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PubMed1986

[Functional results following conservative and surgical therapy of pathologic fractures in malignant diseases].

From 1972-1982 149 pathological fractures in 91 patients were treated. 134 of these were caused by malignant disease. With 78% metastases were the most common cause for fractures. 59% of the patients were women. The most frequent fracture localisation was the femur followed by ribs and humerus. 62% of the fractures but 100% of the leg fractures were treated operatively. The best functional results were achieved after compound osteo-synthesis. The mean survival time of the patients was 10.7 months. The one year survival rate was 24.6% and the two year survival rate was 9.2%. The best survival rates were observed in women, patients with breast cancer metastases, femur shaft- or subtrochanteric fractures. The lowest survival rate was found in male patients, patients with unknown primary tumour and femur neck fractures.

Bone Neoplasms↗
PubMed2004

[MRI-assisted thermometry for regional hyperthermia and interstitial laser thermotherapy].

PURPOSE: To demonstrate the potential of quantitative MRI-assisted thermometry for the treatment of tumor patients with regional hyperthermia (RHT) and interstitial laser thermotherapy (ILTT). METHODS: Two patients and seven tissue samples were investigated using the T1-relaxation time and the chemical shift of the proton resonance frequency (PRF) as temperature sensitive MRI-parameters at 0.2 and 1.5 T. Thermotherapy was applied using either a dedicated MRI-hyperthermia hybrid system or a temperature controlled laser with 830 nm. RESULTS: Both patients were treated successfully showing clinical benefit. T1 and PRF are depending on the applied thermotherapy method and on the MR-system suitable for MRI-assisted thermometry. The clinical application based on phantom results is not necessarily adequate. CONCLUSION: Clinical application and phantom experiments of RHT and ILTT show the potential of MRI-assisted thermometry for further improvement of both minimal invasive thermotherapy methods. Further investigations concerning optimization of the MRI-techniques, the influence of perfusion or the determination of threshold values are necessary.

Adult↗
PubMed2002

[Parosteal osteosarcoma (POS). Clinical and therapeutic aspects].

Parosteal osteosarcoma is a malignant bone-forming tumor, which is characterized by its superficial origin and its high structural differentiation. Because of the radiological and histological variability, finding the right diagnosis is a great challenge for physicians, radiologists, and pathologists, especially at the time of primary manifestation. Usually there is a low-grade malignancy. Often a benign tumor is imitated so that finding the correct diagnosis is indispensable. Wide resection with sufficient margin is the adequate therapy. High-grade parosteal osteosarcoma needs adjuvant chemotherapy. Our own experience with secondary dedifferentiation and the possibility of primary undergrading shows that regarding diagnostics, operative therapy, and follow-up parosteal osteosarcoma should be treated like conventional osteosarcoma.

Adolescent↗
PubMed2002

[Low-grade central osteosarcoma . 3 case reports].

Low-grade central osteosarcoma is a well-differentiated subtype of osteosarcoma, which is often confused with benign lesions. Males and females were affected about equally in our study. The tibia and femur were most commonly involved. Three case reports demonstrate the distinct features of the tumor. Excision of the tumor almost invariably led to recurrences. Wide resection was almost never followed by recurrence and seems to be the treatment of choice for this very rare variant of osteosarcoma.

Adolescent↗
PubMed2000

Rotationplasty--surgical treatment modality after failed limb salvage procedure.

Twelve patients aged between 10.9 and 64.7 (mean 28.5) years with a malignant tumour of the knee region underwent a rotationplasty after failed primary limb salvage procedure. The reasons for failure which finally lead to surgery were recurrent infection in 10 patients and local recurrence of the tumour in 2. The number of operations before the rotationplasty was performed was between 2 and 23 (mean 6.7). According to the primary tumour site, 9 patients underwent a rotationplasty type A1, 3 patients type A2, and 1 patient type BII. In 9 patients the rotationplasty was successful, but 3 patients finally had to undergo amputation. Intraoperative preservation of the vessels was difficult in these 3 patients due to infection and oedema of the arteries or massive fibrous tissues after the previous surgery. After rotationplasty, 3 of 9 patients had to undergo additional surgery because of thrombosis, pseudarthrosis and infection (n = 5, range 1-2). The mean follow-up after rotationplasty was 34.9 (range 13-65) months. The mean functional status according to the MSTS criteria in patients after rotationplasty scored 21.3 of 30 points. In the group of amputees, the score was 19 (range 16-22). Concerning the health-related quality-of-life, the mean score in physical functioning was 76.3 in the group with a rotationplasty versus 50.0 in the group of amputees. Patients with a rotationplasty reached a higher score of global health status (77.1 vs 58.3). Based on the present results we are convinced that rotationplasty can be recommended as a treatment option after a failed limb salvage procedure.

Adolescent↗
PubMed1991

Metastatic angiosarcoma of the brain.

Two patients with metastatic angiosarcoma of the brain are described. In one, a 17-year-old man, the tumor was located at the pineal region and exhibited significant vascularity. It was sensitive to radiation therapy and disappeared after radiation of 50 Gy; however, it recurred after 1 year and a new lesion was found in the liver. The other patient is a 31-year-old woman who experienced sudden onset of headache. Computed tomography scan revealed three separate masses in the brain. One tumor was surgically removed. The other two were sensitive to radiation therapy and disappeared after radiation of 40 Gy. A new lesion was found in the femur 16 months after the operation. Brain metastasis from angiosarcoma is exceedingly rare. Both patients developed symptoms with intracranial hemorrhage. The diagnosis of the metastatic lesions preceded diagnosis of the primary lesion by 12 and 16 months, respectively. Ulex europaeus 1 lectin and factor VIII were very useful in establishing the diagnosis of angiosarcoma.

