Biomedical subjects

J R Neff

Publications and source records attributed to J R Neff.

At least 55 records · Page 3Linked to original sources

PubMed1994

Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma.

PURPOSE AND METHODS: To assess patients with high-grade osteosarcoma treated at our institution for various prognostic factors for the development of local recurrence of disease. Follow-up data were available for all patients and the mean follow-up duration was 65 months in surviving patients. RESULTS: There were 28 local recurrences in this study (7%). Of these, only three patients (11%) were alive at the most recent follow-up point, 28, 53, and 54 months after local recurrence. None of 59 patients who were treated primarily with a radical amputation and none of 10 who underwent a rotationplasty developed local recurrence. Four of 48 patients (8%) who had wide amputations, one of whom had an intralesional amputation, and 23 of 237 (10%) who had limb-salvage surgery developed locally recurrent disease. Of 237 patients who underwent limb-sparing resection, three prognostic factors for local control were identified. The strongest association with local recurrence was chemotherapy response (P < .0001), followed closely by surgical margins (P = .0001). Older patients were more likely to have locally recurrent disease (P = .033), with each decade of life older than the first decade having a relative risk of 1.5 times greater per decade (SE = 0.16; 95% confidence interval, 0.034 to .0650). Factors that were not associated with local recurrence included sex, date of diagnosis, and anatomic site of disease. CONCLUSION: Chemotherapy-induced tumor necrosis and surgical margins are important prognostic factors for local control of patients with osteosarcoma.

Adolescent↗

PubMed1994

Parosteal lipoma: MR imaging characteristics.

OBJECTIVE: The purpose of this study was to determine the characteristics of parosteal lipomas on MR imaging. MATERIALS AND METHODS: We retrospectively reviewed the images and medical records of eight patients with surgically and pathologically confirmed parosteal lipomas. Radiologic studies performed included conventional radiography and MR imaging (n = 8), CT (n = 7), conventional tomography (n = 2), and scintigraphy (n = 5). RESULTS: Osseous reaction was present in all cases, manifesting as either mild cortical thickening best seen on magnification radiographs or larger osseous excrescences seen on all radiologic images. These osseous reactions were surrounded by the lipomatous component of the neoplasm and created a firm attachment of the neoplasm to the underlying bone. The lipomatous component showed typical features of adipose tissue on all images and was usually seen on radiographs (n = 7). However, CT or MR imaging was needed to determine the anatomic location and relationship to surrounding structures before surgery. MR imaging was considered superior to CT for preoperative assessment, primarily because of its multiplanar imaging capability. In addition, cartilage and fibrous tissue (n = 3) were identified adjacent to larger osseous excrescences. Associated muscle atrophy in three cases was caused by nerve impingement. These manifestations of parosteal lipoma were also better assessed with MR images because of improved contrast resolution. The distribution of muscle atrophy could be used to determine the site of nerve involvement preoperatively. CONCLUSION: We conclude that MR imaging is the most useful adjunct to conventional radiography in the presurgical evaluation of parosteal lipomas because of its multiplanar imaging capabilities and improved contrast resolution for detecting muscle atrophy and site of nerve involvement when present. These factors are important for preoperative assessment to help guide surgical intervention.

Adolescent↗

PubMed1994

Simultaneous interphase cytogenetic analysis and fluorescence immunophenotyping of dedifferentiated chondrosarcoma. Implications for histopathogenesis.

Cytogenetic analysis of four specimens (biopsy, definitive surgical, and two separately occurring lung metastases) of a dedifferentiated chondrosarcoma with a rhabdomyosarcomatous component revealed clonal karyotypic abnormalities in each. Anomalies seen in all specimens included a structurally aberrant chromosome 17 and extra copies of chromosomes 5, 7, 12, and 20. The derivation of the chromosomally abnormal cells was determined by a combined immunocytochemical/cytogenetic approach that allowed simultaneous assessment of cytogenetic aberrations and immunophenotypic features of individual cells. S-100 protein and desmin antibodies were used to evaluate the chondrosarcomatous and rhabdomyosarcomatous components, respectively. A chromosome 7-specific centromeric probe was used for determination of aneuploidy. In both specimens obtained from the primary lesion, S-100 protein and desmin-positive and -negative aneuploid cells were observed. These findings: 1) suggest that both the chondrocytic and rhabdomyoblastic cells arose from the same abnormal clone, 2) support the theory of a common primitive mesenchymal cell progenitor with the ability to differentiate or express features of more than one line of mesenchymal differentiation, and 3) indicate that the term dedifferentiated may be an inaccurate designation for this neoplasm.

