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PubMed2001

Uptake of IgG in osteosarcoma correlates inversely with interstitial fluid pressure, but not with interstitial constituents.

The uptake of therapeutic macromolecules in solid tumours is assumed to be hindered by the heterogeneous vascular network, the high interstitial fluid pressure, and the extracellular matrix. To study the impact of these factors, we measured the uptake of fluorochrome-labelled IgG using confocal laser scanning microscopy, interstitial fluid pressure by the 'wick-in-needle' technique, vascular structure by stereological analysis, and the content of the extracellular matrix constituents collagen, sulfated glycosaminoglycans and hyaluronan by colourimetric assays. The impact of the microenvironment on these factors was studied using osteosarcomas implanted either subcutaneously or orthotopically around the femur in athymic mice. The uptake of IgG was found to correlate inversely with the interstitial fluid pressure and the tumour volume in orthotopic, but not subcutaneous tumours. No correlation was found between IgG uptake and the level of any of the extracellular matrix constituents. The content of both collagen and glycosaminoglycans depended on the site of tumour growth. The orthotopic tumours had a higher vascular density than the subcutaneous tumours, as the vascular surface and length were 2-3-fold higher. The data indicate that the interstitial fluid pressure is a dominant factor in controlling the uptake of macromolecules in solid tumours; and the site of tumour growth is important for the uptake of macromolecules in small tumours, extracellular matrix content and vascularization.

Animals↗
PubMed1999

[MRI diagnosis in longitudinal stress fractures: differential diagnosis of Ewing sarcoma].

PURPOSE: To compare MR imaging features of stress fractures, simulating malignancies, and Ewing sarcomas. MATERIALS AND METHODS: MR imaging studies of 4 patients with longitudinal stress fractures of the tibia (n = 2) and the femur (n = 2) simulating malignancy were retrospectively compared with the MRI scans of 10 patients with histologically proven Ewing sarcoma (femur n = 5; tibia n = 3, fibula n = 1, humerus n = 1). The diagnosis of stress fractures was confirmed by follow-up examinations. An additional biopsy was performed in two patients. RESULTS: Despite negative x-ray examinations, MRI showed the fracture line in all patients with stress fractures. In these cases marrow edema was irregular and there was no well defined margin towards normal fatty marrow. In contrast Ewing sarcomas were sharply demarcated in 9/10 cases. Extraosseous enhancing soft tissue was found in Ewing sarcomas as well as in stress fractures. In stress fractures the enhancing mass was repair tissue. Areas of necrosis within the enhancing mass was seen in (8/10) Ewing sarcomas, only. In follow-up studies we observed a decrease of the marrow edema in patients with stress fractures. Occurrence of low signal areas in T1- and T2-weighted sequences within the initial enhanced extraosseous tissue corresponded to bony callus on x-rays films. CONCLUSIONS: Repair tissue in stress fractures can imitate malignancy. The irregularity of the marrow edema without well defined margins, the lack of necrosis in the small enhancing tissue and the proof of the fracture line in the MRI are criteria to differentiate stress fractures from Ewing sarcomas. Short-term follow up studies are helpful to underline the diagnosis.

Adolescent↗
PubMedDate not supplied

[Alloplastic bone replacement in resection defects of the long bones].

Tumor endoprosthesis first have been used for replacement of pathologic lesions of the proximal and distal femur or humerus. Since the development of segmental defect prosthesis and modular tumor endoprosthesis it is possible to replace neoplastic lesions of long bones with diaphyseal parts. Review of our clinic experience involving 46 cases of prosthetic replacement and only one case with a second procedure showed that this is a more viable concept than open reduction and internal fixation with methylmethacrylate supplementation.

Adult↗
PubMedDate not supplied

[Pathogenesis of fibrous cortical defect and non-ossifying bone fibroma].

We were able to show in eighty-one cases that fibrous cortical defects or non-ossifying fibromas of the bone occur only in areas, where tendons insert into the perichondrium of the epiphyseal plate. During growth these tumor like lesions move towards the diaphysis following a cortical line, which begins at the point of insertion of the tendon and is parallel to the longitudinal axis of the bone.

Adolescent↗
PubMed1981

[Malignant fibrous histiocytoma of bone (MFH)--an new tumour? ].

