Cases reported "Bone Neoplasms"

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1/167. Intraosseous epithelioid malignant peripheral nerve sheath tumor of the phalanx. Case report.

    We report the first case of intraosseous epithelioid malignant peripheral nerve sheath tumor (MPNST) occurring in the phalanx. The patient was a 50-year-old Japanese man with an intramedullary lytic lesion of the proximal phalanx. Microscopically, the tumor was composed of epithelioid cells or polygonal cells, forming large cell nests with central necrosis. Most tumor cells were diffusely and strongly immunopositive for S-100 protein and vimentin, and negative for cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, alpha-smooth muscle actin, and HMB-45. laminin-positive material was discontinuously demonstrated between the individual tumor cells. Electron microscopy showed prominent external lamina. Our case indicated that laminin is useful for differentiating epithelioid MPNST from metastatic carcinoma and malignant melanoma.
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2/167. Disapperance of osteogenic sarcoma after irradiation: immunologic observations.

    Sarcoma - lymphocyte-mediated cytotoxicity and serum blocking of this activity was studied by the in vitro microcytotoxicity test in three patients with osteogenic sarcoma who received preoperative irradiation. All three patients had complete histologic disappearance of the tumor between three to five months after irradiation. Lymphocyte cytotoxicity was present before and after treatment in two patients and post-treatment in one. No serum blocking activity was detected in any of these three patients. They are all alive over four years post-therapy without evidence of active disease.
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3/167. Isolated musculocutaneous neuropathy caused by a proximal humeral exostosis.

    We report an isolated musculocutaneous neuropathy caused by a proximal humeral osteochondroma that became symptomatic after the patient played recreational basketball. Lesion resection resulted in complete deficit resolution. Mass lesions involving the musculocutaneous nerve should be considered in patients with atraumatic, isolated musculocutaneous neuropathies that are recurrent or fail to recover, even in the setting of strenuous exercise.
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4/167. Mental neuropathy: report of five cases and review of the literature.

    Mental nerve neuropathy, also referred to as numb chin syndrome, is a rare, seemingly harmless symptom. It is more often associated with cancer, either as first symptom or during the outcome, than with benign diseases. In this review, we will focus on the numb chin syndrome presenting as an isolated neurological symptom. We report five patients with mental nerve neuropathy associated with metastatic disease (small cell lung cancer, prostatic cancer and breast cancer). In one patient, numb chin syndrome preceded the discovery of the disease, while, in the four others, it occurred as a sign of relapse or progression. Isolated mental nerve neuropathy, frequently associated with breast cancer and lymphoproliferative diseases, is generally thought to be the consequence of bone metastases or leptomeningeal seeding, but may also present without an obvious cause, most often secondary to the involvement of the mental nerve itself. Although various therapies may lead to the resolution of this symptom, median survival after diagnosis is generally less than 1 year. The appearance of a mental nerve neuropathy should never be considered as a 'banal' symptom and investigations to detect a possible cancer should be mandatory.
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5/167. Primary lymphoma of bone originating in a rib.

    Malignant lymphoma originating in the bone is rare and is now recognized as being an independent clinicopathologic entity known as primary lymphoma of bone. A 60-year-old man complaining of right chest and back pain consulted our hospital for further examination. Chest X-ray and computed tomogram revealed osteolysis and a surrounding soft tissue mass in the sixth right rib. An ultrasonically-guided needle biopsy of the tumor was performed, and histologic examination indicated the dense proliferation of similar-sized atypical cells with nucleoli and an irregular nuclear border. A diagnosis of diffuse, medium-sized non-Hodgkin's lymphoma, b-cell type was made. En block resection of the tumor and chest wall was performed. Macroscopically, the tumor measured 7.5 x 4.8 x 3.0 cm in diameter, and the histologic findings were similar to those of the preoperative needle biopsy. Unfortunately, postoperative treatment with radiation therapy and chemotherapy was ultimately unsuccessful, and a local recurrence and metastatic lesions appeared in the stomach and para-aortic abdominal lymph nodes 7 months after the first symptom appeared. The patient died 3 months later. Surgery was chosen as the initial therapy as it was considered that a rib resection would not result in serious respiratory compromise and the complete resection of the tumor would be superior to radiation therapy for local control. Some authors have reported that the surgical resection of a primary lymphoma of the bone originating in a rib can yield a good prognosis. However, it is a systemic disease and a more effective therapeutic strategy should be developed.
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6/167. The usefulness of 99mTc-HMPAO-labeled leukocyte scintigraphy in the diagnosis of skeletal metastases of cancers.

