Taninnit Leerapun

Surgical management of conventional grade I chondrosarcoma of long bones.

We retrospectively reviewed 70 patients with low-grade (Grade I) chondrosarcoma of the appendicular skeleton treated at the Mayo Clinic from 1980 to 2001. Fifty-four patients underwent wide resections and three patients underwent marginal excision for radiographically aggressive lesions. Thirteen patients were treated with intralesional curettage for more indolent lesions. The mean age of the patients was 43 years (range, 5-85 years) and the minimum followup was 0.2 year (mean, 8.5 years; range, 0.2-22.8 years). Of the patients who had wide resection, one experienced local recurrence and one had metastasis develop. One patient in the group treated with intralesional curettage had local recurrence and metastasis. We observed no difference in overall survival rate between the intralesional curettage group and the wide resection group. Although there was no difference in the treatment outcome between the two groups, patients with more radiographically aggressive lesions underwent more extensive surgery. The data suggest in selected patients less radiographically aggressive Grade I chondrosarcoma can be safely treated with intralesional curettage without compromising patient outcome.Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Intercalary segmental reconstruction after bone tumor resection.

BACKGROUND/AIMS Intercalary resection can be used for primary as well as metastatic tumors. Reconstruction options include vascularized fibula graft, interposition of an allograft, combination of vascularized fibula and allograft, segmental prosthesis, insertion of an extracorporally irradiated autograft, segmental transportation, either with external fixation or by using an intramedullary rod, intercalary scaffolds augmented with growth factors, and technical refinements for the resection of tumors located close to the growth plate. The purpose of this review is to discuss the indications, limitations and pitfalls of each of these techniques. METHODS The PubMed database was searched for articles on intercalary reconstruction after bone tumor resection and for the different reconstruction options presented in this review. Additionally, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcomes and complications of the reconstruction options. RESULTS With the advance of imaging techniques and the use of chemotherapy for malignant bone tumors, surgical techniques can be refined. There are many techniques for the reconstruction of large intercalary defects of long bones, with which the orthopedic oncologist needs to be familiar. General oncologic principles of achieving a wide margin still need to be respected. CONCLUSION The techniques presented in this review will allow a better functional outcome of patients. It will continue to be important to carefully analyze each patients situation and to adapt and individualize the method of reconstruction used.

An institutional review of clear cell chondrosarcoma.

Clear cell chondrosarcoma is a rare bone neoplasm with a slow progressive clinical course and infrequent metastasis, but with a high local recurrence rate. We sought to ascertain the long-term outcome of patients with this neoplasm and to identify possible factors predicting survival. Sixteen patients with clear cell chondrosarcomas treated at one institution and who had long-term clinical followup were identified. All patients were treated by surgical resection of the tumor, which was classified as clear (> 2 mm) in 10 patients and marginal or intralesional in six patients. Three patients had local recurrence after a median of 1.7 years. Metastatic disease developed in four patients with a median time to diagnosis of 8.1 years. Ten-year overall survival of patients with clear cell chondrosarcomas was 89%, and disease-free survival was 68%. Patients with surgical resections comprising clear margins had longer disease-free survival compared with patients with marginal and intralesional tumors. Inadequate surgical resection of clear cell chondrosarcoma leads to risk of local recurrence and metastatic disease. The malignancy has a tendency to metastasize relatively late, therefore, followup of patients is necessary after the generally accepted 5-year period. Level of Evidence: Prognostic study, Level III (case control study). See the Guidelines for Authors for a complete description of levels of evidence.

Hyaluronan production and chondrogenic properties of primary human chondrocyte on gelatin based hematostatic spongostan scaffold

BackgroundAutologous chondrocyte transplantation is a promising technique for treatment of cartilage defects. Three dimensional chondrocyte cultures on a scaffold are widely used to retain the chondrogenic phenotype. Using a biodegradable gelatin scaffold is one option for the cell delivery system, but molecular and histological studies of the method have not yet been done.MethodsWe evaluated the chondrogenic property of the primary human chondrocyte on a gelatin scaffold as compared to a collagen scaffold over a period of 21 days. We examined the production of glycosaminoglycan by quantitative and histological analysis. Gene expression of cartilage-associated molecules was assessed by quantitative RT-PCR.ResultsThe gelatin scaffold showed the ability to promote chondrocyte expansion, chondrogenic phenotype retention at molecular and mRNA levels.ConclusionsThis scaffold is thus suitable for use as an in vitro model for chondrocyte 3D culture.

