OBJECTIVE: To explore the efficacy of the resection of periacetabular malignant tumors and the reconstruction with modular endoprosthesis.
 METHODS: From August 2006 to December 2012, 22 patients with periacetabular malignant tumors, who received the resection and reconstruction with modular prosthesis, were retrospectively reviewed. There were 11 males and 11 females, and the average age was 44 (16-65) years old. Pathological results showed there were 13 cases of chondrosarcoma, 5 cases of osteosarcoma, 2 cases of Ewing's sarcoma, 1 case of maligant fibrous histiocytoma, and 1 case of giant cell tumor. According to the classification system by Enneking, there were 11 cases of Type II+III resection, 5 cases of Type I+II+III resection, 3 cases of Type I+II resection, and 3 cases of Type II resection.
 RESULTS: All patients were followed up. The average time for follow-up was 49 (11-103) months. At the last time of follow-up, 13 patients (59%) were still alive, 9 patients (41%) died due to their primary disease. Metastasis occurred in 8 patients (36%), and local recurrence occurred in 5 patients (23%). The mean Musculoskeletal Tumor Society (MSTS) score for 13 cases of alive patients at the latest time of follow-up was (18.5±5.7) months. The mean score for 11 patients, whose limb salvage were successful, was 20.7±2.0.
 CONCLUSION Reconstruction with modular prosthesis after wide resection for periacetabular malignant tumor can achieve satisfied outcome.
Acetabulum ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Bone Neoplasms ; mortality ; surgery ; Chondrosarcoma ; mortality ; surgery ; Female ; Giant Cell Tumors ; mortality ; surgery ; Hip Prosthesis ; Histiocytoma, Malignant Fibrous ; mortality ; surgery ; Humans ; Limb Salvage ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Osteosarcoma ; mortality ; surgery ; Prosthesis Implantation ; statistics & numerical data ; Retrospective Studies ; Sarcoma, Ewing ; mortality ; surgery ; Treatment Outcome

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.
Adult ; Aneurysm, False ; diagnosis ; Biopsy ; Bone Diseases ; diagnosis ; Bone Diseases, Metabolic ; diagnosis ; Bone Neoplasms ; diagnosis ; Cell Proliferation ; Diagnosis, Differential ; Diagnostic Errors ; prevention & control ; Female ; Giant Cell Tumors ; diagnosis ; Humans ; Hyperparathyroidism ; complications ; Leukocytosis ; diagnosis ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Neoplasms ; diagnosis ; microbiology ; Osteomyelitis ; diagnosis ; microbiology ; Osteosarcoma ; diagnosis ; Sarcoma ; diagnosis ; Soft Tissue Neoplasms ; diagnosis ; Tibia ; pathology

Foot ; pathology ; Giant Cell Tumors ; diagnosis ; Humans ; Tendons ; pathology

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.
Adult ; Anterior Cruciate Ligament/pathology/surgery ; Arthroscopy ; Femur ; Giant Cell Tumors/diagnosis/surgery ; Humans ; Knee ; Male ; Synovitis, Pigmented Villonodular/diagnosis/*surgery ; Tendons/*pathology

Localized forms of giant cell tumor are known to arise commonly in the synovial membrane of the finger joints. Multinucleated giant cells are its characteristic pathology finding, giant cell tumor shows a low rate of recurrence after complete excision. When occurring at the knee joints, giant cell tumor manifests a wide form of symptoms, from no symptom at all, to intermittent locking. Complete excision is possible by arthroscopy, but if done incompletely, it is reported to recur in 45% of cases. We present here a case of giant cell tumor that has arisen from the anterior portion of the posterior cruciate ligament, excised by arthroscopy and followed by pathologic confirmation.
Arthroscopy ; Finger Joint ; Giant Cell Tumors* ; Giant Cells ; Knee Joint* ; Pathology ; Posterior Cruciate Ligament* ; Recurrence ; Synovial Membrane

OBJECTIVETo investigate surgical methods and therapeutic effects of giant cell tumor of tendon sheath in finger.

METHODSFrom July 2002 to December 2010,70 patients with giant cell tumor of tendon sheath in finger which confirmed by operation and pathology,were retrospectively analyzed. There were 29 males,41 females with an average of 42 years (ranged, 16 to 61), and the course of disease ranged form 4 months to 6 years (mean 11 months). The method of surgery and anesthesia were observed.

RESULTSAll wounds were got stage I healing,no necrosis occurred. Vascular crisis occurred in 6 cases (8.6%), inconformity of diagnosis in 18 cases (25.7%), changing of anesthesia due to situation of tumor in operation in 17 cases (24.3%). The patients were followed up from 2.2 to 10.5 years. Among them, 8 cases (11.4%) recurred, and diagnosied by the second operation without malignant change.

