1,721,083 research outputs found
Osteoblastic osteosarcoma in monostotic Paget's disease.
No full textPaget's disease is a disorder of bone remodelling affecting 1-2% of the general population, most frequently men over 50 years of age. Sarcomatous degeneration occurs in 0.1-0.95% of patients with Paget's disease. It can be observed in monostotic and polyostotic disease. Osteosarcomas account for more than 80% of pagetic sarcomas; osteoblastic pagetic osteosarcomas are rare. In this article, we present the case of a 75-year-old man with secondary osteosarcoma arising in monostotic Paget's disease, initially misdiagnosed as rotator cuff tendinopathy. Imaging studies and biopsy were diagnosti
Surgical treatment for metastatic pathological fractures.
No full textPathological fractures of the long bones occur in 10–29% of patients with bone metastases. The occurrence of these fractures may alter management and prognosis, decrease quality of life and jeopardize survival [1–4]. The fracture hematoma may contaminate the adjacent soft tissue, nerves, vessels and joint, and damage to the microcirculation may favor distant hematogenous dissemination of the tumor [5]
Therapeutic approaches for bone sarcomas
No full textBone sarcomas include a wide variety of primary, non-epithelial, malignant neoplasms originating from bone cells or their precursors. By definition, they have a potential for metastasis. Some bone sarcomas are purely osteolytic, while others produce a calcified matrix (e.g. osteosarcoma), a cartilaginous matrix (e.g. chondrosarcoma), or a mixed osteolytic/osteoblastic matrix. The three main bone sarcomas include osteosarcoma, Ewing sarcoma and chondrosarcoma. Most bone sarcomas occur in children and young adults and develop in the extremities, especially the distal femur, or the pelvis. The most common symptoms are pain and an enlarging mass. The location, depth and size of an enlarging mass can be determined on physical examination. The presence of persistent non-mechanical pain in any bone lasting more than a few weeks should cause concern and lead to further immediate investigation. A palpable mass will only be present if the tumor has progressed through the cortex and distended the periosteum. Radiographs are important in any patient with prolonged bone pain. Conventional radiographs in two planes should always be the first investigation; a bone sarcoma will almost always be obvious in radiographs. Magnetic resonance imaging is the primary imaging method for evaluating bone lesions, their exact location, and their proximity to neurovascular structures. General staging including bone scintigraphy, chest radiographs and CT should be carried out to assess the extent of distant disease. The majority of patients with bone sarcomas require a multidisciplinary approach that includes orthopedic, medical and radiation oncologists, plastic surgeons, pathologists, and radiologists with expertise in bone tumors. Surgery is the primary therapeutic approach. The role of chemotherapy and radiation therapy is individualized. For some bone sarcomas, such as osteosarcoma and Ewing sarcoma, there is a preference to treat the patient with chemotherapy at the beginning of the course, prior to surgical treatment, aiming to treat the potential micrometastatic disease, reduce the soft tissue mass about the bone tumor and/or mature the mass, allowing for easier resection
Bone Metastasis Management ("Advances in")
No full textWhen we were asked to edit an eBook on ‘Advances in Bone Metastasis Management’, we accepted enthusiastically for several reasons. First of all, the idea of an eBook that could be easily available to the readers and disseminate the newer concepts on the subject was appealing; second, the possibility of gathering several excellent authors dealing with the different aspects and concepts on metastatic disease to the skeleton and its treatment sounded exciting to us. But perhaps the most intriguing factor was that of having a really multidisciplinary team approach to the issues of metastatic diseases and its multidisciplinary treatment.
This book certainly does not have the presumption of completeness, rather the aim of offering an update on the newer concepts and treatments of the very frequent problem of bone metastases. It was felt that concise chapters providing both summarized information and updated references on the different aspects of metastasization, medical treatment, radiotherapy, surgical treatments and the newer palliative options could be useful to the readers in our modern era, where sometimes it is not easy to find time to read complete major textbooks.
We certainly hope that this book can meet the needs of our readers
Preliminary results after reconstruction of bony defects of the proximal humerus with an allograft-resurfacing composite.
