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11/18. Werner's syndrome combined with quintuplicate malignant tumors: a case report and review of literature data.

    The authors report a case of Werner's syndrome complicated by quintuplicate malignancy, and review the literature data. Four malignancies occurred synchronously in the case: osteosarcoma of the left distal tibia, malignant melanoma of the left plantar region, gastric cancer, pulmonary coin lesion. The osteosarcoma and malignant melanoma were treated by below-knee amputation and the gastric cancer by palliative surgery; the pulmonary coin lesion did not respond to cisplatin chemotherapy. It was difficult to treat the multiple primary cancer curatively, and patient died of respiratory failure due to a brain tumor seven months after surgery. The postmortem examination revealed a papillary carcinoma of the thyroid gland and a leiomyosarcoma of the lung. In some cases of Werner's syndrome, attention should be paid to the concurrent occurrence of multiple primary malignant neoplasms.
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ranking = 1
keywords = tibia
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12/18. Intestinal leiomyosarcoma following treatment of osteosarcoma in a teenage girl.

    A teenage girl is described who had an osteogenic sarcoma of the tibia at 11 years of age, a pulmonary metastasis at 13 years, and an intestinal leiomyosarcoma at 15 years. She remains well at the age of 18 years. leiomyosarcoma is extremely rare in children either as a primary or secondary tumor.
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ranking = 1
keywords = tibia
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13/18. Postradiation multicentric osteosarcoma.

    The oncogenic effects of radiation are well-established. Osteosarcomas and fibrosarcomas are the two most common histologic types of secondary sarcoma. In this article a case of postradiation osteosarcoma is presented in which four discrete foci of sarcomatous transformation have occurred in the tibia and fibula after irradiation for a rhabdomyosarcoma of the calf 8 years earlier. A review of the literature reveals no similar case. Although synchronous, multifocal osteosarcoma without prior radiation has been described, this case differs in clinical, radiographic, and pathologic features; it best fits the description of postradiation multicentric osteosarcoma.
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ranking = 1
keywords = tibia
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14/18. A case of multicentric synchronous osteosarcoma treated with a vascularized tibia graft from an amputated limb.

    A 10-year-old girl with synchronous lesions of osteosarcoma in the left proximal tibia and in the right distal radius but with no lung metastasis was treated by an innovative procedure. After an above-knee amputation and a wide excision of the distal halves of the radius and ulna, the skeletal defect of the forearm was replaced by the distal tibia harvested from the amputated leg using the microsurgical technique of revascularization. The result was encouraging up to the point of her death due to other, widespread lesions.
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ranking = 6
keywords = tibia
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15/18. Adjuvant interferon treatment and the late development of cerebral metastases in a patient with osteosarcoma.

    A consecutive series of patients with osteocarcoma have been receiving adjuvant interferon therapy at the Karolinska Hospital in Stockholm. We report here a case of tibial chondroblastic Grade III osteosarcoma, a boy aged 17 years, who received interferon therapy for 15 months and survived more than 5 years. The first sign of tumour spread was multiple cerebral metaseases--an observation suggesting an antitumour effect of human leucocyte interferon on osteosarcoma.
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ranking = 1
keywords = tibia
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16/18. Multiple malignant fibrous histiocytoma of bone. A case report.

    A 27-year-old man had tumors in both the femoral and the tibial metaphyses of the left knee. Although histological examination of the biopsy specimens revealed different findings in the 2 lesions, the final diagnosis was malignant fibrous histiocytoma in both.
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ranking = 1
keywords = tibia
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17/18. Scintigraphic "doughnut sign" on skeletal imaging due to a hemangioendothelioma of bone.

    A 61-yr-old patient was referred to our hospital for investigation of pain and tenderness in his left lower limb. Bone scan revealed multiple lesions of tibia and foot, several of which appeared as doughnut-like lesions and corresponded to lytic abnormalities on radiographs. Pathologic examination revealed multiple epithelioid hemangioendothelioma of bone.
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ranking = 1
keywords = tibia
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18/18. Synchronous multifocal bone sarcomas--a case report and molecular pathologic investigation.

    A case of a 54-year-old woman is described who developed synchronously two malignant bone tumors: a dedifferentiated chondrosarcoma in the olecranon and a malignant fibrous histiocytoma (MFH) in the lower tibia. The anaplastic part of the dedifferentiated chondrosarcoma revealed an MFH-like pattern. Myogenous differentiations were not observed in the anaplastic sarcoma cells. The MFH in the tibia showed a storiform-pleomorphic pattern. Single tumor cells showed positivity for M-actin and desmin pointing to myogenous differentiation. dna-cytophotometry of the dedifferentiated chondrosarcoma showed an aneuploid stem cell line. The MFH in the tibia did not reveal aneuploid stem cells. Staining for p53 protein was negative in both tumors. SSCP analysis and sequencing of the p53 gene in both tumors revealed in the dedifferentiated chondrosarcoma a mutation in exon-8 with the transversion from G to T in codon 294 resulting in a substitution of a stop codon for GLU. The mutation was not observed in the MFH. From these immunohistologic, dna-cytometric and molecular biologic investigations, we consider it probable that the tumor in the lower tibia is a second highly malignant bone tumor and not the metastasis of the dedifferentiated portion of the dedifferentiated chondrosarcoma in the olecranon.
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ranking = 4
keywords = tibia
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