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Prosthetics and Orthotics International Feb 2019For transfemoral amputations, the residual femoral length is critically important to prosthetic function. The aim of this report is to describe a novel method of...
BACKGROUND:
For transfemoral amputations, the residual femoral length is critically important to prosthetic function. The aim of this report is to describe a novel method of extending femoral length and to assess its stability over time.
CASE DESCRIPTION AND METHODS:
A 57-year-old woman with recurrent parosteal osteosarcoma was treated with above-knee amputation. A portion of the distal femoral endoprosthesis, which included uncemented fixation with a Compress stem, was retained in an effort to extend the short femoral remnant and maximize stump length.
FINDINGS:
At 3 years follow-up, the Compress stem remained well-fixed, and there was no soft tissue breakdown over the implant. The patient ambulated with a prosthetic limb and no external support.
OUTCOMES AND CONCLUSION:
To the best of our knowledge, this is the first report of using the Compress device as a means to maintain stable fixation and extend residual femoral length following above-knee amputation.
CLINICAL RELEVANCE
Extension of residual bone length in amputated limbs can help improve prosthetic fitting and function. The Compress device may be useful in this application as a means of secure fixation for a modular metallic prosthesis.
Topics: Amputation, Surgical; Artificial Limbs; Bone Neoplasms; Female; Femur; Follow-Up Studies; Humans; Leg Length Inequality; Middle Aged; Neoplasm Recurrence, Local; Osteosarcoma; Prosthesis Design; Prosthesis Implantation; Reoperation; Time Factors
PubMed: 30319024
DOI: 10.1177/0309364618805259 -
Veterinary Pathology Mar 2019Parosteal osteosarcoma is a rare, slow-growing tumor most commonly arising from the surface of long bones. Tissue or histological sections from 5 dogs and 1 cat with...
Parosteal osteosarcoma is a rare, slow-growing tumor most commonly arising from the surface of long bones. Tissue or histological sections from 5 dogs and 1 cat with zygomatic arch masses were examined. Clinical presentations varied from chronic sneezing to facial swelling. Imaging consistently demonstrated osseous proliferation in the area of the zygomatic arch. Histologically, the masses were characterized by well-differentiated fibro-osseous and chondroid components that radiated outward from the periosteum of the zygomatic bone. Cellular atypia and mitotic figures were uncommon. Parosteal osteosarcomas have previously been reported in the skulls of dogs and cats, but only 1 has been reported on the zygomatic arch. Initially, these tumors are of low histologic low grade, but with time, they can show more aggressive behavior and invade the underlying bone.
Topics: Animals; Bone Neoplasms; Cat Diseases; Cats; Dog Diseases; Dogs; Female; Male; Osteosarcoma; Tomography, X-Ray Computed; Zygoma
PubMed: 30244660
DOI: 10.1177/0300985818798110 -
Journal of the Chinese Medical... Oct 2018Most instances of the parosteal osteosarcoma (OGS) are low-grade tumors. However, some parosteal OGSs undergo dedifferentiated transformation. Dedifferentiated parosteal...
BACKGROUND
Most instances of the parosteal osteosarcoma (OGS) are low-grade tumors. However, some parosteal OGSs undergo dedifferentiated transformation. Dedifferentiated parosteal OGS can cause distant metastasis and poor survival, and preoperative chemotherapy may be warranted. This study provides imaging clues for dedifferentiated parosteal OGS before treatment.
METHODS
The study retrospectively enrolled 23 patients with histologically proven parosteal OGS, including 69.6% (n = 16) low-grade and 30.4% (n = 7) dedifferentiated types. Preoperative images including radiography and magnetic resonance imaging were reviewed. The following imaging parameters and clinical outcomes were evaluated: 1) average age; 2) sex; 3) tumor size; 4) presence of string sign; 5) necrosis; 6) hemorrhage; 7) solid soft tissue component; 8) perforating vessels; 9) ossification grade; 10) marginal ossification; 11) periosteal reaction; 12) sunburst reaction; 13) bone marrow edema; 14) bone marrow invasion; 15) perifocal soft tissue edema; 16) adjacent joint involvement; 17) adjacent neurovascular bundle compression; 18) regional lymph node; 19) bone metastasis; 20) preoperative lung metastasis; 21) follow-up lung metastasis; and 22) recurrence.
