Joji Miyawaki

Mesenchymal chondrosarcoma treated with total en bloc spondylectomy for 2 consecutive lumbar vertebrae resulted in continuous disease-free survival for more than 5 years: case report.

Study Design. A case report of an extremely rare malignant spinal tumor successfully treated with total en bloc spondylectomy and chemotherapy. Objective. To describe points for consideration when an osteogenic lesion in the spine is diagnosed and treated. Summary of Background Data. Primary mesenchymal chondrosarcoma in the spine is extremely rare. There were no reports of this tumor being treated with spondylectomy to achieve total surgical resection with a wide margin followed by chemotherapy. Methods. A 44-year-old female presented with low back pain and left flank pain. Magnetic resonance imaging and computerized tomography showed an osteosclerotic tumor of the lumbar vertebrae. Tc-99m HMDP bone scintigraphy was positive, but thallium-201 scintigraphy and gallium scintigraphy were negative. The patient was diagnosed as having chondrosarcoma based on biopsy findings. Results. To resect the tumor completely, total en bloc spondylectomy for 2 consecutive lumbar vertebrae was performed. However, the postoperative pathologic diagnosis was extremely difficult because the patient was initially suspected to have osteosarcoma, but the final diagnosis was mesenchymal chondrosarcoma. Five years after surgery, there have not been any signs of local recurrence or distant metastasis, and the patient has remained continuously disease free. Conclusions. To our knowledge, we reported the first case of mesenchymal chondrosarcoma occurring from the lumbar spine treated with total en bloc spondylectomy and chemotherapy. Successful radical resection of the tumor could be accomplished. Although the effect of chemotherapy on the final results could not be clearly determined, considering that at least continuous disease-free survival was achieved, it is highly likely that chemotherapy contributed to the favorable results.

Ketoprofen in topical formulation decreases the matrix metalloproteinase-2 expression and pulmonary metastatic incidence in nude mice with osteosarcoma

The aim of this study was to investigate whether ketoprofen (KP) in topical formulation affected the tumor growth and pulmonary metastasis of LM8 cells, which were inoculated subcutaneously into the back space of male nude mice. At 7 days after inoculation, the tumor was treated topically for 3 weeks with either a KP‐containing patch (KP group) or a placebo‐containing patch (placebo group). The pulmonary metastatic incidence was 100% in the placebo group and 60% in the KP group. The tumor mass of the KP group without pulmonary metastasis, termed the KP/metastasis(−) group, was smaller than that of the placebo group. Immunohistochemical staining for proliferating cell nuclear antigen (PCNA), terminal deoxynucleotidyl transferase‐mediated dUTP nick‐end labeling (TUNEL), matrix metalloproteinase‐2 (MMP‐2), and vascular endothelial growth factor (VEGF) was performed. The tumors of the KP/metastasis(−) group contained fewer PCNA‐positive cells and many more TUNEL‐positive cells in comparison to the placebo group. In the placebo group, MMP‐2 and VEGF were extensively expressed within the tumor, whereas in the KP/metastasis(−) group the expression of these two proteins was very low. In conclusion, the topical treatment of osteosarcoma with KP decreased the expression of MMP‐2 and VEGF, thus resulting in the suppression of tumor growth and pulmonary metastasis.

Perinatal and postnatal exposure to 4-tert-octylphenol inhibits cortical bone growth in width at the diaphysis in female mice.

The aim of this study was to investigate the effects of 4-tert-octylphenol (OP) on bone growth in vivo. Pregnant mice were exposed to drinking water containing either 1microg/ml OP (LD group) or 10microg/ml OP (HD group) from gestational day 10 and throughout the lactation period. After weaning, the pups were allowed free access to drinking water containing the appropriate OP concentrations. The serum osteocalcin level of the females, but not the males, was significantly lower in the LD and HD groups than in the control group on postnatal day 31. The femurs of the females were analyzed by peripheral quantitative computed tomography and immunohistochemistry for alkaline phosphatase (ALP) was performed in the sections of the formalin-fixed femurs. The periosteal and endosteal circumferences of the cortical bone at the diaphysis were significantly smaller in the LD group, but not the HD group, than in the control group (4% and 6% smaller, respectively), while there were no differences in the cortical bone density, cortical bone area, or cortical thickness among the three groups. There were fewer ALP-positive cells on the periosteal surfaces at the diaphysis in the LD group than in the control group. The values of the strength strain index (xSSI, ySSI, and pSSI) decreased with decreasing the periosteal circumference. In conclusion, the exposure of female mice to OP during the perinatal and postnatal periods inhibited the periosteal bone formation in the cortical bone at the diaphysis of the femur, thereby causing a reduction in bone growth in width.

Mycetoma of foot: a rare case report and review of the literature.

Mycetoma is a chronic infectious disease caused by Actinomycetes, Nocardia, Madurello, Exophiala and Scedosporium, in which a granuloma with draining lesions occur in the foot. It is frequently found in tropical or subtropical regions where people walk barefoot.10,12,25 We report a case of mycetoma in which the patient had never been abroad and whose route of infection was unknown. It was difficult to differentiate from a musculoskeletal tumor.