Adolescent↗
PubMed1979

The histiocytoid hemangiomas. A unifying concept embracing several previously described entities of skin, soft tissue, large vessels, bone, and heart.

The proposal is made that a number of previously described entities of skin, soft tissue, large vessels, bone, and heart actually constitute different manifestations of the same basic process, characterized by the proliferation of a highly distinctive type of cell descriptively identified as a "histiocytoid endothelial cell." The entities in question are angiolymphoid hyperplasia with eosinophilia and related cutaneous and subcutaneous disorders, atypical vascular proliferation of large vessels, hemangioendothelioma of bone, and endocardial benign angioreticuloma of the heart. The main cell that proliferates in all these conditions has the basic features of an endothelial cell, but also exhibits histochemical and ultrastructural characteristics that are more akin to those of a histiocyte. These unusual features could be the expression of a morphologic abnormality or represent an overgrowth of a specific and as yet undefined subpopulation of endothelial cells, such as Majno's "contractile endothelial cell." Whether this group of proliferative diseases is of a reactive or a neoplastic nature is not immediately apparent, although the latter seems more likely. However, it is clear that the behavior of these lesions, as a group, is quite indolent and even self-limited, in contrast to the aggressive behavior and often fatal outcome of the true angiosarcomas that they so closely resemble on microscopic grounds. The term "histiocytoid hemangioma" is suggested for this group of disorders.

Adolescent↗
PubMed1981

Ultrastructural study of osteosarcomas.

The ultrastructural examination of four osteosarcomas (osteogenic, undifferentiated, and pleomorphic) is described. There are three types of tumor cells. Most of the cells are held in contact by desmosome-like tight junctions; they are atypical osteoblasts with cytoplasmic processes, dilated rough endoplasmic reticulum, mitochondria carrying calcific inclusions, lipid droplets surrounded by glycogen, and intracellular fine filamentous fibers. Other cells exhibiting varying degrees of osteoblastic maturity are also seen with multilobed nuclei, a clear cytoplasm, and straight bordered membranes. The last type is chondroid with abundant deposits of glycogen, lipid droplets, and undilated rough endoplasmic reticulum. The matrix is composed of fibrils without periodicity, scattered and deteriorated collagen fibers, and focal calcium deposits of hydroxyapatite crystals as in embryonal bone, dentine, or callus bone.

Adolescent↗
PubMed1998

Vascularized bone grafts in the treatment of juxta-articular giant-cell tumors of the bone.

The clinical results of vascularized bone grafts in 39 patients with giant-cell tumor affecting the extremity were evaluated. The sites involved were the proximal tibia (8), proximal femur (4), calcaneus (1), proximal humerus (8), and distal radius (18). Osteoarticular replacement was performed in patients with giant-cell tumor involving the radius; in 15 of these, a suitably tailored vascularized iliac crest graft was used, and in the remaining three, the fibula was used. Follow-up ranged from 2 to 7 years, with an average of 3.3 years. Clinical results were judged on the basis of functional and radiologic evaluations. Reconstructions involving the distal radius were evaluated separately from the rest of the juxta-articular grafts. Excellent results in 17 and good results in three of the juxta-articular grafts were observed. Eighteen patients with the distal radius affected were followed-up for periods ranging from 2 to 12 years. Non-union was seen in one, carpal subluxation in five, and spontaneous radiocarpal fusion in one patient. A pain-free functional wrist was retained in 17 of these 18 patients. Three local recurrences were observed (2.5 percent). The vascularized bone graft provided a good biological and mechanical support to the subchondral bone and overlying articular cartilage. Satisfactory reconstruction was thus possible following wide resection, without sacrificing joint function and with gratifying oncologic results. The use of a suitably tailored block of vascularized iliac crest is an acceptable method to preserve wrist and radio-ulnar joint motion, following excision of the distal radius affected by a giant-cell neoplasm.

Adult↗
PubMed1993

[Chondromatous tumors in MRT: clinical picture in relation to localization and histopathology].

19 patients with histologically verified cartilaginous tumours (chondromas, chondrosarcomas) were examined with magnetic resonance imaging (MRI) in order to assess differences regarding the MR appearance of these tumours which would provide information on the biological behaviour of these lesions. MR findings were then correlated with histopathology. With regard to the signal behaviour of cartilaginous tumours a good correlation with histopathology could be established insofar as the relatively hypocellular tumours composed of hyaline cartilage exhibited a high signal level on T2-weighted images. There were no significant differences regarding signal characteristics of cartilaginous tumours in various anatomical locations. However, lesions located in the pelvis and the long bones showed predominantly peripheral enhancement whereas tumours of the skull base and larynx exhibited diffuse enhancement patterns in the majority of cases. 10 tumours (6 benign, 4 malignant) exhibited a lobular appearance. No relevant information in respect of tumour grading could be obtained.

Adult↗
PubMed1991

[The percutaneous removal of osteoid osteomas via CT-guided drilling].

Osteoid osteomas were removed by CT-guided core drill excision of the nidus in 4 patients. All osteoid osteomas were located in the lower extremity and included cortical lesions in the femur (n = 2), and the tibia (n = 1) and one spongious lesion in the navicular bone of the foot. Nidus diameter ranged from 2 to 3 mm. The patients were discharged after the procedure same day or next day depending on the kind of anaesthesia performed. Follow-up periods ranged from 6 to 56 months and revealed no signs of recidivation. CT-guided core-drill excision of the nidus seems to be a very promising alternative to surgical procedures because of its high cost-effectiveness and minimal invasiveness.

Adolescent↗