Tabu Gokita

Incidence of Pneumothorax in Advanced and/or Metastatic Soft Tissue Sarcoma Patients during Pazopanib Treatment

Sird After pazopanib’s approval for the treatment of soft tissue sarcomas, pneumothorax was reported as an unexpected adverse event linked to pazopanib treatment. Pneumothorax was rarely reported in the pre-approval clinical trials of pazopanib [1], so the incidence of pneumothorax during pazopanib treatment has not yet been established. We retrospectively reviewed the cases of 32 soft tissue sarcoma patients treated with pazopanib between November 2012 and December 2013 at our institute. The median follow-up time was 3.1 months (range 0.3e9.6

Pulmonary metastasis from giant cell tumor of bone: clinical outcome prior to the introduction of molecular target therapy

Objective We analyzed the risk factors for pulmonary metastasis from giant cell tumor of bone and aimed to discuss their therapeutic strategy and appropriate follow-up period. Methods We analyzed 141 patients of giant cell tumor of bone. The variables analyzed included age, gender, primary site, Campanacci grading, surgical treatment on the primary lesion, radiotherapy and local recurrence. Results Pulmonary metastasis occurred in 12 patients. The risk factors were young age, Campanacci Grade III and local recurrence. Median time from initial surgery to metastasis was 1.3 years (0-3.1 years). Among them, eight patients experienced local recurrence of the primary tumor, and the median time from initial surgery to local recurrence was 0.8 years (0.3-2.9 years). Among seven patients who underwent wide resection, three patients showed local recurrence of the soft tissue. Nine patients underwent metastasectomy for pulmonary metastases. Of three patients who did not undergo metastasectomy, one patient died of uncontrollable metastases, and two patients showed no changes in their metastatic lesions. Conclusions Although we found a correlation between local recurrence and pulmonary metastasis, we were still unable to prevent local or metastatic recurrence by wide resection. Local recurrence and metastasis have been found within ~3 years after initial surgery, and routine image examinations of the primary site and chest after initial surgical treatment should be considered for at least 3 years postoperatively.

A new technique using mesh for extensor reconstruction after proximal tibial resection

BACKGROUND Proximal tibial reconstruction following wide resection in both malignant and benign tumors presents difficulties mainly due to both patellar tendon reconstruction and high risk of infection. The purpose of this study is to determine the efficacy of a new technique using a mesh for extensor reconstruction. METHODS We retrospectively reviewed nine consecutive patients who underwent resection of the proximal tibia with prosthetic reconstruction and reconstruction of the extensor using a mesh between 2009 and 2012. The surgical technique included the attachment of the mesh to the tibial component with a band of meshes looped over the patella and a gastrocnemius flap for coverage. RESULTS One patient had an above-the-knee amputation due to infection. Eight patients were followed up for 33 months (range, 20-50). In the eight patients, extensor lag had a mean of 5° (range, 0 to 20). Active flexion had a mean of 96.25° (range, 80 to 120) and ISOLS scores had a mean of 21/30 (range, 18 to 26). All patients were able to ambulate without crutches at the latest follow-up. CONCLUSION Extensor lag was significantly less compared to previous reports. No complications were observed in eight patients. Utilization of the mesh for extensor reconstruction after the proximal tibial resection is a simple, reliable and successful method.

New endoprosthesis suspension method with polypropylene monofilament knitted mesh after resection of bone tumors in proximal humerus

BACKGROUND Endoprosthetic reconstruction of the proximal humerus is one of the standard procedures after resection of tumors of the proximal humerus and has been considered a reliable method to reconstruct the proximal humerus in recent reports. However, instability of the shoulder joint caused by loss of the rotator cuff and deltoid muscle function is often observed after such an endoprosthetic reconstruction. METHODS We performed the endoprosthesis suspension method with polypropylene monofilament knitted mesh. This suspension method, by which the endoprosthesis is suspended from the bone structure, was used after resection of tumors in 9 patients. We assessed postoperative stability of the shoulder joint by comparing these patients with 12 patients who underwent the conventional surgical technique, by which the mesh-wrapped endoprosthesis is attached only to soft tissue. RESULTS In radiographic and physical evaluation, 4 of the 12 patients in the soft tissue reconstruction group showed shoulder joint instability. No patient in the suspension method group showed subluxation of the humeral prosthesis. The mean shoulder flexion was 35° and 65° and the mean shoulder abduction was 40° and 40° for the soft tissue reconstruction group and the suspension method group, respectively. DISCUSSION Shoulder joint subluxation sometimes occurs because of elongation of the attached soft tissue in the conventional reconstruction with mesh, whereas no shoulder joint subluxation occurs after endoprosthetic reconstruction in the suspension method because the bone structure has no leeway for elongation. Excellent stability of our new method enables exercise of the surgical shoulder at an early stage, leading to improved range of shoulder joint motion.

Cytogenetic study of secondary malignancy in giant cell tumor.

Giant cell tumor (GCT) is classified as a benign bone tumor, but it is locally aggressive, and sometimes metastasizes in a benign state. In addition, malignant transformation occurs once in a while. Most of the secondary malignancies in GCT occur after treatment of benign GCT that has included radiation therapy [1, 2]. As a cytogenetic characteristic of GCT, telomeric associations (tas) were reported [3, 4]. Tas may generate dicentric chromosomes (dic) and chromatoid breakagefusion-bridges, which lead to chromosomal instability and tumorigenesis [5, 6]. Recently, the relationship between cytogenetic abnormalities and clinical behavior in GCT has begun to be elucidated. For example, the DNA ploidy pattern may predict the recurrence potential of GCT, chromosomal abnormalities superimposed on tas are responsible for an aggressive clinical course [7], and centrosome amplification may be useful in predicting the clinical behavior of GCT [8]. Here we report a case of secondary malignancy in GCT. Malignant transformation occurred in a relatively early period, and any radiation therapy was not administered to the primary lesion. Malignant transformation was demonstrated not only by histopathological study but also by cytogenetic analysis. The recurrent tumor, which was a secondary malignancy in GCT, had a near-triploid karyotype with multiple structural abnormalities as observed in pleomorphic sarcoma, while the primary benign GCT had a near-diploid karyotype with tas and dic.

