Michael P. Mott

The Role of Postoperative Irradiation in the Treatment of Locally Recurrent Incompletely Resected Extra-Abdominal Desmoid Tumors

Background: To define the efficacy of postoperative irradiation in patients with recurrent extra-abdominal desmoid tumors in whom surgical intervention has resulted in microscopically or grossly positive surgical margins.

A unique radiation scheme for the treatment of high-grade non-metastatic soft tissue sarcoma: the detroit medical center experience.

Purpose:This is the initial report on the utilization of combined photon irradiation followed by a neutron boost irradiation for the initial management of patients with high-grade non-metastatic soft tissue sarcoma (STS). We present data on local control, complications, disease-free survival and overall survival in patients at high risk for local relapse. Methods and materials: Between 1/1/1995 and 10/31/02, twenty-three patients with high-grade non-metastatic soft tissue sarcoma were referred to the Department of Radiation Oncology at the Detroit Medical Center. These patients were referred for consultation due to surgical margin status (tumor within 3mm of surgical margin (n=11)), or gross residual disease (n=12). There were 14 males and nine females whose ages ranged from 12 to 75 at the time of diagnosis (med=44 years). The most common histology was malignant fibrous histiocytoma (n=6), followed by liposarcoma (n=5), synovial sarcoma (n=4), and angiosarcoma (n=2). Twenty-one of 23 patients also received multi-agent multi-cyclic cyto-reductive therapy. Treatment consisted of initial daily photon irradiation delivered either using twice daily fractions of 120 cGy (n=10) or once daily 200 cGy/fx (n=13).Total photon dose was 36–39.6 Gy. Neutron irradiation was initiated immediately following the photon irradiation and consisted of fraction sizes of 1.0–1.25NGy to a total dose of 6–10 NGy. The neutrons were given once daily. Follow-up is calculated from the day of last radiation treatment. Results: No patient has been lost to follow-up, which has ranged from 18 to 82 months (med=36 months). To date there have been two local relapses and three patients with distant disease development without local relapse. Each of the patients with distant disease has died. The local failures occurred at 9 and 12 months. The 36-month local control is 91%. Thirtysix month disease-free survival was 78%. Overall survival at 36 months was 87%. Three patients had unusual complications consisting of delayed wound healing, and in one of these patients a fracture of the tibia has been noted. Conclusion: The use of this unique radiation sequence post-surgically in patients at high risk for local relapse has resulted in an exciting 36-month local control rate of 91%. The 3-year disease-free survival of 78% and overall survival rate of 87% are exciting but need to mature. The low complication rate is similar to that reported in other large institutional series that have not utilized neutrons. We continue to evaluate the role of combined photon and once-off neutron irradiation in the treatment of patients with high-grade STS that are risk for local recurrence.

Soft Tissue Sarcoma Brachytherapy

Soft tissue sarcomas (STS) are a diffuse group of malignancies that arise from connective tissues such as fat, muscle, nerves, and blood vessels. They account for approximately 1 % of all adult malignancies and approximately 10 % of pediatric malignancies. They do not respect age, appearing in all age groups. Here we present brachytherapy as primary therapy or an adjunct to management.

Superficial CD34‐positive fibroblastic tumor: Cytologic features, tissue correlation, ancillary studies, and differential diagnosis of a recently described soft tissue neoplasm

Superficial CD34‐positive fibroblastic tumor is a low‐grade mesenchymal neoplasm of superficial soft tissues characterized by fascicles of spindle to epithelioid cells displaying nuclear pleomorphism and strong diffuse CD34 immunoreactivity. The intraoperative imprint cytology preparations (ICP) of a superficial CD34‐positive fibroblastic tumor from a 50‐year‐old female are described. To the best of our knowledge, there is no report of the cytologic findings of superficial CD34‐positive fibroblastic tumor in the English medical literature. The ICP, differential diagnosis, tissue correlation, and ancillary studies of this fascinating entity are discussed. Diagn. Cytopathol. 2016;44:926–930.

Tumors for the general orthopedist: how to save your patients and practice

It is likely that most orthopaedic surgeons will see a patient with a benign or malignant musculoskeletal tumor sometime during their career. However, because of the rarity of these entities, many surgeons may benefit from a review of how to evaluate a patient with a bone lesion or soft-tissue mass. A logical approach is necessary in evaluating imaging studies as well as in the workup of children and adults with a possible tumor. It is important to have a good working relationship with a musculoskeletal radiologist to assist in interpreting the images. If the treatment algorithms lead to a conclusive diagnosis of a benign bone tumor, benign soft-tissue mass, or metastatic bone disease, the orthopaedic surgeon may choose to definitively treat the patient. If the workup indicates an indeterminate lesion, it may be prudent to discuss the situation with an orthopaedic oncologist or transfer the care of the patient to a physician with more specialized knowledge. A careful, logical workup is needed prior to surgery to limit risks to the patient and optimize the chances for a favorable outcome.

Venous Hemangioma Presenting as a Superior Sulcus Tumor

Non-small cell pulmonary carcinomas represent the majority of tumors located in the superior sulcus. However, only 5% of all non-small cell pulmonary carcinomas present in the superior sulcus. Other causes of superior sulcus tumors include metastatic tumors, hematologic malignancies, infectious causes, and amyloid nodules, as well as other lesions. We report a case in which a venous hemangioma presented as a superior sulcus tumor.

Giant Cell Tumor of Bone Presenting as Left Posteromedial Chest Wall Tumor

Giant cell tumor is a relatively uncommon bone tumor rarely originating from the chest wall. Given its proximity to vital structures in the thoracic cavity, treatment options may be challenging. We report the case of a patient with a giant cell tumor of the posterolateral chest wall with invasion of the thoracic spine treated with neoadjuvant denosumab, followed by surgical resection.

Bilateral and simultaneous septic arthritis of the acromioclavicular joint in an immunocompromised patient: a case report and review of the literature

S eptic arthritis is a disease that can lead to articular cartilage destruction, joint contracture, and limited motion if not diagnosed and treated promptly. Involvement of the acromioclavicular (AC) joint is rare; typical risk factors can include intravenous drug abuse, intraarticular injection, and an immunocompromised status. There are no prior published cases in the medical literature of bilateral and simultaneous acromioclavicular joint septic arthritis, as such we obtained consent from the patient to present this case study. This article presents the first case study of simultaneous bilateral acromioclavicular joint septic arthritis in an immunocompromised patient treated with open surgical irrigation and debridement and intravenous antibiotics.