[Role of extended amputation in treatment of neoplasms of bones and soft tissues of the limbs and pelvis].
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Adolescent↗
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Results for “FEMORAL NEOPLASMS”
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[Extramusculoperiosteal resection in the treatment of bone tumors].
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Bone Neoplasms↗
[Giant-cell tumor of bone: a review of diagnosis and treatment of 105 cases].
OBJECTIVE: To summarize the experience in the diagnosis and treatment of giant-cell tumor of bone, the selection of various operation methods and their effects were evaluated and discussed. METHODS: From 105 cases of giant-cell tumor of bone data were collected and reviewed. The clinical features were analyzed in association with radiological and histological characteristics. Prognosis was assessed by long-term follow-up. RESULTS: Among 105 cases, one had multiple giant-cell tumors and two had distant metastases. In some cases, the radiological and histological appearances didn't accord with the clinical findings. The recurrence rate was 36% in patients treated with curettage. Although no recurrence was seen in patients treated by local excision, the joint function could not be fully retained. CONCLUSION: Diagnosis should be made on the basis of integrated clinical, radiological and pathological manifestations. Early diagnosis and operation are important. The function of joint must be retained as much as possible. Pre-operative embolization of tumor of sacrum and pelvis is very helpful to ensure operative success and to minimize recurrence.
Adolescent↗
Knee rotation-plasty for malignant musculoskeletal tumors occurring around the knee joint.
BACKGROUND: In addition to the wide excision of malignant musculoskeletal tumor around the knee joint, surgical methods, such as total knee arthroplasty and knee rotation-plasty are available. Therefore, this study was undertaken to clarify the usefulness of knee rotation-plasty. MATERIALS AND METHODS: At the Chiba Cancer Center, knee rotation-plasty was performed in 27 patients with malignant musculoskeletal tumor around the knee joint. Patients were divided into two groups: Group S, in which operations were performed as salvage surgery (8 patients), and Group I, in which operations were performed as initial surgery (19 patients). The lower limb function was investigated in 17 patients (7 patients in Group S and 10 patients in Group I). The lower limb function was assessed by the Knee Evaluation System of International Symposium on Limb Salvage and the Knahr's assessment. RESULTS: Lower limb function in Group S measured an average of 25.7 points (85.6%), while the lower limb function in Group I measured an average of 23.6 points (78.7%). The majority of patients in both groups were capable of walking without a cane or doing light exercise with below-the-knee prosthesis, revealing good lower limb function. CONCLUSION: Whether it is performed as salvage or initial surgery, knee rotation-plasty can be useful method for reconstruction of the knee after wide excision of malignant musculoskeletal tumor around the knee joint.
Adolescent↗
[Efficacy of operative treatment for pathological fractures in bone metastases in relation to length and comfort of survival].
The paper presents a retrospective evaluation of 47 patients with bone metastases treated surgically during the last 10 years at our ward. The mean age of the patients was 62.5 years. There were 31 females (mean age: 62.8 years) and 16 males (mean age: 62.3 years). In 37 cases (78.8%) it as possible to establish the primary localization of the tumour: breast carcinoma--16 cases, ovary cancer 5 cases, lung cancer--5 cases, prostate cancer--5 cases, kidney cancer--2 cases, stomach cancer--1 case, vagina cancer--1 case, hepatocarcinoma--1 cases and plasmocytoma--1 cases. In 10 cases (21.1%) we were unable to establish the primary focus of the tumour. The localization of the metastases was as follows: femur--32 cases, humerus--6 cases, tibia--3 cases, lumbar spine--1 case. Patients treated very briefly after qualification for surgery, in some cases during emergency service. In 2 cases of metastases to the tibia amputations at the femur were performed. The remaining patients were treated by local excisions of the metastatic tumours, followed by: in 33 cases internal osteosynthesis and bone cement application; in 7 cases osteosynthesis, in 4 cases hip arthroplasties and posterior spine instrumentation in 1 case. In 6.4% we had poor results because of the death of 3 patients. The mean follow-up was three months. In 93.6% we had good and very good results--no pain, good function and independence during daily activities. Mean survival time was 13.5 month (range 5-28 months).
Bone Neoplasms↗
Excision of tumours of humerus and femur, with restoration by internal prostheses.
