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ID 107

Treatment of pathological fracture in localised Ewing's sarcoma

S. Bhatnagar, H. Murata, R.J. Grimer, S.R. Carter,

H. Aherns, A. Abudu

Royal Orthopaedic, Birmingham, UK

Material and Methods: We reviewed the treatment and clinical outcome of 32 consecutive patients with Ewing's sarcoma who presented with or developed pathological fracture after biopsy between 1984 and 2004. The minimum follow-up was 18 months. The mean age at diagnosis was 20 years (5 — 51). There were 18 males and 14 females. All patients were newly diagnosed and had localized disease at the time of diagnosis. 21 patients presented with pathological fracture while 11 patients developed fracture during the course of chemotherapy. The femur was the most common location in 15 patients. All the patients had chemotherapy according to the protocol current at the time of treatment. 7 patients had radiotherapy alone while 25 patients underwent surgical excision and reconstruction. Of the patients who had surgery, 7 patients had adjuvant radiotherapy. Fracture healing was the norm after pre-operative chemotherapy. Surgical margins were wide in 17 patients, marginal in 4 and intralesional in 3 patients.

Results: Local recurrence developed in one patient (3%). Metastases occurred in 12 patients (37%). At the time of review 16 patients were free of disease, 3 were alive with disease and 13 patients had died of disease. The cumulative 5 year metasta-ses free and overall survival in all the patients was 58% and 61 % respectively and similar to patients with Ewing's sarcoma without fracture treated at our centre. The prognosis of patients who presented with fracture was exactly similar to those who developed fracture in the course of treatment. Conclusions: We conclude that limb preserving surgery is perfectly safe in patients with Ewing's sarcoma who have associated pathological fracture and survival is not in any way compromised. Survival of patients who present with fracture is similar to those who develop fracture in the course of treatment. The exact role of adjuvant radiotherapy in these patients needs to be clarified.

ID 9

Radiation induced sarcomas of bone - factors that affect outcome

S. Kalra1, R. Grimer1, D. Spooner1, R. Tillman2,

S. Carter2, A. Abudu2

1 Queen Elizabeth Hospital Birmingham, United Kingdom

2 Queen Elizabeth Medical Centre,

Birmingham, United Kingdom

Introduction: To identify patient, tumour or treatment factors that influence outcome in patients with radiation induced sarcoma of bone.

Material and Methods: A retrospective review of an oncology database supplemented by referral back to original records. Appropriate statistical analysis was done.

Results: We identified 44 patients who presented to our Unit over a 25 year period with a new sarcoma of bone following previous radiotherapy. The age of the patients at presentation ranged from 10 to 84 years of age and the time interval from previous radiotherapy ranged from 4 to 50 years (median

12.5 yrs). The median dose of radiotherapy given had been 50 Gy but there was no correlation of radiation dose with time to development of sarcoma. The pelvis was the most common site for development of sarcoma (14 cases) but breast cancer was the most common primary site (8 cases). 9 of the patients had metastases at the time of diagnosis of the sarcoma and all but one of the sarcomas were osteosarcomas. Treatment was by surgery and chemotherapy when indicated and 30 of the patients had treatment with curative intent. The survival rate was 41% at 5 years for those treated with curative intent but in those treated palliatively median survival was only 6 months and all had died by one year. The only factor found to be significant for survival was the ability to completely resect the tumour, thus limb sarcomas had a better prognosis (66% survival at 5 years) than central ones (12%) (p = 0.009). Conclusions: Radiation induced sarcoma is a rare complication of radiotherapy. Both surgical and oncological treatment is likely to be compromised by previous treatment the patient has received. Despite this 40% of patients will survive more than 5 years with aggressive modern treatment.

ID 30

Hemipelvic replacements with saddle prosthesis in the reconstruction of periacetabular primary and secondary tumors

P.K. Jaiswal, A. Gupta, R.C. Pollock, G. Glunn,

S.R. Cannon, T.W.R. Briggs

Royal National Orthopaedic Hospital, London, UK

Introduction: The first purpose of this study was to evaluate the saddle prosthesis in patients with periacetabular tumors in terms of the functional results obtained after several postoperative intervals. The second purpose was to evaluate the complications and how they might be prevented in the future. Material and Methods: Functional results according to the MSTS functional rating system were evaluated at several postoperative intervals in 25 patients treated with internal hemipelvectomy and reconstruction with the saddle prosthesis because of periacetabular malignancies.

Results: At a mean follow-up of 112 months, 14 patients (56%) were free from disease. Complications were observed in 17 cases (68%) including nerve damages (2 cases), deep infections (3 cases), upward migrations of the saddle (2 cases), saddle dislocations (2 cases), sacroiliac subluxations (2 cases), mechanical failures (1 case) and local recurrence (5 cases). The surviving patients achieved an average of 70% of their premorbid function.

Conclusions: Two contraindication (relative) to reconstruction with the saddle prosthesis could be ascertained: osteoporosis and extended involvement of the iliac wing by tumor. This method of reconstruction has a high morbidity and should be performed only at specialist centers, but the functional and oncological outcomes are satisfactory.

ID 158

Local and systemic control in chondrosarcoma still a challenging problem

A. Streitbuerger, J. Hardes, C. Gebert, H. Ahrens, G. Gosheger University Hospital of Muenster Department of Orthopedics, Muenster, Germany

Introduction: Chondrosarcoma is the second most common primary bone sarcoma in patients over 20 years of age. The histological grading of this tumor has a broad spectrum from borderline tumors like aggressive enchondroma to high grade dedifferentiated chondrosarcoma. The wide surgical resection is considered to be the most important aspect of management in the treatment, because current chemotherapy and radiation have no significant role in the treatment of this disease. Therefore local and systemic control in these patients is still a challenging problem.

Material and Methods: In this retrospective study we analysed the data of 255 chondrosarcoma patients (mean age 48 years) treated in the period from 1975 to 2004 in a single institution. The mean follow up was 55 month (range 1 to 365). Results: 204 patients had grade I + II tumours and 51 had grade III + IV tumours according to histological criteria. The most prevalent sites of the tumour were the pelvis (36%), the femur (16%) and the humerus (11%). Local recurrences occurred in 47 patients (18,4%) and metastases were observed in 43 patients (16,8%) after treatment. The statistical analysis

showed no significant influence of chemotherapy or radiation on both, local and/or systemic control.

Conclusions: Despite adequate surgical margins we observed high rates of local recurrences and metastases in the patient population. The ineffectiveness of chemotherapy and radiotherapy regarding to local and systemic control leads to worse results in patients with chondrosarcoma compared to patients suffering from other primary bone tumors like osteosarcoma (e.g. local recurrence rates less than 5 %). Therefore the development of effective adjuvant treatment options is necessary to improve the outcome in these patients. In our opinion bisphosphonates could play a role in the future treatment of chondrosarcoma.

ID 39

Swedging-a forgotten sign in the radiologoc diagnosis of eosinophilc granuloma of long bones

G. Flusser, H. Umas, J. Issakov, O. Merimsky, J. Bickels,

I. Meller, A. Weinbrum, A. Nirkin, Y. Kollender Tel Aviv Medical Center, Tel-Aviv, Israel

Introduction: Eosinophilic Granuloma (EG) is a benign bone lesion, part of the Langerhans Cell Histiocytosis. Most lesions occur in the axial skeleton. Fewer than half occur in long bones. When present in long bone EG is located in the Diaphysis or Metaphysis. The radiografic features are mostly benign but in some cases it may present as an aggressive condition. Dr. Harold Jacobson coined the term "Swedging periosteal reaction" and described it as typical of EG. It is very thick, unilamellar periosteal reaction (PR) surrounding the lesion. It is typified by a thin lucent line separating the PR from the shaft of the bone. Material and Methods: All cases of biopsy proven EG of long bones diagnosed in our center in the last 5 years were reviewed for the presence of swedging. In addition, 10 consecutive cases of Ewing's Sarcoma of long bones which demonstrated PR were reviewed.

Results: Twelve out of 14 cases of EG demonstrated swedging-type of PR. Other two had no PR at all. None of the Ewing's Sarcoma cases had this type of PR. One case of osteomyelitis and one case of stress fracture had similar apearing PR, though other imaging features differetiated them from EG. Conclusions: Swedging-type of periosteal reaction, though not totalt specific, is a useful sign in defferntiation EG from other small round cell lesions of bone.

ID 153

Conservative treatment of patients with extremely aggressive fibromatosis: 10-year experience

S.I. Tkachev, S.I. Aliev, V.V. Glebovskaya, S.M. Ivanov,

O.P. Trofimova, R.M. Karapetyan

N.N. Blokhin Russian Cancer Research Center,

Moscow, Russian Federation

Introduction: The paper presents outcomes of radiation and thermoradiation therapies of patients with extraabdominal soft-tissue desmoid tumors.

Material and Methods: There are 83 patients with extra-abdominal soft-tissue desmoid tumors. All patients with extremely desmoid tumors received conservative treatment

during 1987 to 2002. All were traced back to their primary presentation and first treatment episode.

Results: Changes in neoplastic disease following radiation versus thermoradiation therapies are compared in 57 patients followed up for at least 10 years after discontinuation of conservative treatment (41 females and 16 males were identified). Median age at presentation was 39 years (range 1584). Most patients presented with regression of desmoid tumors within 3 years after discontinuation of conservative treatment, though tumor regression time was longer in some cases. 10-year disease-free survival was greater in patients receiving thermoradiotherapy (radiation and hyperthermia) as compared to irradiation: 74.4 versus 28.6% (p<0.05), while continuing growth and disease recurrence rates were higher after radiation therapy: 9.3 versus 57.1% (p<0.05). Conclusions: Monitoring tumor temperature during local hyperthermia is a factor of relapse-free survival of vital importance.

ID 128

Soft tissue sarcomas of the pelvis

H. Murata, S. Kalra, H. Ahrens, A. Abudu, R.J. Grimer,

R.W. Tillman, S.R. Carter

The Royal Orthopaedic Hospital, Birmingham, UK

Introduction: 99 consecutive patients with new diagnosed soft tissue sarcomas involving the pelvic region were studied to determine the outcome and prognostic factors for survival and local recurrence.