Increasing Incidence of Hip Fracture in Chiang Mai, Thailand

Hip fracture is a major health problem in Thailand. This study attempted to examine the incidence, related factors, and trends of hip fracture in Chiang Mai, Thailand. All hip fracture data among patients aged 50 yr or older were collected from hospitals in Chiang Mai, Thailand from August 1, 2006 to July 3, 2007. Data from the 1997 Chiang Mai hip fracture study were used for comparison. In the study period, 690 hip fractures were reported: 203 males and 487 females (male to female ratio was 1 to 2.4), with a mean age of 76.7 yr. The estimated cumulative incidence was 181.0 per 100,000, and the adjusted incidence was 253.3 (males: 135.9; females: 367.9). A simple fall was the most common mechanism (79%) of fracture, and 80% of the hip fractures occurred in patients aged 70 yr or older. The highest incidence of hip fracture was observed in patients older than 85 yr (1239). At 6 mo postfracture, most patients (61%) used a walking aid. Compared with the 1997 data, hip fracture incidence had increased by an average of 2% per yr, and the incidence of hip fracture had increased significantly from August 1, 2006 to July 31, 2007, especially in patients older than 75 yr. In patients older than 84 yr, the incidence increased by a factor of 2. Urgent strategies for the prevention and treatment of osteoporosis, and hence hip fracture, are needed.

Result of extracorporeal irradiation and re-implantation for malignant bone tumors: A review of 30 patients

Extracorporeal irradiation and re‐implantation (ECI) has been used as limb salvage surgery for musculoskeletal oncology patients. Biological reconstruction, no risk of disease transmission and immunological reaction, ready availability and preservation of bone stock are the major advantage of this surgical technique. This case series details the outcomes of ECI.

Extraskeletal Chondroma on the Sole of the Foot

A 47-year-old female presented with a solitary mass located in the plantar region of her left foot. The mass, which she noticed 2 years ago, grew gradually and caused increasing pain when bearing weight. Physical examination showed a 3.5-cm diameter tender nonmobile mass with firm consistency in the midplantar region. Radiographs showed a ring-like calcification compatible with cartilage tissue. Magnetic resonance imaging revealed a lobulated mass with a hypointense signal on T1-weighted images and a hyperintense signal on T2-weighted images in the mid-substance of the plantar fascia. After a skin incision was performed, the mass was dissected from the skin and subcutaneous tissue. Then, a marginal excision was performed. The histological assessment reported chondrocytes within lacunae embedded in a chondroid matrix with focal calcification. The definitive diagnosis was extraskeletal chondroma. Plantar pain resolved within 3 months and no recurrence was found at the 1-year follow-up. Level of Evidence: Therapeutic Level IV, Case Report

Survival rate and prognostic factors of conventional osteosarcoma in Northern Thailand: A series from Chiang Mai University Hospital

BACKGROUND Osteosarcoma is a common and aggressive primary malignant bone tumor occurring in children and adolescents. It is one of the most aggressive human cancers and the most common cause of cancer-associated limb loss. As treatment in Thailand has produced a lower survival rate than in developed countries; therefore, this study identified survival rate and the poor prognostic factors of osteosarcoma in Northern Thailand. METHODS The retrospective cases of osteosarcoma, diagnosis between 1 January 1996 and 31 December 2013, were evaluated. Five and ten year overall survival rates were analyzed using time-to-event analysis. Potential prognostic factors were identified by multivariate regression analysis. RESULTS There were 208 newly diagnosed osteosarcomas during that period, and 144 cases met the criteria for analysis. The majority of the osteosarcoma cases (78.5%) were aged 0-24 years. The overall 5- and 10-year survival rates were 37.9% and 33.6%, respectively. Presence of metastasis at initial examination, delayed and against treatment co-operation, and axial skeletal location were identified as independent prognostic factors for survival, with hazard ratios of 4.3, 2.5 and 3.8, and 3.1, respectively. CONCLUSIONS This osteosarcoma cohort had a relatively poor overall survival rate. The prognostic factors identified would play a critical role in modifying survival rates of osteosarcoma patients; as rapid disease recognition, a better treatment counselling, as well as improving of chemotherapeutic regimens were found to be important in improving the overall survival rate in Thailand.

Recurrent tibial intra-cortical osteosarcoma: a case report and review of the literature

IntroductionIntra-cortical osteosarcoma is the rarest subtype of osseous-producing tumor. Most reported cases present a low-grade histology with slow progression and good oncological control after adequate treatment. In this report, we describe a case and review the literature to propose adequate treatment.Case presentationWe present the case of a 21-year-old Thai woman who was thought to have an intra-cortical osteosarcoma of the right tibia. We performed a wide resection and reconstruction with bone transportation using an Ilizarov external fixator. The tumor recurred five years later at the same site with a similar histology. We performed a new resection and reconstruction by ankle arthrodesis with adjuvant chemotherapy. At the last follow-up, she had remained active and free from disease for seven years.ConclusionThis case report of recurrent intra-cortical osteosarcoma describes an atypical presentation. The low-grade histology, adequate surgical margin and adjuvant chemotherapy of the recurrent lesion were favorable factors, and our patient has remained free of any tumor recurrence.