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[Autoclaved tumoral autografts. Apropos of 12 cases, 6 of which highly malignant].
Twelve patients presenting with a bone tumor were operated on using autoclaved bone autografts for reconstruction following carcinologic resection. According to the Enneking grading system, 6 were high malignancy tumors (3 osteosarcomas and 3 grade 2 chondrosarcomas), 4 were low grade tumors (1 paraosteal sarcoma, 1 chondrosarcoma, 1 secondary chondrosarcoma, 1 liposarcoma). One was a metastasis from a kidney tumor. The last patient had a femoral osteoid osteoma. Six local recurrences were responsible for 4 reoperations: 2 disarticulations and 2 iterative resections. With a 1-6 years range of follow-up (average follow-up 2.5 years), osseointegration of autoclaved grafts was studied. Fusion at the host/graft junction was roentgenographically observed. In three cases, proximal resorption of the humeral graft occurred. Five biopsies were obtained during reoperation after 1 year, which showed partial revascularization of autoclaved bone autografts. The authors conclude that autoclaved tumoral bone grafts, are reliable and discuss indications. They point out the main contraindication, represented by chemosensitive bone tumors, in which conservation of the removed tumor is necessary to quantify the response to chemotherapy.
Unusual problems of the athlete's elbow, forearm, and wrist.
Early in their medical training physicians often are told, "When you hear hoofbeats, don't think of zebras." Such sage advice is helpful when facing the formidable challenges of information acquisition early on. Later, however, we must be familiar and consider these uncommon conditions when entrusted with the responsibility of properly caring for our patient athletes. This is particularly true in the athlete presenting with symptoms or findings disproportionate to his or her injury, or when symptoms persist despite seemingly appropriate treatment. A high index of suspicion and attention to radiographs and further appropriate work-ups result in detection of most occult unexpected lesions.
Metaplastic breast carcinoma.
Metaplastic breast carcinoma, a rare entity, accounts for only about 0.02% of all breast carcinomas. It involves the transformation of mammary neoplasms into osteoid and chondroid substances. Because of the relatively small patient population and the limited number of controlled studies, there is confusion regarding its classification and staging. Its histogenesis is unknown. The authors describe a 65-year-old woman with findings consistent with metaplastic breast carcinoma. Theories as to etiology and prognosis as well as treatment are discussed.
-Lesser known stress fractures-.
Stress fractures of the tibia may disclose a longitudinal orientation which is obvious at bone scanning; a mild periostosis may appear on plain films; CT demonstrates a radially-oriented fracture in one aspect of the diaphyseal cortex. A cortical dissection-like vertically oriented insufficiency fracture may involve the medial aspect of the femoral shaft underlying the lesser trochanter; the fracture is concentric to the femoral cortex at CT. Insufficiency fractures of the sacrum may be misdiagnosed on plain films; bone scanning displays a typical H-shaped increased uptake which is a specific pattern. Insufficiency fractures of the pubis may appear as tumoral bone destruction; however no soft tissue mass is present at CT which in addition demonstrates normal fat tissue abutting the osseous lesion.
Radiology case of the month. Painful heel following exercise. Lipoma of the os-calcis.
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Radiation-induced sarcoma of bone: clinical and radiographic findings in 43 patients irradiated for soft tissue neoplasms.
Sarcomas rarely follow irradiation of benign lesions of bone as the dangers of this form of therapy is well recognised. Forty-three patients with soft tissue neoplasms - mainly carcinoma - were irradiated and developed sarcomas in the radiation field. Twenty-four of these patients were seen at this centre in the last decade, a considerable increase compared to earlier years. Radiation osteitis may indicate the nature of the tumour but was only present in 50%. A purely lytic or purely sclerotic pattern was commoner than a mixed lytic and sclerotic appearance. CT scan, bone scan and angiography were helpful in delineating disease but did not assist in diagnosing the type of tumour. A tumour arising within the irradiated field is an indication for biopsy. Prognosis of radiation-induced sarcoma (RIS) remains poor, only five of the 43 patients survived 5 years.
[On tissue culture of bone tumor. I].
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[Pathogenesis of bone changes in malignant neoplasms originating from soft tissues of the face and mouth].
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Progress symposium--management of skeletal and soft tissue sarcomas.
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The Scandinavian--Australian Symposium on the Management of Bone and Soft Tissue Sarcomas.
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Detection of malignant soft tissue tumors in bone imaging.
A total of 2530 consecutive bone scans were examined to evaluate the number and the type of soft tissue neoplasms detected with bone-seeking phosphonates. Sixty-eight primary or secondary soft tissue neoplasms of 63 patients accumulated 99mTc -methylene diphosphonate and 2 accumulated 99mTc -diphosphonate, and one metastasis was seen as a nonactive 'cold' focus in the urinary bladder. The localization of tumors was: 19 in the lung, 15 in the liver, 11 in the kidney, 10 in the peritoneal cavity or ascites, 5 in the large bowel, 4 in the vascular or lymphatic system, 3 in the connective tissue or muscles, 2 in the ovary, 1 in the urinary bladder, and 1 in the brain. Our results differ in many respects from those reported in the literature. The causes of the differences are discussed.