Material and Methods: The mean age at diagnosis was 57 years. There were 55 males and 44 females. The mean tumor size was 12 cm (2 — 30).The tumor was deep in 79 patients and superficial in 20. Surgical treatment was excision in 93 patients and hindquarter amputation in 6 patients. Histological grade was grade I in 23, grade II in 22 and Grade III in 53 patients. 7% of the patients had metastases at presentation.

Results: The 5 year overall survival in all the patients was 57% and local recurrence occurred in 22% of the patients. The risk of inadequate surgical margins in patients with tumors within the pelvic brim was 50% compared to 18% for those with tumors located outside the pelvic brim. The significant predictors of local recurrence were inadequate margins and location of the tumor within the pelvic brim. Tumor size, grade and depth did not influence development of local recurrence. Significant predictors of survival included metastases at presentation, tumor grade and depth. The cumulative 5 year survival for patients with deep high grade tumors, deep low grade tumors, superficial high grade and superficial low grade tumors were 45%, 74%, 63% and 100% respectively (p = 0.01). Development of local recurrence adversely influenced development of metastases and overall survival with 5-year overall survival of 66% in those patients without local recurrence compared to 37% in those who develop local recurrence (p = 0.005) Multivariate analysis revealed that for patients with localized disease at diagnosis that histological grade and development of local recurrence were the most important determinant of overall and metastases free survival. Conclusions: We conclude that treatment of patients with pelvic soft tissue sarcoma is challenging with high risk of inadequate margins and local recurrence in those with tumors located within the pelvic brim. Patients who develop local recurrence

have an extremely poor prognosis. Patients with high grade and inadequate surgical margins represent a particular group with very high risk of metastases and death even with radiotherapy and perhaps should be considered for other adjuvant treatment.

POSTER SESSION

ID 269

Do pathological fractures in bony sarcomas relate to prognosis?

J. Bramer1, S.R. Carter1, A.A. Abudu2, R.J. Grimer2, R. Tillman2

1 Academic Medical Center, Amsterdam, Netherlands

2 Royal Orthopedic Hospital, Birmingham, United Kingdom

Introduction: Pathological fractures are thought to adversely influence prognosis in bony sarcomas. The aim of the study was to establish the influence of pathological fracture on local recurrence and survival in high grade chondro-, osteo-, and Ewing's sarcoma's.

Material and Methods: Retrospective survey on prospectively kept database. Recording of patient- and tumor characteristics and treatment to establish comparability of patients with and without pathological fracture in high grade, non-metastatic osteo-, chondro-, and Ewing's sarcoma, treated between 1980 and 2000. Compared were local recurrence and survival between patients with and without fracture. To make groups comparable only extremity tumour were included. Results: In all 3 tumors, groups with and without fracture were comparable, althought tumours tended to be located more proximally in patients with a fracture. No difference was found in local recurrence between fracture and no-fracture group in any of the tumors. 10 Year survival in the patients with a fracture was 35% in the osteosarcoma group (n = 42), and 32% in the chondrosarcoma group (n = 34), which was statistically lower than in patients with these tumors without fracture (survival 59% and 63% respectively; p<0.05). In Ewing's sarcoma (n=19) survival was 73% in patients with a fracture which was comparable with patients without a fracture (63%; p = 0.68).

Conclusions: Pathological fractures do not seem to correlate with local recurrence. In high-grade osteo- and chondrosarcoma they are however correlated with worse survival. This is not so for Ewing's sarcoma, where no correlation of fracture with survival was found. A possible explanation of this could be that Ewing's sarcoma is reacting more than the other

2 sarcomas to chemotherapy.

ID 195

Role of spondylography in detection of changes in skeleton after treatment of intraparavertebral tumors

N.A. Koshechkina, O.A. Kirillova, L.D. Volkova,

T.K. Panferova, N.M. Ivanova, M.D. Aliev N.N. Blokhin Russian Cancer Research Center,

Moscow, Russian Federation

Introduction: The aim —to study the possibilities of X-ray examination of children's vertebra with intraparavertebra tumors, to improve the diagnostic efficacy of this pathology. Material and Methods: There were 95 children under study. The tumor localization was the same in chest and retroperito-

nium cavity. The spondylography was performed in four-views in all cases.

Results: Data analysis of skeleton x-ray examination was exposed that 40% of children who undergo combined with radiotherapy or complex therapy have had the disturbance of physical development, changes in structure and deformation of vertebra, ribs and pelvic bones. The analysis of bone system in children after chemotherapy (37%) did not show the changes. In the group of children with after-radiotherapy effect there were changes: 97% in vertebra, 83% in pelvic bones, 53% in ribs, 73% in transversal appendices of vertebra, the decrease of vertebra body height in 70%, the condensation of their structure in 47%. The rotation of vertebra bodies in combination with small divergence of vertebra was developed in 57%. The disturbance of the development, structure of iliac bone on the tumor side was exposed in 83%, the decrease of width in 70%, deformation, asymmetry of pelvic ring, under-development of one half of the sacrum in 47%. Conclusions: Obtained results allow us to improve the radiotherapy approaches.

ID 196

Imaging of intraparavertebral tumors in children

N.A. Koshechkina, O.A. Kirillova, L.D. Volkova,

N.M. Ivanova, M.D. Aliev

N.N. Blokhin Russian Cancer Research Center,

Moscow, Russian Federation

Introduction: To study clinic and radiology data and efficiency of spondylographics (SG), ultrasound (US), computed tomography (CT), MRI, bone scan in evaluation of diagnostic methods in case of intraparavertebral tumors (IPVT) in children. Material and Methods: 95 patients with IPVT were studied. The age ranged from 8 mouths to 15 years. 78% of patients had neuroblastoma, 13% - neurofibroma, 4% - teratoblasto-ma, 3% - Ewing sarcoma, 2% - rabdomiosarcoma.

Results: intraparavertebral neuroblastoma is often diagnosed in patients under 3 years, most common sites are thoracic spine (50%) and lumbar spine (50%). Others IPVT are most common for children over 10 years. Neurofibromas were lo-calized in cervical and thoracic spine in 57%, terato-blastoma (19%) and Ewing sarcoma (14%), rabdomiosarcoma (10%) were localized in lumbar spine. All neurogenic tumors induced deformation and atrophia of surrounding bone structures. Round-cell sarcomas led to destruction of bone. IPVT often produce severe neurologic disorders. There were no neurologic symptoms in 20% of patients with IPVT. Conclusions: CT and MRI are the methods of choice for diagnostic evaluation of spinal canal and paravertebral tumors.

ID 198

The complex diagnostics of pediatric chondrosarcoma

A.Z. Dzampaev, N.M. Ivanova, D.B. Khestanov,

V.G. Polyacov, Y.N. Soloviyev, N.A. Koshechkina N.N. Blokhin Russian Cancer Research Center,

Moscow, Russian Federation

Introduction: to develop rational complexes of methods of diagnostics and the combined treatment of rare malignant

tumours of bones (chondrosarcoma) in the childhood, directed on improvement of the results of treatment with the account of prognostic factors, describing biological behaviour of a tu-mours and specific features of the patient.

Material and Methods: in Scientific Research Institute of Pediatric Oncology and Hematology from 1979 till 2005 were on observation and treatment 83 patients with the primary chondrosarcoma, the male 44 (54%), and female 38 (46%). By all the patients the diagnosis was established on the basis of the clinical, radiological data and the morphological conclusion. Results: The chondrosarcoma at children makes less than 7% of all initial malignant neoplasms of the bone system. The complex of diagnostic actions is necessary for a sure establishment of the diagnosis.

Conclusions: The most significant in prognostic attributes are duration of the anamnesis, sex, localization of a tumour, its morphological variant and medical pathomorphosis. For statement of the diagnosis it is necessary to use all the clinic and diagnostic data, such as clinical picture, radial methods of diagnostics (ultrasound, X-ray, computer tomography, angiographics, magnetic-resonance imaging) and hystologic examinations. The hystologic research is carried out with the minimal invasive method — trepanobiopsy with the X-ray control, but if this method have not high informative, the method of open biopsy of the tumour is applied.

ID 248

Difficulties of diagnosis of low-grade intraosseous osteosarcoma

G.N. Berchenko, A.K. Morozov, A.V. Balberkin, O.B. Shugaeva Central Institute of Traumatology and Orthopaedics, Moscow, Russian Federation

Introduction: Low-grade intraosseous osteosarcoma (LGIO) is a rare tumour of low-grade anaplasia as compared with common osteosarcoma, characterized by slow development, a weakly pronounced tendency to metastatic spreading, considerably better survival and prognosis. Purpose — studying clinical and morphological peculiarities of LGIO.

Material and Methods: Clinical, roentgenological and morphological peculiarities of LGIO werestudied in a total of six

19-to-36-year-old patients.

Results: The X-ray signs are variable and non-specific. More often, this is a metaphyseal lesion spreading to the articular end of the long bone. Observed herein could be: a periosteal reaction in the form of linear periostitis, or absence thereof, bulging of the bone, osteolytic or mixed portions of destruction, portions of pronounced sclerosis, destruction of the cortical plate, a soft-tissue component. CT and MRI help reveal signs of malignancy, not always detected on X-ray photographs. Due to weakly pronounced atypia of cellular elements and the osteoid, histologically, LGIO is rather often interpreted as a benign lesion. The histological picture of LGIO is variable, being however mainly characterized by the presence of bundles of spindle interweaving tumour cells with inconsiderable polymorphism and cytological atypia, low cellularity, a small number of mitoses, irregular production of the osteoid and comparatively mature bone. In abundant production of the osteoid, LGIO resembles osteoblastoma (2 cases) or parosteal osteosarcoma, in formation of thin

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bone trabeculae, it resembles fibrous dysplasia (1 case). With predominantly spindle-cell component and very low production of osteoid, ILGO looks very much like desmoplastic or chondromyxoid fibroma (2 cases), low-grade fibrosarcoma. Conclusions: Diagnosis of LGIO is one of the most complicated challenges in bone oncology, therefore requiring close cooperation between pathologists, specialists in radiodiagnosis, and orthopaedic surgeons.

