1/11. Delay in the diagnosis and treatment of primary bone sarcoma of the pelvis.BACKGROUND: Symptoms arising from primary bone sarcoma of the pelvic girdle are often insidious in onset and nonspecific in nature. To make the subtle initial signs and symptoms of these tumors more apparent to clinicians, we studied a cohort of patients who had a primary bone sarcoma of the pelvic girdle. Our purpose was to describe the initial clinical findings and to evaluate the duration, frequency, and implications of delays in the treatment of these tumors. methods: We retrospectively analyzed the data on sixty-eight patients who had a primary bone sarcoma of the pelvic girdle. The data that we reviewed included demographic characteristics; histological diagnosis; anatomical location, size, and stage of the tumor; characteristics of the biopsy specimen; duration and description of symptoms before an accurate diagnosis was made; delay before recognition of the tumor on radiographs; results of diagnostic imaging; inaccurate diagnoses; type of intervention based on these inaccurate diagnoses; and outcome with regard to survival. There were forty high-grade sarcomas and twenty-eight low-grade sarcomas. RESULTS: Excluding two asymptomatic patients in whom the sarcoma was noted incidentally, the average duration of symptoms before an accurate diagnosis was made was ten months (median, six months; range, one month to four years). Common symptoms and findings on physical examination included pain in the buttock (twenty-three patients; 35 percent), a mass (twenty patients; 30 percent), sciatica (nineteen patients; 29 percent), pain in the hip (seventeen patients; 26 percent), pain in the groin (thirteen patients; 20 percent), and low-back pain (fourteen patients; 21 percent). In thirty (44 percent) of the sixty-eight patients, the pelvic sarcoma was not recognized initially and an inaccurate diagnosis was made. The misdiagnoses included a herniated lumbar disc, spinal stenosis, spondylolisthesis, tendinitis, bursitis, an inguinal hernia, a stress fracture, a pilonidal cyst, a recurrent urinary-tract infection, and degenerative arthritis of the spine, hip, and knee. Inappropriate treatment for these misdiagnoses included seven operative procedures (two laminectomies, two debridements, one hip arthrotomy, one total knee replacement, and one inguinal herniorrhaphy), six courses of nonsteroidal anti-inflammatory medications, five chiropractic adjustments, four trials of physical therapy, and three local injections of steroids. It took an average of seven months for the clinicians to arrive at the diagnosis of primary pelvic sarcoma. With the numbers available, no significant association between the duration of symptoms before an accurate diagnosis was made and the grade or the stage of the tumor could be detected. In addition, no association between the duration of symptoms and the survival of the patient (p = 0.54) could be determined, with univariate analysis. The grade and the stage of the tumor were strongly associated with the outcome, with a low tumor grade proving to be a favorable prognostic indicator for survival (p = 0.006). CONCLUSIONS: patients who have a primary bone sarcoma of the pelvis often have had symptoms for a long duration that mimic those of more commonly encountered non-neoplastic musculoskeletal conditions. When a patient has symptoms that appear to be out of the ordinary, particularly refractory pain or pain at rest, physicians should include the pelvic girdle in the evaluation and should carefully examine a high-quality radiograph of the entire pelvis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. Metastatic gastroesophageal adenocarcinoma to skeletal muscle: a unique event.Skeletal muscle is rarely the site of metastatic cancer, though a few such cases have been reported. Esophageal adenocarcinoma metastasic to skeletal muscle has not previously been reported in the literature. We describe the case of 71-year-old African American male with stage IV adenocarcinoma of the gastroesophageal junction. He had severe and disabling pain in the right thigh, which was tender to palpation. The pain was unresponsive to nonsteroidal anti-inflammatory drugs and full-dose narcotics. Plain x-ray films and bone scan were nondiagnostic. magnetic resonance imaging showed a soft tissue mass involving the thigh muscles, anterior and medial to the right femur. Computed tomography (CT)-guided biopsy revealed that the thigh mass was metastatic adenocarcinoma consistent with the primary gastroesophageal cancer. Metastasis to muscle is rare, but physicians should be aware of the possibility because detection requires specific tests. We discuss the role of these tests, as well as available treatment options.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Primary sarcomas of the lung: a clinicopathologic study of 12 cases.BACKGROUND: Chest physicians have a limited experience of primary pulmonary sarcomas, which represent a particular entity among rare intrathoracic neoplasms. DESIGN: Retrospective review of medical records. PURPOSE: To study patients with primary sarcomas of the lung diagnosed in our pathology department in order to define their clinical characteristics, treatment, and prognosis. patients: The study group consisted of 12 patients, with a mean age of 53 years. RESULTS: The main symptoms were chest pain, and cough. Imaging findings consisted of: eight single peripheral opacities, three single parahilar opacities, and one lobar actelectasis. The histologic diagnoses confirmed in all cases by detailed immunohistochemical study were leiomyosarcoma (7), monophasic synovial sarcoma (2), one case each of malignant peripheral nerve sheath tumor (MPNST), epithelioid sarcoma, and malignant fibrous histiocytoma. thoracic surgery done in nine cases consisted of six lobectomies with further parietal resection in two cases, and three pneumonectomies. Four patients received chemotherapy and two patients had radiation therapy postoperatively. Follow up available on 12 patients ranged from 3 to 144 (mean 42) months. Long term survival up to 3 years was observed in five patients. Median