RESULTS
The average maximal tumor sizes were 7.1 cm and 10.9 cm in low-grade and dedifferentiated types, respectively (p = 0.033). Sunburst periosteal reaction was visualized in two cases of low-grade type (12.5%) and four cases of the dedifferentiated type (57.1%) (p = 0.025) of parosteal OGS. None of our studied cases revealed preoperative lung metastasis. In the follow-up chest computed tomography, lung metastasis was noted in two cases of conventional type (14.2%), and four cases of dedifferentiated type (57.1%) (p = 0.040) of parosteal OGS. In receiver operating characteristic (ROC) curve analysis, the average tumor size and sunburst periosteal reaction showed good specificity (AUC = 0.070 and 0.072, respectively).
CONCLUSION
Compared with low-grade types, dedifferentiated parosteal OGS exhibits a considerably larger tumor size, more sunburst periosteal reaction, and a more frequent development of lung metastasis in the disease course. Tumor size and sunburst periosteal reaction are the most crucial imaging diagnostic factors.
Topics: Adolescent; Adult; Bone Neoplasms; Cell Dedifferentiation; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Osteosarcoma, Juxtacortical; Young Adult
PubMed: 30190236
DOI: 10.1016/j.jcma.2018.01.014 -
Journal of Medical Case Reports Aug 2018Parosteal osteosarcomas are usually low-grade tumors, however, sometimes they transform to high-grade tumors, which is named dedifferentiation. This phenomenon has been... (Review)
Review
BACKGROUND
Parosteal osteosarcomas are usually low-grade tumors, however, sometimes they transform to high-grade tumors, which is named dedifferentiation. This phenomenon has been reported in long bones. Recently, we encountered a patient with dedifferentiated parosteal osteosarcoma occurring in the maxilla. Here, we report a first case of dedifferentiated parosteal osteosarcoma of the head and neck region.
CASE PRESENTATION
A 45-year-old Japanese woman with a refractory bone lesion in the maxilla presented to our hospital. A biopsy showed atypical spindle cell proliferation involving dedifferentiated high-grade component, which was diagnosed as dedifferentiated parosteal osteosarcoma. Three cycles of neoadjuvant chemotherapy using ifosfamide and pirarubicin were performed followed by sub-total maxillectomy. Histopathological results showed that neoadjuvant chemotherapy was effective for high-grade component. The decision to perform adjuvant chemotherapy (cisplatin and pirarubicin) was made because distant metastasis has been reported, even in cases with dedifferentiated parosteal osteosarcoma in which complete necrosis of high-grade component was achieved due to neoadjuvant chemotherapy. There was no recurrence 15 months after surgery.
CONCLUSIONS
Dedifferentiated parosteal osteosarcoma can occur in the head and neck region. Chemotherapy including anthracycline anticancer agent could be effective for high-grade component of dedifferentiated parosteal osteosarcoma.
Topics: Animals; Female; Head and Neck Neoplasms; Humans; Maxillary Neoplasms; Mice; Middle Aged; Osteosarcoma
PubMed: 30115116
DOI: 10.1186/s13256-018-1747-3 -
The Iowa Orthopaedic Journal 2018Parosteal osteosarcoma is a rare tumor with increased survival compared to conventional high-grade osteosarcoma. Due to this increased survival comes the need for...
BACKGROUND
Parosteal osteosarcoma is a rare tumor with increased survival compared to conventional high-grade osteosarcoma. Due to this increased survival comes the need for reconstructive options that provide good long-term functional results. Current treatment methods include geographic resection with allograft reconstruction versus resection and reconstruction with a distal femoral replacement.
PURPOSE
Our purpose was to compare the long-term functional outcomes of distal femoral replacements to allograft reconstructions, using the musculoskeletal tumor society (MSTS) scoring system.
METHODS
After querying our database, 12 patients were identified and completed a MSTS questionnaire.
RESULTS
There was no difference in functional outcomes between the cohorts at an average of 14 years follow up for the endoprosthetic group and 25 years of follow up for the geographic resection group.
CONCLUSION
At long-term follow-up, patients who undergo a distal femoral replacement for a parosteal osteosarcoma have no difference in functional outcomes compared to those who undergo an allograft reconstruction.Level of Evidence: IV.
