1/64. Perioperative stroke associated with postoperative epidural analgesia.A patient with an epidural catheter for postoperative analgesia developed a stroke in association with a hypotensive episode resulting from a bolus of local anesthetic. After undergoing resection for femoral chondrosarcoma under epidural anesthesia, the patient received a continuous infusion of epidural morphine for postoperative analgesia. lidocaine 1% (10 mL in divided doses) was administered through the catheter for breakthrough pain. The patient experienced a hypotensive episode and was noted to have a motor and cortical sensory deficit of the left arm and leg 8 hours after the hypotensive episode. Clinical presentation and subsequent workup were consistent with a watershed infarction. The patient recovered full neurologic function before discharge. Postoperative hypotension from epidural analgesia may be associated with stroke; however, a cause-and-effect relationship usually cannot be established with certainty.- - - - - - - - - - ranking = 1keywords = chondrosarcoma (Clic here for more details about this article) |
2/64. mutation of p53 with loss of heterozygosity in the osteosarcomatous component of a dedifferentiated chondrosarcoma.We investigated a dedifferentiated chondrosarcoma of a 61-year-old woman with an osteosarcomatous high-grade component for p53 alteration. The low-grade cartilaginous and the high-grade osteosarcomatous components of the tumor were macrodissected and evaluated separately by immunohistochemistry and molecular biology. We used PCR-SSCP analysis and direct sequencing to screen exons 4-8 for p53 mutations. The p53 intron 1-polymorphism was investigated for loss of heterozygosity. A functionally relevant p53 missense mutation in codon 193 of exon 6 (A-to-T transversion) with loss of wild-type allele was detected only in the dedifferentiated component. Using the monoclonal antibody DO-1, immunohistochemistry failed to show p53 overexpression. This evidence of p53 mutation may be regarded as at least a co-factor that "switched" the preexisting low-grade conventional chondrosarcoma to a highly malignant dedifferentiated tumor.- - - - - - - - - - ranking = 6keywords = chondrosarcoma (Clic here for more details about this article) |
3/64. Reactivation of tumor after 19 years? A case of local recurrence in clear cell chondrosarcoma.Local recurrence of a clear cell chondrosarcoma of bone is reported arising 19 years after resection of the original tumour.- - - - - - - - - - ranking = 5keywords = chondrosarcoma (Clic here for more details about this article) |
4/64. Dedifferentiated clear cell chondrosarcoma.Dedifferentiation, a change in the histologic character and clinical behavior of a tumor to a more immature and aggressive one, occurs in approximately 11% of all chondrosarcomas. The original lesion is usually a low-grade chondrosarcoma. Clear cell chondrosarcoma is a rare cartilaginous tumor of low-grade malignancy with a preference for the ends of long bones. It is usually curable by resection. recurrence commonly follows inadequate surgery, and metastases to lung, brain, and bones can develop. However, dedifferentiation has not yet been described in association with clear cell chondrosarcoma. Three patients are described who were initially diagnosed as having clear cell chondrosarcoma of the femur. Two were treated with en bloc resection for a clear cell chondrosarcoma. One of these had an undifferentiated sarcoma in a local recurrence after 6 years. In the second, metastasis of the clear cell chondrosarcoma developed 5(1/2) years after surgery; autopsy revealed undifferentiated sarcoma in the lung, heart, and lumbar spine. The third patient had dedifferentiated clear cell chondrosarcoma at the time of resection following the biopsy diagnosis of clear cell chondrosarcoma. All three died with metastatic disease. These three patients represent three different manifestations of dedifferentiation-at initial diagnosis, at recurrence, and at metastasis. To our knowledge, this is the first description of dedifferentiation occurring in clear cell chondrosarcoma.- - - - - - - - - - ranking = 14keywords = chondrosarcoma (Clic here for more details about this article) |
5/64. Extraskeletal myxoid chondrosarcoma with multiple skeletal metastases.Pulmonary metastases are not unusual in extraskeletal myxoid chondrosarcoma; however, only two patients have been reported with multiple bony metastases. We report here one patient with extraskeletal myxoid chondrosarcoma associated with lung and multiple bony metastases. After chemotherapy, the primary lesion was resected, but lung and multiple bony metastases were found 20 months later. The bony metastases were in the right femur, right humerus, and at multiple vertebral levels. Because of a pathologic fracture of the right femur, the metastases in the right femur and right humerus were surgically stabilized. After chemotherapy, the lung metastases were resected, and those in the vertebral bodies were treated with radiotherapy.- - - - - - - - - - ranking = 6keywords = chondrosarcoma (Clic here for more details about this article) |
