Cytogenetic findings in malignant fibrous histiocytoma.
The cytogenetic findings of two malignant fibrous histiocytomas from two unrelated patients are discussed. Both tumors were characterized by trisomy 7.
Aged↗
Biomedical subjects
J R Neff
Publications and source records attributed to J R Neff.
Cystic masses of the knee: arthrographic and CT evaluation.
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Aneurysm↗
Intraarterial digital subtraction arteriographic evaluation of extremity tumors: comparison with conventional arteriography.
Conventional arteriography and intraarterial digital subtraction arteriography (IADSA) were compared in 36 patients with primary bone or soft-tissue tumors of the extremities. The sensitivity of IADSA was at least equal to conventional arteriography for demonstrating normal or abnormal major arteries and feeding arteries, equal to or superior for depicting tumor stains or draining veins, but slightly inferior for revealing minute tumor vessels. An increase of the matrix size from 256 X 256 to 512 X 512 improved these sensitivities. IADSA with 15% diatrizoate contrast material eliminated the contrast material-induced pain in all patients. With a computer-controlled iris setting, an average of 5 minutes of procedure time and 1.7 R of radiation (0.44 mC kg) per examination could be saved. IADSA reduced the cost of an examination by an average of $67. The results indicate that IADSA was diagnostic in all instances and can replace conventional arteriography for the evaluation of extremity tumors.
Angiography↗
MR imaging and CT of extrahepatic cavernous hemangiomas.
Ten extrahepatic cavernous hemangiomas in seven patients were evaluated by MR and CT. MR was done with a 1.0-T superconducting magnet and spin-echo imaging. The lesions occurred in the musculoskeletal system, parotid gland, and spleen. MR and CT features of hemangiomas were compared, and MR findings in hemangiomas were also compared with those in eight musculoskeletal tumors of nonvascular origin. MR detected 10 hemangiomas, while nine were shown by CT. Also, MR was more accurate than CT in three patients in determining the true extent of hemangiomas. At a pulse-repetition interval of 2000 msec and an echo delay time of 90 msec, all hemangiomas were markedly hyperintense compared with skeletal muscle. Quantitatively, at this pulse sequence, intensity ratios of hemangiomas to skeletal muscle were all seven or greater (mean = 9.89), while the ratios for other tumors were usually less than seven (mean = 5.14). These means differed significantly (p less than .001). Small cavernous hemangiomas were homogeneous, well-defined round or oval lesions, while large hemangiomas consisted of dilated, tortuous vascular channels. Other tumors, however, were usually heterogeneous owing to hemorrhage and necrosis and had irregular margins. MR may, therefore, be useful for distinguishing cavernous hemangiomas from other soft-tissue tumors, particularly sarcomas.
Adolescent↗
Nonmetastatic Ewing's sarcoma of bone: the role of surgical therapy.
The role of the orthopedic oncologist in the management of patients with Ewing's sarcoma (ES) is increasingly demanding. The initial radiographic evaluation demands a minimum sophistication of a current generation computed tomography (CT) evaluation of the chest and primary lesion followed by appropriate biopsy and pathology support. After completion of induction chemotherapy, radiographic reevaluation and restaging are followed by either "tailored port" or standard radiation therapy techniques, or surgical resection, as indicated in selected patients. Improvement of the care of ES patients requires the cooperation of physicians, surgeons, technicians, and social workers with appropriate training and skill.
Adolescent↗
Tumor involvement of peripheral joints other than the knee: arthrographic evaluation.
Arthrography was performed in 24 patients with tumors in the region of the shoulder, elbow, wrist, hip, and ankle. Conventional arthrograms were supplemented by arthrotomograms and/or computed arthrotomograms as necessary. The presence or absence of joint involvement by tumor was correctly identified in 22 of 24 patients (91.7%). It is concluded that arthrography is a reliable method for detecting joint involvement by tumor, and should be performed if plain radiography, conventional tomography, and computed tomography are not definitive in demonstrating joint involvement.
Adolescent↗
Pubic and sacral insufficiency fractures: clinical course and radiologic findings.
Distinctive vertical insufficiency fractures of the pelvis were found in nine osteopenic patients. Each patient had subacute pelvic pain without antecedent trauma. The sacral fractures healed fairly quickly, but the pubic fractures often had a protracted course. Eight patients had combined sacral and pubic fractures; one had only sacral alar fractures. In three patients the sacral fractures preceded the pubic fractures by 3-4 months. All nine patients had skeletal demineralization due to metabolic bone disease, radiation therapy, or multiple myeloma. Recognition of the association between pubic and sacral insufficiency fractures should aid in recognizing the diffuse nature of the skeletal disease so that unnecessary biopsy of the fracture sites can be avoided.
