Cases reported "Femoral Neoplasms"

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1/34. A rotating-hinge knee replacement for malignant tumors of the femur and tibia.

    We evaluated the 2- to 7-year results of a rotating-hinge knee replacement after excision of malignant tumors of the knee joint. There were 25 distal femoral and 7 proximal tibial replacements. The 5-year prosthetic survival for distal femoral replacements was 88%, compared with 58% for proximal tibial replacements. Seven patients underwent prosthetic exchange: 1 for aseptic loosening, 2 for wound slough and perioperative infection, and 4 for articulating component failure. One patient underwent above-knee amputation owing to skin necrosis. The median functional scores at the latest follow-up were 27 by the International Society of limb salvage evaluation system and 80 by the Hospital for Special Surgery Knee Score system. This implant is a promising choice for joint reconstruction after excision of tumors at the knee joint.
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2/34. De novo malignant transformation of giant cell tumor of bone.

    Two cases of malignant lesions are reported, both of which arose secondary to an originally benign giant cell tumor (GCT) of bone. The first case was a typical benign GCT, which occurred in the left proximal tibia of a 31-year-old woman. The tumor was treated by curettage and bone grafting. However, it recurred twice during 15 years of follow-up. The second recurrence showed that the lesion histologically had turned into malignant fibrous histiocytoma. The second case also started as an initially benign GCT that arose in the left distal femur of a 41-year-old man. The patient underwent curettage and bone grafting. The lesion recurred 13 years postoperatively. The histological appearance of the recurrent tumor showed it to be an osteogenic sarcoma. In both patients, radiation and never been given. Malignant transformation has rarely been reported in patients with GCT of bone who have not received radiation treatment.
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keywords = tibia
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3/34. Osteoid osteoma presenting with focal neurologic signs.

    Osteoid osteomas are benign bone tumors, most commonly located in the femur or tibia. In young children, these tumors can be extremely difficult to diagnose. They commonly present nonspecifically with gait disturbance and pain and characteristically respond well to mild pain relievers. We report two patients who presented with neurologic signs, including atrophy, weakness, and diminished deep tendon reflexes of the affected limb. These two patients demonstrate that osteoid osteomas of the lower extremities can present with neurologic signs, and proper diagnosis requires a detailed history and clinical awareness of this phenomenon.
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keywords = tibia
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4/34. Malignant fibrous histiocytoma associated with diaphyseal medullary stenosis.

    An unusual presentation of secondary malignant fibrous histiocytoma of the femur in a patient with diaphyseal medullary stenosis is described. The patient, a 42-year-old man, presented with a painful lump in the right knee. A radiograph of the right femur showed lytic destruction. Characteristic features of longitudinal linear striations in the metaphysis and medullary stenosis in the diaphysis were observed in radiographs of the long tubular bones. A radiograph of the pelvis showed bilateral acetabular bone scleroses. After chemotherapy, surgical resection was done. On light microscopic examination, the tumor had features characteristic of malignant fibrous histiocytoma. Specimens from the diaphyseal medullary stenosis from the femur and tibia showed typical features of bone infarction. Radiographs of other members of the patient's family showed similar features of linear striation, cortical bone thickening, and acetabular sclerosis, including wavy, open growth plate of the iliac crest. The patient's aunt had died of a bone sarcoma in the shoulder region. It is important to recognize this extremely rare clinicopathologic type of diaphyseal medullary stenosis that frequently is associated with secondary high-grade sarcomas.
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keywords = tibia
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5/34. Bizarre parosteal osteochondromatous proliferation (Nora's lesion): a retrospective study of 12 cases, 2 arising in long bones.

    Twelve cases of bizarre parosteal osteochondromatous proliferation (BPOP), also known as Nora's lesion, are reported. Ten lesions were located in the small bones of the hands, and 2 were located in long bones (femur and proximal tibia). Patient age ranged from 12 to 63 years (average, 30.3 years). radiography of the lesions in the hand bones showed calcific masses attached to the underlying cortex, without interruption of the latter. The long bone lesions revealed unusual findings. In the femur, BPOP presented with extensive cortical destruction and was suggestive of a malignant lesion. This presentation has not been described to date. In the tibia, the lesion was located in the soft tissue without cortical attachment. This type of BPOP probably represents an immature lesion that over time will mature to solid cortical attachment. On histologic examination, all lesions demonstrated 3 distinct components with variable degrees of representation: (1) hypercellular cartilage with calcification and ossification, with the calcified cartilage having a characteristic basophilic tinctorial quality; (2) cancellous bone undergoing maturation; and (3) spindle cell stroma without cytologic atypia. In 1 case with a long-standing history, the cartilaginous component was minimal. BPOP, together with florid reactive periostitis and turret exostosis, may represent different stages in the development of a posttraumatic proliferative process. BPOP apparently arises from the periosteal tissues through a process of cartilaginous metaplasia.
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keywords = tibia
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6/34. adamantinoma of the proximal femur: a case report.