6/64. Chromosomal changes in a dedifferentiated chondrosarcoma: a case report and review of the literature.The chromosome abnormalities observed in a dedifferentiated chondrosarcoma are reported. A new molecular cytogenetic technique, spectral karyotyping, was used to identify and confirm structural rearrangements in this case. A review of the literature revealed that nine cases have been reported, in eight of which a complete description of the cytogenetic abnormalities was described. Structural aberrations were most frequently reported in chromosomes 1 and 9, and chromosomes 7 and 19 were most frequently observed to be involved in numerical aberrations (trisomy and tetrasomy). In chondrosarcomas, structural aberrations in chromosomes 1 and 9 and trisomy or tetrasomy of chromosome 7 are among the more frequently observed aberrations.- - - - - - - - - - ranking = 6keywords = chondrosarcoma (Clic here for more details about this article) |
7/64. Atypical hip pain origin in a young athletic woman: a case report of giant cell carcinoma.Primary bone tumors are infrequently encountered in a sports medicine practice. We describe a case in which a young athletic woman with a medical history significant for ulcerative colitis initially presented to our clinic with chronic hip pain. Her initial roentograms were negative for boney pathology and her history and examination were consistent with trochanteric bursitis. However, follow-up radiographs performed 9 months later showed a radiolucent mass that eventually, after open biopsy and histologic evaluation, was determined to be giant cell tumor. This case shows the importance of repeat radiographic studies in patients whose joint pain does not respond or responds slowly to conservative therapy, despite initial normal findings. It also establishes that radiographic findings do not always correlate with actual disease process, for this lesion was found to be giant cell carcinoma--a diagnosis contrary to the original diagnosis of clear cell chondrosarcoma that was suggested by radiology.- - - - - - - - - - ranking = 1keywords = chondrosarcoma (Clic here for more details about this article) |
8/64. Clear cell chondrosarcoma: unusual radiologic appearances with histologic correlation.Clear cell chondrosarcoma is a rare variant of the bone tumors with distinct radiologic and pathologic features. In this report two cases of clear cell chondrosarcomas with atypical radiologic appearances are presented. The findings of X-ray films and MRI are described with histologic correlation. In the first case the lesion showed a very expansile and long segment involvement of the humerus. In the second case the lesion was located in the diaphysis of the femur causing a large cortical destruction.- - - - - - - - - - ranking = 6keywords = chondrosarcoma (Clic here for more details about this article) |
9/64. Revision hip arthroplasty in a patient with a hip rotationplasty (type B III b).We report for the first time a patient who underwent a revision hip arthroplasty after a hip rotationplasty (Winkelmann type B III b) because of a chondrosarcoma in 1988. The clinical symptoms and radiographic findings (X-ray, bone scintigraphy, arthrography) of the aseptic loosening of the acetabular component are presented in detail. Furthermore, we present the functional results after hip revision.- - - - - - - - - - ranking = 1keywords = chondrosarcoma (Clic here for more details about this article) |
10/64. Segmental resection for chondrosarcoma.Specific anatomical and pathological criteria for resectability of so-called central chondrosarcoma of the extremities were set forth and a method of treatment based on autoclaving the segment and surrounding it with massive amounts of fresh autogenous cancellous bone was used in eight patients. Follow-up ranged from 3.2 to 13.5 years. The advantages of the method are: ease of procurement of bone graft, absence of storage and measurement problems, and lack of need for rigid immobilization. No secondary procedures were required because of fracture, resorption, or infection.- - - - - - - - - - ranking = 5keywords = chondrosarcoma (Clic here for more details about this article) |
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