects a more rapid growth of the tumor. CONCLUSIONS: These results suggest a different biologic phenotype and aggressiveness of the tumor in a subgroup of patients and that the stage of the disease at presentation depends more on the properties of these tumors than on late diagnosis.

Adolescent↗
PubMed1978

Surgical treatment of myelomatosis--a review of 18 cases.

The authors review 18 patients with multiple myeloma who had bone destruction of a kind that indicated surgical therapy. Eight patients had paralegic myelopathy and one had compression of the cauda equina. Four of them displayed partial to complete regression. One patient lived for 77 months after the operation, most of the time in excellent condition. The operative technique is discussed, with laminectomy, exeresis, filling of bone with cement and, in some instances, mechanical support from metal plates. Early diagnosis and operation is imperative, postoperative irradiation obligatory in severe cases. Radiation alone may be the method of choice in early stages. The other 9 patients were operated upon for bone destruction in the limbs. A Moore operation on the destroyed hip was performed in one patient, who lived in excellent condition for about four years. Active surgical therapy combined with radiation and cytostatics seems to be of value in many patients with multiple myeloma.

Aged↗
PubMed1993

Diagnosis of osteoid osteoma using STIR magnetic resonance imaging.

Two patients with osteoid osteomas were evaluated with magnetic resonance imaging at 1.5 T using both conventional spin-echo (SE) and short TI inversion-recovery (STIR) sequences. On plain films the classic findings of a radiolucent nidus with a dense surrounding reactive zone of sclerosis were absent. The diagnosis was suspected on observing the presence of marked marrow oedema in the involved bone. Conventional SE images were unimpressive in detecting the bone marrow changes. Increased signal intensity indicating bone marrow oedema was striking on the STIR images and facilitated diagnosis. In cases of suspected osteoid osteoma which do not demonstrate the classic radiologic features, adding the STIR sequence to conventional SE magnetic resonance sequences to enhance detection of bone marrow change is recommended.

Adult↗
PubMed1986

Clear cell chondrosarcoma. A report of two cases and review of literature.

Two cases of clear cell chondrosarcoma located in the distal femur and proximal humerus are reported. Both patients were men aged 35 and 51 years. Their initial symptom was a pathologic fracture. Roentgenographically, one patient showed a purely lytic lesion and another lytic with centrally radiodensity. Microscopic examination revealed that the tumor cells have a centrally placed vesicular nucleus surrounded by a clear cytoplasm, with distinct boundaries. Their cytoplasm stained with S-100 protein by the peroxidase-antiperoxidase method. We found 36 reported cases (including the two reported here), and delineated the clinico-pathologic characteristics of the disease.

Adult↗
PubMed1973

Prophylactic internal fixation of secondary neoplastic deposits in long bones.

The notes and radiographs of 19 patients who had pathological fractures of long bones due to secondary neoplastic deposits were reviewed. Involvement of over half of the cortex is recommended as an indication for prophylactic internal fixation to prevent the development of a pathological fracture. Eight patients were treated successfully in this way. A notable secondary effect of prophylactic internal fixation was the considerable reduction in pain at the site of the lesion.

Aged↗
PubMed1977

Angiographic features of fibromas and fibrosarcomas.

Angiography was done in 38 cases of pathologically-confirmed fibrous-tissue tumor. All benign fibromatous tumors and one case of desmoid fibroma were angiographically normal. A great spectrum of angioarchitecture exists in fibrosarcomas, whether they are of bone or soft-tissue origin. Heterogeneous vascularity was seen in 55% of these cases, and was related to the cell composition of the tumor. There exists a close relationship between the number of vessels in a tumor and its degree of clinical and histopathological malignancy. The most vascular part of a tumor is the least differentiated and should be used for biopsies. Angiography can be used for the grading of fibrosarcomas, and probably for assessing clinical prognosis.

Adult↗