ID 270

Bone and joint infections resembling bone tumours

T.P. Kormas, G. Giakoumakis, N. Koutselinis,

E. Giannakopoulos, J. Kyriazoglou St. Savvas Hospital, Athens, Greece

Introduction: We present 24 cases of infections of bone and joints that presented initially with a clinical picture of a bone tumor and we discus the differential diagnosis between those two entities.

Material and Methods: We treated 24 patients with an acute infection of a bone or a joint. AH they were referred to us by other units with the indication of a sarcoma. Usually, there was a painful growth and osteolysis; the clinical picture was no typical. The patients had biopsy and histology, as well as direct microscopic examination of the samples for bacteria and cultures for aerobic and anaerobic bacteria and investigation for brucella. They were investigated for fungal and TB infections with PCR. A few selected cases had tests for hyda-tic cyst and HIV. The joint fluid was examined under polarized light for uric acid crystals.

Results: Lab tests found 6 cases with tuberculosis of bone, 9 cases with staphylococcal osteomyelitis. 3 hydatids, 3 HIV, 1 infected TKA, 1 knee gout, 1 osteomyelitis due to plaster pressure and 1 spinal brucellosis. The lesions affected spine, sacrum, femur, knee and humerus.

Conclusions: The clinical picture of infections of the skeleton may be subtle and atypical but the prognosis is often grave if they don't receive proper treatment immediately. High index of suspicion, biopsy, swabs and appropriate diagnostic investigations help to establish the diagnosis and select the proper treatment.

ID 283

Specific features of clinicoradiological and histomorphological diagnoses

N.N. Pavlenko, I.I. Zhadenov, T.D. Maksushina,

L.A. Kesov, D.Yu. Sumin, V.A. Muromtsev Saratov Institute of Traumatology and Orthopedics,

Saratov, Russia

Background: Analysis of the literature demonstrates clinico-radiological semiotics of some primary bone tumors to be developed rather poorly. There are no clear-cut criteria to differentiate benign from malignant tumors. This leads to diagnostic mistakes. For instance, mistakes in the diagnosis of tumors of the spine and flat bones, as mentioned by various authors, occur in more than 80% of cases. It is no doubt today that the diagnosis of bone tumors is a complex assessment including clinical, radiological, biochemical, morphological

and special investigations. The purpose of this study was to analyze specific features of clinicoradiological and histo-morphological diagnosis in patients with giant-cell tumors. Materials and Methods: A total of 216 patients (pts) with giant-cell tumors or bone cysts, 8 to 72 years of age, were managed at the Saratov Institute of Traumatology and Orthopedics during 1990 through 2006. Among the 216 pts there were 73 (33.7%) females and 67 (31.1%) males with giant-cell tumors; 36 (16.6%) females and 40 (18.6%) males with bone cysts. The complex examination consisted of clini-coradiological and histomorphological investigations. Preliminary and final histomorphological analyses were made on operative specimens from all pts.

Results: We compared clinicoradiological and histomorpho-logical diagnoses of pts with giant-cell tumors and bone cysts. Variability of the radiological and clinical evidence of giantcell tumors available to a much degree depended upon histology of the giant-cell tumors. Indeed, some radiological signs such as bone swelling together with trabeculocellular picture of the lesion are considered exclusively pathognomonic of benign giant-cell tumors. In females with giant-cell tumors in our study (34) their clinical and histomorphological diagnoses did not coincide in 46.6% of cases. Differential diagnosis of giant-cell tumors was a problem in cases with lytic lesions. Morphological study should therefore receive preference in the accurate diagnosis of these neoplasms. The diagnosis may be verified by cytology and histology each of the methods having its advantages and disadvantages as to individual types of giant-cell tumor. In males (34) with giant-cell tumors their clinical and histomorphological diagnoses did not coincide in 50.7% of cases. The giant-cell tumors were differentiated from other bone tumors, dysplasias and dystrophies that had similar clinical and radiological symptoms (chondromas, chondroblastomas, hemangiomas, fibrous dysplasias, dystrophic cysts, osteogenic sarcomas). The latter is sometimes mistaken for lytic type of giant-cell tumor because of intensive growth and painful course. In females (12) with bone cysts discrepancy between the clinical and histomorphologi-cal diagnoses was found in 33.3%. In males (11) with bone cysts discrepancy of the diagnoses was found in 27.5%. Bone cysts required differentiation from other bone tumors, dysplasias and dystrophies that had similar clinical and radiological symptoms (chondromas, chondroblastomas, hemangiomas, fibrous dysplasias, osteogenic sarcomas, osteomyelitis). Conclusions: Differential diagnosis between giant-cell tumors and bone cysts remains an important problem and requires more profound study in spite of the progress in this field.

ID 230

Surgical treatment malignant bone tumors in children with growing endoprosthesis

W. Wozniak, A. Szymborska Institute of Mother and Child,

Department of Oncological Surgery, Warsaw, Poland

Introduction: The primary malignant bone tumors present 7% all malignant tumors in children and youth. Most frequent are osteosarcoma, sarcoma Ewingi and chondrosarcoma. The development of reconstructive techniques causes that possibilities of large bone defects completing increase.

Material and Methods: In Clinic, between 2000 to 2005, 41 limb salvage operations have been done with using growing endoprostheses. The patients were in age from 4 to 25 years. In mostly tumor was localized near the knee. In 36 pts. endoprosthesis was elongeded mechanically and 5 electromagnetic endoprosthesis.

Results: Alive 39 pts. 74% of patients had excellent and good functional score. The best results we achieved with regular rehabilitation. In 12 pts. we observed complications. Conclusion: The limb sparing surgical procedures is effective methods of therapy. These kind of operations have relatively small complications, but still are. In those below the 10 years, the growing endoprosthesis are recommended, because their elongation proceeds together with the patient growth.

ID 256

Bone remodelling around the passive growing component of expandable endoprosthesis

P.K. Jaiswal, A. Gupta, O. Stokes, R. Pollock,

S.R. Cannon, T.W. Briggs, G. Blunn

Royal National Orthopaedic Hospital, London, UK

Introduction: When inserting the passive component of an expandable prosthesis a polyethylene sleeve is commonly used. The sleeve migrates towards the lateral cortex and causes a cortical reaction and hence the use of the sleeve has been discarded recently. This study quantifies the amount of cortical reaction and degree of cortical drift in patients that had sleeves and those that did not.

Material and Methods: We reviewed X-rays and case notes of all patients that had an expandable endoprosthesis in a 20 year period. The thickness of medial and lateral cortices of the tibial diaphysis was measured at 6 months and on the last follow up radiograph. The distance from the edge of the sleeve (or prosthesis) from the cortical edge was also compared. Retrieved components also had their histology reviewed. Results: The sleeve shifted laterally on average by 2 mm (range 0.5 - 3 mm) and touched the cortex. This was associated with an increase in lateral cortical thickness by 2.27 mm (range 1 - 3 mm). When the sleeve was used the prosthesis was inserted in the mid-line. When the sleeve was not used the tibial component tended to be inserted in valgus. Conclusions: The presence of a sleeve is associated with a cortical reaction and the sleeve tends to migrate laterally. The clinical implications of this and the evolution of the design will be discussed in the meeting.

ID 272

Treatment of The Benign Lesions of The Femoral Neck Yurdoglu Ciha, Ada Mujd, Zengin Serd, Ozbaydar Ugur S.B. Okmeydani Egitim Hastanesi, Istanbul, Turkey

Introduction: Benign lesions of bone frequently are found in the proximal femur. Bone tumors such as fibrous dysplasia, giant cell tumors, chondroblastomas, simple bone cysts aneurysmal bone cysts are often seen in this region. Benign lesions of the proximal femur are usually larger in size and they weaken the supporting framework of femoral neck.

Material and Methods: Twelve patients were treated and seen in followup. Six men and 6 women between the ages of 10 and 45 years (average 30 years) were seen at an average followup of 33 months. Seven patients had fibrous dysplasia;

3 had simple bone cysts; 1 had aneurysmal bone cyst and 1 had chondroblastoma. All patients were treated with curettage and morselized allogenic bone grafting. In addition to this treatment three patients treated with deep frozen fibular strut graft; three patients treated with proximal femoral nail and two patients treated with screws.

Results: There were no complications. The functional results were excellent (nine), good (two), fair (one). Nine lesions healed completely and three healed partially which all had fibrous dysplasia.

Conclusions: Allogrrafts have a distinct place in the treatment of benign bone lesions of the femoral neck.

ID 63

Giant cell tumour of bone and pulmonary metastases

M. Rocca1, A. Briccoli1, M. Salone1, M.S. Benassi1,

P. Ruggieri1, R. Perris2

1 Rizzoli Orthopaedic Institute, Bologna, Italy

2 CRO, Aviano, Italy

Introduction: Giant cell tumour of bone (GCT) despite its benign classification has the capacity to locally recur and rarely may develop lung metastases. In literature, data on lung metastases shows different development pathways: spontaneous remission, dimensional stability, or increase in size and number.

Material and Methods: The Rizzoli Institute archives registered to December 2005 1209 patients with bone GCT. Nineteen (1.5%) underwent surgery, by the same team, for lung metastases. Nine were males, age ranging from 16 to 62. Site of primary GCT was the upper limb in 8 cases, lower limb in 10, spine in 1. In 13 cases a local recurrence was evident. Lung metastases were monolateral in 11 pts.

Results: Average disease free interval (DFI) from the onset of the primary tumour was 30.3 months in 17 pts; in 2 cases lung metastases were evident at presentation. All patients were operated with a contemporary mono or bilateral thoracotomy and wedge resection. The average number of resected metastases was 8 (1-23). Follow-up consisted in repeated CT scan. Thirteen patients were freed from metastases and are continuous disease free: average follow-up 96.1 months. Four patients are alive with lung relapse: average follow-up 107 months. Two patients died after 12 and 64 months respectively. Prognostic factors were evaluated. Histological specimens of the primary tumours were also evaluated with real-time PCR techniques for expression of genes related to lung metastases, and in particular the NG2 gene. Conclusions: In conclusion, resection of lung metastases from bone GCT is strongly suggested when their volume increases in time and it is possible to free patients from disease.

