Giant-cell tumour of bone.
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Bone Neoplasms↗
Biomedical subjects
M Szendröi
Publications and source records attributed to M Szendröi.
Surgical treatment and prognostic factors in giant-cell tumor of bone.
The rate of local recurrence in the giant-cell tumor of bone (GCT) is influenced by many factors. GCT aggressiveness is related to mitotic activity, aneuploidy of tumor cells, chromosomal abnormality, excessive metalloproteinase expression and alterations in different oncogenes. Statistically, there was no correlation between the recurrence rate and the size and site of tumor, stage of disease and involvement of subchondral bone. However, statistical analysis revealed that the use of adjuvants (phenol, bone cement, etc) and the type of surgical intervention (en block resection versus curettage and grafting) were factors with a prognostic value. Although recurrence or malignant transformation in GCT cannot be predicted yet, about 96% of the patients can be cured. In the majority of cases, recurrences have no fatal consequences for the patient but may lead to various degrees of disability due to repeated and more radical surgical procedures. Joint-sparing surgery and careful curettage with the use of adjuvants should be the treatment of choice whenever possible. In the future, modern instruments of molecular biology will be used to aid the evaluation of primary and recurrent tumors and will have an increasing influence on surgical planning.
Bone Neoplasms↗
Advances in orthopaedic oncology.
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Bone Neoplasms↗
Mid-foot reconstruction following involvement of five bones by giant cell tumor.
We report on a patient who had giant cell tumor involving multiple bones of the mid-foot. The tumor originated from the navicular bone, but also destroyed the cuboid, and all cuneiform bones. This unusual presentation of giant cell tumor presented a therapeutic challenge for the surgeons. The patient was treated with en bloc resection and the bony defect replaced with a massive iliac crest graft which united within 9 months and has remained stable for 7 years without local recurrence, and with excellent function of the foot.
Adolescent↗
[Dual fluorescence in situ hybridization analysis of synovial sarcoma].
Synovial sarcoma have (about in 95% of the cases) the specific and characteristic reciprocal chromosomal translocation t(X; 18) (p11.2; q 11.2). Application of dual-colour fluorescence in situ hybridization (FISH) on interphase nuclei to identify the specific translocation has a diagnostic importance for daily pathological practice. For visualisation of the translocated chromosomal fragments of synovial sarcoma cells on imprint smears, chromosome X painting probes and chromosome 18 centromeric probes were used. Our present study indicates that the precise preoperative diagnosis of synovial sarcoma using dual-colour FISH is possible on smears and this possibility (to identify specific chromosomal translocations in soft tissue tumours) is a landmark in the preoperative diagnosis of soft tissue sarcomas.
Adult↗
The prognostic significance of DNA cytophotometry and proliferation index (Ki-67) in giant cell tumors of bone.
We studied DNA ploidy by smear cytophotometry and proliferation activity by Ki-67 MIB immunohistochemistry in 69 primary and recurrent giant cell tumors (GCT) from 50 randomly selected patients. The obtained results were evaluated with comparisons made to the available clinical data. From the 46 primary tumors 63% showed diploidy and 37% aneuploidy. A significantly (P=0.026) higher recurrence rate (64%) was observed in aneuploid than in diploid tumors (31%). In the course of the recurrences, both the ratio of aneuploid tumors as well as the proliferation index of the tumors increased, though the degree of the latter was non-significant. Aneuploidy did not mean an unambiguous tendency towards malignant transformation; however, a close follow-up of recurrent aneuploid tumors, and wide excision of the recurrence instead of intralesional curettage are the recommended procedures. The DNA cytophotometry and proliferation index of GCTs--as compared to other histologic examinations--are of prognostic value in the evaluation of the recurrence potential of the GCTs.
Adolescent↗
Tumor surgery of the pelvic region.
During the past ten years the authors operated on 27 tumors of the pelvic region, 12 of them involving the pelvic blade, 6 the periacetabular region, further 9 the os pubis and ischii, respectively. Most of the cases (16) were chondrosarcomas. The mean age of the patients--13 male and 14 female--was 41 years. As to surgical radicality 11 wide, 10 marginal and 6 intralesional resections were performed. After a mean follow-up period of 3 years (0.5-11 years) 19 patients are alive tumor-free, 2 with tumor, 4 died and 2 were lost to follow-up. As postsurgical complication wound-healing disorder and inguinal hernia occurred in 5 cases, on the surgical field thrombosis with secondary compartment syndrome and renal insufficiency developed in one case. The authors draw the attention to the difficulties and indications of the pelvic resections (internal hemipelvectomies).