A personal experience is recounted of operations in cases of tumour involving the humerus or femur with restoration by endoprostheses. Twenty-four patients were treated in this way from 1950 to 1969 inclusive and have been followed up for between four and twenty-four years. The patients selected for treatment have presented chondrosarcoma (ten), so-called benign giant-cell tumour of bone, usually recurrent (nine), angiomatous osteolysis (two), seemingly single thyroid or renal metastasis (two), and ununited pathological fracture after irradiation of a tumour (one). Development of the prostheses from early beginnings is outlined. Some points in surgical management are referred to. The complications and results are recorded.
Adult↗
Mesenchymal chondrosarcoma--report of four cases.
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Adolescent↗
Segmental resection for chondrosarcoma.
Specific anatomical and pathological criteria for resectability of so-called central chondrosarcoma of the extremities were set forth and a method of treatment based on autoclaving the segment and surrounding it with massive amounts of fresh autogenous cancellous bone was used in eight patients. Follow-up ranged from 3.2 to 13.5 years. The advantages of the method are: ease of procurement of bone graft, absence of storage and measurement problems, and lack of need for rigid immobilization. No secondary procedures were required because of fracture, resorption, or infection.
Adult↗
[Osteosarcoma and brain metastasis].
INTRODUCTION: Since the advent of multimodal therapy, survival among patients with osteosarcoma in general and among those with aggressive tumors has improved. Consequently, the pattern of relapse is also changing. Brain metastasis is considered to be a rare event in osteosarcoma, although recent reports suggest that the incidence of this complication may be increasing. CASE REPORT: We report two girls with osteoblastic osteosarcoma of the femur with poor response to preoperative chemotherapy. Both patients developed brain metastasis concurrent with or after the development of lung metastasis. Clinical manifestations of brain metastasis were symptoms of intracranial hypertension in one patient, and a complex partial seizure in the other. DISCUSSION: We advocate periodic neurologic examination and neuroradiologic screening for the early detection of brain involvement in patients whose disease recurs within 1 year of diagnosis, in those with metastasis at diagnosis and in those with a poor histologic response to preoperative chemotherapy.
Brain Neoplasms↗
Giant cell tumor and the skeletally immature patient.
Conventional wisdom suggests that giant cell tumor (GCT) does not occur in the skeletally immature individual; however, we believe that GCTs of bone, though rare, do occur in children. We are reporting the occurrence of GCT of bone in three patients who were skeletally immature at the time of their initial presentation. In our review of the reports since 1954 that document this condition, we were also able to find a total of 318 patients, of whom 130 were skeletally immature at the time of their tumor presentation. From the data compiled, we found a 7.5% incidence of GCT of bone in skeletally immature individuals at a mean age of 10.5 years. Based on our review and the experience with our three patients, we believe the diagnosis of GCT of bone should be considered in the differential diagnosis of a destructive lesion of bone in skeletally immature individuals. Giant cell tumor in the skeletally immature is being reported here to better define its incidence and increase awareness of its occurrence. Management options will also be discussed.
Adolescent↗
Intra-articular osteoid osteoma: diagnostic imaging in three cases.
PURPOSE: To report our experience pertaining to three cases of intra-articular osteoid osteoma assessed by means of integrated imaging and review of literature. MATERIALS AND METHODS: Medical records, radiologic and nuclear medicine findings pertaining to three cases of intra-articular osteoid osteoma were retrospectively evaluated and compared with those of surgery. All the patients (2 males, one female; age range 8-38 ys) affected by intra-articular osteoid osteoma respectively of the elbow, tibio-talar joint and hip were evaluated by means of radiographic examination and Magnetic Resonance Imaging (MRI). SE T1-w and T2-w, GRE T2*-w, GRE 3D T1-w and STIR pulse sequences were used and axial, coronal and sagittal images were acquired. Two patients underwent CT scan. One patient underwent skeletal scintigraphy. All the patients underwent surgery. RESULTS: In 2 out of 3 cases plain radiography allowed the radiologist to suspect the presence of the lesion. In the remaining one, plain radiography failed to detect both the nidus and the perilesional osteosclerosis; nevertheless, a small osteochondral erosion of the humeral condyle suggested the presence of joint inflammation, thus leading to further investigation. CT scan well depicted the presence of the nidus and, in one case, the presence of joint effusion. MRI was always able to detect the nidus, which presented as lesion of low to intermediate signal in T1-w images, low signal in the T2-w images in one patient and high signal in the remaining two; in these latter STIR images showed high intensity nidus and edema of neighbouring cancellous bone. Furthermore, in all patients MRI clearly depicted joint effusion. Skeletal scintigraphy demonstrated both the lesion and the inflammatory involvement of neighbouring soft tissue. In all patients histologic specimen confirmed the diagnosis of osteoid osteoma with joint inflammation and synovitis. CONCLUSIONS: According to our results and literature data the pre-surgical diagnosis of osteoid osteoma is very difficult to achieve. Indeed, only the combination of clinical information and radiologic and nuclear medicine findings enables the radiologist to make the right diagnosis.