No full textWe retrospectively studied 14 patients with proximal and diaphyseal tumours and disappearing bone (Gorham's) disease of the humerus treated with wide resection and reconstruction using an allograft-resurfacing composite (ARC). There were ten women and four men, with a mean age of 35 years (8 to 69). At a mean follow-up of 25 months (10 to 89), two patients had a fracture of the allograft. In one of these it was revised with a similar ARC and in the other with an intercalary prosthesis. A further patient had an infection and a fracture of the allograft that was revised with a megaprosthesis. In all patients with an ARC, healing of the ARC-host bone interface was observed. One patient had failure of the locking mechanism of the total elbow replacement. The mean post-operative Musculoskeletal Tumor Society score for the upper extremity was 77% (46.7% to 86.7%), which represents good and excellent results; one patient had a poor result (46.7%). In the short term ARC effectively relieves pain and restores shoulder function in patients with wide resection of the proximal humerus. Fracture and infection remain significant complications
Fibromyxoma of the axis
No full textFibromyxoma of bone is a rare benign tumor of fibrous tissue origin. The typical location is the jaws. Sporadic extragnathic cases have been reported, but fibromyxoma of the spine has not been reported. The histological appearance of fibromyxoma is benign and includes abundant extracellular fibrous and myxoid stroma with varying amounts of calcification and ossification. Myxoid changes are usually extensive. Extragnathic fibromyxoma of bone should be distinguished from benign cartilage-forming bone tumors, such as chondromyxoid and myxoid chondrosarcoma and myxoma of bone. It has also been suggested that fibromyxoma is a variant of myxoid fibrous dysplasia, whereas other authors reported extragnathic fibromyxoma resulting from myxoid degeneration of bone tumors, such as chondrosarcoma or fibrosarcoma. The overtreatment of patients with fibromyxoma of bone due to an aggressive imaging appearance should be avoided; the prognosis is excellent compared with the jaw variant and depends on the location and extent of the tumor. This article describes a case of a 21-year-old woman with fibromyxoma of bone originating from the spinous process of the axis. Clinical examination showed a tender mass in the midline of the posterior aspect the neck and slight limitation of neck range of motion; neurologic examination was normal. Diagnosis was obtained with a preoperative biopsy. Marginal excision of the lesion with posterior laminectomy of the axis was performed. The facets were preserved, and no fusion was performed. At last follow-up 2 years after diagnosis and treatment, the patient was asymptomatic with no evidence of local recurrence
Post-radiation sarcomas. Clinical outcome of 52 patients.
No full textBackground Previous studies reported on post-radiation sarcomas. However, the incidence, latency from radiation therapy, treatment, and survival has been difficult to evaluate. We performed a retrospective, single-institutional study to determine these factors for post-radiation sarcomas. Materials and Methods We retrospectively studied 52 patients with post-radiation sarcomas diagnosed and treated from 1985 to 2011. The mean age was 49 years; 45 patients had bone and 7 soft tissue sarcoma. The mean follow-up was 45 months. Survival was analyzed with respect to age at diagnosis, type (bone vs. soft tissue), histology, location (trunk vs. extremities), size, and surgical treatment (resection vs. amputation). Results The risk of post-radiation sarcoma was 0.06% at a mean latency of 15 years (3-50 years) after radiation therapy. The most common histology was osteosarcoma followed by malignant fibrous histiocytoma and fibrosarcoma; all sarcomas were high grade. Survival of the patients with post-radiation sarcomas was 85% at 1 year, 51% at 2 years, 48% at 3 years, and 45% at 5 years. Univariate predictor of survival was only the type of the sarcoma. No variable was significant in multivariate analysis. Conclusions Prognosis of post-radiation sarcomas is poor; the type of the sarcomas is the only significant variable for survival
Successful treatment of aneurysmal bone cyst of the proximal fibula with embolization
No full textWe present an 8-year-old girl with evolution of an aneurysmal bone cyst of the proximal fibula after intralesional surgery, treated successfully with one selective transfemoral embolization with N-2-butyl-cyanoacrylate. By the first 5 days, the patient experienced complete pain relief. Post-embolization imaging follow-up showed progressive homogenous trabecular bone formation and gradual reduction of the size of the lesion. These findings canceled our initial consideration for surgical treatment. Three years after the embolization, healing of the lesion and remodeling of the proximal fibula were observed without evidence of recurrence. Our successful results with excellent response seen 3 years after embolization are in favor and should increase the awareness of surgeons regarding embolization for aneurysmal bone cysts in difficult anatomic locations such as the proximal fibula. © 2012 Springer-Verlag
Similar Survival but better Function for patients after limb salvage versus amputation for distal tibia osteosarcoma.
No full textBackground Amputation has been the standard surgical treatment for distal tibia osteosarcoma. Advances in surgery and chemotherapy have made limb salvage possible. However, it is unclear whether limb salvage offers any improvement in function without compromising survival. Questions/Purposes We therefore compared the survival, local recurrence, function, and complications of patients with distal tibia osteosarcoma treated with limb salvage or amputation. Methods We retrospectively reviewed 42 patients with distal tibia osteosarcoma treated from 1985 to 2010. Nineteen patients had amputations and 23 had limb salvage and allograft reconstructions. We graded the histology using Broders classification, and staged patients using the Musculoskeletal Tumor Society (MSTS) and American Joint Committee on Cancer (AJCC) systems. The tumor grades tended to be higher in the group of patients who had amputations. We determined survival, local recurrence, MSTS function, and complications. The minimum followup was 8 months (median, 60 months; range, 8-288 months). Results The survival of patients who had limb salvage was similar to that of patients who had amputations: 84% at 120 and 240 months versus 74%, respectively. The incidence of local recurrence was similar: three of 23 patients who had limb salvage versus no patients who had amputations. The mean MSTS functional score tended to be higher in patients who had limb salvage compared with those who had amputations: 76% (range, 30%-93%) versus 71% (range, 50%-87%), respectively. The incidence of complications was similar. Conclusion Patients treated with either limb salvage or amputation experience similar survival, local recurrence, and complications, but better function is achievable for patients treated with limb salvage versus amputation. Local recurrence and complications are more common in patients with limb salvage
- …
