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Localization of indium-111 leukocytes in noninfected neoplasms.

Indium-111-labeled autologous leukocyte studies in general carry a high sensitivity, specificity, and accuracy for the investigation of infections and abscesses. However, past studies have described sporadic cases in which 111In leukocytes localized in tumors. Our experience using 111In leukocytes for the investigation of fever of unknown origin in cancer patients, however, indicates a relatively high incidence of 111In leukocyte localization in noninfected neoplasms. Out of the 61 patients studied for fever of unknown origin, 21 patients (34%) manifested abnormal localization of 111In leukocytes in neoplasms without clinical evidence of infection. These included patients with abnormal localization in: (a) lymph nodes, (b) soft-tissue tumors, and (c) bone neoplasms. The tumors included both primary and secondary lesions, and hematologic as well as solid tumors. The mechanism of 111In leukocyte localization in tumors is still not completely explained. Interpretations of 111In leukocyte studies in cancer patients with fever should take into consideration the possibility that localization may occur in neoplastic tissue per se and does not always indicate the presence of infection.

Adult↗

Malignant fibrous histiocytoma originating at the site of a previous fronto-temporal craniotomy.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in adults. MFH occurrence in the bones of the skull is extremely rare, and, to our knowledge, it has not been reported in a patient with a history of craniotomy. A 69 year old woman presented with a large mass in the left fronto-temporal bone. The patient's medical history included a left fronto-temporal craniotomy 8 years prior to the present admission for neck clipping of an aneurysm of the left middle cerebral artery. Following preoperative work up, the skull tumor was resected, and pathology showed that the mass was composed of spindle-shaped fibroblastic cells arranged in a storiform pattern, and of numerous multinucleated giant cells. A diagnosis of MFH was established. The patient died of intracranial hemorrhage from a subsequent tumor 22 months after resection of the first tumor.

Aged↗

Computed tomography of orthopedic tumors of the pelvis and lower extremities.

An analysis of 6 representative cases of tumors of the pelvis and lower extremities demonstrates the clinical usefulness of computerized tomography (CT) in preoperative evaluation. CT provides information regarding precise size of the mass, its location and relationship to muscle bundles and fascial planes, definition of the margins of the mass, relation to neural, vascular and bony structures not previously available by plain film and angiography. This information is of particular value to the orthopedic surgeon in evaluating the feasibility of en bloc resections of tumors and in planning reconstructive procedures.

Adolescent↗

Desmoplastic fibroma of the cranium: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Desmoplastic fibroma is a benign bone tumor that can be locally aggressive. It usually occurs in the long bones and mandible. We report on a patient with a desmoplastic fibroma arising in the temporal bone and review previously published cases of desmoplastic fibroma originating within the cranium. CLINICAL PRESENTATION: A 43-year-old woman presented with a 12-year history of progressively worsening head asymmetry. Magnetic resonance imaging and computed tomography demonstrated a mass originating from the bone and involving the adjacent soft tissues. INTERVENTION: A temporal parietal craniectomy was performed with excision of a large tumor involving the bone. An acrylic cranioplasty was used to replace the bone. Pathological examination of the lesion identified desmoplastic fibroma of the cranium. After surgery, the patient's cranial asymmetry was corrected. CONCLUSION: Desmoplastic fibroma of the cranium is rare. Surgical resection is the treatment of choice.

Adult↗

Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases.

55 cases of malignant phyllodes tumours of the breast are described. 36 patients (i.e. 65.5%) of the studied group survived 5 years with no evidence of disease after surgery. It was proved that a simple mastectomy is sufficient therapy for patients with tumour limited to the breast. Metastases to the axillary lymphatic nodes are very rare. The main reason for treatment failure is distant metastases in the lungs. The only prognostic factor in the studied group was the grade of histological malignancy, determined by such criteria as the ratio between the malignant sarcomatous tissue and that typical for phyllodes tumour, the degree of cell polymorphism, mitotic activity, and possible multidirectional differentiation (towards malignant neoplasms of soft tissue and bones).

Adult↗

[Surgical treatment of bone and soft tissue tumors in the sacroiliac area--low- and high-grade neoplasms].