Adolescent↗
[Major reconstructions of the hip by allograft composite prostheses (long-term follow-up of 34 cases)].
Reconstruction after major resections of malignant tumors can be achieved by association of prostheses and of massive allografts. In 34 patients, we could reconstruct: the proximal femur in 21 cases, after an average resection of 180 mm, with a "composite" allograft prosthesis (with a bone graft around the stem) or a "composite and combined" allograft prosthesis (in which the femur allograft was associated with the trochanteric tendons, to facilitate the reinsertion of the glutei muscles); 10 hemipelvis in which the cup was inserted in an hemipelvic allograft; 3 proximal femurs and acetabulum (with composite cups and stems). In comparison with metallic reconstruction prostheses, composite prostheses improved function, limited complications, and increased longevity. The association of allografts and prostheses not only allows reconstructions which could be hardly achieved with only prostheses (especially for the pelvis), but also improves functional result and longevity, thanks to the biological fixation of the osseous and tendinous allografts. Considering our 15 years follow up in oncology, we have now extended these procedures to the major bone losses of the femur and pelvis following iterative revisions of standard prostheses for arthritis.
Acetabulum↗
Medical management of osteoid osteoma.
OBJECTIVE: To see if the results of managing osteoid osteoma with medical treatment alone is comparable to those after surgery or other ablative therapy. DESIGN: A case series. SETTING: A tertiary care centre. PATIENTS: Eleven patients with osteoid osteoma treated over a 5-year period. The condition was diagnosed from a typical history, patient age, standard radiography, computed tomography, bone scanning, complete blood count and measurement of the erythrocyte sedimentation rate. INTERVENTIONS: Continued medical treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) for 6 months after pain ceased. Surgery was done only in those who refused or could not tolerate medical treatment. MAIN RESULTS: Medical treatment successfully controlled the pain in all patients. Two patients decided to undergo surgery because of intolerance to the NSAIDS. In 7 patients the symptoms resolved after a mean time of 2.5 years. Two patients were still taking NSAIDS 5 years from the time of diagnosis. CONCLUSIONS: The natural history of osteoid osteoma is self-limited so patients should be offered nonoperative treatment, reserving ablative treatment for those who are unable or unwilling to take NSAIDs until their symptoms resolve.
Adolescent↗
[The application of transposition of the gastrocnemius muscle in the limb-salvage operations of the proximal tibial tumors].
OBJECTIVE: To evaluate the efficacy of transposition of the gastracnemius muscle in the limb-salvage operation of the proximal tibial tumor. METHODS: From 1995, transposition of the gastrocnemius muscle was applied to cover the devitalized bone, bone cement or autologous bone graft in 15 cases with tumors of the proximal tibia (transposition of medial heads of gastrocnemius muscle in 12 cases, and lateral heads of gastrocnemius muscle in 3 cases respectively). Among them, there were 7 osteosarcomas, 5 giant cell tumors, 1 malignant fibrous histocytoma, 1 chondrosarcoma and 1 osteoblastoma. The operations included segmental devitalization with 95% alcohol in 7 cases, knee reconstruction of the unilateral tibial plateau with iliac graft in 5 cases, segmental devitalization with microwave in 2 cases, local resection and bone graft in 1 cases. RESULTS: Apart from 2 cases whose wounds needed suturing again due to the liquefaction of the subcutaneous fat around the incision, no wound complications were occured in other 13 patients. No significant loss in the function of the leg and ankle was observed after transposition of the gastrocnemius muscle. There was no local recurrence, but 3 patients died due to lung metastases. CONCLUSION: Transposition of the gastrocnemius muscle after resection of promixal tibial tumors can improve the local blood supply, cover the deep structures and prevent from the failure of limb-salvage operation due to wound complications.