Malignant fibrous histiocytoma of bone (MFH) is a histologically defined bone tumour, which can be distinguished from osteo- and fibrosarcomas. The present paper deals with the question whether MFH can be distinguished from these tumours on clinical grounds. One hundred and fifty-seven previously published, and four additional cases have been analysed with respect to their localisation and their biological, clinical and radiological behaviour and their prognosis. It was found that MFH can be distinguished from osteosarcomas on clinical grounds and that this is significant in relation to treatment; its distinction from fibro-sarcomas is clinically not justified.

Adolescent↗
PubMed1975

Aneurysmal bone cyst secondary to other osseous lesions. Report of 57 cases.

Fifty-seven aneurysmal bone cysts which were associated with or secondary to other lesions of bone are reported. The most common associations were with solitary or unicameral bone cyst, and with osteoclastoma. Other associated lesions included osteosarcoma, nonosteogenic fibroma, osteoblastoma, hemangioendothelioma, and hemangioma of bone. Five aneurysmal bone cysts were secondary to fracture or other bone trauma.

Adolescent↗
PubMed1998

Giant cell tumor of bone: oncological and functional results of long-term follow-up.

BACKGROUND: Giant cell tumor (GCT) of bone is a rare and unpredictable lesion. Its standard treatment has ranged from surgical curettage to wide resection and varying oncological and functional results have been reported. METHODS: A retrospective review of 47 patients (17 males and 30 females) with GCT of bone was performed to evaluate the oncological and functional results. The patients were followed up for at least 5 years. The average age of the patients was 32 years (range 15-66 years). The tumor sites were distal femur in 15 cases, proximal tibia in 10, distal radius in five, spinal column in four, proximal femur in three, proximal humerus in three, proximal fibula in two, pelvis in two and others in three. Enneking's surgical stages were Stage 1 in three, Stage 2 in 34 and Stage 3 in 10 cases. In these 47 patients, 80 surgical procedures were performed. RESULTS: The rate of local recurrence was 75% in the 28 patients undergoing intralesional excision, 50% in those receiving excision and curettage and 0% in those receiving wide resection. Although there was no statistical significance, surgical stages tended to be correlated with the local recurrence rate (Stage 1, 0%; Stage 2, 53%; Stage 3, 70%). Functional evaluation was performed according to the most recent system of the Musculoskeletal Tumor Society. Functional results of the patients with extremity tumors were 28.2 (average) in those undergoing intralesional excision, 30 (average) in those receiving excision and curettage and 27.1 (average) in those receiving wide resection. Functional results were significantly correlated with the initial surgical stages (Stage 1, 30; Stage 2, 27.5; Stage 3, 24.4; Kruskal-Wallis test, P = 0.016). CONCLUSIONS: To preserve good function of the extremities and avoid local recurrence, we consider that intralesional excision with adjunctive therapy such as phenol cauterization should be employed for the treatment of benign GCT of bone.

Adolescent↗
PubMedDate not supplied

Osteoid-osteoma inducing pronounced overgrowth and deformity of bone.

A rare complication of osteoid-osteoma is localized overgrowth and/or deformity of bone. Six of 64 cases reviewed had this growth disturbance. All patients developing deformities had their onset of symptoms before 5 years of age. Not one of the patients had limb equalization or correction of the deformity after removal of the osteoid-osteoma. The longest follow-up was 8 years. Speculations on the underlying cause for this form of growth abnormality, and the incidence in infants and very young children suggests that immediate surgical treatment is the best course of action.

Adolescent↗
PubMed2000

Augmented amputations of the lower extremity.

Ten patients who had amputations of a lower extremity for high-grade sarcomas underwent bone augmentation with either allograft or autograft between 1988 and 1996. There were eight transfemoral amputations and two transtibial amputations. The transferred segments consisted of one proximal tibia and six distal tibia autografts, two allografts, one autograft talar dome and first metatarsal, and one with a patellar cap of a supracondylar amputation. The average length of followup was 54 months. There were no nonunions of any of the grafts. There were three wound problems requiring additional operations. One autograft resorbed, and one autograft had a late infection. There was one local recurrence. Augmentation to provide length resulted in a 42% increase in bone length in those performed purely for length. All patients were able to use standard prostheses. Functional outcome was appropriate to the amputation level. Half of the patients avoided more proximal levels of amputation because of the ability to augment the osteotomy. The use of nonvascularized structural autografts or allografts is a simple procedure that can produce a superior residual limb in patients undergoing amputation. Its use should be considered in patients for whom traditional amputation techniques will result in poor function, difficulty in fitting a prosthesis, or greater than necessary anatomic loss.