Preoperative Planning and Operative Techniques of the Shorter Tapered Stem Compared to the Metaphyseal Fit Stem in Cementless Total Hip Arthroplasty

BACKGROUND In order to prevent postoperative dislocation due to prosthetic impingement as a result of total hip arthroplasty (THA), the combined anteversion (CA) theory, which combines the anteversion of the femoral stem and the acetabular socket, has been revised in recent years. Particularly, it is necessary to keep CA within the target zone. METHODS The aim of this study was to investigate whether postoperative CA can be kept within the target zone while using the operative technique which prepares the socket first in cementless THA, by estimating the anteversion of the metaphyseal fit stem or the shorter, tapered wedge stem using preoperative 3-dimensional computerized planning, and by adjusting the anteversion of the socket using a navigation system that considers CA. One hundred fourteen patients (118 hips) were recruited for the study. RESULTS Postoperative CA in THA using the metaphyseal fit stem was kept within the target zone for 56 of the 60 hips (93.3%). Using the shorter, tapered wedge stem, 49 of the 58 hips (84.4%) were within the target zone. No postoperative dislocations were observed in any hips. CONCLUSION We found that the metaphyseal fit stem worked better than the shorter, tapered wedge stem in terms of meeting the planned CA. The shorter, tapered wedge stems were flexible in rotation according to the anatomical configuration of the proximal femur. Therefore, the stem could be placed second with the metaphyseal fit stem, but we recommend placing the stem first with the shorter, tapered wedge stem.

Risk factors for neurological complications after operative treatment for schwannomas

Schwannoma is a common benign soft tissue tumor. Although schwannomas can be theoretically enucleated without nerve damage, neurological complications occasionally develop following enucleation. The aim of this study was to elucidate the incidence of and risk factors for postoperative neurological complications following schwannoma enucleation. Ninety-eight schwannomas from 95 patients that were treated by surgical excision between January 2003 and December 2014 were included in this retrospective case series study. Patients were 49 men and 46 women with a median age of 60.5years (range, 22-87years). The incidence of postoperative neurological complications was evaluated in all the patients, and characteristics, such as age, tumor size, sex, preoperative symptoms, MRI findings, tumor location, and the nerve of origin, were compared between the cases with or without complications at the last follow-up. In our study population, postoperative neurological complications were observed in 18.4% of the cases. In univariate analysis, preoperative sensory disturbance, tumor location, and the nerve of origin were associated with the incidence of postoperative neurological complications (p<0.001, p=0.034, and p=0.003, respectively). In multivariate analysis, tumors showing preoperative sensory disturbance and tumors located in the proximal aspect of the limbs were identified as independent risk factors for postoperative neurological complications (p<0.001 and p=0.014, respectively). A certain percentage of schwannoma cases undergoing enucleation would show postoperative neurological complications. Therefore, patients with schwannoma, in particular, those with risk factors for postoperative neurological complications, should be informed regarding the possibility of postoperative complications. In cases of schwannoma enucleation, the procedure should be meticulously performed to minimize the damage to the affected nerve of origin.

A case of nodular-type muscular sarcoidosis: findings of imaging, histopathology, and polymerase chain reaction

We report a case of nodular-type muscular sarcoidosis with no systemic symptoms. Thallium-201 scintigraphy showed intense uptake in the muscular lesion mimicking malignant soft tissue tumor. Magnetic resonance imaging (MRI) demonstrated characteristic signal patterns of peripheral high intensity with central low intensity (“three stripes” pattern). Microscopy revealed sarcoid granuloma with typical histopathological characteristics. Propionibacterium acnes was detected on polymerase chain reaction analysis of the excised tissue.

PLASMA LEVELS OF THE COAGULATION FACTOR XIII IN PATIENTS WITH BONE TUMORS

It is well known that the coagulation factor XIII (FXIII) is deeply involved in wound healing and tissue regeneration. We measured the plasma levels of FXIII (FXIII levels) before and after surgery in 80 patients with bone tumors [benign tumors in 30 patients (BT group), malignant tumors in 30 patients (MT group), and carcinoma metastasis in 20 patients (CM group)] and in the control group which consisted of 30 patients with osteoarthritis of the hip joint who had underwent total hip arthroplasty (THA). The numbers of patients whose preoperative FXIII level was below the lower limit of normal were as follows: 0 (0%) among 30 patients in the control group; 7 (23%) among 30 patients in the BT group; 12 (40%) among 30 patients in the MT group; and 9 (45%) among 20 patients in the CM group. Among patients with bone tumors examined in this study, patients with osteosarcoma who underwent chemotherapy showed a significant decrease in FXIII levels (p < 0.01). We indicated not only FXIII levels in patients with bone tumors, but also the natural time-course of FXIII levels in patients who underwent orthpaedic surgery of THA at the first time.