Aged↗
Role of radiologic imaging in management planning of giant cell tumor of bone.
The radiologic studies of 24 patients with giant cell tumors were evaluated with respect to their ability to determine tumor extent and to influence management. Computed tomography (CT) was the most accurate method for detecting soft tissue tumor extension, and conventional tomography was the best technique for evaluating penetration of subarticular cortical bone. Detection of these findings led to performance of en bloc tumor resection rather than curettage and grafting in patients with lower extremity tumors. Arthrotomography was helpful in some instances in detecting cartilage and joint invasion by tumor, joint invasion being an indication for extra-articular rather than transarticular tumor resection. Scintigraphy was not as accurate as conventional tomography or CT in determining intraosseous tumor extent because of increased tracer uptake beyond the true tumor limits in several cases. Angiography has been largely replaced by CT in evaluating giant cell tumors.
Adolescent↗
Parosteal osteosarcoma.
Forty-one cases of parosteal osteosarcoma were reviewed clinically, radiologically and pathologically. The fibrous and cartilaginous elements of each tumour were graded from I to IV for malignancy. Primary intramedullary involvement was found in one third of Grade I lesions, two-thirds of Grade II and nearly 90% of Grade III lesions. Thirty-five patients with adequate follow-up were also studied and evaluated as to the adequacy of surgical management in relation to the later development of local recurrence or metastasis or both. No metastases were seen from Grade I tumours despite a number of local recurrences. One third of patients with Grade II and half of those with Grade III tumours developed pulmonary metastases and died, all with involvement of the medullary cavity before distant spread. No patients with adequate surgical management developed local recurrence; in those with inadequate treatment there was an 88% local recurrence rate.
Adolescent↗
Scintigraphic evaluation of giant cell tumor of bone.
Technetium-99m methylene diphosphonate bone scans were performed in 21 patients with giant cell tumors of bone. All tumors showed increased radiophosphate uptake, often more intense at the tumor periphery than in its center. However, radionuclide bone scanning often overestimated intraosseous tumor extent as a result of increased tracer uptake beyond true osseous tumor limits. In addition, it failed to detect soft-tissue tumor extension in nine patients. Therefore, scintigraphy is less useful than either computed or conventional tomography in planning surgical margins of giant cell tumors. Gallium-67 citrate scans obtained in seven patients showed slight uptake in four tumors and no uptake in three. Radiogallium imaging is thus of limited use in evaluation of suspected giant cell tumors of bone.
Adolescent↗
Principles of tumor management.
Primary musculoskeletal tumors are rare in the practice of orthopaedic surgery because they are unusual in the general population. The orthopaedist is often the first physician faced with the decision of how the patient should be evaluated and treated. The best opportunity for control of the tumor and maximal function is dependent on the initial management. History and physical examination are essential. Each patient must be appropriately staged to determine the anatomic extent of the tumor and its histologic type and grade. Plane x-ray examination, tomograms, isotope bone scans, angiograms, and CT are all useful tools in the staging of a musculoskeletal tumor but must be requested with specific questions asked of the radiologist if maximal benefit is to be obtained from them. Serum determination of calcium, phosphorus, alkaline phosphatase, protein electrophoresis, and sedimentation rate and urine determination of protein electrophoresis are the minimal laboratory evaluations suggested. Following careful staging of the patient and discussion with the pathologist regarding possible diagnoses and treatment, a thoughtful biopsy should be done. Consideration should be given to an immediate limb salvage procedure when appropriate, based on a frozen section diagnosis. This requires that the surgeon who performs the biopsy accept the responsibility for the definitive treatment of the patient.
Arm↗
The management of Ewing's sarcoma: role of radiotherapy in local tumor control.
The role of radiotherapy in the management of Ewing's sarcoma is discussed in view of both historical and current treatment policies. In particular, a comparison of radiotherapy and surgery as modalities for local control is presented. The technical aspects of dose and volume of radiotherapy are discussed together with its time relationship to chemotherapy and surgery. Although studies are in progress evaluating lower doses and smaller volumes than those used traditionally, until the results of these are available it would seem prudent to recommend the standard therapy as outlined in the guidelines of the recent Intergroup Ewing's Sarcoma Study Trial ( IESS -II). Recommended doses are: 4500 rad to the whole bone (except the contralateral epiphysis when the tumor is at or near the end of a long bone) plus a 5-cm margin around the tumor and any soft tissue extension, followed by 500 rad to a 5-cm margin, followed by 500 rad to a 1-cm margin given at 180-200 rad/day 5 days/week. Since many studies have shown it to be safe and possibly advantageous to postpone irradiation until induction chemotherapy has been completed, this appears to be the emerging approach. The value of partial excision (debulking) prior to irradiation is unclear at the present time. Radiotherapy may not be indicated for those patients with tumors of the lower limb when the unfused epiphyses would need to be irradiated. In addition, patients with pathologic fractures and with tumors of bones that are deemed expendable (such as ribs or clavicles) are probably best managed by complete surgical resection.