Adolescent↗
PubMed2000

Reconstruction of hip stability after proximal and total femur resections.

Dislocation is the most common complication after proximal and total femur endoprosthetic reconstruction. The current study describes a surgical technique of acetabular preservation and reconstruction of the joint capsule and abductor mechanism that recreates joint stability and avoids dislocation. Between 1980 and 1996, 57 patients underwent proximal or total femur resection with endoprosthetic reconstruction. Forty-six patients had primary sarcoma of bone, nine had other bone tumors, and two had metabolic bone disease. The acetabulum was spared and not resurfaced in all patients. Bipolar hemiarthroplasty was performed in 49 patients, and fixed unipolar hemiarthroplasty was performed in eight. Soft tissue reconstruction included Dacron tape capsulorrhaphy over the prosthetic neck, reattachment of the abductor mechanism to the prosthesis, and extracortical bone fixation. The average followup period was 6.5 years (range, 2-18.2 years). Dislocation occurred in only one (1.7%) patient, and aseptic prosthetic loosening occurred in three (5.3%) patients. Four patients with primary bone sarcoma had local recurrence, of whom one required amputation of the limb. The limb salvage rate was 98%. Eighty-one percent of the patients had a good to excellent functional outcome. Acetabular preservation, capsulorrhaphy, and reconstruction of the abductor mechanism recreate hip stability and avoid dislocation after proximal and total femur endoprosthetic reconstruction.

Adolescent↗
PubMed2002

Giant cell tumor of long bone: a Canadian Sarcoma Group study.

A multicentric retrospective study of giant cell tumor of bone was conducted among Canadian surgeons. The hypothesis was that no differences would be found in health status, function, or recurrence rate irrespective to the nature of filling material or adjuvant used in patients treated with curettage. One hundred eighty-six cases were collected. There were 96 females and 90 males. The mean age of the patients was 36 years (range, 14-72 years), the minimum followup was 24 months, and the median followup was 60 months. Sixty-two percent of the tumors involved the knee region. One hundred fifty-eight were primary tumors and 28 were recurrences. Campanacci grading was as follows: Grade 1, seven patients; Grade 2, 100 patients; Grade 3, 76 patients; and unknown in three patients. Fifty-six patients had a pathologic fracture. Resection was done in 38 patients and 148 patients had curettage. The latter was supplemented with high speed burring in 135 patients, cement in 64 patients, various combinations of autograft or allograft bone in 61 patients, phenol in 37 patients, and liquid nitrogen in 10 patients. Structural allografts were used in 25 patients. The overall recurrence rate was 17%, 18% after curettage, and 16% after resection. Patients with primary tumors treated with curettage had a 10% recurrence rate. For recurrent lesions treated by curettage, the recurrence rate was 35%. The nature of the filling material used or the type of adjuvant method used or any combination of both failed to show any statistical impact on the recurrence risk. The results from the Musculoskeletal Tumor Society rating from 1987 were significantly lower in patients who sustained a displaced fracture. Results from the bodily pain section of the Short Form-36 also were found to be lower when a pathologic fracture was present. Results from the Musculoskeletal Tumor Society Rating 1987, the Short Form-36, and the Toronto Extremity Salvage Score did not show differences when either cement or bone graft were used after curettage.

Adolescent↗
PubMed2003

Endoprosthetic reconstructions for bone metastases.

The purpose of the current study was to help define the role that endoprosthetic reconstructions have in the treatment of metastatic bone disease. Of the 522 endoprostheses implanted at the University of California at Los Angeles (UCLA) between December 1980 and January 2002, 37 (6.9%) were used in 37 patients with metastatic disease. Upper extremity locations outnumbered lower extremity locations 2:1. The 20 males and 17 females ranged in age from 10 to 82 years, with a median age of 54 years. Metastatic renal and breast carcinoma predominated and accounted for 60% of the lesions. The lesion was a primary metastasis in 27 patients (73%) and a revision of failed previous surgery in 10 patients (27%). Only five patients experienced local complications none of whom required reoperation or amputation. Thirty-three of the 37 patients died of disease progression at a median of 12 months (range, 4-49 months). Function after endoprosthetic reconstruction for metastatic disease is similar to that of function for endoprosthetic reconstructions used for primary malignant tumors, but clearly is dependent on the patient's general condition. Although infrequently used to treat bone metastases, endoprosthetic reconstruction can be a useful alternative reconstruction in selected situations.