Bone Neoplasms↗

PubMed1993

Biologic and clinical significance of cytogenetic and molecular cytogenetic abnormalities in benign and malignant cartilaginous lesions.

Cartilaginous neoplasms are often histologically and therapeutically challenging. Predicting biologic behavior can be difficult. In this study, 120 nonneoplastic, benign, and malignant cartilaginous lesions from 103 patients were cytogenetically analyzed in a 6-year period after short-term culture. For selected cases, fluorescent in situ hybridization (FISH) techniques using chromosome-specific probes were performed on metaphase/interphase preparations and on paraffin-embedded tissue sections. Clonal abnormalities of chromosomes 2, 3, 5, 7, 8, and 12 were most frequently observed. Involvement of chromosomes 5, 8, and 12 may be etiologically significant because of the gene localizations for the human cartilage link protein, Langer-Giedion syndrome (a rare syndrome characterized by multiple exostoses), and type II collagen (a major component of normal cartilage) respectively, to these three chromosomes. That chromosome 7 abnormalities were observed only in malignant tumors is of diagnostic value. The identity of three marker chromosomes and the significance of trisomy 7 (a finding of controversial meaning), were determined with FISH. That the presence of chromosome aberrations and increasing histologic grade strongly correlated (p = 0.001) is of prognostic importance. Moreover, complex aberrations were observed nearly exclusively in high-grade tumors (p = 0.001). The data show that nonrandom chromosome loci are aberrantly affected in cartilaginous lesions and that these abnormalities may be of significant histopathogenetic consequence. In addition, these chromosome abnormalities appear to be diagnostically and prognostically valuable in classifying and grading chondromatous neoplasms.

Adult↗

PubMed1993

A case report of fibrolipoma with t(12;16)(q13;q24).

Chromosomal analysis of a fibrolipoma of the shoulder of a 55-year-old man showed the following abnormal complement: 46,XY,t(12;16)(q13;q24). Comparison with two previously characterized fibrolipomas showed abnormalities reportedly observed in "classic lipoma." A unique or distinguishing anomaly for fibrolipoma was not detected. Therefore, fibrolipoma appears to be distinct histologically but not cytogenetically.

Chromosomes, Human, Pair 12↗

PubMed1993

Prognostic significance of histopathologic response to chemotherapy in nonmetastatic Ewing's sarcoma of the extremities.

PURPOSE: To evaluate more accurately the effectiveness of preoperative chemotherapy in the treatment of patients with Ewing's sarcoma, we studied histopathologically the chemotherapeutic response and correlated it to oncologic outcome. PATIENTS AND METHODS: Between June 1983 and December 1989, 68 patients with nonmetastatic Ewing's sarcoma of the extremities were treated at our institute with preoperative chemotherapy (without radiation therapy) and surgery. The specimens were retrospectively evaluated for areas of viable tumor cells and graded from I to III (macroscopic, microscopic, or no residual disease, respectively) in a blinded fashion. Clinical follow-up data were available on all patients for a mean of 60 months (range, 32 to 111). RESULTS: This histopathologic analysis was strongly correlated with oncologic outcome (P = .004). Patients who demonstrated grade III response (no identifiable viable tumor nodules present) had improved 5-year disease-free survival rates as compared with patients with grade II (microscopic nodes present; P = .023; 90% v 53%) and grade I responses (macroscopic nodules present; P = .0003; 90% v 32%). Patients with grade II necrosis had statistically improved survival rates over those with grade I necrosis (53% v 32%; P = .074). CONCLUSION: This new histopathologic analysis technique for the evaluation of neoadjuvant chemotherapy effectiveness (which does not rely on tumor volume for its assessment) is a valuable prognostic indicator for patients with Ewing's sarcoma treated with surgery. Based on this preliminary report, cases of grade I or II chemotherapeutic tumor response should be considered clinical failures and a different, more aggressive postoperative chemotherapy regimen should be considered.