ID 150

Platelet rich plasma improves bone formation in a long bone defect on a high surface scaffold

K. Szalay1, J. Vogel1, W. Richter1, V. Ewerbeck2,

P. Kasten2, M. Szendroi2,

1 Department of Orthopaedic Surgery,

University of Heidelberg, Heidelberg, Germany;

2 Department of Orthopaedic Surgery,

Semmelweis University, Budapest, Hungary

Introduction: Autogenous bone grafting is considered as the golden standard for filling bone defects even today, despite significant problems arising from high complication rate, donor-site morbidity, and limited amount of donor bone. The concept of tissue engineering is based on three pillars including scaffolds, cells and growth factors. There is a new high surface ceramic scaffold called calcium deficient hydroxy-apatite (CDHA) that proved to be superior to known low surface scaffolds regarding bone formation. Well established potent cells are mesenchymal stem cells (MSC) that can be obtained autogenously from bone marrow and can be rapidly expanded. Platelet rich plasma (PRP) contains high concentrations of growth factors, which play an important role in the early phase of bone healing. The aim of this study was to assess the effect of PRP on new bone formation in a critical sized diaphyseal bone defect with combination of MSC and an absorbable CDHA scaffold in a rabbit model.

Material and Methods: Critical sized bone defects (1.5 cm) were created in the radius of New Zealand White rabbits (n = 6/group). Animals were treated in compliance with the guiding principles in the Care and Use of Animals. The Committee on Animal Experimentation of Baden-Wuerttemberg approved the experiment. The defect was filled with CDHA ceramic cylinders alone, MSC/CDHA composites, PRP/ CDHA composites or PRP/MSC/CDHA composites. Empty defects and defects filled with autogenous spongiosa served as controls. The observation period was 16 weeks. Bone marrow was aspirated of the tibia, MSC were isolated and expanded to cell numbers of 5x106. PRP was produced allogeneously by centrifugation of whole blood from 5 rabbits. X-rays were taken every 4 weeks to determine the actual position of the ceramic implant and time course of bone formation. Mechanical stiffness was evaluated by a four-point non-destructive bending test. ji-CT scans were used to assess the amount of newly formed bone and the resorption of the implanted ceramic, and verified by analysis of histological slides. The effects of the independent variables, i.e., "stiffness", "bone formation" and the "resorption of CDHA" were examined by multifactorial analysis of variance (ANOVA). Differences between the subgroups of the independent variables were checked in post-hoc tests.

Results: We did not observe displacement of the implant. ji-CT scan showed significantly higher amounts of new bone formation (p<0,001) and ceramic resorption (p<0,0005) in the MSC/CDHA, PRP/CDHA and PRP/MSC/CDHA groups compared to the empty CDHA, but there were no differences among these groups. Biomechanical testing showed a higher flexural rigidity of the groups with MSC and PRP (p<0,05) compared to the empty CDHA group.

Conclusions: Bone healing is better using either mesenchymal stem cells or PRP in critical bone defects filled with the

new high surface ceramic CDHA. However, an additive effect was not observed using combination of the two components.

ID 249

Aggressive aneurismal bone cyst of the vertebral column and pelvis

G.N. Berchenko, A.I. Snetkov, A.R. Frantov Central Institute of Traumatology and Orthopaedics, Moscow, Russian Federation

Introduction: Aneurysmal bone cyst is a benign tumor of bone that can be locally aggressive and cause extensive weakening of the bony structure and impinge on surrounding tissues. Material and Methods: Clinical, roentgenological and morpho-llogical peculiarities of aggressive aneurysmal bone cysts (AABC) were studied in a total of eight 6-to-17-year-old patients. Results: AABC was localized in the bones of the cervical, thoracic and lumbar portions of the vertebral column (2, 3 and 1 patients, respectively), as well as in the pelvic bones (2 patients). The roentgenological signs of AABC are similar to those of a low-grade anaplasia malignant neoplasm, i. e., a pronounced periosteal reaction, total destruction and penetration of the cortical plate, rapid dissemination of the pathological process in soft tissue. Histological signs of AABC are as follows: presence of blood-filled cavities and connective-tissue septa separating them, stroma containing proliferating fibroblast-like cells, histiocytes, unevenly localized multinucleated giant cells; high cell-to-ma-trix ratio, well differentiated intercellular matrix of various degree of maturity, predominantly benign cytological characteristics of the cells with no signs of either anaplasia, or pathological mitoses, as well as local invasion of the pathological tissue to the adjacent soft tissue (sometimes in the form of satellite nodes). Pathological tissue extended to the adjacent bones in four patients (vertebral bones — 3 patients and pelvic bones —

1 patient). Pathologic fractures were formed in four patients. Differential diagnosis is primarily made with a teleangiectatic variant of a low-grade osteosarcoma. Surgical treatment consisted in an extensive marginal resection followed by alloplasty of the defect, and sometimes combined with Collapan.

Conclusions: AABC is a locally expanding benign lesion characterized by considerable destruction of the bone involved and dissemination of the pathological process into the adjacent soft tissue, sometimes accompanied by destruction of the articular surface, and formation of a pathologic fracture.

ID 264

A rare case of de novo bone involving peripheral T-cell lymphoma, unspecified

K. Bodo, W. Weybora, E. Spuller, A. Leithner, R. Rad!

Institute of Pathology, Department of Orthopedics,

Medical University Graz, Austria

Introduction: We report a case of de novo T-cell lymphoma of the spine of a 60-year-old man who showed a lytic lesion in TH 10-12. Malignant lymphoma involving bone is unusual, accounting for approximately 7% of all bone malignancies. T-cell lymphomas are vanishingly rare.

Material and Methods: Magnetic resonance imaging showed a large, heterogeneous enhancing lesion involving the medul-

lary and cortical bone of the vertebrae with cortical disruption and extension into the adjacent paravertebral soft tissue. Diagnosis was made on a biopsy from the vertebral bone by routine histology and immunohistochemistry.

Results: The biopsy showed sheets and clusters of cells resembling lymphocytes with slightly irregular nuclei. Between the lymphocyte resembling cells a population of large lymphoid cells with immunoblast-like nuclei were interspersed. Immu-nohistochemistry showed positive reactions with the T-lineage markers CD3 and CD4. Most of the cells expressed CD3, some of them CD4. There was a loss of the T-cell antigens CD5, 7 and 8. There was no reaction with CD20, 21, 22 and CD30. Conclusions: This is a rare case of a peripheral T-cell lymphoma, unspecified, diagnosed in the spine. The morphologic and immunohistochemical characteristics of the cells classify this lesion as a peripheral T-cell lymphoma, unspecified. To the best of our knowledge there are only few cases reported about a de novo lymphoma like this involving bone.

ID 56

Osteolytic lesions of the calcaneus: a series of 19 patients

A. Leithner1, S. Scheipl1, W. Ertl1, N. Kastner1, R. Radl1,

R. Windhager1, K. Bodo2

1 Department of Orthopaedic Surgery, Medical University Graz, Austria;

2 Institute of Pathology, Medical University Graz, Austria

Introduction: Bone tumours rarely occur in the calcaneus. The purpose of this series was a retrospective analysis of all calcaneal osteolytic lesions archived in the Graz Bone Tumour Registry.

Material and Methods: Between 1998 and 2006 19 patients (12 male, 7 female) with a mean age at diagnosis of 27 years (8-79) were treated due to an osteolysis of the calcaneus. The causes of osteolysis were four primary malignant tumours, two bone metastases of carcinomas, ten benign tumours, and three tumour-simulating processes. Preoperative x-rays were available in eleven cases and analysed for the accuracy of the primary suspected diagnosis on the basis of x-rays only. Results: In all but two cases the x-ray was typical for the process causing the osteolysis. However, in two cases of calcaneal osteosarcoma the x-ray features with a clear defined osteolysis, a sclerotic rim and trabeculations seemed typical for a benign process. In these two cases even MRI did not help to suspect a malign process.

Conclusions: Although in most cases, based on an x-ray, it is possible to distinguish between a malignant and a benign cause for an osteolysis of the calcaneus, caution should never be laid aside, as especially calcaneal osteosarcoma may mimic a benign process. Therefore, in almost all cases a biopsy should precede definitive treatment.

ID 237

Calcaneus's malignant neoplasm in children surgical treatment

W. Wozniak, A. Raciborska, A. Szafraski,

I. Walenta, I. Malesza

Institute of Mother and Child, Department

of Oncological Surgery, Warsaw, Poland

Introduction: Malignant neoplasm of calcaneus is very rare among children and constitute 3% of all bone tumors. The purpose of this paper is to present methods and surgical treatment results of calcaneus malignant neoplasm among children with the application of a large allogenic graft of the head of femur with a fragment of the nec ion of a large allogenic graft of the head of femur after excision of the calcaneus can assure longterm very good functioning results.

Material and Methods: The Clinic's material consist of records 3 patients treated for primary malignant bone neoplasm. The surgery was conducted under general anesthesia. Skin incision was made on the surface of inner side of the foot. After the dissection of the calcaneus together with the tumor wide resection) reconstructed the defect. An allogenic graft was modeled and it was connected with the tarsal bone using a metal clasp (arthrodesis). The Achilles tendon was sawn on to the graft. The limb was immobilized in plaster. Results: Apart from edema of the surrounding tissues early post-operation complications were not observed. The flexion movement of the foot's back and sole were partially maintained. Local oncological radicalism was obtained among all the children. He graft healed up. The children can move without aid. Conclusions: The application of a large allogenic graft of the head of femur after excision of the calcaneus can assure long-term very good functioning results.

ID 92

Giant cell tumor of the capitate bone

T. Er, R. Kartal, T. Yildirim, S. Erdost, V. Sahin Baltalimani Hospital for Bone Diseases, Istanbul, Turkey

Introduction: Giant Cell tumors of bone (GCTOB) are usually benign, mostly seen around the knee and distal radius but rarely in hand and wrist. A thorough review of the literature revealed only 4 primary GCTOB of the capitate. We are reporting a case of GCTOB of the capitate.

