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The role and limitations of radiofrequency ablation in treatment of bone and soft tissue tumors.

Percutaneous radiofrequency ablation (RFA) has evolved as an alternative therapy for treatment of certain patients with liver tumors. This novel image-guided intervention is a minimally invasive form of therapy with negligible morbidity. RFA has also been used for treatment of selected patients with renal and lung malignancies who may not be suitable surgical candidates. With the exception of osteoid osteomas, surgical management remains the treatment of choice for primary bone and soft tissue tumors. The role of RFA in definitive treatment of sarcomas has not been investigated. However, RFA has replaced surgery for treatment of osteoid osteomas and can play a role in palliation of painful bone and soft tissue tumors.

Bone Neoplasms↗

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) in the hand.

PURPOSE: The purpose of this study was to review our experience with a benign surface bone lesion referred to as bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, named for the pathologist who described it in 1983. The lesion may be confused with a variety of tumors, particularly solitary osteochondromas, which are rare. METHODS: The files in the Department of Pathology at the Hospital for Joint Diseases were reviewed over a 21-year period for all surface bone lesions involving the tubular bones in the hand. There were a total of 10 cases of BPOP compared with only a single case of an osteochondroma. RESULTS: Radiographs generally showed a well-marginated uniformly dense mass arising from the surface of the affected bone without any disruption in its bony architecture. Surgical excision is the definitive treatment and included the fibrous pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and any area of the cortex of the host bone that appeared abnormal. Although in the medical literature the recurrence rate for BPOP is high, we had only one recurrence in our series. CONCLUSIONS: BPOP is a benign surface bone lesion that may be confused with benign and malignant tumors. Although there is a cleavage plane between the lesion and host bone, we recommend excising the pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and decorticating any abnormal-appearing areas in the underlying host bone. This may explain the low recurrence rate in our series.

Adult↗

Extraskeletal osteochondroma of the buttock.

Osteochondromas are common and typically arise from the metaphyseal ends of long bones. An osteochondral neoplasm of the soft tissue, which is a lesion of uncertain pathogenesis, is uncommon and usually arises from the synovial tissue in joints and tendon sheaths. Rarely, extraskeletal osteochondromas also arise outside of synovial compartments. Most of the reported cases were presented in the hands and feet, especially in the fingers. Here we describe a 44-yr-old female patient who presented with a pain in the left buttock. A well-defined osseous mass was detected in the buttock. It consisted of sharply demarcated, mature hyaline cartilage that was covered with a fibrous capsule, which changed gradually into cancellous bone, more pronouncedly at the center. The diagnosis of an extraskeletal osteochondroma should be considered when a discrete, ossified mass is localized in the soft tissues. A case of pathologically proven extraskeletal osteochondroma of the buttock is presented with a literature review, magnetic resonance imaging, and radiological findings.

Accidental Falls↗

Improved shoulder contour following forequarter amputation with an osteomyocutaneous free flap from the amputated extremity: two cases.

To cover a large soft-tissue defect and to reconstruct the shoulder contour after forequarter amputation, we used an osteomyocutaneous free flap incorporating an elbow joint from the amputated extremity in two patients. These flaps were well vascularised and reliable. They provided excellent coverage of large soft-tissue defects and they maintained shoulder contours. This procedure is useful for reconstruction after extended forequarter amputation and chest wall resection.

Adolescent↗

Imaging findings of extrapulmonary metastases of osteosarcoma.

PURPOSE: To review imaging findings of extrapulmonary metastasis from osteosarcoma and to evaluate them for any consistent pattern and correlation between imaging findings. MATERIALS AND METHODS: This study was retrospectively conducted in 13 patients with extrapulmonary metastasis of pathologically confirmed osteosarcoma. We evaluated the radioisotope (RI) scans (n=16), ultrasonography (USG) (n=4), computed tomography (CT) scans (n=10), MRIs (n=6), clinical records, and pathological reports for assessment of imaging findings and correlation between radiologic findings and RI uptake of the lesions. Points evaluated were the following: uptake on RI scans, presence of mineralization on CT, and MRI, size, enhancement pattern, attenuation on CT, signal intensity (SI) on MRI, and echogenicity on USG. RESULTS: Extrapulmonary metastatic sites were diverse, including another bone other than the primary site (n=6), lymph node (n=4), pleura (n=2), liver (n=2), pancreas (n=1), kidney (n=1), peritoneum (n=1), muscle (n=1), and subcutaneous fat layer (n=1). One patient had tumor growth within the pulmonary artery and jejunum. Among 21 metastatic sites in 13 patients, bone scan was performed in 16 cases and RI uptake was detected in 10 lesions. Calcification was detected in eight lesions on radiologic imaging, including plain radiography, USG, CT, and MRI. Two lesions showed RI uptake without definite calcification or ossification on MRI and plain radiography, respectively. We analyzed the enhancement pattern and mass size in 18 metastatic sites and these factors had poor correlation with uptake on RI scans. CONCLUSION: The sites and imaging findings of extrapulmonary metastasis of osteosarcoma were variable. All the lesions with mineralization were detectable on RI scans prior to radiologic imaging. RI scan has a limited role in the evaluation of metastatic lesions without mineralization.

