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CT of the soft tissue structures of the neck.

CT is an excellent means of evaluating patients with neck masses. It has the capability of defining the precise location of a mass and its effect on adjacent structures. The information obtained on CT may be used to determine the best possible approach for biopsy or surgery and to determine radiation therapy ports.

Bacterial Infections↗

Cytogenetics as a tool in the histologic subclassification of chondrosarcomas.

Chondrosarcomas are a heterogeneous group of bone neoplasms of which the basic neoplastic tissue is cartilaginous. Frequently the histologic diagnosis and grading of chondrosarcomas is difficult and the histologic appearance does not always reflect the biologic behavior of these tumors. Therefore, it is important to find other parameters that can be of help in the proper diagnosing and grading of these neoplasms. To this end, we attempted to correlate the chromosomal pattern of chondrosarcomas to their histologic subtypes and grades. The cytogenetic analysis of two intermediate-grade chondrosarcomas of bone, and a review of the literature, are presented.

Bone Neoplasms↗

Xeroradiography of bone and soft tissue tumors.

Xeroradiography was used for the study of 233 cases of bone and soft tissue tumors, both benign and malignant, 177 of which were histologically proven. In 150 cases, comparative x-ray films were also available. In bone tumors, xeroradiography was more effective than film radiography in 33 cases (44%), less effective in 16 cases (22%) and the 2 techniques were substantially equivalent in 25 cases (34%). In soft tissue tumors, xeroradiography was more effective than film radiography in 59 cases (78%), less effective in 2 cases (3%) and equivalent in 15 cases (19%). Xeroradiography is held to be a useful second-line technique in selected bone tumors, in particular for the study of trabecular structure, periosteal calcifications and cortical bone. In the field of soft tissue tumors, xeroradiography can be a promising first-choice examination in the presence of a mass or when a recurrence is suspected. The advantages and drawbacks of this technique in both types of tumors are reviewed and discussed.

Bone Neoplasms↗

Computed tomography-guided core needle biopsy for bone and soft tissue tumors.

BACKGROUND: Imaging-guided core needle biopsy is a well-established technique for the diagnosis of bone and soft tissue tumors and tumor-like lesions in specialized orthopedic oncology centers. OBJECTIVE: To present our results of computed tomography-guided core needle biopsy with assessment of the accuracy of the technique. METHODS: Between July 1998 and October 2000, 215 CT-guided core needle biopsies were performed and histologically examined in the Unit of Bone and Soft Tissue Pathology, Tel Aviv Sourasky Medical Center. There were 80 soft tissue and 135 bony lesions. All biopsies were performed by the same radiologist and the histologic examination by the same pathologist. To assess the accuracy of the procedure, we compared the diagnosis at biopsy with the diagnosis after definitive surgery (when available). RESULTS: Bone core needle biopsy (n = 135) showed malignancy in 89 cases (primary or recurrent bone sarcoma, lymphoma, myeloma, metastatic carcinoma or melanoma). There were 29 benign lesions. In 17 cases the result was inconclusive and an open incisional biopsy was performed. Of the 80 soft tissue biopsies, 35 were malignant (25 soft tissue sarcomas, 6 lymphomas, 4 metastatic carcinomas); 40 were benign (myositis ossificans, neurofibroma, desmoid tumor, schwannoma, hematoma and others), and 5 were inconclusive and followed by an open incisional biopsy. The core needle biopsy histologic diagnosis was compared with that of the definitive surgery and the diagnostic accuracy was 90%. Only three samples initially diagnosed as benign turned out to be malignant. No significant complications occurred during the procedures. CONCLUSIONS: CT-guided CNB of musculoskeletal lesions is a safe and effective procedure that assures sufficient and proper material for histologic examination. The accuracy of this method in our center was 90%. Tumor sampling is extremely important, especially in soft tissue sarcomas, and cores should be taken in different directions, including areas of necrosis. The processing is quick, especially for bone CNB, and diagnosis can be achieved within 24 hours. The material undergoes excellent fixation and the immunostains are reliable.

Biopsy, Needle↗

Presence of telomerase activity in different musculoskeletal tumor histotypes and correlation with aggressiveness.