A Clinicopathological Analysis of Soft Tissue Sarcoma with Telangiectatic Changes

Background. Soft tissue sarcoma with a hemorrhagic component that cannot be easily diagnosed by needle biopsy is defined here as soft tissue sarcoma with telangiectatic changes (STST). Methods. We retrospectively reviewed clinicopathological data of STST from 14 out of 784 patients (prevalence: 1.8%) with soft tissue sarcoma. Results. Tumors were found mostly in the lower leg. Histological diagnoses were undifferentiated pleomorphic sarcoma (n = 5), synovial sarcoma (n = 5), epithelioid sarcoma (n = 2), and malignant peripheral nerve sheath tumor and fibrosarcoma (n = 1). No history of trauma to the tumor site was recorded in any patient. Needle aspiration transiently reduced the tumor volume, but subsequent recovery of tumor size was observed in all cases. Out of 14 patients, 9 presented with a painful mass. MRI characteristics included intratumoral nodules (64.3%). The local recurrence rate was 14.3%, and the 2-year event-free survival rate was poorer (50%) than that of most sarcomas. Conclusions. STST is unique in its clinicopathological presentation. Painful hematomas without a trauma history, intratumoral nodules within a large hemorrhagic component, and subsequent recovery of tumor size after aspiration are indicative of the presence of STST.

Is immunohistochemical staining for β-catenin the definitive pathological diagnostic tool for desmoid-type fibromatosis?: a multi-institutional study

Immunohistochemical staining with anti-β-catenin antibody has been applied as a diagnostic tool for desmoid-type fibromatoses (DFs). In recent years, specific gene mutation (CTNNB1) analysis has also been reported to be useful for diagnosis of DF; however, the association between CTNNB1 mutation status and immunohistochemical staining pattern of β-catenin is rarely reported. The purposes of this study are to clarify the relationship of the staining pattern of β-catenin with the CTNNB1 mutation status and various clinical variables, and to investigate the significance of immunohistochemical staining of β-catenin in cases diagnosed as DF. Between 1997 and 2017, 104 cases diagnosed as DF from 6 institutions in Japan were enrolled in this study: Nagoya University, National Cancer Center Hospital, Niigata University, Okayama University, Kyushu University, and Cancer Institute Hospital. For all cases, immunohistochemical staining of β-catenin and gene mutation analysis of CTNNB1 were performed. Of 104 cases, 87 (84%) showed nuclear staining of β-catenin, and 95 (91%) showed positive staining in the cytoplasm. The proportion of cases showing strong nuclear staining of β-catenin was significantly higher in the cases with S45F than in those with T41A or wild type. The proportion of cases stained strongly in the cytoplasm rather than in the nucleus was significantly higher in the group of T41A than that of S45F or wild type. Among 17 cases in which nuclear immunostaining was absent, CTNNB1 mutation was observed in 5 cases (29.4%). There were unignorable cases of DF with negative β-catenin immunostaining despite a definitive clinical and pathological diagnosis of DF and/or positive CTNNB1 mutation.

The Significance of Rectus Femoris for the Favorable Functional Outcome After Total Femur Replacement.

Background: In treatment of tumors, we usually reconstruct after resection of the entire femur using only metallic modular endoprostheses among many procedures and defined it as a total femur replacement. We studied the interrelation between the preservation of rectus femoris and the functional outcome after total femur replacement. Methods: We rated the functional outcomes of 21 patients who underwent total femur replacement. We categorized the subjects into 2 groups: group A (rectus femoris preserved) and group B (rectus femoris unpreserved). We examined them based on the Mann-Whitney U test between the 2 groups in average through the Musculoskeletal Tumor Society functional scores. Results: The average score of group A was 20 of 25 (11–25; 80%), whereas the average score of group B was 10 of 25 (4–13; 40%). There was significant difference between the groups (P = 0.00168877). Conclusion: We found that the preservation of rectus femoris is imperative for achieving the favorable functional outcome in total femur replacement.

Intraneural metastasis of gastric carcinoma leads to sciatic nerve palsy

BackgroundSoft tissue metastases, in particular intraneural metastasis, from any carcinomas seldom occur. To our knowledge, no case of sciatic nerve palsy due to intraneural metastasis of gastric carcinoma is reported in the literature.Case presentationA case is reported of a 82-year old woman with sciatic nerve palsy with intraneural metastasis of gastric carcinoma. Although she had undergone partial gastrectomy with T2b, N0, M0 two years ago and primary site was cured, she developed sciatic nerve palsy from the carcinoma metastasis directly to the nerve. Operative resection and Histological examination revealed poorly differentiated adenocarcinoma, the same as her primary site adenocarcinoma.ConclusionsSciatica is usually caused by a herniated disc or spinal canal stenosis. Sciatic nerve palsy may be caused by nondiscogenic etiologies that may be either intrapelvic or extrapelvic. It is important to image the entire course of the nerve to distinguish these etiologies quickly. The longer the nerve compression the less likely a palsy will recover. Surgery is a good intervention that simultaneously obtains a tissue diagnosis and decompresses the nerve.