Material and Methods: A 24 year old female presented with a mild swelling on the dorsum of her left hand, painful during dorsiflexion and strong grip. There was no history of trauma or previous treatment. Plain roentgenogram showed a lytic lesion destructing the capitate almost totally. MRI revealed a neoplastic lesion expanding beyond the cortex both dorsally and palmarly. Open biopsy revealed GCTOB. Radiologic bone survey and lung CT revealed no pathology. Enblock resection and reconstruction with a bicortical bone graft from the iliac crest was done.

Results: At the 6th month control, she had no pain. Wrist flexion and extension were 30 degrees each, 20 degrees of radial and 15 degrees of ulnar deviation could be done. Graft was incorporated with 3rd and 4th metacarpals, and surrounding carpal bones. The control MRI revealed no recurrence, bone scintigraphy was done, again revealing no pathology.

Conclusions: GCTOF remains to be difficult to treat. Intra-lesional resection, curettage, adjuvants, grafting, filling the defect with bone cement, marginal or wide resection and even amputation are all argued. In our case, tumor had expanded beyond both the dorsal and the palmar cortices when applied and had signs of being intra-articular. We preferred enbloc resection of the tumor and intercarpal and partial carpo-metacarpal arthrodesis. Our patient is fully functional with no complaints during her daily activities, yet the risk of recurrence still exists since the 90% of recurrences are seen within 2 years and recurrence may be seen up to 10 years postoperatively.

ID 187

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Giant-cell tumor of flat bones

I.V. Boulytcheva, A.N. Machson, Y.N. Soloviev Hospital No: 62, Moscow, Russian Federation

Introduction: Giant-cell tumor may present substantial problems in differential diagnosis. Conventional giant-cell tumor of bone is a distinct, locally aggressive neoplasm. Radiographic imaging, gross findings, histology is well known and described in the literature. The differential diagnosis from giant-cell reparative granuloma, brown tumor, nonossifying fibroma, chondroblastoma and chondromyxoid fybroma and also solid areas of aneurysmal bone cysts may cause numerous questions and take a lot of practical knowledge. Bone erosion in pigmented villonodular synovitis can sometimes present difficulties in differential diagnosis. Material and Methods: We collected 12 rare cases of giantcell tumor of pelvic flat bones. All patients were between 2054 years of age with equal distribution between men and women. All cases occur in ilium and pubis, with iliac crest and acetabulum being the most frequent sites.

Results: Radiological features of the giant-cell tumor of pelvic bones were of large lytic defects with markedly expanded contours of bone. Large soft tissue component accompanied 6 of 12 cases. In these anatomic sites, the extent of the disease and its relationship to adjacent structures are best evaluated by computed tomography and magnetic resonance imaging. In 7 cases the magnetic resonance revealed secondary aneurysmal bone cyst changes. The radiographic features were nonspecific and overlap with usual differentials including malignant fibrous histiocytoma. In 4 cases prominent fibroxanthomatous and fibrohistiocytic reaction were revealed. In 2 cases several areas of hemangiopericytoma-like features were observed. In 2 cases a storiform arrangement of fibroblasts and macrophages resembled a benign histiocytoma. All 12 tumors were resected with no evidence of recurrence, but in 1 case where the tumor had features of prominent aggressive growth, proliferation and mitotic activity. Conclusions: Early necrotic changes predominantly involved mononuclear cells with development of degenerative atypia mimicking malignant change. Necrosis in giant-cell tumors of pelvic bones was not a specific feature, more so reflecting the speed of growth. Among 12 cases only 1 recurrence was documented, showing more prominent aggressive growth and mitotic activity of the tumor, radiographic imaging of the expansion of the bone contours and soft tissue component. No metastatic disease has been developed.

ID 121

Malnutrition related complications in post hemipelvectomy patients

M.G. Serna-Thome, C. Lever-Rosas, I. Zeichner-Gancz,

A.E. Padilla-Rosciano

Instituto Nacional De Cancerologia, Mexico, Mexico

Introduction: Hemipelvectomy is a very radical surgical procedure that is not performed frequently. The magnitude of this surgery causes a high consumption of energy and protein conducting the patients to a state of hypercatabolism. It is reported that hemipelvectomy presents about 5070% of complications. The objective of this study is to evaluate the complications of the surgical wound and the flap (infection, abscess, dehiscence of the wound) and its relation with the malnutrition that suffer the patients after this surgical procedure.

Material and Methods: In this study, were included 14 cases, consisting in those patients that suffered any local complication secondary to the procedure such as infection, abscess or dehiscence of the wound. Data on sex, age, weight, height, size, body mass index (BMI), serum levels of albumin prior to surgery and 1-2 weeks after the presence of a complication. For the albumin it was considered as a mild depletion when it was from 3.4-2.8 g/dl, moderate 2.7-2.1 g/dl and severe <2 g/dl. The BMI was considered as normal from

20-24.9 kg/m2 and overweight from 25-29.9 kg/m2. The analysis was performed with the statistical software Stata 7, using descriptive measures.

Results: Of the 14 patients, were male 71% and 29% female. Mean age was of 35.5±9.7 years (male 34.2±10.3 years and female 39±8.2 years). Height of 1.61±0.07 m (males 1.64±

0.13 m, women 1.60±0.67 m). Mean corporal weight was of 67.4±13.1 kg (male 63.2±9.1 kg, female 80.17±17.7 kg). Body mass index was of 25.8 kg/m2 (male 24.6 kg/m2 female 29.8 kg/m2). Initial serologic concentration of albumin was 3.3±0.9 g/dl (male 3.7±0.8 g/dl, female 2.2±0.4 g/dl) and final concentration was of 2.4±1.0 g/dl (male 2.6±1.1g/dl, female 2.0±0.6 g/dl). Infection was observed in 92.8% of the cases, without abscess and 50% had dehiscence of the wound. Six patients (42.8%) had two types of complications. Conclusions: All the patients were admitted with a normal to obese nutritional state, according to the body mass index. Mild serologic albumin depletion was observed in these patients, at the moment of the complication the depletion was from mild and even severe in the female population. A high percentage of patients suffer malnutrition during the hospital stay (from the moment of the surgery to the presence of the complication), this probably contributes to the presence of local complications. It is required special attention on the nutritional status of the patient during the immediate postoperative period, even though that the patients tolerate oral nutrition, this is not enough to cover the nutrimental requirement during this period of hypercatabolism, secondary to the external hemipelvectomy.

ID 97

A video information program for children before lower limb amputation or rotationplasty

E.B. Toele, W.P. Bekkering, A.H. Taminiau Leiden University Medical Center, Leiden, Holland

Purpose: After several years of work and discussion the development of an information package for children before lower limb amputation or rotationplasty, has come to an end. The information on the DVD and photos gives a complete view about the medical treatment. And, even more important, social and emotional questions are answered. The information can be used as psychological preparation for surgery to diminish pre and postoperative anxiety.

Subjects: Years of experience and knowledge about psychosocial preparation were used to develop an information DVD and photo book. The DVD is based on social and emotional problems the patients have after the diagnosis of bone cancer and around the surgical intervention. The DVD is specially made for teenagers and young adults because this group can benefit very well from the possibility to identify with peers. It makes accepting the need to undergo an amputation or rota-tionplasty a little easier.

Methods: The information on DVD is given in a non-directive manner and prevents emotional mechanisms to become active. Four patients in the age of 14 until 19 years old appear as role models and are interviewed about their lives after surgery. Emotions as pain, anger and hope, and ways of coping with the situation are shared by the patient. Also living with prostheses, appearance, future and relationships are important issues, which are shared by peers. Two patients in the age of 13 and 16 years old are followed during the period of surgery, revalidation and fitting of their prostheses. Photos of their medical and physical treatments are included to complete the preparation package.

Discussion: In our opinion, psychological preparation of patients undergoing mutilating surgery like an amputation or rotationplasty should be attended by specialists at the field of psychosocial functioning. This information package should be handled by these specialists and could be helpful in their activities preparing this specific patient group before surgery, reduce stress, anxiety and stimulate the rehabilitation process.

ID 129

Prognostic factors in soft tissue synovial sarcomas

H. Murata, S. Kalra, A. Abudu, S.R. Carter,

R.M. Tillman, R.J. Grimer

The Royal Orthopaedic Hospital, Birmingham, UK

Introduction: Synovial sarcoma is a morphologically well-defined neoplasm that most commonly occurs in soft tissue accounting for 5% to 10 % of all soft tissue sarcomas. We reviewed 156 patients with synovial sarcoma of soft tissues treated at a supra-regional centre to determine survival and prognostic factors.

Material and Methods: There were 77men and 79 women with mean age at presentation of 38 years (3 to 84). Follow-up periods ranged from 3 to 494 months (median 43 months). Tumor was located in lower extremities in 111 pati-

ents, upper extremities in З4 patients, and trunk and pelvis in 11 patients,

Results: Overall survival was бб% at 5 years and 48% at 10 years, The 5 and 10 year survival for the 2З patients who had metastases at the time of diagnosis was 1З% and 0% respectively compared to 75% and 54% for those without metastases at diagnosis, Local recurrence occurred in 18 patients (1З%). The significant prognostic factors for survival included presence of metastases at diagnosis and development of local recurrence. Tumour size and depth, age of patients and use of chemotherapy did not significantly influence survival,

Conclusions: We conclude that the clinical factors which influence survival of patients with synovial sarcoma are different from those of soft tissue sarcomas in general. Biological factors may better predict prognostic survival than the usual clinical factors,

ID 260

Study of the neurinomas with ultrasonographic contrast media: recognition of a characteristic pattern

A. de Marchi, S. Pozza, C. Sena, A. Linari, C. Faletti Piedmont Sarcoma Group, Turin, Italy

Introduction: the neurinomas are benign tumours that take origin from the scabbard of the peripheral nerves. High resolution ultrasonographic constitutes an excellent methodic to visualize and differentiate the tumours of the peripheral nervous system to show the continuation live broadcast with the nerve ending to the two poles of the lesion. Besides the study of the vascularization with power-doppler, nowadays is always more frequent the use of the ultrasonographic contrast-media, that allows an expansion of the deriving signal from the vases. Purpose of our study is appraise if exists a characteristic distribution of the vases in the neurinomas and try in such way a characterization of the same.

