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Query: UMLS:C0029463 (osteosarcoma)
 16,637 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The presence of pathologic fracture in osteosarcoma raises concerns of tumor dissemination by the fracture hematoma and has been considered a contraindication to limb salvage surgery. Because this is a theoretical concern, there are little clinical data available in the literature on which to base treatment of these patients. Eighteen patients with osteosarcoma who sustained a pathologic fracture and had a minimum of 24 months of followup were reviewed retrospectively. Surgical treatment included nonoperative therapy, amputation, and limb salvage groups. Patients who refused surgical intervention (2) had a uniformly poor outcome. Patients who underwent amputation (6) had no local recurrences and 33% developed metastases. Patients who underwent limb salvage (10) experienced 3 local recurrences and 6 distant recurrences. Although the distant recurrence rate for patients undergoing amputation was no different from the rate for those undergoing limb salvage, the difference in local tumor control approached statistical significance. All patients who developed local recurrence died. Surgical treatment needs to be individualized and based on factors such as fracture displacement, stability, radiographic and histologic response to chemotherapy, and the perceived ability to resect the fracture hematoma completely.
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PMID:The surgical treatment of patients with osteosarcoma who sustain a pathologic fracture. 859 61

The prognosis of bone and soft tissue sarcoma is influenced by factors such as pulmonary metastasis, local curability and sensitivity to chemotherapy. In cases with pulmonary lesion, the prognosis has not been favorable, but recently long-term survivors are increasing in number by effective chemotherapy, and the removal of primary and metastatic lesions. As in cases without metastatic lesions, the prognosis of high-grade sarcoma were influenced by local curability and sensitivity to chemotherapy. On the other hand, the prognosis in low grade sarcoma is mainly decided by local curability. To assure local curability the following should be considered. 1) safety surgical margin, 2) preoperative radiation therapy if the safety margin is not predicted, and 3) risk factors in local curability, which are lymph node metastasis, skip metastasis and tumor thrombus. If these risk factors are detected before operation, a more radical procedure should be planned. Moreover, cutaneous angiosarcoma and epithelioid sarcoma, which are occasionally associated with these risk factors, should be operated by ablative procedure even if the risk factors are not detected. 4) In cases with pathological fracture or inadequately operated, surgical intervention to prevent transplantation should be undertaken as soon as possible. Effective chemotherapy could improve the prognosis of high grade sarcoma. Thus, chemotherapy should be used for osteosarcoma, Ewings sarcoma, round cell sarcoma etc. However, non-effective chemotherapy might make the prognosis worse. Therefore, alternative administration of effective chemotherapeutic agents proved by clinical evaluation would be more reasonable than remaining with a certain protocol.
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PMID:[Prognostic factors of bone and soft tissue sarcoma]. 868 30

Enchondroma is a benign growth of cartilage arising in the bone metaphysis as a solitary or multiple primary lesions. The form of multiple enchondromatosis with unilateral predominance is termed Ollier's disease. We have recently treated a case of Ollier's disease with the chief complaint of deformity of the left hand. The patient was an 11-year-old boy. Radiographic examination showed honeycombed clear spaces in the metaphyses of the middle and proximal phalanges of the left ring and little fingers as well as of the fourth and fifth metacarpals, and thinning of the cortex of these bones, but with no evidence of pathological fracture. The tumors of the left fourth and fifth metacarpal bones and of the phalanges of the left ring and little fingers were removed, and the metacarpophalangeal joint of the little finger was capsulotomized. The patient was free from recurrence 19 months after surgery. With regard to the prognosis of Ollier's disease, malignant transformation into chondrosarcoma or osteosarcoma has been reported of the chondroma. Since Ollier's disease is self-limited in that it usually stops spontaneously as the patient grows, and since the cartilaginous lesions in occasional cases may regress or even disappear, any cartilaginous lesions that are still active or painful after termination of the growth period should be examined thoroughly under suspicion of undergoing malignant transformation.
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PMID:A case of Ollier's disease of the hand. 901 45