Adolescent↗

PubMed1993

Magnetic resonance imaging of soft tissue and cystic masses about the knee.

Magnetic resonance imaging (MRI) of the knee is the most frequently performed joint MRI examination. The use of MRI has revolutionized assessment of both intra-articular and periarticular musculoskeletal masses about the knee and has largely supplanted other radiologic methods of evaluation. The purpose of this article is to review the MRI appearance of the numerous types of soft-tissue and cystic masses that arise about the knee.

Cysts↗

PubMed1993

The role of surgical therapy in patients with nonmetastatic Ewing's sarcoma of the limbs.

Of 131 patients with primary Ewing's sarcoma (ES) with extremity locations, treated between April 1972 and May 1987, 13 had amputation; 56 had a local resection with 31 (55%) requiring radiation therapy (RT) as an adjuvant to local therapy. Sixty-two of 131 patients (47%) had RT only. Local recurrences were reported in 5% of patients treated with surgery alone, 1% of the group treated with surgery and radiation therapy, 24% of patients treated with radiation therapy alone (46% for cesium-radiation therapy, and 12% with cobalt-radiation therapy).

Adolescent↗

PubMed1992

Clonal chromosomal abnormalities in desmoid tumors. Implications for histopathogenesis.

Desmoid tumors (aggressive fibromatosis) are regarded as lesions of uncertain histopathogenesis. Cytogenetic analyses of 26 desmoid tumor specimens from abdominal or extraabdominal sites of 22 patients with or without Gardner's syndrome (GS) showed clonal karyotypic abnormalities in 7 cases, random abnormalities in 14 cases, and striking telomeric fusion in 5 cases. Loss of chromosome Y, a reported feature of fibromatosis in penile and palmar locations, was detected as a clonal aberration in two patients. Additionally, involvement of 5q was observed in six patients, two of whom had GS. Clonal interstitial deletions of 5q were observed in three patients, one with and two without GS. These findings confirm a clonal and probable neoplastic origin for desmoid tumor and suggest that abnormalities of the Y chromosome and 5q may be important in the genesis of this neoplasm.

Adolescent↗

PubMed1992

Ring chromosome in parosteal osteosarcoma. Clinical and diagnostic significance.

In this study, two specimens of a parosteal osteosarcoma, a rare primary bone neoplasm comprising only 3-6% of all osteosarcomas, were cytogenetically analyzed utilizing standard techniques. In contrast to the complex karyotypes previously reported in osteosarcoma, this particular histologic subtype was characterized by a single chromosomal aberration, a ring chromosome. Ring chromosomes have been described as characteristic for two other low-grade malignant mesenchymal neoplasms, well-differentiated liposarcoma and dermatofibrosarcoma protuberans. We propose that the observation of a ring chromosome in osteosarcoma also correlates with a low-grade malignant potential.

Adolescent↗

PubMed1992

Giant cell tumor of bone. Chromosomal analysis of 48 specimens and review of the literature.

Giant cell tumor of bone (GCT) is a distinct clinical, radiographic, and pathologic benign entity that constitutes 5% of all primary bone tumors. For a 5-year period, 47 benign GCTs and 1 malignant GCT from 34 different patients were cytogenetically characterized. Analysis showed clonal karyotypic abnormalities in 16 specimens. Clonal structural abnormalities detected in more than one patient included translocations involving 11p15, fus(14p;21p), and fus(15p;21p). None of the clonal numerical abnormalities observed occurred in more than one patient. Thirty-seven of the 44 successfully analyzed specimens (84%) demonstrated telomeric fusion, with most frequent involvement of chromosomal telomeres 11p, 13p, 15p, 18p, 19p, and 21p. We also compared the presence or absence of random and/or clonal karyotypic abnormalities with clinical behavior to determine if a relationship existed. Most notably, chromosomal abnormalities were detected in all 13 successfully analyzed recurrent lesions, five of which were clonally aberrant. This study summarizes the cytogenetic findings and their relevance in 48 specimens analyzed at our institution and reviews the findings of the 18 other published cases.