Topics: Adolescent; Adult; Bone Transplantation; Databases, Factual; Female; Femoral Neoplasms; Femur; Follow-Up Studies; Humans; Limb Salvage; Male; Middle Aged; Osteosarcoma; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 30104942
DOI: No ID Found -
The American Journal of Surgical... Sep 2018Low-grade osteosarcoma (LGOS) encompasses low-grade central osteosarcoma (LGCOS) and parosteal osteosarcoma (POS). LGOSs are characterized by a supernumerary ring and...
Low-grade osteosarcoma (LGOS) encompasses low-grade central osteosarcoma (LGCOS) and parosteal osteosarcoma (POS). LGOSs are characterized by a supernumerary ring and giant rod chromosomes containing the 12q13-15 amplicon. The fibroblast growth factor receptor substrate 2 (FRS2) gene is located close to MDM2 and CDK4. Recent studies identified consistent amplification of FRS2 gene in atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma. The aim of this study was to evaluate the frequency of FRS2 amplification and its relationship with the clinicopathologic features of LGOSs. The amplification of FRS2 and MDM2 genes were analyzed by fluorescence in situ hybridization using 22 LGOSs (3 LGCOSs, 14 classic POSs, and 5 dedifferentiated POSs) and 85 control samples of bone and soft tissue. The clinicopathologic features of the 22 LGOSs were described. Amplification of FRS2 was detected in 21/22 (95%) of the LGOSs, including 3 (100%) LGCOSs and 18 (95%) POSs. All 22 LGOSs showed MDM2 amplification (100%). The only MDM2/FRS2 LGOS was dedifferentiated POS (the dedifferentiated component was conventional osteosarcoma). In the control group, all of the atypical lipomatous tumor/well-differentiated liposarcoma/dedifferentiated liposarcomas (DDLs) (10/10, 100%) were FRS2-amplified, whereas the remaining 75 control cases were FRS2-nonamplified. These findings indicate that the FRS2 gene is consistently amplified in classic and dedifferentiated LGOSs but not in their histologic mimics. These results offer another avenue for investigating the biology of LGOSs. Whether FRS2-nonamplified tumors exhibit unusual clinicopathologic features needs further investigation. Some so-called "high-grade osteosarcomas harboring 12q13-15 amplification" may be unrecognized dedifferentiated LGOSs.
Topics: Adaptor Proteins, Signal Transducing; Adult; Aged; Bone Neoplasms; Female; Gene Amplification; Humans; Male; Membrane Proteins; Middle Aged; Osteosarcoma; Proto-Oncogene Proteins c-mdm2; Young Adult
PubMed: 30001240
DOI: 10.1097/PAS.0000000000001125 -
South Dakota Medicine : the Journal of... Apr 2018Primary cutaneous osteosarcoma is an exceedingly rare malignant mesenchymal neoplasm of the skin which produces bone, osteoid, or chondroid material and does not involve...
Primary cutaneous osteosarcoma is an exceedingly rare malignant mesenchymal neoplasm of the skin which produces bone, osteoid, or chondroid material and does not involve the underlying bone. The most common site for extraskeletal osteosarcoma is in the deep soft tissues of the thigh, upper extremities, and retroperitoneum; however, it may occur anywhere in the body. Involvement of the skin is rare and when it does occur it is more commonly due to metastatic disease rather than a primary malignancy. Only 16 cases of primary cutaneous osteosarcoma have been described in the literature. We report an uncommon case of primary cutaneous osteosarcoma. Our patient is an 84-year-old male with an unremarkable medical history who presented to the dermatology clinic complaining of a 0.5 x 0.4 cm pink flesh to translucent-appearing, shiny, papule on the right superior jawline which was not connected to the underlying bone. Clinically the differential diagnosis included basal cell carcinoma, trichoepithelioma, and other cutaneous adnexal tumors. An excisional biopsy was performed which demonstrated an unremarkable epidermis with a hypercellular reticular dermis with occasional large spindled cells with amphophilic cytoplasm. The deep dermis was involved by mature osteoid formation and infiltration of highly mitotically active, atypical epithelioid and spindled cells with abundant nuclear pleomorphism, amphophilic cytoplasm, and poorly defined cell borders. Occasional multinucleate forms were seen. Immunohistochemistry was performed which showed strong positive staining with vimentin. Without connection to the underlying bone, osteosarcoma of periosteal, parosteal, or osseous origin was excluded. Based on these histomorphologic findings, a diagnosis of primary cutaneous osteosarcoma was made. Our case adds to the dearth of literature regarding primary cutaneous osteosarcoma and provides primary care physicians, dermatologists, and pathologists much needed insight into this rare condition.