Material and Methods: From January 2003 to February 2006 we appraised in our department 24 lesions that base on the theire characteristic ultrasonographic, we identify as probable neurinomas. the patients (13F,10M) had an inclusive age among 15 and 90 years (middle age 46 years). We use the Technos Esaote echograph and it's dedicated software (CnTI).

Results: The cases that we have examined have introduced the following characteristics: In 17/24 damage we identified a contrast media enhancement defined "reticulate", in which are identified two patterns: reticulate to wide sweaters in 7/17 cases and reticulate to narrow sweaters in 10/17 cases. In 7/24 we observed a nearly homogeneous distribution of the contrast media, instead of the presence of little areas that remained without enhancement even in late venous phase. Such picture denominated "unhomo-geneous diffused" and divided in two subtypes based on the presence of one (4/7 cases) or more (3/7 cases) avascular areas. The percentage analysis results that the 70,8% of the neurinomas introduce a pattern of type to reticulate, the remainder 29,2% introduces to unhomogeneous diffused enhancement pattern.

Conclusions: In base to our experience we think that the particular identified patterns may be of aid in the lesion recognition of the same nature.

ID 244

Our experience in standardizing surgical treatment of soft tissue sarcoma

D. Kolokolov, B. Bokhian, D. Burov, V. Sobolevski, M. Aliev N.N. Blokhin Russian Cancer Research Center,

Moscow, Russian Federation

Introduction: The adequate surgical treatment of patients with soft tissue sarcoma is still controversial. There are no common standards of minimally mandatory resection volumes. Purpose was to evaluate the preliminary results of radical resection locally advanced primary and recurrent soft tissue sarcomas affected adductor compartment of the thigh with a rectus abdominis musculocutaneous flap plastic reconstruction. Material and Methods: From 2002 to 2005 fifteen patients with high-grade locally advanced soft tissue sarcoma localized in adductor compartment of the thigh underwent treatment at our department. 4 patients had primary sarcoma and 11 — recurrent sarcoma. We use CT and more often MRI in the preoperative planning of the tumor extent. Mean size of the tumors was 14.6 cm. Compartmental resection and a transferred rectus abdominis musculocutaneous flap reconstruction was performed in all these patients. Mean follow-up was 8.6 months. Results: All operations were radical. Postoperative complications occurred in 2 patients. None of this group had local recurrence of disease. Lung metastasis was revealed in 1 patient. Conclusions: 1) We consider that compartmental resection is the standard of surgical treatment in patients with locally advanced soft tissue sarcoma of adductor compartment, which consists of the adductive (longus, brevis, magnus) muscles, m. pectineus, m. gracilis and surrounding fascia. 2) Using a rectus abdominis musculocutaneous flap for wound reconstruction decrease the postoperative complication rate and is recommended as a standard of surgical treatment in this group of patients.

ID 259

Ultrasound guidance and histological correlation in the biopsy of soft tissues masses. Our experience

A. de Marchi, S. Pozza, M. Stratta, L. Verga, P. Pignataro, A.Linari, E.M. Brach del Prever, U. Albertini, C. Faletti Piedmont Sarcoma Group, Turin, Italy

Introduction: Ultrasound-guided biopsy of superficial and deep masses of the muscle-skeletal apparatus is a minimally invasive, fast and low cost technique. In our experience the biopsies are always performed after a detailed assessment of the intralesio-nal vascularization with use of ultrasound contrast media. We assessed the effectiveness of ultrasound-guided biopsies in the diagnosis of the soft tissues masses by comparing histology on the biopsy with histology on the surgical specimen.

Material and Methods: From January 2003 to January 2006 we performed 112 ultrasound-guided biopsies in 109 patients (65 males and 44 females, age 15-94 years). 16 and 18 G BioPince TruCut needles were used with the proper gui-ding-device. Prior to biopsy all lesions were assessed with a "Technos" (Esaote) ultrasound machine using contrast media (SonoVue, Bracco). In two patients the biopsy was repeated since the sample was not sufficient for a hystolo-gical diagnosis; in another patient the biopsy was repeated

for a perceived discordance between histological and clinical data.

Results: 105 patients underwent a surgical excision of the mass after the biopsy. Two patients refused the proposed surgery and two were lost at follow-up. In 97/105 patients (92.4%) histology from the biopsy and histology from the surgical specimen were concordant. In 13 cases an open excisional biopsy was also performed before a complete surgical removal of the mass because of the aggressiveness of the lesion or because of a perceived discordance between histological and clinical data. Conclusions: Ultrasound-guided biopsy of soft tissues is a safe and reliable diagnostic procedure. In our experience percutaneous biopsy was able to provide a correct preoperative diagnosis in 92.4% cases, thereby allowing the timely choice of the most suitable therapeutic approach, particularly important in high risk patients.

ID 37

Adult high-grade limb liposarcoma approached by limb sparing surgery and adjuvant radiation therapy

Y. Kollender, V. Soyfer, J. Issakov, J. Bickels,

I. Meller, M.J. Inbar, O. Merimsky

Tel-Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel

Introduction: ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of soft tissue sarcomas have been recently published. "Early detection of recurrence might influence the possibility of a curative treatment. The patient should be followed every three months with history and physical examination. MRI of the site of resection of the primary tumor is proposed twice a year for the first 2-3 years and then once a year. For patients with high grade tumors, a chest X-ray is recommended every 3-4 months in the first 2-3 years, twice a year up to the 5th year, and once a year thereafter".

Material and Methods: A cohort of 38 adult patients with high-grade limb liposarcoma was approached by limb sparing surgery and post-operative radiation therapy.

Results: The 10-year local recurrence free survival was 83%, the 10-year metastasis free survival was 61%, the 10-year disease free survival was 51%, and the 10-year overall survival was 67%. The median values of these parameters have not been reached yet. Analysis of failure and success showed no association between these parameters and the age of the patients, the gender, the location of the primary tumor, the type of liposarcoma and the quality of resection. Conclusions: Our results point to the fact that liposarcoma might recur even 10 years after the end of definitive therapy and might spread to unexpected sites as for soft tissue sarcomas. ESMO guidelines may require adaptation to liposarcoma follow-up.

ID 163

Treatment and outcome of soft tissue liposarcoma

D.A. Campanacci, G. Beltrami, M.M. Mela,

A. Franchi, R. Capanna CTO Careggi, Firenze, Italy

Introduction: Liposarcoma is the second most frequent soft tissue sarcoma and the traditional approach is the combina-

tion of surgical treatment with radiation therapy and/or chemotherapy in selected cases. The purpose of the present study was a retrospective review of the data of 149 consecutive patients affected by liposarcoma of the extremities, treated in author's Institution during the last fifteen years, with the aim to correlate the observed outcome with treatment modalities and with recognized prognostic factors,

Material and Methods: There were 91 males and 58 females with an average age of 54 years (min ^-max 92). The tumor grading following Broders criteria showed a low grade lesion in 48% of cases and a high grade lesion in 52% of cases. The histologic pattern showed a conventional liposarcoma in З2 cases (21.5%) and a well differentiated liposarcoma in 21 patients (14%). The most frequent histologic finding was a myxoid liposarcoma in 52 cases (З5%) while a pleomorphic liposarcoma was seen in 25 cases (17%). Both myxoid and round cell component was present in 12 cases (8%) and a round cell liposarcoma was seen in З cases (2%). Dedifferentiated liposarcoma occurred only in 4 cases (2.5%). The size of the tumor was smaller than 5 cm in 11% of patients, ranging from 5 to 10 cm in 51% of cases and larger than 10 cm in 29% of cases; in 9% of patients the original size was not available. The tumor was at first presentation in 54% of cases, it was a local recurrence in 29% of cases and a radicalization of a previous inadequate surgery was done in 17% of cases. The tumoral lesion was located in the lower limb in 124 cases (8З%), in the upper limb in 1б (11%) and in the soft tissues of the trunk in 9 patients (б%). Surgery alone was performed in З1% of cases while chemotherapy and/or radiation therapy was associated in б9% of cases. A preoperative treatment was delivered in 10 cases, a postoperative treatment in 7З cases, while both neoadjuvant and adjuvant therapy was performed in 20 cases. After resection, a soft tissue flap was used for reconstruction in 19 cases (1З%); the flap was rotational in 5 cases while a microsurgical free flap was used in 14 cases,

Results: In 8 cases (5%) a local recurrence occurred and in 27 cases (18%) a metastatic lesion was seen. Local recurrences were treated with surgical excision in 5 cases and with amputation in З cases. Metastatic lesions were seen to occur in lungs in 1З cases, in the soft tissue of the thoracic wall in

З cases and in multiple site in 11 cases. At latest follow up, 70% of patients were continuously disease free, 5% were disease free after local recurrence or metastasis excision, 9% were alive with disease, 8% were dead of the disease, 2% were dead of other cause and б% of cases were lost at follow up, Eleven patients (7%) underwent an amputation, in 5 cases as first surgical procedure, in З cases after a local recurrence and in З cases for complications of the radiation therapy, Conclusions: The authors present the results in soft tissue liposarcoma, considering correlations with treatment modalities and prognostic factors of the disease,

ID 27

Aggressive fibromatosis of soft tissue totally involved scapula: uncommon presentation of a case report

Demiralp Baht, Erler Kaan, Qigek Ilke, Ozdemir Tane, Solakoglu Can

Gulhane Military Medical Academy, Ankara, Turkey

Introduction: Aggressive fibromatosis basically originated from musculo-aponeurotic junction and known also as des-

moid tumors that is locally aggressive and diffusely spreading margins. It has been reported that patients with an extraabdominal desmoid tumors may have multiple minor bone abnormalities, including cortical thickening; exostoses; cysts and deformities in long bones. However, no previous reports have documented extra-abdominal desmoid tumor totally invased scapula.

Material and Methods: We described a rare case of a 31-year-old man of the extra-abdominal desmoid tumor located in scapular region and invasing totally scapula bone and transpassing to the scapulo-thorasic region. He had a pain that started at his shoulder and extended to his scapular region while he was doing exercises. Physical examination revealed a 15x10x5 cm mass that was not adherent to the skin but infiltrating underlying tissue and muscles at his right scapular region. The mass was firm, smooth-surfaced and well defined. Tenderness was noted around the mass. The computed tomography, tridimension reconstruction of the scapula, the magnetic resonance imaging and tru-cut biopsy were performed. Pathological examination was leading to the diagnosis of fibromatosis reported and wide resection was suggested. Type III intra-articulary total scapulec-tomy was applied.