    The usefulness of bone marrow scintigraphy with 99mTc-HMPAO-labeled leukocytes (leukocyte bone marrow scintigraphy) in the diagnosis of skeletal metastases of cancers was investigated in 70 lesions in 27 patients with various types of cancer. The final diagnosis of skeletal metastases was based on one or more criteria consisting of histological confirmation, typical findings of metastases by bone radiograph, CT and MRI, or progressive swellings of the lesions with severe pain due to nerve compression. Of the 70 lesions, 55 were finally diagnosed as metastases, and 15 as benign lesions. Leukocyte bone marrow scintigraphy showed photopenic defects in 52 of the 55 metastatic lesions (sensitivity 95%), and the remaining 3 negative lesions were found positive for metastases by MRI. In contrast, MRI could evaluate only 39 of the 55 lesions because 16 lesions in the ribs, scapula and sternum were not visualized. Of these 39 lesions, MRI showed positive findings for metastases in 33 (sensitivity 85%), and negative findings in 6 with photopenic defects found by leukocyte bone marrow scintigraphy. Of the 15 benign lesions, 3 were false positive for metastases on leukocyte bone marrow scintigraphy (specificity 80%). We conclude that 99mTc-HMPAO-labeled leukocyte bone marrow scintigraphy may be useful in the diagnosis of skeletal metastases of cancers, particularly when MRI fails to evaluate the lesions.
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7/167. Hyperostotic macrodactyly and lipofibromatous hamartoma of the median nerve associated with carpal tunnel syndrome.

    A new case with 14-year follow-up of an extremely rare variety of congenital hand macrodactyly is presented. The disease characteristically presents a diffuse proliferation of fibrofatty tissue, but in this special type, osteocartilaginous deposits around the joints can also be found. The case presented included the troublesome feature of a lipofibromatous hamartoma in the median nerve at the wrist and its branches producing carpal tunnel syndrome. The patient obtained benefit from carpal tunnel release and epineurolysis. The hyperostotic development was managed with conservative resection of the periarticular osteochondromas. The literature reviewed suggests that the hyperostotic cases of macrodactyly do not differ from general cases of this congenital condition, except for the osteochondral deposits. These tumours develop during adulthood or after previous trauma, before epiphyseal closure.
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8/167. Multiple peripheral nerve compressions related to malignantly transformed hereditary multiple exostoses.

    Autosomal dominantly transmitted hereditary multiple exostoses is an uncommon disorder consisting of multiple projections of bone capped by cartilage. The lesions are most numerous in the metaphyses of long bones but may appear on flat bones. Sarcomatous transformation occurs in 1-25% of patients. We report a 33-year-old man with sciatica, previously diagnosed as hereditary multiple exostoses, presenting with multiple peripheral nerve compressions. Electrodiagnostic studies showed profound axon-loss multiple neuropathies involving the sciatic, superior gluteal, and inferior gluteal nerves. magnetic resonance imaging of the left pelvis showed a large mass in the sacral area that was suggestive of a chondrosarcoma. An open intralesional excision biopsy confirmed chondrosarcoma transformed from chondromatosis. Excision of the lesion was effective in eliminating the impingement of nerves and retarding progressive osseous growth. We suggest that malignant transformation be suspected in cases with focal compression neuropathy of patients known to have multiple exostoses. osteochondroma as a possible cause for compression neuropathy is discussed.
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9/167. Osteomas of the internal auditory canal: a report of two cases.

    OBJECTIVES: To determine the optimal medical or surgical treatment of osteomas of the internal auditory canal (IAC) as well as their growth characteristics. STUDY DESIGN: Information was obtained from case histories, images from computed tomography and magnetic resonance imaging, surgical and pathologic findings, and long-term clinical results. methods: Two patients, along with 10 additional patients reported in the literature, with osteomas of the IAC with varying symptoms were studied. Clinical history, audiometric and vestibular test results, and radiographic studies were reviewed on all patients. Histopathologic examination of the surgical specimens confirmed the presence of osteomas. The clinical outcomes were studied to determine if the preoperative symptoms had resolved. RESULTS: Eight of 12 patients underwent surgical removal of their IAC osteomas. Three of eight patients had total resolution of all symptoms. Three patients had improvement of their sensorineural hearing loss. Five patients had resolution of their dizziness. Four patients noted resolution of their tinnitus. In the absence of auditory symptoms, vestibular symptoms may be controlled with medical therapy. Long term follow-up of the two patients discussed showed little or no growth over a 4- to 5-year period. CONCLUSIONS: Surgical intervention may be warranted to remove an osteoma of the IAC if symptoms are present. patients should be made aware that symptoms may or may not improve. Continuation of symptoms may be a result of chronic compression of the auditory and vestibular nerves.
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10/167. Pelvic osteosarcomas causing lumbosacral nerve root compression presenting as herniated intervertebral disc: report of two cases.

    Osteosarcomas of the pelvic bone are rare. Neurological complication of osteosarcomas in this location is also rare. diagnosis is not always easy, and misdiagnosis may occur due to pelvic bone destruction and nerve root compression. We present two cases of pelvic osteosarcoma with lumbosacral radicular symptoms who were previously thought to have lumbosacral herniated intervertebral disc.
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