Primary synovial chondromatosis is a relatively uncommon condition. Synovial chondrosarcoma is considered to be very rare and it is not always clear whether the sarcoma develops by malignant ...transformation of synovial chondromatosis or whether it arises de novo. Differentiation of the two conditions on clinical and radiographic features is not possible and on histological criteria can be difficult. We report the case of a 59-year-old man who, 4 years after a synovectomy for synovial chondromatosis, developed a synovial chondrosarcoma of the hip. The literature is reviewed.
We performed a histological examination and DNA analysis on samples of tissue from a forty-seven-year-old woman who had a clinical diagnosis of pigmented villonodular synovitis. The histological ...examination confirmed the diagnosis. The evaluation of the samples of tissue with preferential X-chromosome inactivation analysis (a molecular biological method for the study of clonality in tumors) showed that the lesion was polyclonal in origin. We concluded, therefore, that pigmented villonodular synovitis is more likely to be a reactive process than a true neoplasm.
Differentiation between benign fibrous dysplasia and malignant adamantinoma of the tibia is challenging because of the impact the diagnosis has on the choice of treatment (none or extensive surgery). ...The histologic and pathologic similarities of the lesions and the controversial relationship between fibrous dysplasia, osteofibrous dysplasia, and adamantinoma complicate the matter. We found a large overlap of histologic features in lesions considered either fibrous dysplasia or osteofibrous dysplasia on the basis of the radiologic findings. The purpose of this study was to determine the value of the plain radiograph of the lower leg in combination with clinical findings to differentiate the benign from the malignant condition. The clinical symptoms, radiographs, and histologic slides of 46 patients with fibrous dysplasia and 22 with adamantinoma in the tibia were reviewed retrospectively. In only one of 12 patients with radiologic or histologic characteristics of osteofibrous dysplasia were both radiologic and histologic criteria for the diagnosis present. A linear discriminant analysis was performed on six clinical (age, spontaneous pain, pain after trauma, swelling only, pain and swelling, and bowing deformity) and 25 radiologic signs. Fibrous dysplasia and its variant osteofibrous dysplasia could be identified correctly in 87% (40 of 46 patients) and adamantinoma in 95% (21 of 22 patients) by using the patient's age and four radiologic signs. When results from the discriminant analysis of a randomized subgroup of patients (32) were used on the other subgroup (36 patients), fibrous dysplasia was correctly identified in 84% (21 of 25) and adamantinoma in 82% (nine of 11). Fibrous dysplasia is more prevalent than adamantinoma in a young patient, when radiographs show a ground-glass appearance and anterior bowing and when there is no multilayered periosteal reaction and moth-eaten destruction. When radiologic signs and the patient's age are combined, fibrous dysplasia and adamantinoma can be discriminated in a high percentage of patients.
Enchondroma is the most common primary benign bone tumor of the hand, especially the phalanges, whereas chondrosarcoma is uncommon at this site. Although phalangeal chondrosarcoma may have ominous ...histologic features, its biologic behavior is relatively indolent.
Thirty-five cases of phalangeal lesions previously diagnosed as chondrosarcoma were studied. Histologic and tumor-biologic parameters (Ki-67 and p53 immunohistochemistry) were investigated and correlated with clinical behavior.
All cases were characterized by unequivocal malignant histologic features (Grade 2 or higher) or Grade 1 malignant histologic features combined with the presence of cortical destruction and soft tissue extension. The median age of the patients at the time of diagnosis was 67 years (range 21-87 years), with a slight female predominance. Occurrence in the hand was more common than in the foot, with the proximal phalanx affected most often. Treatment varied from local therapy (curettage or local excision) in 16 patients to amputation or exarticulation in 19 cases. Follow-up ranged from 8-432 months for 28 patients. Ten of 15 tumors treated by local therapy recurred whereas none of 13 tumors treated by radical surgery recurred. The median survival was 20.8 years; none of 28 patients developed metastases nor died of disease. Both the type of treatment and localization in the proximal phalanx were associated independently with local recurrence.
Phalangeal chondrosarcoma behaves as a locally aggressive lesion and, in contrast to chondrosarcomas located elsewhere, rarely metastasizes. Treatment is indicated only because of its locally destructive growth. The authors believe that given the excellent survival data, curettage with adequate follow-up should be considered as the treatment of choice if technically feasible, especially in those cases in which amputation would lead to a significant loss of hand function.