[Efficient use of flash sequences in the staging of bone and soft tissue tumors].
Delineation of neoplasms from normal tissue is possible using Flash sequences. These sequences prove useful in preoperative staging of bone tumours and soft tissue tumours. However, contrast between neoplastic and surrounding normal tissue is lower than in optimal selected spin-echo sequences. Flash-90 sequence is superior to Flash-10 sequence in the demonstration of intraosseous extension of predominantly sclerotic, calcified and purely fibrous tumours. In contrast, Flash-10 sequence proves superior for the demarcation of osteolytic tumours with minimal fibrous tissue content. Delineation of extraosseous tumour masses against muscle can best be achieved using Flash-90 sequence after intravenous administration of Gadolinium-DTPA. Flash-90 sequence enables sharp demarcation of extraosseous masses of bone tumours against surrounding fat, whereas Flash-10 sequence proves useful in the delineation of non-lipomatous soft tissue tumours against normal fat.
Polyhistioma: a malignant tumor of bone and extraskeletal tissues.
Polyhistioma, a neoplasm whose basic cells are small and round like those of Ewing's sarcoma, but which differentiate into various mesenchymal structures, most often bone, is described. Those cases that produce cartilage have been called mesenchymal chondrosarcoma; the others therefore are mostly urecognized. The name "polyhistioma" is suggested in the hope that with this terminology more of these tumors will be diagnosed. Polyhistiomas are not excessively rare; they affect bone and soft tissue. Half the patients with polyhistiomas died within 2 years. Treatment has resulted in survival of over 20 years. Thirty-eight of the 144 patients with polyhistioma have survived 5 years or more following first definitive treatment. Thirty-seven cases of the disease are presented.
Giant intracranial and extracranial cavernous malformation. Case report.
Massive enlargement of an extracerebral cavernous malformation and extension across tissue planes is very uncommon. The authors present the case of a 49-year-old woman with a giant cavernous malformation in the left frontotemporal area. It progressively enlarged during several decades, extended through the calvaria to the extradural space, and was surgically treated. The lesion may have originated in the soft tissue or the skull. The locations of cavernous malformations in various parts of the body are reviewed and their mechanisms of growth are discussed. Surgical excision is the treatment of choice.
Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: chondrosarcoma and other cartilaginous neoplasms.
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Cytology of pleural, peritoneal and pericardial fluids in children. A 40-year summary.
OBJECTIVE: To determine the applicability of the cytologic examination of serous fluids in the management of malignant neoplasms in children. STUDY DESIGN: A review of the reports of all cytologic specimens of pleural, peritoneal and pericardial fluids from children examined in our laboratory during a 40-year period. A total of 226 specimens from 146 patients under 18 years old with a documented neoplasm were analyzed by diagnosis and fluid type. The data were tabulated and analyzed in a format that allowed comparison with the results of earlier studies. RESULTS: Eighty-eight specimens (39%) from 66 patients (45%) were suspicious or positive for malignancy. The positive specimens included lymphoma and leukemia (52%), neuroblastoma (14%), Wilms' tumor (9%), gonadal and extragonadal germ cell neoplasms (8%), bone and soft tissue sarcomas (7%), epithelial neoplasms (5%), Ewing's sarcoma (2%) and other neoplasms (3%). Positive results were obtained in 47% (66/139) of pleural fluids, 23% (15/65) of ascitic fluids, 27% (4/15) of peritoneal washings and 43% (3/7) of pericardial fluids. CONCLUSION: Cytologic examination of serous fluids is a simple and useful procedure in the management of pediatric neoplasms. This study showed a higher proportion of positive effusion cytology with lymphoma/leukemia and a lower proportion with sarcoma as compared with earlier reports. Pleural fluids were the most common specimen type and showed the highest proportion of positivity.
Necrotizing effect of phenol on normal tissues and on tumors. A study on postoperative and cadaver specimens.
We investigated the necrotizing effect of a 75% alcoholic solution of phenol on normal tissue harvested during surgery (muscles, fatty or connective tissue) or post mortem (peripheral nerves, arteries, epidermal tissue, joint and epiphyseal cartilage) and on tumor tissue (60 samples freshly harvested from patients suffering from bone tumors). The necrotizing effect was measured by determining the thickness of the cell layers demonstrating nuclear pyknosis or necrosis after 2 min of phenolization in a light microscope by ocular measurements in microns. No effect could be seen in epidermal tissue and in cartilage, whereas all other normal tissues exhibited necrotic zones between 40 and 500 microns. In all the tumors except those with chondromatous tissue, necrotic zones between 40 and 1000 microns were found. No difference in extension of the necrotic zone was seen between specimens from benign and malignant tumors and tumor-simulating processes. Phenolization cannot be recommended for the treatment of chondromatous tumors.