[Ultrastructural changes in venous angiodysplasia of the Klippel-Trenaunay type].
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Malignant fibrous histiocytoma of bone is a histologically well-defined tumor. Our aim is to describe five own cases and to analyze the published cases in order to demonstrate, the controversial aspects of clinical pathology. The essential histological criteria are the storiform tissue pattern and the presence of fibroblastic and histiocytic cells and giant cells. Inclusive of our cases, the total number reported stands at 196. There are features of malignant fibrous histiocytoma of bone about which there is almost general agreement: 1. The tumor occurs at all ages with an average onset from the age of 10 to the age of 50. 2. The tumor occurs in both the long and flat bones, but the main sites are the distal femur and the proximal tibia. 3. The tumor lacks any initial distinctive features in its clinical phase, but with respect to its biological behaviour, malignant fibrous histiocytoma of bone can be distinguished from osteosarcoma.
Computed tomography (CT) and/or digital subtraction angiography (DSA) were performed on four patients with primary or recurrent giant-cell tumor of bone. In three cases presented, the tumor was examined with CT and had a precontrast attenuation value of about +50 to +65 HU with unequivocal nonhomogeneous contrast enhancement. In both cases in which DSA was used, contrast-medium enhancement could be recorded by DSA that had definitely not been seen with conventional angiography. It is suggested that in the future CT and DSA may replace conventional angiography in the diagnostic workup of giant-cell tumors.
Clinical and radiographical data are presented for a case of suspected pathological fracture of the right ulna in a 66-yr-old women mastectomised two years previously. Multiple skeletal lesions were noted, often morphologically different from those usually observed in metastasis of breast cancer, with a fibrous and cystic appearance reminiscent of von Recklinhausen's disease. However, indisputable serohumoral data, the histological picture on biopsy, and repair of bone as a result of immuno-antiblastic management showed that true metastases were involved. The radiographical picture and the response to therapy make it clear that atypical bone pictures must be carefully watched, since metastasis from breast cancer may be responsible for special morphological and structural features requiring close differential investigation.
The authors present 5 cases of monoarthritis which revealed adjacent bone tumours: a bony metastasis, a fibrosarcoma and three bone lymphomas. In three cases, the synovial histology showed lesions of non-specific synovitis without neoplastic invasion. A review of the literature demonstrates the rarity of these mono- or oligo- arthrites adjacent to bone tumours and two types can be distinguished: neoplastic invasion of the synovium or reactive non-specific synovitis without invasion.
Parosteal osteosarcoma is an uncommon malignant tumor of bone, and in a review of Mayo Clinic records we identified eleven cases of so-called dedifferentiated parosteal osteosarcoma. Ten of the eleven patients had had a long history of treatment for multiple recurrences of the tumor as a low-grade parosteal osteosarcoma and then for a definite recurrence as a high-grade undifferentiated osteosarcoma. The prognosis in this group of patients was similar to that in patients with conventional osteosarcoma.
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The results of clinical roentgenologic examination of 2 patients with lymphangiomatosis are discussed. The analysis of angiographic findings has shown that arteries and veins remained unchanged in affected area. Lymphography revealed fully changed lymphatics in affected areas. Numerous markedly dilated lymph vessels and cystic cavities of different shape and size were noted. In bony spongiosus substance the fissural spaces were filled with oily contrast medium. Roentgenologically, they appeared as numerous small conglomerates limited to bone contours.
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The authors present 60 cases of histologically confirmed giant cell tumor classified by a radiological grading as quiet, active and aggressive form. On the basis of our acquired experience and mainly from the follow-up films, all the pertinent radiological findings are analysed either for a more correct therapeutic guidance or for an adequate post-operative follow-up (favourable evolution, definitive recovery, local relapse, malignant degeneration).
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Experience with the treatment of 108 patients with fractures and false joints of the neck of the hip (79 observations) and bone tumors (29 observations) is described. An original method of individual endoprosthezing was used. The individual endoprosthesis was shown to give better results in some respects as compared with those obtained by usual methods, e. g. a dislocation of the endoprosthesis was practically excluded. A complete conformity of the form and size of the prosthesis improves the biomechanics of the articulation.
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The authors present four cases of parosteal osteogenic sarcoma, which is a rare primary tumour of bone. The radiologic and histopathologic features are discussed. The discussion concerns mostly the indication for "en bloc resection" as the initial treatment with or without replacement by autogenous or homogenous bone graft. Amputation should be considered when there is local recurrence.