Desmoplastic fibroma is a rare benign primary bone tumor, histologically identical to the extra-abdominal desmoid tumor of soft tissues. The incidence in major series of bone tumors is 0.1%-0.3%. In ...the present study 18 cases from the files of the Netherlands Committee on Bone Tumors are reported, with an emphasis on the radiographic features. Eight female and ten male subjects were affected, with a fairly even age distribution from the second to the seventh decade of life. The most frequent sites of involvement were the femur and the pelvis. Radiographically the lesions nearly always demonstrated benign features with respect to pattern of destruction, margins, and reactive bone formation; however, soft tissue extension was sometimes present. Although desmoplastic fibroma usually presents with pain or swelling, in 5 of the 18 cases the existence of the lesion was an accidental finding, and in 2 cases the patient had long-standing, vague complaints of pain. Though overall benign radiographic features may support the final diagnosis, the main and often troublesome histological differential diagnosis is of a low-grade fibrosoma. En bloc resection is the treatment of choice in view of the high incidence of recurrence after curettage.
Mesenchymoma of bone. A case report Reijnierse, M; Kroon, H M; Van der Heul, R O ...
Journal of bone and joint surgery. American volume
75, Številka:
1
Journal Article
Thirty-one cases of aneurysmal bone cyst of the spine with a minimum follow-up of 1 year as registered by the Netherlands Committee for Bone Tumors are reported. Aneurysmal bone cyst is a benign, ...sometimes expansive and destructive, lesion frequently occurring between the ages of 10 and 20 years. Located in the vertebral column, it undermines the structural integrity of the spine, and neurologic complications can occur. In all cases the posterior elements were involved, with extension into the vertebral body occurring in 22 cases. Extension to adjacent vertebra occurred 5 times, but the intervertebral disc appeared to be left intact. Twenty-nine of 31 cases were treated surgically. Posterior approaches provided insufficient access to lesions also located to the vertebral body and were associated with a higher recurrence rate (5 of 18 cases) than anterior approaches (1 of 11 cases). Of 10 cases in which the surgical removal was incomplete, 4 healed and 6 had a local recurrence. Selective embolization was used twice, and its application is discussed. On the basis of this material and a review of the literature, treatment by intralesional curettage combined by adjuvant therapy such as preoperative embolization is advised.
The evolution of crushed cartilage grafts in a growing nasal septum of young rabbits was histologically investigated. Crushing leads to necrosis of the greater part of the graft. The characteristic ...distribution of surviving cells in isolated areas at the surface of the graft reflects different mechanical properties of the centrally and peripherally located cartilage. The necrotic parts are eliminated and replaced by new cartilage formed by surviving chondrocytes or perichondrium. The result is a complex structure composed of two types of cartilage and of fibrous tissue without any distinct organization, but nevertheless capable of growth. However, it lacks strength to transform growth into adequate lengthening of the septum. Subsequently, this will lead to the development of multiple deviations. It is concluded that crushed cartilage is no suitable implant for the reconstruction of parts of the septum which are essential in supporting the outgrowth of the nose.
The cartilaginous nasal septum of the child is often involved in trauma or congenital deformation. In perspective of its role in postnatal growth of the midface, the wound healing of septal cartilage ...in reaction to various surgical procedures was studied in young rabbits. It was concluded that (1) elevation of mucoperichondrium does not induce significant histologic reactions in the septal cartilage and (2) the wound reaction of cut edges includes only a +/- 0.8-mm-deep zone and lasts no longer than 2 weeks, resulting in a stump, encapsulated by fibrous tissue. Reconnection of separated parts occurs 2 weeks after surgery, mostly by merging of the perichondrial layers. Reimplantation of resected cartilage does not lead to normalisation of septal growth. This is not caused by extensive necrosis, loss of morphological organisation or decreased growth potential of the reimplanted cartilage. The essential factor seems to be dislocation (duplication, angulation) of the implant versus the non-mobilised parts of the septum preventing the growth of the implant to contribute fully to the lengthening of the total septum.
PDF
