Cases reported "Bone Neoplasms"

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11/414. Evaluating marrow margins for resection of osteosarcoma. A modern approach.

    Intraoperative evaluation of bone marrow margins by frozen section analysis is a common practice in the surgical treatment of osteogenic sarcoma. The purpose of this study was to assess the clinical use of intraoperative marrow margin evaluation to rule out occult intramedullary tumor extension in osteosarcoma surgery. One hundred twenty-eight consecutive patients with high grade osteosarcoma diagnosed between 1988 and 1996 (Group 1) were reviewed retrospectively and compared with 92 consecutive patients treated from 1979 to 1984 (Group 2). Eighty-five patients in Group 1 met the inclusion criteria of having high grade intramedullary lesions of the long bones observed on preoperative magnetic resonance imaging evaluation of the lesion and intraoperative frozen section analysis of the bone marrow margin. Thirty-three patients in Group 2 met the same inclusion criteria with the exception of having preoperative magnetic resonance imaging. Ninety-two marrow margins in Group 1 and 33 marrow margins in Group 2 were evaluated by frozen section. All 92 marrow margins in patients in Group 1 were negative by frozen section analysis and permanent histologic analysis. Of the 33 marrow margins in patients in Group 2, three (9.1%) were reported positive for tumor. Of these, one was found to be a false positive result on permanent pathologic examination. In addition, one false negative frozen section result was found, which was positive for tumor on permanent pathologic examination. The difference in true positive results of marrow margins between Group 1 and Group 2 was statistically significant. Intraoperative marrow margin evaluation by frozen section is not mandatory with modern imaging techniques. Preoperative evaluation of tumor extent using magnetic resonance imaging and intraoperative evaluation of the specimen by the pathologist (done by bivalving the specimen) are reliable methods to ensure adequate surgical margins in most cases of conventional osteosarcoma of the long bones.
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12/414. Use of polymethylmethacrylate in large osseous defects in the foot and ankle following tumor excision.

    foot and ankle surgeons are occasionally confronted with having to fill large defects following excision of osseous lesions. This can prove to be quite challenging to the surgeon in regards to the requirement of large amounts of autogenous, allographic, or synthetic bone graft material. The amount of time spent nonweightbearing postoperatively can be quite prolonged, and the evaluation for tumor recurrence at the graft--host interface is difficult to ascertain. Polymethylmethacrylate has been used extensively in orthopedic surgery for many years in a safe manner for total joint replacement. It has also been used to fill large defects following tumor excision (i.e., giant cell tumor) and as an alternative to bone graft. This article briefly reviews the concepts of using polymethylmethacrylate in this manner and presents the use of polymethylmethacrylate in the treatment of foot and ankle lesions with three case presentations. The authors' purpose for this paper is to simply expand on the current medical literature available regarding the use of polymethylmethacrylate in the foot and ankle and to increase the awareness of foot and ankle surgeons regarding its use as a treatment alternative. A follow-up to this article is planned to present a larger patient population, longer term follow-up, and outcomes data.
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ranking = 0.125
keywords = operative
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13/414. Malignant mixed mesodermal tumor arising in a benign cystic teratoma.

    The occurrence of sarcoma in a benign cystic teratoma is very rare. We report the first poorly differentiated, malignant mixed mesodermal tumor with a component of rhabdomyosarcoma to arise in a benign cystic teratoma of the ovary. The tumor was staged as FIGO IC due to capsule invasion. Although combination chemotherapy of cisplatin, ifosfamide and mesna, was instituted, the disease took a rapidly progressive course. After an unusual metastasis to the scapula was detected, the patient deteriorated and died in the forth postoperative month.
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ranking = 0.125
keywords = operative
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14/414. Clear cell chondrosarcoma of the pelvis in a skeletally immature patient.

    We report on a case of clear cell chondrosarcoma (CCCS) of the left iliac bone in a 12-year-old skeletally immature boy. Radiographic examination revealed an aggressive osteolytic lesion with areas of mineralization. Fluid-fluid levels were seen on T2-weighted MR images. Laboratory data showed slight elevation of serum alkaline phosphatase. The biopsy specimen showed histological features of CCCS with some resemblance to osteosarcoma, such as prominent irregular osteoid formation among clear tumor cells. Surgical treatment was accomplished without pre- or post-operative chemotherapy. Because of the patient's age, elevated serum alkaline phosphatase, and histopathology with prominent osteoid production, this case could be confused with osteosarcoma. Although CCCS is an extremely rare bone tumor in children, it is important to be aware that it may arise in a skeletally immature patient. CCCS, unlike osteosarcoma, is not treated with neo-adjuvant chemotherapy.
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ranking = 0.125
keywords = operative
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15/414. Conservative surgery for chondrosarcoma of the first metacarpal bone.