    adamantinoma is a rare low-grade malignant bone tumor with an indolent course. The tibia is involved in 85%-90% of long-bone cases. We encountered a patient with primary adamantinoma of the proximal femur. A 60-year-old woman fell and fractured her proximal left femur in the area of a cystic lesion. She underwent an osteosynthesis procedure, and bone union was obtained. After 3 years she developed pain in the left thigh, and a radiographic abnormality was found at the fracture site. A metastatic bone tumor was suspected, and curettage and cementing were carried out. Histologically, we found an epithelial component but failed to detect any primary cancer. Local recurrence became evident after another 6 years. A marginal excision was performed and a bipolar femoral prosthesis was implanted. We finally diagnosed the patient with adamantinoma. In this report we describe the characteristics of this tumor and discuss the reasoning concerning the differential diagnosis and therapeutic plan.
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keywords = tibia
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7/34. Bilateral multiple malignant transformation of Ollier's disease.

    We treated a 26-year-old man with a 19-year history of Ollier's disease. Secondary chondrosarcomas developed metachronously at four separate locations: both femora, left proximal tibia and fibular head. All four lesions were surgically excised, and each specimen was histologically identified as grade 1 or 2 chondrosarcoma. Clinical follow-up for 20 years beginning at the time of first tumor surgery has shown no evidence of local recurrence or metastasis. This is the first report of multiple bilateral metachronous malignant transformation of multiple chondromatoses in a patient with Ollier's disease.
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keywords = tibia
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8/34. Intracortical small cell osteosarcoma.

    A case of intracortical osteosarcoma, a rare form of osteosarcoma that may radiologically simulate a variety of benign and malignant bone lesions, is described. To date, all cases have arisen in the diaphysis of either the tibia or femur, and histologically have been of osteoblastic type. In contrast, the current tumor was a small cell osteosarcoma, another uncommon variety of osteosarcoma. A summary of the reported cases of intracortical osteosarcoma is given, and the literature on small cell osteosarcoma is briefly reviewed.
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keywords = tibia
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9/34. Case report 722. Osteosarcomatosis in a skeletally immature girl.

    We report a case of a clinically and radiographically dominant osteosarcoma of the proximal end of the tibia, in which the second skeletal focus of osteosarcoma was apparent on MRI, after having escaped detection on routine radiographs and scintigraphy. Detection of the second lesion significantly altered the subsequent treatment and prognosis. The improved sensitivity of MRI may increase the accuracy of the diagnosis of osteosarcomatosis. Although further study is needed, MRI study of long bones, especially T1-weighted images in the coronal plane, may be considered as a screening procedure to exclude occult skeletal involvement in patients with osteosarcoma and negative standard metastatic evaluation.
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keywords = tibia
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10/34. Report of four cases with high-grade surface osteosarcoma.

    High-grade surface osteosarcoma is the rarest of the three types of surface osteosarcoma. Four cases with high-grade surface osteosarcoma arising from the distal femur and tibia are reported in this study. One patient was previously diagnosed with Turner's syndrome. Radiologically, three cases presented characteristic appearances suggesting high-grade bone-forming sarcoma arising from the bone surface; however, one case was similar to other juxtacortical lesions such as periosteal and parosteal osteosarcoma, which typically have a better prognosis than high-grade surface osteosarcoma. Therefore, all cases underwent biopsy to determine a definitive diagnosis. Our strategy of treatment for high-grade surface osteosarcoma was a combination of wide resection and pre-/post-operative chemotherapy, equivalent to the treatment for conventional intramedullary osteosarcoma. At the last follow-up, two cases were still undergoing chemotherapy, one case was continuously disease free during the follow-up period of 81 months, and one patient was living with no evidence of disease 60 months after surgery. The aim of this study is to report the clinical information, oncological outcome and appropriate treatment for high-grade surface osteosarcoma.
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keywords = tibia
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