Telomerase is a ribonucleoprotein enzyme that maintains the protective structures at the ends of eukaryotic chromosomes, called telomeres. Telomerase activity was observed and correlated with aggressiveness in different neoplasms such as breast, prostate, blood and brain cancers, among others. To investigate whether telomerase activity is an index of aggressiveness in bone and soft tissue lesions of the extremities, 66 biopsy samples from our tissue bank were studied. These samples included 43 high-grade sarcomas, 9 aggressive benign tumors and 14 totally benign lesions. The samples were collected from patients homogeneously treated at the Rizzoli Orthopaedic Institute with a follow-up ranging from 4 to 11 years (median, 7 years). A non-radioactive polymerase chain reaction-based enzyme-linked immunosorbent assay was used for the study. All tumors investigated were positive for telomerase activity. Among benign lesions, only 2 aneurysmal bone cysts showed higher telomerase activity than the cut-off point, whereas all the other benign lesions had lower activity. Our results indicate that high levels of telomerase activity in bone and soft tissue lesions correlate with more aggressive clinical behavior in patients treated with surgery alone. An interesting inverse correlation between telomerase activity and occurrence of pulmonary metastasis was detected in osteosarcoma patients treated with chemotherapy. A parallel increase of telomerase activity and malignancy was observed in the adipose and cartilagineous tissue lesions. Our data suggest that telomerase activity could be considered a marker of tumor aggressiveness for bone and soft tissue lesions. The results obtained in osteosarcoma samples suggest that low levels of telomerase activity may be predictive of the prognosis and should influence the therapeutic protocol.

Bone Neoplasms↗

Aggressive papillary tumors of the temporal bone: an immunohistochemical analysis in tissue culture.

Aggressive papillary tumors of the temporal bone are neoplasms that are locally invasive and destructive. Previously classified on histologic study as middle ear adenomas or adenocarcinomas, observational evidence suggested that they arose from endolymphatic sac. To evaluate this hypothesis, we established a tissue culture from cells derived from such a papillary tumor and compared immunohistochemical stains of the original tumor with stains on endolymphatic epithelium. Similarities in expression of neuroectodermal antigens were observed. Similar staining antigens in cells derived from tumor and the endolymphatic sac provide evidence that epithelium from endolymphatic sac is the site of origin for these aggressive neoplasms. In tissue culture the cells remain contact inhibited and dependent on serum or growth factors with survival beyond the expected senescence at 30 to 50 generations. Therefore the cell culture technique provides a model for study of the disruption of growth control and invasive properties of this tumor.

Adenocarcinoma, Papillary↗

Serum lysozyme (muramidase) activity in dogs with neoplastic disease.

The lysozyme (muramidase) activity was measured in the sera of 84 dogs with neoplastic disease. Neoplasms included 32 lymphomas, 13 primary bone neoplasms, 5 melanomas, 5 thyroid neoplasms, 9 soft tissue sarcomas, 5 mast cell sarcomas, and 15 carcinomas. The sera from 21 healthy dogs served as control. Dogs with neoplastic disease had significantly (P less than 0.005) higher serum lysozyme activity than did the healthy controls. For lymphosarcoma, dogs with clinical signs of systemic disease had significantly higher serum lysozyme activity than did dogs without clinical signs. For bone neoplasms, dogs with metastatic disease had higher serum lysozyme activity than did dogs without metastasis. Increased lysozyme activity may be a useful marker of macrophage-mediated host responses to neoplasms in dogs.

Animals↗

Human giant cell tumors of bone identification and characterization of cell types.

Cells cultured from human giant cell tumors of bone were characterized on the basis of morphological features, proliferative capacity, presence of granulocyte-monocyte antigens, receptors for skeletal hormones, and soluble cell products. Three major cell types were identified. One population consisted of mononuclear cells with fibroblastic morphology, which proliferated in culture and most likely represent the neoplastic element of the tumor. Phenotypically they resembled a connective tissue stromal cell. A second population of mononuclear cells lacked receptors for skeletal hormones and did not persist in culture. These cells were likely of monocyte-macrophage lineage. A third population of cells consisted of large multinucleated giant cells. These cells possessed phenotypic features of osteoclasts including receptors for calcitonin. Human giant cell tumors of bone are most likely a neoplasm of connective tissue stromal cells, which have the capacity to recruit and interact with multinucleated giant cells that exhibit phenotypic features of osteoclasts.

Antibodies, Monoclonal↗

Radiotherapy and chemotherapy of limb tumours.

The place of radiotherapy and chemotherapy-separately, together, and in combination with surgery-in the treatment of limb tumours affecting skin, soft tissue, and bone is discussed.

Bone Neoplasms↗

Prevalence and growth characteristics of malignant stem cells in B-lineage acute lymphoblastic leukemia.