    A rare case of a chondrosarcoma of the first metacarpal bone is presented. The lesion was radiographically interpreted initially as an enchondroma and treated conventionally by curettage and cancellous autologous bone grafting. After final histology, a low-grade chondrosarcoma was reported. A resection of the entire first metacarpal bone was performed, followed by reconstruction using an autologous corticocancellous bone graft and plate fixation, creating arthrodeses of the adjacent joints. Although isolated enchondromas are considered to have no malignant potential, histological examination is essential to rule out malignancy. A preoperative biopsy should be recommended in lesions suspected to be chondromas. Chondrosarcomas are rarely located in bones of the hand, where they are usually treated by amputation. With the case presented we wish to advocate that cases of low-grade, intraosseous chondrosarcoma (stage IA) can be treated by conservative surgery, especially when it is located in the thumb.
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ranking = 0.125
keywords = operative
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16/414. Extraskeletal myxoid chondrosarcoma of the knee.

    Extraskeletal myxoid chondrosarcoma is an uncommon neoplasm, accounting for less than 2% of all soft tissue sarcomas. It affects adult males with a median age in the fifth decade at the time of diagnosis. The tumor usually arises in the deep soft tissues, especially in the lower extremities. patients present with a gradually enlarging mass that may or may not be associated with pain. This report describes a 25-year-old man who initially presented with a 4- to 5-year history of right knee pain and an enlarging mass in the right knee. Evaluation revealed a cartilaginous neoplasm with no evidence of metastatic disease. The tumor was widely excised and an allograft reconstruction was performed. The patient was closely followed with an eventual above the knee amputation for recurrent myxoid chondrosarcoma. At 34 months, retroperitoneal metastases were noted on abdominal CT. The patient underwent a left radical nephrectomy, renal vein thrombectomy and enucleation of the mass in the right kidney, distal pancreatectomy, and splenectomy. The patient received postoperative chemotherapy. Forty-eight months after initial diagnosis, the patient was found to have recurrent abdominal and retroperitoneal lesions. At 64 months, the patient died from complications of extraskeletal myxoid chondrosarcoma.
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ranking = 0.125
keywords = operative
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17/414. osteosarcoma arising in a solitary osteochondroma of the fibula.

    We present a case of osteosarcoma arising in an osteochondroma of the right fibula in a 30-year-old woman. The available radiographic studies of the lesion were not suggestive of malignant transformation. The lesion and underlying bone were excised. Histologic examination showed a conventional high-grade osteoblastic osteosarcoma that focally eroded the fibrocartilaginous cap. The patient received postoperative chemotherapy and shows no evidence of disease 27 months following operation. The occurrence of osteosarcoma in an osteochondroma is an extremely rare event, and only a few cases are on record in the literature.
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ranking = 0.125
keywords = operative
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18/414. Osteoid osteoma of the elbow: a diagnostic challenge.

    BACKGROUND: Osteoid osteoma is a painful benign neoplasm that is rarely found in the elbow region. methods: The study included fourteen patients, and we believe that this is the largest reported series of patients with osteoid osteoma of the elbow evaluated at one institution. Most of the patients had had symptoms for a prolonged period and had had multiple invasive procedures before an accurate diagnosis was made. Although findings on physical examination generally are nonspecific and are not always accurate in localizing the lesion, plain tomograms and computed tomography scans were most helpful in identifying the nidus in the present study. Thirteen of the patients had limited motion of the elbow before the definitive diagnosis was made, and ten of these thirteen had a mean flexion contracture of 38 degrees. RESULTS: Removal of the nidus resulted in relief of pain and improvement in the range of motion of the elbow in all fourteen patients. A persistent postoperative flexion contracture was more common in the patients who had had a previous arthrotomy of the elbow than in those who had not had that procedure. CONCLUSIONS: It is important to recognize this uncommon entity to avoid the morbidity associated with a prolonged delay in diagnosis. Because the symptoms resolve after excision of the lesion, the surgeon can avoid unnecessary soft-tissue dissection and release of the contracture.
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ranking = 0.125
keywords = operative
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19/414. Large bursa formation associated with osteochondroma of the scapula: a case report and review of the literature.

    bursitis or large bursa formation associated with osteochondroma has rarely been reported. A 33-year-old male presented with upper back pain, a rapidly developing mass beside the lateral border of his right scapula and snapping elicited by movement of the scapula. Plain radiograms and CT revealed osteochondroma on the ventral surface of the scapula without any unmineralized component and a huge cystic lesion around the osteochondroma. Aspiration of the cystic lesion showed the presence of sero-sanguineous fluid. MRI following the aspiration showed a thin cartilaginous cap with distinct outer margin and no soft tissue mass around the cap. Pathological examinations confirmed the diagnosis of osteochondroma with the large bursa formation. Clinical examination 19 months postoperatively showed an uneventful clinical course.
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ranking = 0.125
keywords = operative
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20/414. Recurrent osteoblastoma of the hamate bone. A two-stage reconstruction with a free vascularized iliac crest flap.

    An osteoblastoma in a carpal bone is very rare and presents a problem of reconstruction after wide tumour excision. We report a case of recurrent osteoblastoma of the right hamate bone with involvement of the ulnar carpal bones and soft tissues that was successfully treated by en bloc resection, temporary interposition of bone cement and fixation with K-wires, followed by reconstruction with a free vascularized iliac crest flap, tailored to the exact size of the defect, in a second procedure. Rapid fusion was achieved and hand function preserved with no evidence of recurrence 3 years postoperatively.
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ranking = 0.125
keywords = operative
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