Adipose Tissue↗

Nonrepair of exposed frontal bone after Mohs' surgery for extensive basal cell carcinoma.

When it is necessary to expose frontal bone with or without periosteum after Mohs' surgery for extensive carcinomas of the forehead, simple wound care will allow granulations to cover the bone and healing will be complete. In situations where it is not advisable to cover exposed frontal bone with or without periosteum, simple care of the defects should allow complete healing.

Adult↗

Update on new diagnostic and therapeutic approaches for sarcomas.

Sarcomas represent a family of uncommon malignancies related by histopathology and developmental biology. Sarcomas arise from any of the mesodermal tissues anywhere in the body (muscles, tendons, adipose tissue, blood vessels, and joints) from cells of mesenchymal origin or in the peripheral nervous system, derived from the ectoderm. Mainly diagnosed in the extremities, sarcomas can be present also in soft tissues of the trunk, abdomen, and retroperitoneum, as well as the head and neck. During the last decade, improvements in diagnostic techniques have made it possible to identify and characterize a subset of sarcomas arising within the gastrointestinal tract known as gastrointestinal stromal tumors, which were previously commonly misclassified as leiomyosarcomas. Sarcomas are extremely heterogeneous, so expert histopathologic characterization is essential to choose the appropriate path of multidisciplinary treatment and predict possible clinical outcomes. The aim of this review is to provide a brief overview of the epidemiology, pathology, clinical presentation, and new approaches to the treatment of adult soft-tissue and bone sarcomas.

Bone Neoplasms↗

[Continuous intra-arterial infusion chemotherapy for malignant bone and soft tissue tumors in pelvis and trunk areas].

We evaluated the effectiveness of intra-arterial infusion chemotherapy for 21 cases of malignant bone and soft tissue tumors in the pelvis and trunk areas. Eight cases are alive for one or two years without operation. In all cases, pain was decreased and quality of life improved. We concluded that intra-arterial infusion chemotherapy is one of the useful treatments for malignant bone and soft tissue tumors in the pelvis and trunk areas.

Adolescent↗

Improving survival for childhood cancer in Slovakia.

Data from the National Cancer Registry of Slovakia were used to evaluate survival for 2,958 childhood cancer patients registered between 1968 and 1987 and aged 0-14 years at diagnosis. Actuarial survival rates were computed for children diagnosed in 4 successive 5-year periods and compared. Overall 5-year survival rose from 20% for the period 1968-1972 to 46% for the period 1983-1987. The increase was statistically significant in age groups 1-4, 5-9 and 10-14 years. Survival for children aged less than l year also increased slightly, but this was not statistically significant. In most of the major diagnostic groups, survival increased markedly. Five-year survival rose significantly for leukaemias, lymphomas, CNS neoplasms, Wilms' tumours, bone tumours, soft-tissue sarcomas and germ-cell tumours. Despite this progress, survival in Slovakia remains lower than the corresponding figures from registries in Western Europe and the United States.

Adolescent↗

[Tissue bank for the musculoskeletal system. Clinical applications].

From June 1987 to June 1990, the musculoskeletal system tissues bank of the Orthopaedics and Traumatology Department of the University Clinic of Navarra has used 310 allografts. Of this, 219 has been used in our Department, 142 of cancellous bone and 42 of cortical bone. 24 of patellar tendon and 11 of fascia lata. The other 91 grafts have been sent to other hospitals in the country. In the present work we make a retrospective study that included the patients who were operate with allograft. We observe the differences between several types of allografts comparing them with conventional surgery technics. Within the complications we distinguished a 10.52% of infection in cortical bone allografts used in patients with neoplastic treatment. In the other type of allograft we didn't present this complication. We concluded that a bone bank or a musculoskeletal system tissues bank has a great usefulness in different reconstructive surgery technics and arthrodesis. They are used more frequent in orthopaedics and traumatology surgery improving the development of this surgery.

Adolescent↗