Acetabulum↗
[Study of the reactivity of giant cell tumors of bones to different lectins].
The authors have examined 18 cases of giant cell bone tumours using various lectins. Type I stromal cells resembling fibroblasts and participating in the construction of matrix were Con A positive. The intensity of Con A binding and the number of positive cells increased with increasing stage. The nature and intensity of PNA-lectin binding in giant cells, after digestion with neuraminidase, varied according to the stage. While in Group I giant cells, 30 % of cells were negative and, in the great majority of cells, the reaction was limited to a clearly defined segment of the membrane, in Group III tumours, the proportion of negative cells was approximately 1 % and a diffuse and very intense intracytoplasmic reaction was observed in 60 % of the positive cells. According to the authors, the histochemical study of lectins could help classify giant cell tumours.
Adolescent↗
Multicentric extraabdominal desmoid tumour: a case report.
The very rare condition of multicentric desmoid tumours involving two distant and apparently independent sites is reported in a 17-year-old man. The tumours grew simultaneously and reached approximately equal size. No evidence of familiar polyposis or any other feature of Gardner's syndrome were noted. The proximal desmoid tumour developed from the left hip region and extended into the femoral bone, whereas the distal mass was attached to the left popliteal fossa infiltrating the flexor muscles, the nerves and vessels. On the basis of the good results published recently in the literature and our own earlier experiences, the intralesional resection of the desmoid tumours was completed with postoperative fractionated radiotherapy.
Adolescent↗
[Behavior of adamantinoma of the long bones based on long-term follow up studies].
Authors report on the long time (in average 12 years, range: 5-36 years) follow-up results of 5 cases of adamantinoma, localized on the tibia. In one case recurrence was found very late, 20 and 36 years after the primary wide resection, and resection was repeatedly performed. Because of problems of differential diagnosis in one case the tumor was excised intralesionally (curettage + plasty with cancellous bone). 7 years later the persistence of the process was found only. 1 patient died in consequence of pulmonary metastasis 9 years after the primary operation. Wide resection is suggested both for the removal of the primary tumor and the recurrences, appearing very late. For the reconstruction of the bone autologous fibula is proposed. Adamantinoma is thought to be a low malignity tumor, the outcome of which cannot be predicted from the clinical and histological findings. Considering the late recurrences and metastasis a long range, minimally 10 years, following of the patient is thought to be necessary.
Adult↗
New aspects in the treatment of bone sarcomas.
The author reports on the progress made in the treatment of bone tumours in the last two decades. There is a short description of new entities like the solid form of aneurysmal bone cyst; dedifferentiated and clear-cell chrondrosarcoma; low malignant central osteosarcoma; periosteal and high-grade surface osteosarcoma, which have recently been reported in the literature. The response to the chemotherapy in osteosarcoma and the problems of limb-saving surgery in bone tumours are discussed.
Adolescent↗
Osteoporosis--a modifying factor of surgical treatment.
Increasing knowledge of fragile bone has been gained by non-invasive mineral assessments. Its future importance seems to be twofold. First by, it seems likely that patients with low bone mineral will be treated to try to increase this bone mineral or at least to keep it steady. Secondly, in the presence of osteoporosis special strategies must be taken into consideration. In many locations osteoporotic fractures may need special solutions. It seems that osteosynthesis with plates and screws which have their definite indications in younger patients may be replaced by alternatives, such as cerclage wiring and intramedullary implants. Polymethylmethacrylate has been a good adjunct to strengthen screw fixation and to fill defects after compression of fragile cancellous bone.
Adolescent↗
Examination and evaluation of surgical margins in bone tumours. Comparative pre- and postoperative CT and MR imaging.
An objective method of evaluating surgical margins and the extent of limb-preserving surgery is described in a study of 10 malignant bone tumours. The resected specimen was imaged by computerised tomography and magnetic resonance, and the appearances compared with the preoperative images of the tumour. CT was better than MR for detecting bony changes, but MR was more satisfactory for showing the extraosseous and intramedullary outline of the tumour. These two methods should therefore be combined. Intralesional excision is an absolute indication; marginal excision a relative indication for reoperation.
