Jun Nishida

Osteosarcomas after the age of 50: a clinicopathologic study of 64 cases--an experience in northern Japan.

Background: The clinicopathologic profile and prognostic factors of osteosarcomas after the age of 50 years have been obscure.Methods: Clinicopathologic features were analyzed in 645 patients with osteosarcoma who were registered at the Tohoku Musculoskeletal Tumor Society and National Cancer Center in Tokyo between 1972 and 2002.Results: Sixty-four patients (9.9%; 34 men and 30 women) were more than 50 years old. The most common location was the distal femur (n = 13), followed by the pelvis (n = 10), proximal femur (n = 9), and proximal fibula (n = 6). Seven (11%) patients had lung metastasis at initial presentation. On radiographs, an osteolytic appearance without periosteal reactions was a common and characteristic feature. Forty-eight tumors (75%) were classified as conventional osteosarcomas. Fourteen cases (22%) were secondary; postradiation osteosarcoma was most common in these patients, but there was no Paget’s sarcoma. At the initial presentation, misdiagnoses without biopsy were made in 15 (23%) of the 64 cases. Preoperative chemotherapy was given to 22 patients, but the effect was poor in 18 cases (82%). Fifty-four patients underwent surgery, whereas the other 10 patients were treated without surgery because of systemic or inoperable local conditions. The overall survival rate at 5 years was 55.5%. Multivariate analysis showed initial pulmonary metastasis, axial tumor location, and larger tumors as significant prognostic factors.Conclusions: In northern Japan, most patients with osteosarcoma after the age of 50 had primary osteosarcoma. Careful radiological examination and biopsy are mandatory for correct diagnosis. Current systemic chemotherapy is not effective for this age group. Alternative treatment strategies should be considered.

Solid variant of aneurysmal bone cyst of the cervical spine.

Study Design. A case of the solid variant of aneurysmal bone cyst affecting the posterior component of the fourth cervical vertebra is reported. Imaging studies showed an expansile destructive lesion. After curettage, autologous iliac bone grafting with posterior fusion was performed. There was no sign of local recurrence 2 years after surgery. Objectives. To emphasize the occurrence of the solid variant of aneurysmal bone cyst in the cervical spine. Summary of Background Data. The solid variant of aneurysmal bone cyst is rare, and only 12 cases occurring in the vertebrae, including 3 in the cervical vertebrae, have been reported. The condition is difficult to diagnose radiologically before biopsy or surgery. Methods. A 9-year-old girl presented with pain in the nape of the neck without any neurologic deficit. She was found to have the solid variant of aneurysmal bone cyst in the posterior component of the fourth cervical vertebra, which had destroyed the lamina and spinous process. Part of the posterior aspect of the C4 vertebral body was also involved. Curettage of the lesion was performed, and the defect in the posterior component of the vertebra was reconstructed using an autologous iliac bone graft with posterior fusion using a halo vest. Results. Magnetic resonance imaging disclosed a homogeneous low intensity mass at the lamina, spinous process, and vertebral body of C4 on T1-weighted images. The mass showed heterogeneous high signal intensity on Gd-enhanced images. Histologically, the resected specimen showed predominant fibroblastic proliferation, with minor foci of reactive osteoid formation and an area of osteoclast-like giant cells. Neither cellular atypia nor mitotic figures were evident. There was no sign of local recurrence 2 years after surgery. Conclusions. The solid variant of aneurysmal bone cyst should be included in the differential diagnosis of any lytic expansile lesion of the spine, even though it is a destructive lesion. Gd-enhanced magnetic resonance imaging may be helpful for distinguishing the solid variantfrom conventional aneurysmal bone cyst.

A low-grade extraskeletal osteosarcoma.

Abstract. The case of a 35-year-old woman with low-grade extraskeletal osteosarcoma of the left leg is presented. Radiographs showed peripheral ossification of the lesion, suggesting myositis ossificans. Most of the tumor was composed of cartilage, and the cellularity and cell atypia of the proliferating chondrocytes were mild to moderate. In the periphery, bone formation with a relatively clear margin and proliferation of spindle cells with minimal nuclear atypia were observed. The average percentage of cells positive for MIB-1 was 9.0%. A diagnosis of low-grade extraskeletal osteosarcoma was made on the basis of these histologic findings. The clinical course 47xa0months after a wide excision was uneventful.