We used a stroma-supported culture method to study the prevalence and growth characteristics of malignant stem cells in acute lymphoblastic leukemia (ALL). In 51 of 108 B-lineage ALL samples, bone marrow-derived stroma not only inhibited apoptosis of ALL cells but also supported their proliferation in serum-free medium. When single leukemic cells were placed in the stroma-coated wells of microtiter plates, the percentage of wells with leukemic cell growth after 2 to 5 months of culture ranged from 6% to 20% (median, 15%; 5 experiments). The immunophenotypes and genetic features of cells recovered from these cultures were identical to those noted before culture. All cells maintained their stroma dependency and self-renewal capacity. Leukemic clones derived from single cells contained approximately 10(3) to 10(6) cells after 1 month of culture; other clones became detectable only after prolonged culture. Cell growth in stroma-coated wells correlated with the number of initially seeded cells (1 or 10; r = .87). However, the observed percentages of positive wells seeded with 10 cells always exceeded values predicted from results with single-cell-initiated cultures (P < .003 by paired t-test), suggesting stimulation of leukemic cell growth by paracrine factors. In conclusion, the proportion of ALL cells with clonogenic potential may be considerably higher than previously thought.

Adipose Tissue↗

[The use of computed and magnetic resonance tomography in the diagnosis of neoplasms of the pelvic bones and sacrum].

The experience of the computed tomography (CT) application in the pelvic bones and sacrum tumors diagnosis in 46 patients was summarized. The data obtained were defined more precisely using magnet-resonance tomography (MRT). MRT in contradistinction to permits to differentiate the soft tissues and reveal the tumoral invasion of dura mater and the spinal cord substance, the spinal cord nerves affection. Using CT it is possible to estimate more accurately the bone structure and tumoral elements, containing calcium.

Bone Neoplasms↗

[Isolated trigeminal neuropathy associated with a fatty tumor of Meckel's cavum].

INTRODUCTION: In recent years there has been increasing interest in isolated trigeminal sensory neuropathy. We present a case with an unusual association of this neuropathy and a fatty tumour of Meckel's cavum. CLINICAL CASE: A 24 year old man consulted for occasional episodes (during the previous two months) of dysesthesia of the right maxillary region. These were self-limiting and lasted only a few minutes. There was no lacrimation, apparent trigger factor, conjunctival injection or reduction in level of consciousness. There were no abnormal findings either on general or on full neurological examination. On cranial CT there was no signal from the tip of the right petrous temporal bone, but no space-occupying lesion nor pathological uptake of contrast material. On cranial MR there was an extra-axial lesion in the superior part of the tip of the right petrous temporal bone of 2 x 2 cm, localized to Meckel's cavum and right cavernous sinus, with a small lobule in the right lateral part of the prepontine cisterna. CONCLUSIONS: Trigeminal sensory neuropathy has been described in association with different connective tissue disorders, infections of the central nervous system, vascular dilatations and very varied types of tumours, particularly meningioma. The commonest site for lesions related to this clinical condition is the posterior fossa. A tumour in Meckel's cavum is rarely found in relation to this diagnosis, and from our review of the literature, involvement of fatty tumours seems to be rare.

Adult↗

December 2004: one-year-old girl with aggressive skull tumor.

December 2004. Twelve-month old girl presented with recurrent subcutaneous lesion in the left parietal region, one year after excision of a "benign" tumor. An MRI demonstrated left temporo-parietal skull tumor infiltrating the soft tissue, surrounding craniotomy flap, and extending to the brain parenchyma. Biopsy revealed biphasic neoplasm displaying nests of poorly differentiated neuroblastic cells positive for synaptophysin and pigmented cuboidal epithelioid cell positive for keratins, epithelial membrane antigen and MHB-45. In addition, some neoplastic cells were immunoreactive for synaptophysin as well as HMB-45 and epithelial markers, suggestive of their origin from a common progenitor. Interestingly, cell with the neuroblastic immunophenotype displayed 80% nuclear MIB-1 reactivity indicating that the aggressiveness of the neoplasm was confined mostly to this pattern of differentiation. The overall histological features are consistent with a rare malignant variant of a melanotic neuroectodermal tumor of infancy.

Brain Neoplasms↗

[Operative treatment of bone and soft tissue tumors involving pelvic region, especially retroperitoneal area including lumbar region].

During the past 17 years, 35 of 60 patients with malignant bone and soft tissue tumors of the pelvic and surrounding tissues, were treated surgically. There were 13 bone tumors and 22 soft tissue tumors, There were 12 recurrent cases and 23 non-recurrent cases with cumulative 5-year survival rates of 20% and 70%, respectively. In the tumors involved even in the iliolumbar area, curative resection was difficult with poor prognosis. Serious complications also developed with high incidence immediately after operation, including ileus, severe infections and postoperative bleeding. When the affected limb was preserved, many difficulties were encountered in functional recovery. Therefore, we combine preoperative radiation and intra arterial infusion for the prevention of recurrence at the resection margin. However, we have not obtained completely satisfying results. Operations involving these tumors should be performed in cooperation with other fields.

Bone Neoplasms↗