Adolescent↗
PubMed2004

VEGF expression in osteosarcoma correlates with vascular permeability by dynamic MRI.

Dynamic enhanced magnetic resonance imaging has been used to assess tumor angiogenesis in osteosarcoma. Vascular endothelial growth factor has been shown to correlate with pulmonary metastasis and a poor prognosis in osteosarcoma. The purpose of this investigation was to determine whether vascular endothelial growth factor expression in osteosarcoma correlates with vascular permeability detected by dynamic enhanced magnetic resonance imaging and to explore the role of dynamic enhanced magnetic resonance imaging as a noninvasive means of assessing tumor angiogenic activity. Fifty-five osteosarcoma patients with osteosarcoma enrolled in a treatment protocol that included dynamic enhanced magnetic resonance imaging. In 15 patients, tumor tissues were available for vascular endothelial growth factor immunohistochemical studies. A two-compartment model used the exchange rate constants (kep) between the plasma and tumor compartments to quantify vascular permeability during dynamic magnetic resonance imaging studies. Immunohistochemical staining for vascular endothelial growth factor was graded according to the intensity and number of positively stained cells. Vascular endothelial growth factor-positive tumors showed higher mean vascular permeability when compared with vascular endothelial growth factor-negative tumors. Vascular permeability also correlated with increasing vascular endothelial growth factor expression. The preliminary results in this study show an association between vascular endothelial growth factor and dynamic MR signal enhancement in osteosarcoma. Dynamic enhanced magnetic resonance imaging should be investigated as a means to prognosticate osteosarcoma patients with osteosarcoma according to their tumor angiogenic activity.

Adolescent↗
PubMed2003

Percutaneous radiofrequency coagulation of osteoid osteoma in children and adolescents.

The purpose of this paper was to evaluate the effectiveness of percutaneous radiofrequency ablation of osteoid osteoma in children and adolescents. Twenty-three patients aged 4.5-19.5 years were retrospectively reviewed. All patients with lower limb lesions were able to bear full weight on their operated limb immediately after the procedure, and to resume their daily activities within 24-48 h. Pain disappeared immediately after surgery in 21 cases, and in lower limb lesions the gait was back to normal after an average of 5 days. No septic or neurovascular complications were observed. At an average follow-up of 3.5 years, all the patients including two cases of initial failure were free of pain and had a normal gait. Clinical healing was confirmed by computed tomography and bone scan performed in 12 cases. This precise and minimally invasive method is safe, effective and associated with reduced health care resources. It could be recommended as the treatment of choice for osteoid osteoma of the limbs in children and adolescents.

Adolescent↗
PubMed2004

Radiotherapy for symptomatic metastases to bone in children.

Thirty-seven children less than age 19 years were treated from 1985 through 1998 with radiotherapy for symptomatic metastases to bone. The most common primary tumors were neuroblastoma (18), Ewing's sarcoma (5), and osteosarcoma (5). The interval from diagnosis of the primary tumor to treatment of the first symptomatic metastases involving bone ranged from 0 to 163 months (median 19). Thirty-seven children were treated with 150 courses of radiotherapy. Forty-three courses consisted of a single dose of 300 to 1,000 cGy. One hundred thirteen courses of radiotherapy consisted of five or fewer treatment fractions. Sixteen osseous sites were treated with two courses of radiotherapy and two sites were treated with three. The most commonly irradiated symptomatic bone sites were skull, spine, and hip/femurs. Survival from the first course of radiotherapy administered for metastases to bone varied from 1 to 52 months, with 11 patients (29.7%) surviving 12 or more months and only 3 patients (8.1%) surviving more than 2 years. The majority of children seemed to derive palliation from the radiotherapy based on assessment by family and medical personnel as well as by self-report in older patients. Children with symptomatic metastases to bone have an extremely poor prognosis, and short courses of radiotherapy are suggested as palliation. Repeat courses of radiotherapy can be given for persistent or recurrent symptoms.

Adolescent↗