Operative treatment of tumors in the sacroiliac area is very difficult for the orthopedic surgeon. We reviewed low- and high-grade neoplasms in the sacrum and part of the ilium. Primary bone tumors were giant cell tumor, chondrosarcoma and others; invading bone tumors were carcinoma, rhabdomyosarcoma and others; soft tissue tumors were liposarcoma, metastasis of extraskeletal chondrosarcoma and others; total, 19 cases. The preoperative treatment performed was embolization, intra-arterial infusion (chemotherapy) and radiation therapy. The surgical approach used were the posterior, posterolateral, anterior and posterior, anterior and lateral combined approach. The transiliac procedure using the posterolateral approach gives better visualization adjacent to the sacroiliac area. The gap between the sacrum and the ilium is bridged by grafting the resected ilium. The anterior and lateral combined approach was used in the resection of large iliac tumors, and the abdominoinguinal approach was selected for large retroperitoneal tumors. The surgical treatment performed ranged from simple to wide excision, including the external iliac vessels or rectum, and also palliative surgery. Reconstructive surgery was done for reconstruction of the pelvic ring, spinal fusion using instrumentation and replacement of artificial vessels. Many complications and functional loss requiring treatment were encountered.

Adolescent↗

[Can ultrasound detect skeletal metastases?].

78 radiologically certified skeletal metastases--osteolytic as well as osteoplastic--were examined via sonography. A defect of the cortex could be seen in 82%, a periostal reaction in 28.2% and a concomitant soft tissue tumorous formation in 79.4%. In proving a soft part component sonography is superior to the conventional x-ray. Our study shows that osseous metastases can be verified by sonography.

Bone Neoplasms↗

Core needle biopsy and fine-needle aspiration in the diagnosis of bone and soft-tissue lesions.

Although core needle biopsy (CNB) and fine needle aspiration (FNA) procedures are widely used for the diagnosis of epithelial neoplasms, these procedures have not gained popularity on patients suspected of having bone or soft-tissue neoplasms. This article describes the University of Texas, M.D. Anderson Cancer Center experience with CNB and FNA procedures in bone and soft tissue performed in over 800 patients.

Biopsy, Needle↗

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗

[Angiographic findings in chondrosarcomas].

In chondrosarcomas, angiography may be helpful in confirming malignancy, delineating the anatomic extent and detecting recurrence. The angiographic findings in three chondrosarcomas are demonstrated including a vertebral one, abrupt narrowing of tumor vessels, neovascularlity and accumulation of contrast medium during the capillary phase. Changing calibre of arteries and neovascularity are better seen on selective angiograms and after subtraction technique.

Adult↗

Radiographic imaging of musculoskeletal neoplasia.

BACKGROUND: Imaging is an integral part of the diagnosis, staging and evaluation of outcomes for bone and soft-tissue neoplasms. Each of the available imaging tools has a different role. METHODS: The authors reviewed the efficacy of the current imaging modalities in the diagnosis, staging, and follow-up of patients with musculoskeletal neoplasia. RESULTS: Plain-film radiography remains the gold standard in the differential diagnosis of bone lesions. Bone scintigraphy is an excellent screening modality, and computed tomography is especially useful in evaluating lesions of the axial skeleton. The superior soft-tissue resolution and multiplanar capabilities achieved with magnetic resonance imaging, however, has replaced the need for CT scans in many cases. CONCLUSIONS: The technological advances seen in recent years in all areas of imaging have improved the capabilities of these modalities to assist in the diagnosis, definition of tumor extent, and accurate staging of musculoskeletal tumors.

Bone Neoplasms↗

Technetium-99m MDP demonstration of neoplastic lesions involving bone and adjacent soft tissue.

Four patients are presented with malignant tumors involving both bone and adjacent soft tissue. In each of these neoplasms (two representing adenocarcinoma of the prostate, and one each of squamous cell carcinoma of lung and chondrosarcoma), the lesions were detected by accumulation of Tc-99m MDP. Involvement of both bone and soft tissue was confirmed by CT examination or surgery. It is probable that the lesions originated in bone and then extended to soft tissue.

Adolescent↗

Ossifying fibromyxoid tumor resembling parosteal osteosarcoma.

Ossifying fibromyxoid tumor (OFMT) is a rare soft tissue neoplasm which varies in the amount of bone tissue laid down. We report on a case of OFMT in a 59-year-old male which mimicked a large parosteal osteosarcoma on radiography, MRI, and CT. T1-weighted MR images showed high-intensity areas which reflected fatty marrow. The metaplastic bone was connected to the cortex of the femur, but the tumor did not involve the medullary cavity. The tumor was irradiated and the patient was administered chemotherapy. Wide excision of the tumor and hip rotation plasty was performed. The patient has been disease free for 18 months.

Bone Neoplasms↗