Vascularized iliac bone graft for iliosacral bone defect after tumor excision

We present the clinical outcome of five patients who had reconstruction of large osseous defects in the iliosacral region after excision of aggressive bone tumors using pedicled-or free-vascularized iliac bone grafts. Surgical margin, incidence of recurrence and metastasis, patient survival, time to bone union, and postoperative function were evaluated. Limb-salvage surgery resulted in wide excisions in two patients with giant-cell tumors of bone and chordoma, respectively, a marginal excision in one patient with a schwannoma, and intralesional excisions to preserve nerve roots in two patients with giant-cell tumors. There was no recurrence at final followup in any of the patients. Bone union required an average of 5.4 months. The postoperative functional results were excellent in all patients except for the patient with a chordoma. In one of the patients with a giant-cell tumor, the screws and rod were removed partially because of skin necrosis in the instrumentation area. This technique is considered a good alternative for reconstruction of a large osseous defect in the pelvis because graft harvest is relatively simple and rapid, especially if a pedicled iliac bone transfer is performed.Level of Evidence: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Leiomyosarcoma of the lumbar spine: case report.

Study Design. A primary leiomyosarcoma in the L2 vertebral body without any neurologic deficit is reported. The radiologic diagnosis was a metastasis, and the histologic diagnosis was confirmed by transpedicular needle biopsy. Objective. To emphasize the occurrence of primary leiomyosarcoma in the lumbar spine. Summary of Background Data. Leiomyosarcoma is a rare malignant neoplasm of the bone, and only one report of the primary spinal tumor exists. In the case of leiomyosarcoma of the bone, metastasis, most commonly of the uterus or gastrointestinal tract, must be carefully ruled out before the diagnosis of primary leiomyosarcoma in the bone is confirmed. Methods. Leiomyosarcoma of the second lumbar vertebra in a 47-year-old woman with no neurologic deficit is reported. Imaging findings indicated a nonspecific high-grade lesion. A total spondylectomy of L2 with en bloc excision of the lower half of L1 and the upper third of L3 vertebral bodies was performed after preoperative radiation therapy. The defect of the vertebral body was reconstructed by titanium mesh cage, and T11 to S1 vertebrae were instrumented by the pedicle screw and rod system. Results. The surgical margin was marginal. Histologically, the tumor cells were elongated, with abundant cytoplasm and cigar-shaped nuclei, showing proliferation in fascicles and bundles. No sign of local recurrence or metastasis was evident 2 years and 1 month after surgery. Conclusions. Leiomyosarcoma should be included in the differential diagnosis of spindle cell tumor of the spine, and it should be confirmed or excluded by immunohistochemical and/or ultrastructural studies. If the expected surgical margin is definitive, a total en bloc spondylectomy should be performed.

Desmoplastic Fibroma: Aggressive Curettage As a Surgical Alternative for Treatment

In this article, the authors present 5 patients with desmoplastic fibroma and review the literature. Four patients had aggressive curettage with bone graft, and 1 had aggressive curettage alone. Although the literature reports that many patients have recurrence after curettage, there have been no recurrences in these 5 patients during followup periods ranging from 5 years 6 months to 9 years. Although wide excision has been recommended in the literature, treatment with aggressive curettage achieved clinical and radiographic control of the lesions for at least an intermediate duration of followup.

Stress fracture of the second metacarpal bone

Stress fractures are usually encountered in athletes; however, only eight such cases involving the metacarpal bones have been reported in the English literature. We report on the rare case of a 15-year-old female tennis player with a stress fracture of the second metacarpal bone.

Congenital pseudoarthrosis of the tibia treated with low-intensity pulsed ultrasound stimulation (LIPUS)

A 16-year-old Japanese boy was admitted to our institution in September 2000 because no apparent callus had appeared around a fracture after 6 weeks of cast fixation. Physical examination revealed a tenderness of the right lower leg, and multiple small subcutaneous tumors and café-au-lait spots in extremities and trunk. Radiographs showed the fracture of the right lower tibia with bony sclerosis and a localized fusiform osteolytic lesion at the fracture site. The affected tibia bowed anteriorly and the medullary space in the lower tibia was narrow. A diagnosis of Boyd type IV congenital pseudoarthrosis of the tibia was made. Treatment with low-intensity pulsed ultrasound (US) stimulation (LIPUS) was administered for 20 min/day, and a nonweight-bearing gait was continued with a cast or brace fixation. At 6 months after the treatment, a small amount of bridging callus was seen. We continued the treatment for 1 year until the solid fusion was observed on radiographs and the patient started full-weight-bearing.

Familial occurrence of telangiectatic osteosarcoma: cousin cases.

Familial occurrence of osteosarcoma is rare. We report cousin cases, an 11-year-old girl and an 8-year-old boy with telangiectatic osteosarcoma. The tumors occurred in the metaphysis of the distal tibia and the lamina of thoracic vertebra. The local behaviors appeared aggressive, but the clinical courses were relatively indolent in both cases. The histologic features were similar, showing anaplastic tumor cells producing osteoid and proliferation of blood cavities. Clustering of malignancies within a family suggests the presence of a genetic factor.

Ossified soft tissue recurrence of giant cell tumor of bone

We report 3 cases of soft tissue recurrence of giant cell tumor of bone. A peripheral rim of ossification in the soft tissue mass is pathognomonic of recurrence in the patients after resection of giant cell tumor.