Cases reported "Bone Neoplasms"

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1/9. Long-term control of multiple lung metastases from osteosarcoma obtained by conventional radiotherapy: a case report.

    An osteosarcoma patient whose lung metastases were successfully treated with radiotherapy is reported. The patient developed multiple lung metastases repeatedly after successful treatment of the primary lesion in his femur. Resection of the lung metastases was performed 5 times during 4 years (12 metastatic nodules in total). One of the specimens was evaluated using the micronucleus test, which suggested moderate radiosensitivity of the tumor. He further developed 2 metastases 19 months after the last operation, and these tumors were treated with conventional radiation with 60 and 64 Gy, respectively. The tumors regressed slowly after radiation and disappeared later. Although he developed another lung metastasis 2 years later, the lesion was also treated with radiation with 66 Gy and all of the 3 irradiated tumors are now under control at 43 months after the first radiotherapy and 15 months after the second one. Our experience would suggest that some (at least) metastatic osteosarcomas have reasonable radiosensitivity, and radiation therapy including radiosurgery may be a good alternative to surgery in patients for whom operation is not indicated.
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2/9. chondrosarcoma of the proximal femur with myxoid degeneration mistaken for chondromyxoid fibroma in a young adult. A case report.

    BACKGROUND: Fine needle aspiration cytology (FNAC) is effective in the diagnosis of bone tumors when combined with careful radiologic and clinical evaluation. However, cases where clinical or radiologic findings are atypical or unusual may lead to an erroneous diagnosis. CASE: A 19-year-old male presented with a pain in the left hip area that had been slowly progressive over a 10-month period. Clinical and radiologic findings suggested either giant cell tumor or chondroblastoma. The smeared aspiration specimen showed loosely cohesive, oval to round cells with moderate amounts of pale pink cytoplasm admixed with pinkish-blue, chondromyxoid material. The individual cells contained a single nucleus with evenly distributed, fine chromatin. A few osteoclastic giant cells were scattered in the smears. A cytologic diagnosis of myxoid lesion with a few giant cells, suspicious for chondromyxoid fibroma, was made. The diagnosis of chondrosarcoma was made by subsequent histologic examination. CONCLUSION: Absence of the usual clinicoradiologic features of chondrosarcoma combined with an unusual cytologic presentation in this case led to a misdiagnosis. In most centers, FNAC has achieved undisputed status as a diagnostic tool, and cytologic diagnosis often forms the basis of the therapeutic protocol. However, at some sites FNAC diagnosis is more problematic. awareness of the limitations and pitfalls of FNAC is just as important as knowledge of the scope of FNAC in bone tumors. Tumors with chondromyxoid features provide particular difficulties.
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3/9. Sacral radiculopathy secondary to multicentric osteosarcoma.

    STUDY DESIGN: A case of multicentric osteosarcoma presenting with sacral radiculopathy is reported. OBJECTIVE: To present unusual clinical and radiologic findings of multicentric osteosarcoma. SUMMARY OF BACKGROUND DATA: Multicentric osteosarcoma is a rare variant of osteosarcoma. To the authors' knowledge, no cases of multicentric osteosarcoma presenting as sacral radiculopathy have been reported previously. methods: A 14-year-old boy had a large sacral tumor extending into the spinal canal, which was found to account for the initial symptoms, which mimicked those of herniated nucleus pulposus. At diagnosis, a bone survey showed multiple foci of osteosarcoma in the long bones. RESULTS: The patient was treated with chemotherapy, but died of the disease 8 months after the initial presentation. CONCLUSION: Multicentric osteosarcoma should be considered in the differential diagnosis for a pediatric patient with low back pain and sciatica.
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4/9. in vitro characteristics of a sacrococcygeal chordoma maintained in tissue and organ culture systems.

    Explants of a human sacral chordoma were successfully maintained on collagen-coated coverslips, gelfoam sponge matrices, and Millipore filter platforms for up to 30 days. Tumor cells cultured on collagen-coated coverslips became increasingly vacuolated whereas those maintained in organ culture were entirely free of vacuoles after 22 days in vitro. A single basic tumor cell, small and polygonal with a large central spherical nucleus and abundant endoplasmic reticulum and golgi apparatus, was recognized. vacuoles were formed as the result of the progressive expansion of smooth endoplasmic reticulum. Coalescence of these vacuoles produced the physaliferous cell of light microscopy.
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5/9. Oncogenic vitamin d resistant hypophosphatemic osteomalacia (benign ossifying mesenchymal tumor of bone): case report.