overall survival was 48 months. overall 5-year survival rate was 38%. CONCLUSIONS: Primary sarcomas of the lung are a rare and aggressive malignancy. Treatment and prognosis do not differ from other soft tissue sarcomas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. Clear cell sarcoma presenting as an interdigital neuroma.The incidence of malignant soft-tissue sarcomas in the general population is approximately 1.4 per 100,000. Approximately 2% of all cancer deaths are attributable to these tumors. Presented is a case history of a soft-tissue malignant neoplasm that was originally thought to be an interdigital neuroma and that eventually required a modified Chopart's amputation. A review of the literature is presented on other soft-tissue malignant tumors that have an affinity for the foot and ankle. The intention of presenting this case is to caution physicians that malignant lesions can simulate a benign process and should always be considered in the differential diagnosis of any foot mass.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Primary sarcoma of the lung: potential dangers of immunocytochemistry.A case is presented of a successfully resected primary pulmonary sarcoma in a 27-year-old man, followed by an eight-year disease-free follow-up. Details of the histological findings are presented, and the factors associated with good prognosis discussed. Immunocytochemical stains were carried out this year when the case was reviewed, and not at the time of resection. Had the immunostains been available at the time, the results would have suggested that the tumour might be a secondary deposit, and so have caused needless anxiety to the patient and his physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Nodular fasciitis presenting as a rapidly enlarging episcleral mass in a 3-year-old.A rapidly enlarging periocular mass in a child obligates the treating physician to rule out a malignancy, especially a rhabdomyosarcoma. A 3-year-old girl presented with a 5-day history of a rapidly growing episcleral mass superonasal to the globe, adjacent to the superior rectus muscle insertion. The lesion was locally excised. A sarcoma could not be excluded on frozen sections. Permanent sections and electron microscopy revealed nodular fasciitis, a benign lesion with a pseudosarcomatous histologic appearance. No recurrence has been noted at 9 months follow-up. Nodular fasciitis is a benign proliferation which should be considered in the differential diagnosis of a rapidly enlarging subconjunctival or orbital mass in a child.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Sarcomatous tumor of the chest wall with osteochondroid differentiation. Evidence of mesothelial origin.We describe a case of sarcomatous tumor of the chest wall with differentiation toward bone and cartilage that was observed in an asbestos-exposed worker. Although the mesothelial nature of the tumor was at first considered, it was not proven. Later, the tumor was shown to be a mesothelioma using a panel of pertinent antibodies that included a recently described anti-mesothelial cell marker. In addition, asbestos bodies were found in association with the sarcoma cells. Our findings indicate that whenever physicians encounter any type of primary sarcomatoid tumor involving serous membranes, the possibility of malignant mesothelioma should be regarded a priori.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Selected soft tissue malignancies of the foot: an in-depth study with case reports.Soft tissue malignancies represent a diagnostic and therapeutic challenge to the podiatric physician. In order to improve prognosis and increase survival rates of affected patients, prompt clinical and histologic recognition of suspect lesions is necessary. Here we present information and case reports on selected soft tissue malignancies including Kaposi's sarcoma, malignant melanoma, synovial sarcoma, and epithelioid sarcoma to aid the practitioner in recognizing these serious lesions that occur in the foot.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Epithelioid sarcoma. Report of a case.Epithelioid sarcoma is familiar to orthopedic surgeons but not to dermatologists. Because this malignant neoplasm presents as a subcutaneous mass, often with overlying epidermal changes, the patient may be seen by a dermatologist for evaluation. The differential diagnosis often includes nodular fasciitis and tenosynovitis. The histopathologic interpretation of the biopsy specimen may be difficult, so it is helpful for the physician to suspect and consider epithelioid sarcoma in the differential diagnosis given to the pathologist. Early, accurate diagnosis can be achieved and can thus spare the patient significant morbidity or even death.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Psychologic support for children with soft tissue and bone sarcomas.Advances in pediatric hematology and oncology during the last decade have increased the survival rate of children with cancer. If treatment is to be successful, optimally, psychologic and physical issues, though they may become indistinguishable from one another, must be taken into consideration. Using the system theory concept, I examined the impact of the various professionals on the sick child. To facilitate better care, the liaison Pediatric psychiatry Service at Beth israel Medical Center in new york city developed a series of psychiatric interventions that deal with the psychologic needs of the various components of the medical-therapeutic system. These include preparation of a psychosocial profile of the sick child and his family; group meetings for nurses, house staff, and attending physicians in hematology and oncology; and discussions with the parents. The patient is perceived as a biopsychologic system, the natural unit in which it is possible to discern and abstract the psychologic subsystem and the biologic subsystem. Psychiatric intervention with the psychologic subsystem is intended to facilitate the cure and recovery of the biologic subsystem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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