Adolescent↗

PubMed1992

Trisomy 2 in proliferative fasciitis.

We report trisomy 2 as the sole clonal karyotypic abnormality in a case of proliferative fasciitis. To our knowledge, this is the first cytogenetic report of proliferative fasciitis.

Aged↗

PubMed1992

Cytogenetics of sacral chordoma.

Only four cases of chordoma have been described cytogenetically. We report the cytogenetic findings of a fifth case. Chromosome analysis of a primary sacral chordoma from a 69-year-old man showed the following chromosome complement: 43,XY,-2,-3,del(4)(q32),-6,+7,-11,der(12)t(9;12)(q12;p11),add(16)(q23),- 20,add(22)(q13),+mar.

Aged↗

PubMed1992

Titanium-induced arthropathy associated with polyethylene-metal separation after total joint replacement.

Complications of total joint replacements are not infrequent. The authors describe five patients with displacement of the polyethylene component in two knee (metal-backed patellar component) and three hip joint replacements. Clinical, radiographic, surgical, and pathologic findings were reviewed in all cases. Conventional radiographs revealed abnormal position of the metal components in all patients and opaque curvilinear periarticular deposits in four. Arthropathy caused by deposition of small titanium particles from metal friction (in the absence of interposed polyethylene) was pathologically proved to correspond to the periarticular opacity. The subtle radiolucent polyethylene component was identified in all patients; adequate visualization in some cases may necessitate imaging with additional methods such as magnification, phosphor plate, and soft-tissue radiographic techniques; conventional tomography; and arthrography. Early recognition of these abnormalities in patients with painful joint replacements may allow less extensive surgical revision and prevent development of titanium-induced arthropathy.

Aged↗

PubMed1992

Clonal karyotypic aberrations in enchondromas.

Enchondromas, benign cartilaginous tumors arising within the medullary cavity of bone, are frequently difficult to differentiate from their malignant counterpart. In this study, cytogenetic analysis was performed on seven cases of solitary enchondroma. Normal karyotypes were observed in five cases. Clonal abnormalities were detected in two cases. An isochromosome of the short arm of chromosome 6 characterized one case, and t(12;15)(q13;q26) in addition to random numerical and structural abnormalities such as telomeric association was observed in the other case. An i(6p) and structural rearrangements involving 12q13 previously have been described in chondrosarcoma. Our findings suggest that similar clonal karyotypic abnormalities exist in benign and malignant cartilaginous neoplasms.

Adolescent↗

PubMed1991

Cytogenetic analysis of two sacral chordomas.

Cytogenetic analysis of two sacral chordomas revealed two distinct abnormal clones in one of the cases: 44,XY,t(1;3)(q42;q11), -2,der(7)t(2;7)(q23;q32), -21 and 46,X,t(Y;8)(q12;q22), t(1;14)(p34;q32),t(5;10)(q13;p11). All cells analyzed from the second case were cytogenetically normal. To the best of our knowledge, chordomas have not previously been subjected to cytogenetic analysis.

Aged↗

PubMed1991

Clonal chromosomal abnormalities in hemangiopericytoma.

We report the cytogenetic findings in nine hemangiopericytomas studied after short-term culture. Clonal chromosome abnormalities were present in four cases. One case had a simple translocation (12;19)(q13;q13.3) as the sole abnormality whereas complex and multiple chromosomal abnormalities involving almost all chromosomes in the complement characterized tumors from the three other cases.

Chromosome Aberrations↗

PubMed1991

Cytogenetic findings in aneurysmal bone cysts.

Cytogenetic analysis was performed on samples from ten patients diagnosed with aneurysmal bone cyst. Six of the patients were male and four were female, with ages ranging from 7 to 24 years. Results were obtained in eight of the cases; all were karyotypically normal.

Adolescent↗