Pathological fracture in histologically proven post-Paget osteosarcoma of the humerus is a rare complication. Due to individual requests as well as age and comorbidity, a course of primary palliative treatment was chosen in the present case. Survival time after diagnosis was 9 months and the patient died of a tumor-independent disease. Even in combined treatment, consisting of surgery and (neo-)adjuvant radio-/chemotherapy, prognosis of osteosarcomas secondary to Paget's disease remains very disappointing. Therefore, in treatment of this highly lethal tumor the patient's individual requests and personal situation often require more consideration than in many other malignancies.
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PMID:[Pathologic humeral fracture in secondary osteosarcoma of the humerus: a rare complication of osteodystrophia deformans Paget]. 917 45

Osteosarcoma involving the distal right femur was diagnosed in a nine-year-old female neutered Rottweiler seven years after total hip arthroplasty had been performed on that limb. The findings were consistent with a primary bone tumour and pathological fracture of the right femoral condyle with loosening of the orthopaedic implant and fracture of the polymethylmethacrylate at the distal aspect of the femoral component. Possible hypotheses to explain the association of osteosarcoma with total hip arthroplasty suggest that the neoplastic process was the result of some derangement of host tissue and the healing process or that the implants or their by-products were carcinogenic. Given the large number of total hip arthroplasties that are routinely performed in dogs, the development of a malignant lesion appears to be an extraordinary complication and may be completely coincidental.
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PMID:Osteosarcoma following total hip arthroplasty in a dog. 920 Jan 18

A case of an osteosarcoma following a pathological fracture through a small benign-looking cortical lesion of the proximal humerus is described. The unusual evolution from a small cortical lesion to a malignant lesion raises the question whether this is a case of an intracortical osteosarcoma that has some distinct features from those of previously reported cases.
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PMID:Unusual evolution of a benign-looking cortical defect of the proximal humerus. A case of intracortical osteosarcoma? 958 58

Paget's disease of bone is a common condition characterized by bone pain, deformity, pathological fracture, and an increased incidence of osteosarcoma. Genetic factors play a role in the pathogenesis of Paget's disease but the molecular basis of the disease remains unclear. Previous genetic linkage studies have mapped the rare Paget's disease-like bone dysplasia familial expansile osteolysis (FEO) to chromosome 18q21-22, and recent work has shown evidence of linkage between this locus and Paget's disease in one family. Here we studied the relationship between the 18q21-22 locus and Paget's disease in eight large multiplex families from diverse ethnic backgrounds with inherited Paget's disease. Paget's disease was inherited as an autosomal dominant trait in all families, with high penetrance by the sixth decade. Analysis of seven highly polymorphic markers from chromosome 18q21-22 showed positive summated two-point log10 odds ratio (lodscores) of +2.97 with the marker D18S42 at a recombination fraction (theta) = 0.05, and of +2.95 with the marker D18S60 at theta = 0.00, values which are close to the cut-off of +3.0, which is generally accepted as evidence of linkage. Segregation analysis of the haplotypes and formal statistical analysis using the HOMOG program provided evidence for genetic heterogeneity, however, with evidence for linkage in five families and against linkage in the remaining three families (chi square 8.82; df = 2; p < 0.025). Multipoint linkage analysis in the five linked families showed lodscores of above +3.5 across the whole susceptibility region and a maximum summated lodscore of 3.89 at the marker D18S465. In the three nonlinked families, negative multipoint results were obtained for the whole region, with lodscores below -2.0 in one family, excluding this as a candidate locus for the disease. Our studies demonstrate the importance of hereditary factors in the pathogenesis of Paget's disease and confirm evidence of linkage between Paget's disease and chromosome 18q21-22 in some families. This raises the possibility that Paget's disease and FEO may share a common molecular basis, perhaps due to different mutations in the same gene or family of genes. Data from three families did not support evidence of linkage to 18q21-22 however, indicating that Paget's disease is genetically heterogeneous and suggests the presence of at least one additional locus which remains to be discovered.
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PMID:Paget's disease of bone: evidence for a susceptibility locus on chromosome 18q and for genetic heterogeneity. 962 21

