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Analysis of 12 observations with a typical histological appearance revealed only in one case a local relapse. In two tumours the authors found a structure encountered in aneurysmatic osseous cysts and in one case, due, to the presence of a major number of osteoclasts, the differential diagnosis with a giant-cell bone tumour was rendered more difficult. Electron microscopic examination revealed that tumours of this type are formed by cartilage cells differentiated in different ways. In cellular areas two main types of cells are found: light and dark ones. Some of the elements of both types had multilobular nuclei.
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With malignant tumors of the skeleton the same therapeutic limb-saving guidelines must apply for the proximal sections of the locomotor system--the shoulder and pelvic girdles--as for the limbs themselves, especially since amputation here can hardly be surpassed by other resectional interventions with respect to operative risk, disfigurement and functional loss. The possibilities of surgical therapy for tumorous invasion of the pelvic girdle and the extremities are considered in some detail.
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The authors report three observations of rather extensive aggressive chondroblastoma and draw attention to difficulties of histological diagnosis, which result out of a less typical histological picture, in which signs of differentiation into cartilaginous tissue may be missing. Differential diagnosis may be facilitated by proper recognition of the cytologic character of chondroblasts by the positivity of S-100 protein, and by proving characteristic properties of chondroblasts in electronmicroscopic examination. In treating this type of tumors an increased risk of local recurrence (in one of our patients) and aggressive behaviour to surrounding tissues should be considered, exceptionally pulmonary metastases may develop, as was the case in one of our presented patients.
Today rotationplasty is well established as an acceptable procedure for limb salvage in patients who have a malignant tumor in the femur or tibia. The main indication is that it is the alternative to amputation. Rotationplasty should further be used in the very young child because of growth-dependent complications that can be expected after tumor resection and any kind of reconstruction. This article covers the classification of the different types of rotationplasties, the operative procedure, prosthetic care, and the functional results.
Seven cases of chordoma were studied immunohisto-chemically with antibodies directed to epithelium, nerve, mesenchyme, muscle and histiocyte. Six cases of chondrosarcoma and three cases of mucinous carcinoma of colon were studied as control. The results showed that the chordomas were positive for cyto-K 6/7, EMA 7/7, CEA 6/7, Vim 7/7, S-100 7/7, alpha-AT 7/7, Lyso 4/7, while negative for GFAP and Des in all 7 cases indicating that chordoma, just like notochord, had the potentiality of multidirectional differentiation. In contrast, none of the chondrosarcomas was positive for cyto-K, EMA or CEA, but positive for Vim and S-100 in 6 cases. Three cases of colon mucinous carcinoma were positive for epithelial antibodies, but none reacted with other antibodies. Thus, immunohistochemical studies are of help in the diagnosis and differential diagnosis of chordoma.
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Of sixteen adult patients with clear-cell chondrosarcoma, ten were men. The tumor usually involved the proximal part of the femur or humerus. Roentgenographically, the lesion was usually well defined and indistinguishable from chondroblastoma. Serial roentgenograms occasionally showed malignant progression of the lesion. Histologically, benign giant cells and cells with clear cytoplasm were always present, and areas of conventional chondrosarcoma were seen in about half the cases. Excision usually resulted in recurrence; resection seemed to be curative. Four of the sixteen patients died as a result of the tumor. Clear-cell chondrosarcoma should be distinguished from chondroblastoma and treated more aggressively.
The regional blood flow of 30 distraction segments in 27 patients was measured during distraction osteogenesis. There were three groups of patients. Group A consisted of seven patients with high grade malignant tumors who received chemotherapy preoperatively and postoperatively. Group B consisted of eight patients with low grade malignant and aggressive benign tumors, who all were treated without chemotherapy. Group C (the control group) consisted of 12 patients with nontumoral conditions. Using quantitative technetium scintigraphy, the regional blood flow within the distracted segment and surrounding soft tissues was measured. The measured radioisotope count was expressed as the ratio of the distracted site to the control site (blood flow ratio). The blood flow ratio for all the cases averaged 1.70 +/- 0.70. Group A had a lower blood flow ratio, which was statistically significant in comparison with the other two groups. The external fixation index showed no significant difference in callus formation among these three groups. No correlation was found between the blood flow ratio and external fixation index. Chemotherapy decreases regional blood flow, but with distraction osteogenesis the regional blood flow can be kept within the normal range or higher. Distraction osteogenesis may overcome the effects of chemotherapy by increasing blood flow.
Twenty-one skeletally immature patients with a Grade IIB osteosarcoma about the knee were treated with a modified Van Nes rotationplasty. Fourteen patients were followed up for 4 to 10.5 years (mean followup, 8 years). Functional assessment using Enneking's method showed all had good or excellent results. No patient thought that the reconstruction affected their ability to achieve recreational, sporting, or career goals. The reconstruction is durable and is not associated with an increase in late complications.