Results: Adjuvant radiotherapy was performed with 50 Gy for 10 days. At the end of two years follow-up period, local recurrence was observed by MRI evaluation. Local excision was performed. His follow-up examinations have been continuing. Conclusions: Aggressive fibromatosis basically originated from musculo-aponeurotic junction and known also as desmoid tumors that is locally aggressive and diffusely spreading margins. No previous reports have documented extra-abdominal desmoid tumor totally invased scapula. We describe an rare case of extra-abdominal desmoid tumor occurred in scapular region and invasing totally scapula bone and transpassing to the scapulo-thorasic region.

ID 234

Surgery and combination therapy results in sinovial sarcoma: analysis of 25 cases

A.L. Zubarev, V.A. Bizer, G.T. Kudryavtseva,

A.A. Kurilchik, I.V. Zvyagina

Medical Radiology Research Center, RAMS, Obninsk, Russia

Background: There are many problems to be solved in the treatment for sinovial sarcoma (SS) accounting for 5-10% of all soft-tissue sarcomas.

Materials and Methods: The study was performed in 25 SS patients (pts), age 12-63 years (median 40.1 years). The diagnosis was made basing on x-ray, ultrasound, computed tomography, histological and immunohistological analysis. 92% (23) of the pts had tumors greater than 5 cm. More than 70% of the pts had stage III disease. 23 (92%) cases had G3 and 2 (8%) cases had G2 tumors. Eight pts (group 1) received ther-mochemoradiotherapy (TCRT) including distant radiotherapy (up to an isoeffective total tumor dose 50-78 Gy) in combination with local hyperthermia up to 42oC in the tumor (4 sessions) between irradiation fractions and neoadjuvant and adjuvant (3-6 cycles) polychemotherapy. Pts from group

2 (n=11) received surgery alone. Group 3 (n = 6) received TCRT and surgery. The groups were well balanced with respect to patient characteristics. Surgical procedures were

radical and organ-preserving except for 4 amputations in group 2.

Results: Immediate and earliest postoperative results were 3 (37.5%) partial responses, 5 (62.5%) stabilizations in group 1; complete response in all patients in groups 2 and 3. All recurrences were reported within the first year following treatment (4, 50% in group 1; 7, 64% in group 2; 1, 17% in group 3) except 1 case from group 2 who developed recurrence at

1.5 years following treatment. The 5-year overall (OS), recurrence free (RFS) and metastasis free (MFS) survival rates were respectively 8± 11.01%, 31.4±20.59%, 9.3±12.3% in group 1; 16.7±14.82%, 28.6±15.48%, 38.3±14.54% in group 2; all pts survived 5 years including 1 case dying within year 6, 81.8±16.44%, 54.5±24.8%) in group 3.

Conclusions: Surgery remains the principal and mandatory treatment modality in SS. OS rate in group 1 was very poor. The 5-year OS and RFS rates in group 3 were significantly better than in other groups while MFS was better than in group 1 alone which confirmed the effect of multi-modality treatment in SS.

ID 119

Angiosarcoma metastatic to ovary. Case report

A.O. Cortes-Flores, H. Martinez-Said, M. Cuellar-Hubbe,

B.A. Soto-Davalos, A.E. Padilla-Rosciano National Cancer Institute Mexico, Mexico, Mexico

Introduction: Angiosarcomas are rare tumors, originated from endothelial cells. They represent 1-2% of the soft tissue sarcomas. They appear frequently in head and neck skin in old patients or in soft tissues. The visceral angiosarcoma is even less frequent, it has been reported in liver, spleen, adrenal glands, thyroid and heart, it has been rarely described in ovary, with around 20 reports in the literature as primary tumor, and rarely in metastatic fashion to the ovary. This case is presented due to the unusual presentation.

Material and Methods: Case report.

Results: 32 years old female, with capillary hemangioma in lumbar sacral region, diagnosed 4 years before, that presents abscess in gluteus region, surgical drainage was carried out in December 2003, finding tumoral tissue, biopsy reported angiosarcoma. She was admitted at the National Cancer Institute of Mexico in January 2004 with 5 cm tumor on right gluteus, not well defined. CT shows a 12x5 cm tumor located in right gluteus that extends to lumbar region, without muscle involvement. A wide resection was carried out in February 2004, reporting a 4x3 cm. tumor in right gluteus, ulcerated with central necrosis. Pathology reported a residual high degree angiosarcoma with free surgical margins. 60 Gy was administrated in July 2004. In October 2004 she presented acute abdominal pain and a mass in left lower quadrant. She was submitted to surgery, finding an ovaric and left salpinx mass. Pathological report was metastatic angiosarcoma. We suggest chemotherapy but she didn't accept it. In February 2005 presented 1 cm, purple nodes in surgical wound. Biopsy reported angiosarcoma. One month later presented progression. MRI showed a rectal extrinsecal compression that displaced sacral nerves. In April 05, last follow-up. CT showed lung metastasis. Conclusions: Ovarian metastasis of soft tissues angiosarcoma are extremely rare, and less common as acute abdomen.

There only few cases reported in the literature with ovarian metastasis and none presented as surgical emergency. The ovarian metastasis should be distinguished of primary ovarian carcinomas or even benign lesions. The characteristics of metastatic lesions include bilaterality, multiple nodules, superficial involvement and little parenchymal and lympho-vascular invasion, and a history of primary tumor elsewhere.

ID 109

Routine MRI surveillance following definitive treatment of bone and soft tissue sarcoma

A.C. Watts, K.H. Teoh, I. Beggs, D.E. Porter New Royal Infirmary, Edinburgh, UK

Introduction: Local recurrence following definitive treatment of bone or soft tissue sarcoma is a predictor of increased morbidity. Early detection may affect outcome. The role of magnetic resonance imaging (MRI) screening following definitive treatment is controversial. There is no evidence in the literature that it is of value in detecting local recurrence earlier. This study investigates the experience of one treatment centre with routine surveillance MRI following treatment of sarcoma. Results: There were thirty-seven men and twenty-eight women identified between 1996 and 2003. The mean age at diagnosis was 47 years (range 6-78 years). Twenty five percent (16 patients) had a primary bone tumour. Eight had a Ewings sarcoma, 3 osteosarcoma, 4 chondrosarcoma, and one giant cell tumour. Soft tissue sarcoma were liposarcoma (17 patients), leiomyosarcoma (6), synovial (5), fibromyxoid (5), epithelioid (2), spindle cell (2), malignant fibrous histiocytoma (6), rhabdomyosarcoma, MPNST, and two undifferentiated high-grade tumours. Sixteen patients had local recurrence (25%). Six were identified on surveillance scan, and the remaining ten required interval scans because of clinical suspicion of tumour recurrence. All those detected on surveillance had intra-lesional or marginal resections. Conclusions: Surveillance scanning has a role in the early detection of local recurrence of bone and soft tissue sarcoma. Whether this results improvements in prognosis require longer-term follow up studies.

ID 96

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Bone metastases from ovarian cancer

D.H. Park, R. Pollock, T.W.R. Briggs, S.R. Cannon,

J.A. Skinner, A.M. Flannagan

Royal National Orthopaedic Hospital, Stanmore,

Stanmore, UK

Introduction: We report 2 cases of bone metastasis from ovarian tumours over a 15 year period at our institution. Material and Methods: We reviewed all histological reports of bone metastases over a 15 year period at our institution and identified 2 patients with bone metastasis from epithelial and granulosa cell tumour of the ovary.

Results: Patient A, aged 50, presented with a pathological fracture of her right proximal femur which was found to be a solitary metastatic lesion from an epithelial ovarian tumour. She underwent a proximal femoral replacement followed by total abdominal hysterectomy and bilateral salpingo-oophor-

ectomy. Post-operatively she had radiotherapy to her right leg and a course of chemotherapy. Follow-up at З0 months revealed no recurrence with a Musculoskeletal Tumour Society (MSTS) score of 77%. Patient B presented with a history of right shoulder pain and a past history of a granulosa cell tumour of the ovary for which she had total abdominal hysterectomy and bilateral salpingo-oopherectomy 4 years before, She was found to have a solitary metastatic lesion in her right scapula and underwent a right scapulectomy with clear margins. Her post op MSTS score was 57%. She did not receive adjuvant therapy and on follow-up at б months was found to have bilateral lung metastases. Histological reports of both patients post operatively confirmed metastatic lesions from epithelial and granulosa cell tumour of the ovary. A review of the literature shows that skeletal metastases from ovarian cancer is rarely reported and few publications have documented the efficacy of adjuvant therapy such as radiotherapy, chemotherapy or hormonal treatment,

Conclusions: Bone metastases from ovarian cancer may be treated aggressively. Management requires a multidisciplinary team approach in a centre specialising in management of bone tumours. There is a need for increased awareness of the role of adjuvant therapy in the management of this condition,

ID i25

Postoperative intravenous patient-controlled analgesia-adminsiterd ketamine plus morphine spares morphine

A. Weinbroum, J. Bickels, N. Marouani, D. Stocki, S. Chazan, A. Gorodetzky, A. Nirkin, I. Meller, V. Rudick, Y. Kollender Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel

Introduction: Pain after surgery for bone and soft tissue tumor is intense, and may require large amounts of analgesics, especially opioids. The concomitant use of ketamine and opioids in patients undergoing general surgery has shown to reduce pain and spare opioids. We compared the effects of standard morphine dose alone vs. subanesthetic dose of ketamine plus бб% of the standard morphine dose via intravenous patient controlled analgesia (IV-PCA) on pain intensity in the orthopedic oncological patients,

Material and Methods: Forty patients underwent surgery under standardized general anesthesia. Postoperatively, they received via IV-PCA (lockout time 7 min) randomly, prospectively and double-blindly (n = 20/group) morphine

1.5 mg/bolus (standard dose) or ketamine 5 mg + morphine

1 mg/bolus. Treatment started when the coherent 5/10 on a visual analog scale (VAS), andpatient subjectively-rated pain as lasted up to 24 h. Intramuscular rescue diclofenac 75 mg was also available,

Results: The mean hourly pain intensity among the ketami-ne + morphine patients was lower ~ 50% compared to that in the morphine alone group, as was the morphine consumption. PONV was recorded trice in the only MO group; one of the ketamine + morphine patients reported a momentary unpleasant sensation,

Conclusions: The combination of IV-PCA subanesthetic dose of ketamine plus ЗЗ% lower dose of morphine reduces pain and spares morphine after surgery for bone and soft tissue tumor than the higher dose of morphine alone,

ID 126

Frequency of application of the intravenous patient-controlled analgesia (iv-pca) device is not an option?

