F. Bertoni

Malignant fibrous histiocytoma of bone the experience at the Rizzoli Institute: Report of 90 cases

Ninety cases of malignant fibrous histiocytoma (MFH) of bone are reported. An analysis is presented with regard to sex, age, site, symptoms, radiography, macroscopic, and microscopic features. The staging was assessed according to the following classification: I B 3 cases; II A 11 cases; II B 66 cases; III: 10 cases. Among nonmetastatic patients, 68 had surgical treatment (adequate, 46; inadequate, 22); 8 had radiotherapy, and 3 refused any treatment. Among surgically treated patients, 20 had adjuvant chemotherapy, also. Follow‐up information was obtained in all cases. Overall survival rates were 34% at 5 years, and 28% at 10 years. Surgery alone did not appear to be successful (5‐year survival, 28%). Adjuvant chemotherapy improved the survival rate only in patients who underwent adequate surgery (5‐year survival, 57%). The recurrence rate after surgical treatment was high (31%) with significant differences after inadequate (64%), wide (19%), or radical (6.5%) surgical treatment. Adjuvant chemotherapy was ineffective in preventing local recurreace. Radiation therapy effected a clinical cure in three cases; the authors believe that radiation therapy has to be used only in inoperable tumors.

Solid variant of aneurysmal bone cyst

Background and Methods. Of the 200 cases of ABC in the Rizzoli Institute files, 15 had solid features on both gross and histologic examination. Inasmuch as fibrous proliferation with giant cell and bone production along with fibromyxoid areas and small aneurysmal spaces were found in the solid parts of the aneurysmal bone cyst, a grossly solid and radiographically osteolytic bone lesion with these microscopic features was called a solid aneurysmal bone cyst. Some authors call the same lesion extragnathic giant cell reparative granuloma.

Osteosarcoma : low-grade intraosseous-type osteosarcoma, histologically resembling parosteal osteosarcoma, fibrous dysplasia, and desmoplastic fibroma

Background. Low‐grade intraosseous osteosarcoma is a rare variety of osteosarcoma and it is difficult to recognize.

The correlation between the radiologic staging studies and histopathologic findings in aggressive stage 3 giant cell tumor of bone.

The histologic features of aggressive Stage 3 benign giant cell tumor of bone were correlated with their radiologic staging studies. Our series includes 24 patients treated at the University of Florida, Department of Orthopaedic Oncology, from January 1979 to July 1983. Particularly in 13 cases, results of routine specimen histologic as well as of the histologic study of macrosections containing the entire resected specimen (the tumor and surrounding bone and soft tissue) were evaluated. Surgical staging studies including plain radiographs, bone scintigrams, computerized axial tomography scans, tomography, and angiography were used to delineate the anatomic location of the lesion. Within this group of giant cell tumors, the general histologic features resemble those of the classic giant cell tumor. However, certain aggressive features best demonstrated on the macrosections, such as cortical and subchondral invasion, capsular and reactive bony zone iniltration, “digital extension” of the tumor, and neovascularity correlated well with the anatomic localization and aggressiveness found on the staging studies. Those findings emphasize the value of staging studies in the delineation of the histologic potential of these benign aggressive lesions.

Clear cell chondrosarcoma of bone - A report of 8 cases

We report 8 cases of clear cell chondrosarcoma from 350 cases of chondrosarcoma (2.2%) seen at Istituto Rizzoli. The lesion is always low grade in nature and occurs in an epiphyseal location, usually in the proximal femur or humerus. This relatively inaccessible location may hinder the exact diagnosis. Wide resection is the treatment of choice, although 3 of our patients underwent intralesional or marginal procedures. At present all patients are free of disease. However, a longer follow-up is essential because of the slow-growing nature of this sarcoma.

The istituto Rizzoli experience with small cell osteosarcoma

Osteosarcoma has been divided into numerous varieties based on clinical, radiographic, and histologic characteristics. Small cell osteosarcoma is a distinct subtype with a histologic appearance in which the bulk of the lesion is composed of round malignant cells with minimal areas of spindle cells. Osteoid production is always present. The lesion may mimic Ewings tumor and other lesions in which round cells are seen. We report the clinical, radiologic, and pathologic features of this tumor, as well as the clinical outcome and response to therapy. Cancer 64:2591–2599, 1989.

Dedifferentiated peripheral chondrosarcomas

Peripheral dedifferentiated chondrosarcoma (CS) is an exceedingly rare variant of the highly malignant entity of dedifferentiated chondrosarcoma. Only five such cases have previously been reported. Seven cases are analyzed and evaluated for the presentation and natural history of this highly malignant lesion when it arises in a tumor that was previously an osteochondroma. Both peripheral and central dedifferentiated chondrosarcomas are high‐grade malignant lesions and require wide or radical surgical margins for adequate treatment. Despite adequate resection, survival is poor; five of the seven cases presented herein died of metastatic spread of their disease. These cases of the peripheral variant of dedifferentiated chondrosarcoma occurred in patients who were younger than patients with central dedifferentiated chondrosarcomas and may be present with longer duration of symptoms because they occur in previously long‐standing benign osteochondromas. As such, they may be easily overlooked clinically and radiographically. Therefore, careful histologic analysis of all cartilage lesions arising on the surface of bone is essential to prevent overlooking foci of high‐grade sarcomatous dedifferentiation.

Case report 348

This 54-year-old man complained of pain in his right knee for four years. Physical examination initially demonstrated a moderate effusion on the anterior aspect of the knee. No discrete mass could 9 be palpate& Radiological studies performed at the time of the appearance of the symptoms initially disclosed swelling of the knee with no bony abnormalities or identifiable soft tissue mass. Five months prior to admission to the hospital, a lytic lesion was identified radiologically in the proximal portion of the right tibia (Fig. 1). Five months later

Scintigraphy of Aggressive Fibromatosis

Thirteen patients with aggressive fibromatosis underwent skeletal scintigraphy and computed tomography as part of their preoperative staging. Bone involvement was visible on plain radiographs of three patients. For the other 10 patients, the presence or absence of bone involvement was shown best by computed tomography (CT) in five instances, and best by scintigraphy only once. The two studies were equally useful four times. Although skeletal scintigraphy has previously been found to be very accurate for the evaluation of bone involvement by soft tissue sarcomas, it was less useful in these patients with aggressive fibromatosis.