    A 53-year-old Japanese woman suffered hypophosphatemic osteomalacia secondary to bone tumor. Her clinical symptoms did not improve for a long time following the oral administration of Alfacalcidol (vitamin D3). A bone survey using radiographs revealed a small tumor located in the proximal head of the left fibula. hypophosphatemia and low levels of 1-alpha,25-dihydroxycholecalciferol (1-alpha,25(OH)2D3) returned towards normal levels soon after an en-bloc tumor resection, and bone pain and muscle weakness gradually disappeared. The histology, especially of the trabecular bone of the left fibula, showed typical features of osteomalacia with demineralization. The tumor comprised numerous small blood vessels, spindle shaped or oval neoplastic cells, a few multinucleated giant cells, osteoid tissue with or without calcification, chondroid tissue and hemangioma. The spindle shaped or oval cells contained a round nucleus with no mitotic figures. These clinical and histological findings coincide well with a diagnosis of benign ossifying mesenchymal tumor of the bone with vitamin d resistant hypophosphatemic osteomalacia.
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6/9. Clear cell chondrosarcoma. A report of two cases and review of literature.

    Two cases of clear cell chondrosarcoma located in the distal femur and proximal humerus are reported. Both patients were men aged 35 and 51 years. Their initial symptom was a pathologic fracture. Roentgenographically, one patient showed a purely lytic lesion and another lytic with centrally radiodensity. Microscopic examination revealed that the tumor cells have a centrally placed vesicular nucleus surrounded by a clear cytoplasm, with distinct boundaries. Their cytoplasm stained with S-100 protein by the peroxidase-antiperoxidase method. We found 36 reported cases (including the two reported here), and delineated the clinico-pathologic characteristics of the disease.
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7/9. Clear cell chondrosarcoma.

    The clinical, radiologic, and histopathologic features of three cases of clear cell chondrosarcoma are described. On radiographs, this rather benign-appearing tumor resembles a chondroblastoma when it occurs at the end of a long bone, and may occasionally show a calcified matrix. However, it has distinctive tumor cells with a centrally placed vesicular nucleus surrounded by clear cytoplasm. The lesion has a low-grade malignancy and is amenable to en bloc surgical resection, which results in a much better prognosis than that of conventional chondrosarcoma.
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8/9. Clear cell chondrosarcomas arising from rare sites.

    Three cases are reported of clear cell chondrosarcoma arising from unusual sites: talus, rib and vertebra. Radiographically, two tumors showed osteolytic features and the vertebral tumor showed osteoplastic change. Histologically, all tumors consisted of clear cells that had a centrally placed nucleus surrounded by clear cytoplasm, osteoclast-like giant cells, areas of conventional chondrosarcoma, and various amounts of reactive bone. The tumor in the talus was initially diagnosed as benign chondroblastoma, but it recurred. The rib tumor showed marked cystic formation stimulating aneurysmal bone cyst. The osteoplastic radiographic feature in vertebral tumor was considered to be due to the abundant bone formation.
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9/9. A 14-year-old patient with Ewing's sarcoma presenting at autopsy with multiple neurofibrillary tangles and lewy bodies in addition to hemiatrophy of the central nervous system.

    The autopsy findings of a 14-year-old Japanese girl with Ewing's sarcoma, who had multiple neurofibrillary tangles and lewy bodies and hemiatrophy of the central nervous system (CNS), are reported. She had retinoblastoma of her right eye 8 months after birth, which was treated with chemotherapy and irradiation (40 Gy), twice, seizures 1 year and 2 months after birth, and thereafter severe mental retardation. She showed left hemiparesis after a febrile seizure at the age of 7 years and CT disclosed the right cerebral hemiatrophy. For the last 2 years of life she suffered from Ewing's sarcoma. Extrapyramidal signs were absent. Neuropathologically, tangles consisting of paired helical filaments were distributed symmetrically in virtually all the grey matter. They were particularly numerous in the frontal cortex and substantia nigra, but sparse in the nucleus of Meynert, hippocampus, and brainstem. Several lewy bodies, which were ultrastructurally identical to those seen in Parkinson's disease, were present in the substantia nigra (more on the left than right) and locus coeruleus. Morphometrically, the number and size of substantia nigral neurons were reduced, the reduction in the latter being more marked than the former, but the melanin pigment contents and shapes of the remaining neurons appeared normal. The right cerebral hemiatrophy with contralateral cerebellar hemiatrophy may have been attributable to irradiation. Although our patient did not have parkinsonism, her features resembled those of a 28-year-old autopsy case reported by Popovich et al. [1987].
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