Antineoplastic Agents↗
Dynamic computed tomography scanning of benign bone lesions: preliminary results.
The majority of benign bone lesions can be evaluated adequately using conventional radiologic techniques. However, it is not always possible to differentiate reliably between different types of benign bone lesions on the basis of plain film appearances alone. Dynamic computed tomography (CT) scanning provides a means for further characterizing such lesions by assessing their degree of vascularity. Thus, it may help in distinguishing an osteoid osteoma, which has a hypervascular nidus, from a Brodie's abscess, which is avascular. Dynamic CT scanning may also help in the differentiation between a fluid-containing simple bone cyst, which is avascular, and other solid or semi-solid benign bone lesions which show varying degrees of vascularity. However, because of the additional irradiation involved, dynamic CT scanning should be reserved for evaluation of selected patients with benign bone lesions in whom the plain film findings are not definitive and in whom the CT findings may have a significant influence on management.
Adolescent↗
The computed tomographic findings of popliteal cysts.
The computed tomographic (CT) findings of two popliteal cysts are presented, and the correlated anatomico-pathologic changes are discussed. The characteristic findings include thin, well-defined cyst wall, fluid density contents, central septum or septi, and medial popliteal location with mediocaudal extension. These findings, however, may vary due to herniation or rupture of the synovial membrane, gelatinous cyst contents, or metaplastic change of the cyst wall. Differential diagnoses include liposarcoma, popliteal aneurysm or hematoma, thrombophlebitis, xanthoma, fibrosarcoma, or other soft tissue tumors.
Bursa, Synovial↗
Diagnosis of post-traumatic syringohydromyelia presenting as neuropathic joints. Report of two cases and review of the literature.
Two paraplegic men with post-traumatic syringohydromyelia presented initially with neuropathic arthropathy of the elbow and shoulder, respectively. Both patients had sustained spinal trauma years earlier and had been lost to orthopedic and neurosurgical follow-up study. Characteristic history and physical findings were present in both patients. Conventional myelography failed to demonstrate the lesion in the first patient. The diagnosis in the second patient was confirmed by lumbar injection of low-dose metrizamide followed by immediate and delayed computerized axial tomography in the supine and lateral positions. Both patients were treated by surgical decompression and subarachnoid shunts with arrest of the neurologic deterioration. To the authors' knowledge, this is the first report of patients with post-traumatic syringohydromyelia presenting with neuropathic joints. The present case reports illustrate the need for long-term follow-up studies of patients with spine injury in specialty clinics. The use of computerized axial tomography and low-dose intrathecal metrizamide is advocated for diagnosing post-traumatic syringohydromyelia.
Adult↗
Surgical treatment of giant-cell tumor of the spine. The experience at the Istituto Ortopedico Rizzoli.
We reviewed the cases of nine patients with a giant-cell tumor of the vertebrae. All segments of the spine can be affected by the tumor, but there was a predilection for the lumbar segments in our series. Pain was present in all patients. The maximum duration before the diagnosis was made was three years and the minimum, forty-five days (average, 12.2 months). In six patients a neural deficit was also present. One patient was treated many years ago by radiation therapy alone; three patients were treated by decompressive laminectomy; two, by excision of the lesion and postoperative radiation therapy; and three patients underwent lesional but extensive excision as well as arthrodesis without any preoperative or postoperative radiation therapy. We have obtained good results with the latter treatment; after follow-ups of sixty, twenty-six, and twenty-four months in three patients the pain and the neural symptoms subsided, while roentgenographic examination showed no evidence of local recurrence. In all patients the autogenous bone grafts appeared to be incorporated, without any secondary deformity. We concluded that, due to the development of better surgical techniques, the surgical approach is probably the best modern treatment for a giant-cell tumor located in the spine.
Adult↗
Giant-cell tumor of bone in skeletally immature patients.
Giant-cell tumor of bone is predominantly an affliction of adults and is rarely found in skeletally immature patients. We are reporting six new cases of histologically confirmed giant-cell tumor of bone in patients with radiographically open epiphyseal plates. These patients account for 1.8 per cent of the 326 giant-cell tumor of bone observed at the Bone Tumor Center of the Istituto Ortopedico Rizzoli in Bologna, Italy.
Adolescent↗
Case report 207. Giant cell reparative granuloma of left femur arising in polyostotic fibrous dysplasia.
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Adult↗