We investigated predictive factors for local recurrence in 540 patients with non-metastatic osteosarcoma of the extremity treated with surgery and neoadjuvant chemotherapy, between March 1983 and October 1994. The median follow-up was 7.5 (2.5-15) years. Local recurrences developed in 31 (6%) patients after a median time of 2 (0.5-7) years. Local recurrence did not correlate with patients' age and sex, histologic subtype, site and tumor volume, presence of pathologic fracture, chemotherapy regimen and type of surgery. Local recurrence-free survival (LRFS) correlated with the quality of surgical margins and response to chemotherapy: the 7-year LRFS was 97% after adequate surgical margins and 71% after inadequate surgical margins (p < 0.0001), and was 95% in good responders and 90% in poor responders (p = 0.001). Only 1 of 31 patients with local recurrence was free of disease 15 months after the last treatment, 3 were alive with uncontrolled disease and 27 died. This post-relapse outcome is significantly worse than in patients who relapsed with metastases only (25% free of disease, 0.5-9 years after the last treatment). We conclude that, in osteosarcoma of the extremity, limb-salvage procedures should be planned only when the preoperative staging indicates that it is possible to achieve adequate surgical margins. If the pathologic examination of the surgical specimen shows inadequate surgical margins, an immediate amputation should be considered, especially if the histologic response to preoperative chemotherapy was poor.
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PMID:Predictive factors for local recurrence in osteosarcoma: 540 patients with extremity tumors followed for minimum 2.5 years after neoadjuvant chemotherapy. 970 94

A 20-year-old female with right femoral osteosarcoma noted severe pain and swelling of the right thigh, and was transferred to the authors' hospital after suffering a pathologic fracture of the right femur. Plain x-ray disclosed a tumor shadow extending from the pathologic fracture of the distal portion of the femur to the center of the diaphysis. MRIs showed a broad lesion and hematoma, and invasion to the femoral vascular bundle was suspected. Angiograms revealed vascularization coincidental to the tumor, and an irregular vascular wall of the femoral artery, which was shifted posteriorly. After consultation with the patient and her family, rotation plasty was performed. The sciatic nerve was isolated and preserved; major vessels were sectioned proximally and distally because of tumor tissue invasion to the femoral artery and vein. After wide excision of the tumor, the leg was rotated outward 180 degrees, and osteosynthesis was performed between the remaining femur and the tibia, followed by microsurgical anastomosis of vessels. Five years postoperatively, no local recurrence or metastasis has been observed. The patient has excellent functional recovery without pain, and no other complications.
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PMID:Rotation plasty for osteosarcoma of the femur. 985 44

Two cases of osteogenic sarcoma with skeletal muscle metastases are described. A 40-year-old woman presented with progressive swelling of both calves and a soft tissue back lump. She had been diagnosed with mandibular chondroblastic osteogenic sarcoma 6 years earlier. Radiographs showed calcified masses. MRI scans and bone scintigraphy revealed multiple soft tissue masses in both calves. Bone scintigraphy also showed uptake in the back lump, right thigh and left lung base. Biopsy confirmed metastatic chondroblastic osteogenic sarcoma, which initially responded well to chemotherapy. However, the metastatic disease subsequently progressed rapidly and she died 21 months after presentation. The second case concerns a 20-year-old man who presented with a pathologic fracture of the humerus, which was found to be due to osteoblastic osteogenic sarcoma. He developed cerebral metastases 17 months later, followed by metastases at other sites. Calcified masses were subsequently seen on radiographs of the abdomen and chest. CT scans confirmed the presence of densely calcified muscle metastases in the abdominal wall, erector spinae and gluteal muscles. The patient's disease progressed rapidly and he died 30 months after presentation.
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PMID:Osteogenic sarcoma with skeletal muscle metastases. 1042 40


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