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Liposarcoma complicating neurofibromatosis is a rare entity. Until now, only two cases have been reported in the literature. The authors present two new cases of liposarcoma arising in generalized neurofibromatosis with detailed microscopic findings. Other neoplasms associated with neurofibromatosis are also discussed.
Magnetic resonance imaging (MRI) techniques provide a versatile method of manipulating soft tissue contrast in the extremities. Different pulse sequence techniques are discussed with respect to the optimization of contrast differences between muscle, marrow, and abnormal tissue.
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The interilio-abdominal amputation was fulfilled in 62 patients for the period from 1960 to 1979. The postoperative mortality was 6,4%. General five-year survival was 24,3% +/- 5,6. The survival terms were dependent first of all on the tumor type. The advances of anesthesiology, reanimatology and operative oncology have considerably reduced the danger of interilio-abdominal amputation. So, indications for the operation can become wider even in the cases when it has a palliative character.
Nonossifying fibromas appear to be histiocytic lesions. On the basis of light and electron microscopic studies, as well as behavior, they are identical to benign fibrohistiocytomas found in soft tissues. The fibroblastic appearance of some of these lesions by light and electron microscopy, especially in older lesions, reflects the ability of histiocytes to behave as facultative fibroblasts. Final data of the cell of origin for these lesions must await more definitive studies by other methods, perhaps using immunologic, immunoperoxidase and/or surface markers techniques.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A patient undergoing cytostatic therapy for osteosarcoma of the right humerus had bone scans at 2-mo intervals. A skeletal focus of increased radiotracer accumulation occurred and subsequently was confirmed by CT and MRI. A necrotic metastasis was found during biopsy. There were no remaining viable tumor cells. This finding confirms the presence of the flare phenomenon in skeletal metastases in primary malignant bone tumors and that radionuclide imaging may fail to detect intramedullary foci of viable metastases in these tumors.
Guidelines for the prediction of pathologic fracture would facilitate the management of patients with metastatic bone defects. Unfortunately, existing clinical guidelines have not been validated, often run counter to engineering practice, and do not accurately predict the risk of fracture for many patients. To serve as a basis for improved guidelines, a factor of risk for a pathologic fracture is defined as the load applied to a bone divided by the load at which the bone fails. Failure loads for bones with metastatic defects have been measured in vitro, and depend on defect geometry, bone properties, and the type of loading. For a diaphyseal defect that destroys 50% of the cortex, strength reductions of between 60% and 90% can occur. The load-bearing capacity of a long bone with a diaphyseal defect also can be predicted using computer models if the geometry of the defect and properties of surrounding bone are known. Similarly, new methods that apply basic engineering principles to computed tomography data allow prediction of the load-bearing capacity of vertebrae with simulated defects. By contrast, the data presented here suggest that by using plane radiographs or computed tomographic (CT) examinations, experienced orthopaedic surgeons cannot accurately estimate the strength reductions or load-bearing capacity for proximal femurs with intertrochanteric defects. By combining new methods to predict the load-bearing capacity with estimated loads for activities of daily living, it is possible to calculate a factor of risk for pathologic fractures.
Bony metastases are ubiquitous in patients with advanced cancer, and pathologic fractures may occur within either lytic or blastic foci. Approximately 90% of such fractures that require surgical intervention occur in the femur, humerus, or periacetabular pelvis. Techniques for internal fixation or prosthetic replacement have been designed with the realization that destructive bony lysis often extends well proximal and distal to the actual fracture site, and bony union will not occur after irradiation unless absolutely rigid fixation is achieved. Intramedullary fixation using some type of interlocking device, either proximally or distally, is preferable to extramedullary fixation of fractures. The mean postfracture survival for most patients is approximately 2 years.
The goals of treatment for patients with metastatic disease are control of pain and maintenance of function. Prosthetic arthroplasty is a useful technique for selected indications. Specific indications include (1) reconstruction of large destructive areas that are not amenable to internal fixation, (2) salvage of failed internal fixation devices, and (3) salvage of lesions in which there are no radiotherapy options to prevent disease progression. Custom modular devices allow resection of varying segments of the skeleton. Immediate rigid fixation is achieved with cemented intramedullary stems. Patients are allowed to bear full weight as tolerated immediately postoperatively. A custom modular diaphyseal segmental replacement system allows resection of large diaphyseal lesions and immediate fixation. The complication rate is low after arthroplasty.
Two patients with dysplasia fibrosa who also had a tumor of mesenchymal origin are presented. One of them underwent one time resection of dysplasia fibrosa focus and the tumor, the other had the tumor resected 17 years after surgical resection of focus in the femur. The authors suggest an etiologic relationship between these two conditions based on mesenchymal changes--the occurrence never described previously. They also indicate efficacy of surgical treatment.
The rotationplasty procedure of the femur, as first described by Borrgreve, is the functional improvement of an abnormally shortened lower limb. In the last 15 years this procedure has been used in its original form and as modification for tumors of the femur and proximal tibia. The reconstruction of the femoral vessels as an important part of the operation has not enough been accentuated. Principally two types of reconstructions can be performed: the vessels are dissected in the adductor canal or a segmental resection and reanastomosis are performed. Between January 1990 and April 1993 classical and modified rotationplasties were performed for malignant tumors in 34 patients in our institution. In all cases a segmental femoral vessel resection with end-to-end anastomosis were performed. No intra- and postoperative vascular related complications occurred. The authors emphasize the advantage of this method: reanastomosing resected femoral vessels by experienced vascular surgeons is a save, time-saving method. In addition, the radicality of the operation increases in order to obtain excellent long term results.