Samuel Kenan

Malignant Transformation of Fibrous Dysplasia A Case Report and Review of the Literature

A 34-year-old man developed a spindle-cell sarcoma originating in a preexisting lesion of monostotic fibrous dysplasia. A review of the literature reveals 83 cases of a malignant degeneration in fibrous dysplasia; osteosarcoma was the most common type of tumor. The next most common were fibrosarcoma and chondrosarcoma. The malignant tumor usually developed in the third or fourth decade of life. The most frequent anatomic sites were the craniofacial bones, the femur, and the tibia. Twenty-three of the 83 cases were treated with local radiation. In fibrous dysplasia, any abrupt alteration in the clinical course, manifested by pain and swelling, raises the possibility of malignant degeneration.

Tuberculous gluteal abscess without bone involvement

Abstractu2002A cold abscess secondary to tuberculous spondylitis or osteomyelitis is a well-recognized entity. However, a soft tissue tuberculous abscess without bone involvement is rare. We present such a case.

Subperiosteal hemangioma. A case report and review of the literature.

Subperiosteal hemangioma (SPH), an exceptionally rare lesion, was diagnosed in a 68-year-old man. SPH is usually small and is most commonly located in the midshaft of a long tubular bone such as the tibia or fibula. A wide range of age groups is affected. SPH may present with mild pain or local swelling unassociated with trauma. Radiologically, it usually appears as a shallow cup-shaped depression surrounded by cortical thickening. Several other periosteal and intracortical lesions must be considered in the differential diagnosis, but the final diagnosis rests on microscopic evaluation. The treatment of SPH is marginal excision; local recurrences have not been reported after such treatment.

The Expandable Prosthesis

efore 1970, amputation was the treatment for malignant bone tumors such as B osteosarcoma if attempts at local control failed. Even with this aggressive surgical approach, the five-year patient survival rate was less than 20% In the last decade, however, there have been several major innovations, which have produced better results. These innovations include the following. A better understanding of the natural history and behavior of malignant bone tumors. New diagnostic modalities with high resolution, such as technetium bone scan, computerized axial tomography (CAT) scan, and magnetic resonance imaging (MRI). These diagnostic methods allow early diagnosis and along with providing precise details on both the anatomical location and the relationship of the tumor to the surrounding structures. Major improvements in adjuvant multidrug chemotherapy.2 Improved surgical techniques in limbsparing surgery.3 Improved orthopedic bioengineering in the design of new internal expandable prostheses. The combination of these factors have improved the survival rate for malignant bone cancer patients. At Mount Sinai Medical Center, New York City, this rate is nearly 80%.4

Subperiosteal giant-cell reparative granuloma

We present a case of subperiosteal giant-cell reparative granuloma followed over six years showing the complete evolution from the early phase of subperiosteal haematoma to the end stage of an ossified haematoma. Such lesions, although they are histologically similar to true giant-cell tumours, can be distinguished by the patients age, their location on the diaphysis, and by their radiological and histological features.

Case report 652

A case of primary liposarcoma of bone involving the glenoid region of the right scapula in a 57-year-old man is presented. The diagnosis was confirmed by open biopsy. The differential diagnoses have been considered. To the best of our knowledge, this may be the first reported case of primary liposarcoma of bone in the scapula.

Osteoblastoma of the humerus associated with type-I Gaucher's disease. A case report.

We report a unique case of juxtacortical osteoblastoma of the humeral shaft, which stimulated the appearance of an extraosseous extension of Gaucher-cell deposits. The tumour was treated successfully by curettage and bone grafting. We can find no previous report of this association between osteoblastoma and Gauchers disease.

Case report 845

A 59-year-old white man presented with a history of pain in the left knee. The pain had started 6 months earlier when he struck his knee against a file drawer. At the beginning, the pain was intermittent and later subsided. Lately, the patient noticed continued swelling of the proximal par t of his left leg for which he sought medical advice. His past medical history was remarkable for diabetes mellitus and hypertension. Physical examination revealed a full range of mot ion of the left knee. There was a firm swelling of the proximal par t o f the left tibia with no tenderness or skin changes and the neurovascular bundle was intact. Plain radiography revealed a large, well-circumscribed, lucent lesion involving the proximal end of the tibia and reaching the articular margin with a sclerotic border (Fig. 1). Magnetic resonance imaging (MR) was performed and showed the lesion as hypointense on Tl-weighted images and bright on T2-weighted images. Both signals were homogeneous (Fig. 2). An open biopsy was then performed.

Case report 773

A case of osteochondroma of the pelvis secondary to radiation therapy after radical nephrectomy for a Wilms tumor is reported. The occurrence of such a complication is discussed. Proof was obtained by open biopsy. The indications for surgical resection of such a tumor were considered. The differential diagnosis, although limited in scope, was discussed.

Case report 711

We present a patient with parosteal osteosarcoma. The lesion arose at the surface of the femur without involvement of the marrow cavity. Some 24 months following resection of the involved bone, she developed distant metastases with no evidence of local recurrence. Neither the primary nor the metastatic lesions showed high-grade malignancy.