Adolescent↗
[Pseudotumoral articular and juxta-articular amyloidosis complicating myeloma].
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Aged↗
Lytic bone lesions in human neuroblastoma xenograft involve osteoclast recruitment and are inhibited by bisphosphonate.
Neuroblastoma is the second most common solid tumor in childhood and frequently metastasizes to the bone marrow and the bone matrix. The mechanism involved in bone metastasis and destruction in neuroblastoma is poorly understood. Using a model of bone invasion in immunodeficient mice, we demonstrated that neuroblastoma cells recruited osteoclasts to generate osteolytic lesions and invade the bone matrix. In further support of a contributory role for osteoclasts in neuroblastoma bone invasion, we demonstrated that treatment with the bisphosphonate compound, ibandronate, significantly delayed the progression of osteolytic lesions. The data suggest that bisphosphonates may be clinically effective in the treatment of bone metastases in neuroblastoma.
Adrenal Glands↗
99mTc-MIBI imaging as a predictor of therapy response in osteosarcoma compared with multidrug resistance-associated protein and P-glycoprotein expression.
UNLABELLED: In vitro studies have demonstrated that (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) is a transport substrate of multidrug resistance (MDR)-related proteins. The aim of this clinical study was to evaluate whether (99m)Tc-MIBI scintigraphy was a functional imaging tool for in vivo detection of multidrug resistance-associated protein (MRP) expression in osteosarcoma and to investigate the role of MRP and (99m)Tc-MIBI imaging to predict the clinical outcome. We also examined whether the scintigraphic parameters would help to distinguish the functional capacity of P-glycoprotein (Pgp) and MRP. METHODS: Twenty-four patients with a diagnosis of osteosarcoma were studied before neoadjuvant chemotherapy. Tumor-to-background ratios of both early (10 min) and delayed (1 h) images and the percentage washout rate (WR%) of (99m)Tc-MIBI were calculated. Immunohistochemical analysis of MRP and Pgp was performed on biopsy specimens, and the response to preoperative chemotherapy was assessed by histopathologic examination. RESULTS: Fifteen of 24 osteosarcoma samples in our series (62.5%) showed significant expression of MRP. The level of MRP expression was significantly correlated with the WR% of (99m)Tc-MIBI (r = 0.58, P = 0.003), and the WR% of (99m)Tc-MIBI was significantly faster in patients with high MRP expression than in those with a low MRP score (P = 0.007). The clearance rate of (99m)Tc-MIBI was significantly slower in tumor samples with negative or low expression of both Pgp and MRP (16% +/- 6.2%) when compared with osteosarcomas with high expression of both proteins (31.7% +/- 8.7%) (P = 0.001). There was not a significant difference between the WR% of (99m)Tc-MIBI in tumors with coexpression of both proteins and in tumors with high expression of either Pgp or MRP. Both the rate of MRP expression and the WR% of (99m)Tc-MIBI were significantly correlated with response rate. CONCLUSION: Our results suggest that the WR% of (99m)Tc-MIBI is correlated with MRP expression. Both the WR% of (99m)Tc-MIBI and MRP expression are correlated with therapy response. (99m)Tc-MIBI can be used as a general probe for functional imaging of both Pgp and MRP; however, it is not capable of differentiating the functional status of either MDR-related glycoprotein.
ATP Binding Cassette Transporter, Subfamily B, Mem↗
Uncemented intramedullary fixation of implants using polyethylene sleeves. A roentgenographic study.
Forty-three prostheses with noncemented, high-molecular-weight, polyethylene-sleeved components were used in the treatment of bone tumors around the knee in growing children. The average age of the patients was 11 years. There were 27 boys and 16 girls. There were 17 sleeved components in the distal femur and 26 in the proximal tibia. The average follow-up time was 27 months. The roentgenograms were nominally obtained at three, six, 12, 18, and 24 months, and irregularly thereafter, and were assessed using a zonal evaluation scheme. A sclerotic interface around the polyethylene sleeves invariably developed and progressed in density up to 28 months postoperatively. There were significant zonal differences in sclerosis, particularly between the plateau and the mid-sleeve zone. Only in one patient did a sleeve become loose and require revision.
Bone Neoplasms↗