A. Weinbroum, J. Bickels, N. Marouani, D. Stocki, S. Chazan, A. Gorodetzky, A. Nirkin, I. Meller, V. Rudick, Y. Kollender Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Introduction: Pain after surgery for bone and soft tissue tumor is intense, and may require large amounts of analgesics, especially opioids. The self-rated pain visual analog scale (VAS) is the current method used to evaluate level of pain. This methodology has been questioned; however, no better way to estimate such need has been suggested. We compared the use of intravenous patient-controlled analgesia (IV-PCA) vs. the patient's VAS data obtained by the nurse, aiming at establishing a correlation between these two parameters in orthopedic oncological patients.

Material and Methods: Twenty patients underwent surgery under standardized general anesthesia. Postoperatively, they received via IV-PCA (lockout time 7 min) morphine

1.5 mg/bolus. Treatment started when coherent patients subjectively rated pain 5/10 on a VAS and lasted up to 24 h. Intramuscular rescue diclofenac 75 mg was also available. Results: Our data show that both the effective application of the device and the non-effective ones, i.e. activation of the device while locked-out, did not correlate with the use of morphine. Conclusions: Our data suggest that the effective and the non-effective applications of the IV-PCA device does not indicate the true patient's numerical VAS estimation obtained by the medical personnel.

ID 273

Clinical picture, diagnostics and treatment of Baker's cyst in children

G. Chochiev, N. Filatova, O. Alborov, N. Malakhov Vladimir Republic pediatric orthopedic-neurologic rehabilitation center, Regional clinical hospital,

Vladimir, Russian Federation

Introduction: The problem of etiology, pathogenesis and treatment of popliteal region Baker's cysts concerns different specialties of medicine including surgeons, othopaedicians-traumatologists, rheumatologists, pediatricians, tuberculosis specialists, infection disease specialists and oncologists. Materials and Methods: The basis of study included comparative analysis of results from investigations and treatment of 123 patients, 3 to 15 years of age. Treatment arm had 59 patients, who were treated with paracentetic administration of cyclophosphamide in the cyst cavity and control arm with 47 patients after surgical resection of cyst, who were under observation in Vladimir Republic pediatric orthopedic-reha-bilitation center. Besides this, data from advanced clinico-la-boratorical findings of 17 patients with cyst in popliteal fossa, who are undergoing in-patient treatment in the Clinics of Arthrology, Research Institute of Pediatrics of the Russian Academy of Medical Sciences were included in the study. Results: Following results were observed from the clinico-experimental findings. Idiopathic cyst of popliteal fossa was predominantly observed in boys (62,6%) at school-going age (median age — 8,4 years) with high locomotor activeness

against the background of 76,6% patients with signs of dysplasia of connective tissues. Ultrasound findings of tumor-like mass of popliteal fossa is a highly informative diagnostic procedure, used in both out-patients and in-patients with popliteal fossa cyst in all stages, which allows us to determine the localization of cyst, it's value, multi-stage and to evaluate the effectiveness of treatment. Paracentetic-cytostatic treatment of politeal fossa cysts are rationally carried out under ultrasound guidance, which allows us to maximally visualize the manipulation process, it's radicalness and to avoid liable mistakes and complications. Cytologic, Immunologic findings of synovial fluid from cystic cavity of polite-al fossa in children, and also the pathological morphologic findings of its envelope testifies the presence of inflammation of bursa, that is, bursitis. Minimal stage of inflammation intensity shows the possibility of its irritative character. It's found that, direct co-relation in between the primary volume of the cyst and number is mandatory for paracentetis treatment. In majority of overwhelming situations, cysts with a volume up to 4 ml are effectively treated after a single procedure of cyclophosphamide administration. Cysts with greater volume need a puncture of up to 4 times. Experimental findings of cyclophospahamide's effect in joint tissues of healthier animals determined a three-fold threshold of toxic dose in comparison with therapeutic dose.

Conclusions: Our approved treatment of idiopathic Baker's cysts with administration of cyclophosphamide in to the cavity has pathogenetic substantiation and effectiveness. Immediate and long-term results from clinical and laboratoriy data, data from ultrasound and morphological findings testify the presence of local and general complications and adverse effects for the administration of drug in applicable doses.

ID 274

Differential diagnosis of symptomatic torticollis and malignancy in children

G. Chochiev1, A. Gankin1, O. Alborov1, T. Zirina2,

V. Gankina1

1 Vladimir Republic pediatric othopaedic-neurologic rehabilitation center, Vladimir, Russian Federation

2 Regional cancer dispensary, Vladimir, Russian Federation

Introduction: Lately, a considerable growth of oncological and dystropic diseases are observed in children. Routine approach to symptomatic torticollis thereupon, needs a review towards application of high-tech investigational methods in equivocal situations.

Materials and Methods: In the last 2 years, 3 patients from

3 to 6 years of age were under our observation, hospitalized with a diagnosis of symptomatic torticollis of unknown etiology. During examination, we noted that the constrained position of patients' head with inclination to a side, forcible correction of the head position to the correct side, lead to pain in cervical spine. During this procedure, neck muscle tension, which is found in children with congenital myogenic torticollis was not noted. In cervical spine x-rays, including x-rays through oral cavity, precise expressible osteopathology was not found. Earlier patients received conservative treatment, including wearing entrenchment collars, exercise therapy, massage, thermal procedures, and physiotherapy

without any positive effect. In suspicion of changes in bone structure of cervical spine, we performed computerized tomography of cervical spine. In one case, the diagnosis was put forth as dystrophic osteocyst of the tooth of second cervical vertebra and in the other two cases dystrophic osteo-cysts at the arch of second and third cervical vertebrae. As an objective interest towards soft tissue elements in the region of pathologic mass, ultrasound investigation was performed on "Aloka-500", in which no pathologic changes were observed. Considering the possible arise of pathological fractures of the dystrophic cyst, fixation of cervical spine was implemented with the help of entrenchment collars with modest effort of traction towards cranial direction, which was the irritating moment for the stimulation of regenerative processes in dystrophic bone tissue. Patients received exercise therapy, directed towards the eradication of forming pathologic orthostatic reflexes with the practice of isometric relaxation. Results: By performing computerized tomography, within

4 months after the start of treatment, active infill of osteocyst with normal bone tissue was observed. Within six months after the treatment, during check-up, children did not have any complaints. Placement of head was correct, in the median line, movement in the cervical spine was without any restrictions, and palpation of transverse and spinal processes of vertebrae was painless. Children were restricted for a year to elements such as, acrobatics (topsy-turvy) and wrestling, considering the huge overload to the cervical spine. Results of treatment were assessed as good.

Conclusions: Considering the above mentioned, we reckon that, during childhood it is mandatory to investigate the patients to rule-out malignancy before the treatment of patients with symptomatic torticollis. Computerized tomography and ultrasound investigation of cervical spine, performed in these patients, allow us not only to establish the correct diagnosis, but also control the specific treatment in patients with such difficult pathology.

ID 286

The use of pelvic spacer devices to facilitate delivery of radical radiotherapy in the treatment of bone and soft tissue sarcomas of the pelvis

D.H. Park1, R.C. Pollock1, B.M. Seddon2, A.M. Cassoni2,

F. Saran3, O.M. Stokes1, J.P. Cobb1, J.A. Skinner1,

T.W.R. Briggs1, S.R. Cannon1

1 The London Bone and Soft Tissue Tumour Service, The Royal National Orthopaedic Hospital, Middlesex, UK

2 Department of Oncology, University College Hospital NHS Trust, London, UK

3 Sarcoma Unit, Royal Marsden Hospital, London, UK

Purpose: We report a series of patients with soft tissue and bone sarcomas of the pelvis who had pelvic spacer devices inserted in the pelvis to facilitate radical radiotherapy, and report functional outcomes following treatment. Introduction: Treatment of malignant bone and soft tissue sarcomas affecting the pelvis is challenging. While some tumours can be resected locally, others may require internal hemipel-vectomy and reconstruction, hindquarter amputation, or may be inoperable. Some patients will need to be treated with radical doses of radiotherapy, for example patients who have in-

operable tumours, who decline amputation, or who require post-operative radiotherapy. Delivery of a radical radiotherapy dose to the lower abdomen and pelvis is technically challenging because of proximity of normal tissue structures such as bowel. Pelvic spacer devices can be used to displace bowel away from the tumour, allowing delivery of a dose of radiotherapy that would otherwise be limited by normal tissue toxicity. Methods & Results: We performed a retrospective review of all patients who presented with a soft tissue and bone sarcomas of the pelvis and who underwent an insertion of a pelvic spacer followed by radical dose radiotherapy (55-70 Gy). Available patients were followed up and evaluated using the Musculoskeletal Society Tumour Score (MSTS) and the Toronto Extremity Salvage Score (TESS). There were ten pati-

ents; 5 had Ewing's sarcoma, З had osteosarcoma, 1 had spindle cell sarcoma and 1 had alveolar soft part sarcoma. 4 patients had metastases on presentation. The average age was З0 years (14 to 5б years), and average follow-up was 15 months (12 to 24 months). 4 patients died and б are still alive. There were no surgical complications. The average length of hospital stay following spacer insertion was б (2 to 10) days. The placement of a spacer allowed delivery of the optimal planned radiotherapy dose to be delivered in all cases,

Conclusion: Pelvic spacer insertion is feasible and allows delivery of optimal radical doses of radiotherapy to pelvic sarcomas. Furthermore, radical radiotherapy can be offered as an alternative to those declining morbid surgery, and seems to be associated with good functional outcomes,

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