Topics: Aged, 80 and over; Chin; Diagnosis, Differential; Humans; Male; Ossification, Heterotopic; Osteosarcoma; Rare Diseases; Skin Neoplasms
PubMed: 29996033
DOI: No ID Found -
Oncology Letters Jul 2018Expression of human serum albumin-micro RNA miR-148b in patients with stage-I and II parosteal osteosarcoma and its effect on prognosis were investigated. A total of 47...
Expression of human serum albumin-micro RNA miR-148b in patients with stage-I and II parosteal osteosarcoma and its effect on prognosis were investigated. A total of 47 cases of fresh tissues of stage-I and II parosteal osteosarcoma and the corresponding para-carcinoma normal bone tissues resected by operation were collected; the expression of miR-148b in parosteal osteosarcoma tissues and normal bone tissues was detected, and the correlations of miR-148b expression in parosteal osteosarcoma tissues with clinicopathological parameters and prognosis were analyzed. The expression level of miR-148b in parosteal osteosarcoma tissues was significantly lower than that in para-carcinoma normal tissues (P<0.05). It was found that the low expression of miR-148b was correlated with the lung metastasis (P<0.05). Moreover, Kaplan-Meier survival curve analysis showed that the overall survival rate of patients in the low-expression miR-148b group was lower than that in the high-expression group (P<0.05). Multivariate Cox regression analysis revealed that the miR-148b level (P=0.003) was an independent prognostic factor affecting the prognosis. The results of this study showed that the expression of miR-148b in stage-I and II parosteal osteosarcoma tissues declines, which is related to the poor clinical prognosis of parosteal osteosarcoma.
PubMed: 29963175
DOI: 10.3892/ol.2018.8709 -
Clinics in Orthopedic Surgery Jun 2018Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate...
Unsintered hydroxyapatite (u-HA) and poly-L-lactide (PLLA) composites (u-HA/PLLA) are osteoconductive and biodegradable. Screw (Super-Fixsorb MX30) and plate (Super-Fixsorb MX40 Mesh) systems made of u-HA/PLLA are typically used in small bones in maxillofacial surgeries. After the resection of bone tumors in larger bones, reconstructions with β-tricalcium phosphate (β-TCP) implants of strong compression resistance have been reported. After a resection, when the cavity is hemispheric- or concave-shaped, stabilization of the implanted β-TCP block is necessary. In the current series, u-HA/PLLA were used to stabilize the mechanically strong implanted low-porous β-TCP blocks in six bone tumor cases, including three giant cell tumors of bone, and one case each of chondroblastoma, chondrosarcoma, and parosteal osteosarcoma. The mean age of patients at the time of surgery was 31.3 years (range, 19 to 48 years). The bones involved were two ilia (posterior), a femur (diaphysis to distal metaphysis), and three tibias (proximal epiphysis, proximal metaphysis to epiphysis, and distal metaphysis to epiphysis). Neither displacement of the implanted β-TCP block nor any u-HA/PLLA-related complications were observed. The radiolucent character of the u-HA/PLLA did not hinder radiological examinations for potential signs of tumor recurrence. The method of using u-HA/PLLA components for the stabilization of β-TCP blocks makes the procedure easy to perform and reliable. It can extend the application of β-TCP blocks in reconstruction surgery.
Topics: Adolescent; Adult; Bone Neoplasms; Bone Substitutes; Calcium Phosphates; Cohort Studies; Durapatite; Female; Femur; Humans; Male; Middle Aged; Orthopedic Procedures; Polyesters; Plastic Surgery Procedures; Tibia; Young Adult
PubMed: 29854351
DOI: 10.4055/cios.2018.10.2.253 -
Proceedings (Baylor University. Medical... Jan 2018Dedifferentiated parosteal osteosarcoma is a rare tumor and is even rarer when involving the skull bones. We present a case of a 57-year-old man with a partially...
Dedifferentiated parosteal osteosarcoma is a rare tumor and is even rarer when involving the skull bones. We present a case of a 57-year-old man with a partially ossified progressive enlarging left skull mass in the left temporoparietal region, with erosion of the outer table. Radiological diagnosis of dedifferentiated parosteal osteosarcoma was suggested, and histopathology confirmed the diagnosis.
PubMed: 29686561
DOI: 10.1080/08998280.2017.1391047