Hideki Hamada

Multivariate analysis for clinical prognostic factors in 163 patients with soft tissue sarcoma

Clinical and histologic findings in 163 patients with localized soft tissue sarcoma (STS) in the extremities and trunk were reviewed. There were 91 male patients and 72 female patients ranging in age from 2 to 84 years (median, 46 years). The histologic status of the tumors was as follows: low grade, 29 cases; intermediate grade, 52 cases; and high grade, 82 cases. The primary tumors were treated by intralesional excision (two cases), marginal (88), wide local (52), or amputation (21). Subsequent adjuvant therapy was given to 61 patients; 17 had radiotherapy (RT), 27 had chemotherapy (CH), and 17 had combined RT and CH. The overall survival (P < 0.1) and disease‐free survival (P < 0.001) were better in the group that received multimodal treatment (radical surgery and adjuvant chemotherapy with or without radiotherapy) than in the group treated only by surgery. This suggests the favorable role of adjuvant therapy. The univariate and the Cox multivariate analysis for prognosis revealed that sex, tumor‐related symptoms, tumor size, tumor depth, and histologic grade were the significant factors. Among the treatment schemes, adjuvant chemotherapy was the only one that affected survival, especially for the intermediate‐grade tumors. Initial surgical treatment (marginal versus wide local excision) significantly contributed to the local control of the primary tumors.

Clinical significance of bone morphogenetic activity in osteosarcoma. A study of 20 cases.

Bone morphogenetic activity of osteosarcomas from 20 patients was assayed. The activity was demonstrated as ectopic bone formation on implantation of a lyophilized fraction of the tumor into athymic nude mice in 8 of 20 cases. Osteosarcomas producing bone morphogenetic protein (BMP) differed in clinical features from those not producing BMP. They were characterized radiologically by perpendicular spicules, histologically by osteoblastic type cells, and clinically by an increased serum alkaline phosphatase level, relative resistance to preoperative chemotherapy with Adriamycin (doxorubicin) plus high‐dose methotrexate, and a tendency to metastasize to other bones and the lungs. Cancer 56: 1682‐1687, 1985.

Extradural spinal angiolipoma: Report of a case studied with MRI

The current report describes a case of extradural angiolipoma with spinal cord compression that was studied by magnetic resonance imaging. In considering the strategy for the surgical management, it is desirable to determine the histologic type of spinal cord tumors before the operation. The literature of spinal angiolipoma is reviewed, and the possibility of using magnetic resonance imaging to define the histologic type of spinal cord tumors before operation is discussed.

Uptake and localization of99mTc-methylene diphosphonate in mouse osteosarcoma

The localization of99mTc-methylene diphosphonate (99mTc-MDP) in mouse osteosarcoma was studied using a skeletal scintigraphic method and macro- and microautoradiographic methods. On the skeletal scintigraph, the tumor showed a high uptake of99mTc-DMP and its concentration was about 20 times as high as the value seen in the muscular tissue. The macroautoradiography showed high activity in the tumor bone region and little activity in the nonossified region. On the microautoradiography, the activity of99mTc-MDP was localized in the mineralized matrix of tumor bone and was almost nil in the nonmineralized matrix (osteoid) and the tumor cells. These findings indicate that the mineralization of the tumor bone matrix plays an important role in99mTc-MDP uptake in osteosarcoma.

MONOPHASIC AND BIPHASIC SYNOVIAL SARCOMA

Seven cases of synovial sarcoma (SS), two with biphasic and five with monophasic histology, were studied immunohistochemically using monoclonal antibodies to intermediate filaments, keratin, and vlmentin. Slender spindle cells and plump cells were constant components of all the tumors. Epithelioid cells were present only in biphasic SS. Epithelioid cells and plump cells were positively stained by both keratin and vimentin. Slender spindle cells were stained positive for vlmentin and negative for keratin. Staining manner of each cell type was similar irrespective of monophasic or biphasic pattern. Present immunohistochemical studies suggested that monophasic or biphasic patterns in SS should be regarded as a different expression of the same disease. In addition, immunohistochemistry proved to be a useful tool to detect plump cells which were difficult to find on routine staining.

Surgical Treatment of Bone Tumors Arising from Pelvic Ring

Six patients with periacetabular pelvic tumors were treated with a new type of constrained total hip replacement without reconstruction of pelvic continuity later wide resection. Five of six patients were able to walk with the supporting aids without pain after a follow-up of 6 months to 3 years. There was one local recurrence and one metastasis. No prosthetic failure and symptomatic loosening were found. Pelvic tumors away from the acetabulum were resected with wide margins and had no local recurrence. They had almost normal function. In sacral tumors (11 cases), there were two local recurrences and two deep infections. The preservation of the S2 nerve root appears to be adequate for normal control bladder and bowel functions. Moreover, stability of the spinal column can be obtained with complete preservation of the body of the S1 vertebra.

Desmoplastic fibroma of the axis. A case report.

Desmoplastic fibroma of the bone appears in a wide variety of bones but rarely involves the spine. A 24-year-old male with desmoplastic fibroma of the axis treated by complete resection and posterior spinal fusion is reported. There was no recurrence of the tumor three years after surgery. Complete resection and reconstructive surgery for spinal instability are recommended for this benign spinal tumor.

Replacement by Ceramic Prostheses for the Treatment of Malignant and Benign Aggressive Bone Tumors

Originally, the investigators of limb-salvage operations were mainly concerned with postoperative function. This objective has been realized not only by the progress of prosthetic design, but by the various efforts intended to minimize the resection area [1–5]. The next concern concentrated on two goals: to extend the yardsticks for the indication of the prosthetic replacement for the growing, younger patients and to improve the design of the prosthesis for long-term application, because most of the patients who undergo this type of operation are relatively young. In addition, the loss of bone stock around the prosthesis after longterm use would make any revision surgery more difficult. Several kinds of extending prostheses and temporary resection-arthrodesis were attempted for attaining the first goal [6–9]. Operations employing prostheses with porous-coated stems and anti-micromotion blades, prostheses with porous-coated segments for bone grafts and cement-fixed stems, long-stem prostheses with allografted segments, and ceramic prostheses were performed for achieving the second objective [10–18]. On the other hand, allograft, reimplantation of affected bone with both extracorporeal and intracorporeal irradiation were also carried out because these bones can be permanently used if they could be revascularized and reconstructed with normal bone tissue [19–22]. These methods have another advantage in that they preserve joint cartilage and the attachment of muscle or ligament because these tissues are more resistant against irradiation. However, these methods bear the problem of a high rate of complications, such as infection, fracture, or necrosis [23].

A Limb-Saving Operation for Cases with Malignant Pelvic Bone Tumors

At present, primary malignant tumors involving the pelvic bone are treated with hemipelvectomy. However, a limb-saving operation should theoretically obtain the same surgical margin in tumor resection as that of a hemipelvectomy (Fig. 1). Based on this functional consideration, limb-saving operations have been performed on selected patients. In this paper, we describe the methods of resection and reconstruction, and the functional results in limb-saving operations of primary malignant pelvic tumors.

Preoperative Chemotherapy for the Treatment of Osteosarcoma

At present, preoperative chemotherapy preceding limb-salvage surgery, is indispensable therapy for patients with osteosarcoma, in addition to being the most important prognostic factor. The aims of preoperative chemotherapy are (1) to control micrometastasis, (2) to control the primary tumor, and (3) to assess the effectiveness of the drugs used by grading of primary tumor necrosis.