Adolescent↗
[Experience with the surgical management of primary and secondary chondrosarcoma].
Forty eight primary and 20 secondary chondrosarcomas were treated surgically 1975 through 1991. An evaluation of the data of the Bone Tumor Register of the Semmelweis Medical University proved that the incidence of the malignant transformation and development of secondary chondrosarcomas is 3% and 2.6% among solitary osteochondromas. The authors summarize the clinicopathological characteristics of the malignant transformation. A retrospective evaluation of the histological grade of the malignancy proved that 67% of tumors were classified as grade I; 18% as grade II and 15% as grade III. The survival of the patients was mainly determined by the grade of the malignancy. A 95% 5-years survival was found in the grade I group and a 10% survival only in the grade II and III groups. In the cases of highly malignant chondrosarcomas radical surgical intervention i.e. amputation is recommended, considering the most often extra-compartmental location of the tumors. Low malignant and intra-compartmental highly malignant chondrosarcomas should be treated, however, by limb saving surgery. In the cases of large inresecable but low malignant chondrosarcomas debulking surgery is also acceptable.
Adolescent↗
[Osteogenetic cells in myositis ossificans].
We have used the lectins Arachis hypogaea (PNA), Canavalia ensiformis (Con A) and Triticum vulgaris (WGA) for the examination of bone forming cells in 8 variously differentiated cases of myositis ossificans. The development of myositis ossificans could be characterized with the appearance of a WGA binding cell population. In this cell population the lectin binding spots may be found in the perinuclear cytoplasm, possibly in the Golgi complex. The lectin binding of the bone forming cells has disappeared in the ripe myositis ossificans. We think that the WGA binding cell population may be equal with the progenitor cells, wandering in form the stroma ot the bone marrow and that the ability of WGA binding may be a characteristic developmental marker of these cells.
Adult↗
[Results of the treatment of osteoblastomas].
Until now 19 patients were treated for osteoblastoma in our University Department. Operation was performed in every case and recurrence was found in one patient. The clinical-pathological characteristics of the benign, latent, active and aggressive osteoblastomas are discussed. In benign active process excision, in benign aggressive tumors, depending from the localization, resection en bloc is suggested. In cases localized near to the joint, weighing the damage of function in consequence of a possible resection and the increased risk too, a thorough excision is proposed completed with local adjuvant treatment and frequent control of the patient.
Adolescent↗
[Results with endoprostheses and bone transplantation in surgery for bone tumors].
Seventy six bone tumor patients were treated by limb salvage operations at the Orthopaedic Department of the Semmelweis Medical School in Budapest from 1981 through 1991. The bone defect was reconstructed with endoprostheses in 25 cases and with bone grafts in 51 cases. The mean follow-up period of 72 patients was 51 months (min. 12 months). There were local recurrences in 11% of the patients. Two complications occurred at the tumor endoprostheses, which functional rating were excellent or good in 75%. The most common complications at the bone grafting were infection (9.8%), fracture (11.8%), which did not influence the end result, and nonunion (9.8%) occurring often in homografts of resection-arthrodesis during the chemotherapy. This complications could be managed in all but two cases without loss of the limb. The bone grafts performed acceptable (excellent or good) functional result in 66% of the patients. Authors suggest reconstruction of the bone defect with bone grafting in cases of semimalignant and low malignant tumors, prefer, however, tumor endoprosthesis implantation in high malignant bone tumors which need chemotherapy.
Adult↗
[Experience with surgical treatment of osteosarcoma].
The authors treated 79 patients with osteosarcoma by surgery and chemotherapy 1975 through 1991. The appearance, localization and differential diagnosis are discussed. Attention is called to the doctor's delay. The effective pre- and postoperative chemotherapy decreased the incidence of the lung metastases and increased the survival rate (71% 3 years overall survival and 41% 5 years survival) and made the limb-sparing surgery possible. The development of the reconstructive surgical technique and new designs of tumor endoprostheses enabled us to perform limb-sparing surgery in more than one third of the cases at the same survival chance. The limb-sparing means a decisive change in the quality of the rehabilitation of the osteosarcoma patients.
Adolescent↗