CONCLUSIONThe best anesthesia for giant cell tumor in finger should choose brachial plexus to fully expose,complete resection and less harmful damage; while the operation should complete resection at the stage I, and followed up actively, the second operation can be carried out for recorrenced.

Adolescent ; Adult ; Female ; Fingers ; surgery ; Giant Cell Tumors ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Tendons ; pathology ; surgery ; Young Adult

OBJECTIVEAnalyze the immunophenotype of the different cells in the various subtypes of giant cell tumor of tendon sheath (GCTS) and investigate the value of clusterin in pathological diagnosis and histogenesis of giant cell tumor of tendon sheath.

METHODSA total of 104 cases of GCTS from the surgical pathology files of Shanghai Jiaotong university affiliated the sixth people's hospital were identified. Immunohistochemistry (IHC) for clusterin, desmin, CD163, CD68, p63, p53, Ki-67 and CD35 was performed on all cases, using EnVision technique.

RESULTSAll cases of GCTS were researched, including 44 cases of localized type (L-GCTS), 32 cases of diffused type (D-GCTS), 26 cases of pigmented villonodular synovitis (PVNS) and 2 cases of malignant type. There was a slight female predominance in all these subtypes, and the male to female ratio was about 38:66. L-GCTS usually occured within the small joints (90.9%, 40/44), while D-GCTS, PVNS and M-GCTS commonly occured within the large weight-bearing joints [68.8% (22/32), 100% (26/26) and 2/2 respectively]. Of 74 cases with follow-up, the recurrence rates of L-GCTS, D-GCTS, PVNS and M-GCTS respectively were 30.3% (10/33), 30.4% (7/23), 18.8% (3/16) and 2/2. The different subtypes of GCTS had the same cell components, including the large synovial-like mononuclear cells, the small histiocytoid cells, foamy histiocytes cells, inflammatory cells, fibroblasts and the osteoclast-like multinucleated giant cells. There were obvious differences among immunophenotype of the various cell components in GCTS: the large synovial-like mononuclear cells were strong positive for clusterin, partly positive for desmin and Ki-67, and negative for CD163. The small histiocytoid cells were strong positive for CD163 but negative for clusterin and desmin. The osteoclast-like multinucleated giant cells were strong positive for CD68 but negative for clusterin, CD163 and desmin. Normal synoviocytes were strong positive for clusterin, partly positive for desmin. The number of the large synovial-like mononuclear cells that were positive for clusterin in D-GCTS were more than that in L-GCTS (P < 0.01) and PVNS (P < 0.05).

CONCLUSIONSGCTS was synovial tumors, not belonged to the category of fibrohistiocytic lesions. The true tumor cells may be the large synovial-like mononuclear cells, and the number of the cells in the D-GCTS was obviously more than that in L-GCTS and PVNS. This may be the reason that the biological behavior of D-GCTS was more aggressive, destructive and recurrent. Clusterin was an useful marker in pathological differential diagnosis of GCTS.

Adult ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; Biomarkers, Tumor ; metabolism ; Clusterin ; metabolism ; Desmin ; metabolism ; Female ; Follow-Up Studies ; Giant Cell Tumors ; metabolism ; pathology ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Receptors, Cell Surface ; metabolism ; Sex Factors ; Soft Tissue Neoplasms ; metabolism ; pathology ; Tendons

OBJECTIVETo analyze the manifestation and investigate the value of MRI in the diagnosis of giant cell tumor of tendon sheath (GCTTS).

METHODSTwenty patients with GCTTS proved by operation and pathology were retrospectively analyzed. There were 8 males and 12 females. The average age was 35.5 years, range from 15 to 61 years. All the patients underwent MRI examination.

RESULTSAmong the 20 cases, 16 patients had the tumor in knee joint, 2 patients had the tumor in interphalangeal articulation of foot and ankle joint respectively. Nineteen patients had limited tumor and 1 patient had diffuse tumor. The soft tissue mass localized beside lower extremity osteoarticulation was displayed on MRI images. On T1WI, the signal intensities of GCTTS almost equaled to those of skeletal muscle in 15 cases and were slightly lower than those of skeletal muscle in 5 cases. On T2WI, the signal intensities tended to range between those of skeletal muscle and fat in 4 cases, almost equaled to those of skeletal muscle in 13 cases, and were slightly lower than those of skeletal muscle in 3 cases. In the 16 patients with gadolinium-enhanced images on T1WI, 5 patients showed homogeneous enhancement and 11 patients showed inhomogeneous enhancement. Four patients had adjacent bone destruction.

CONCLUSIONThe location, shape and inner signal characteristic of GCTTS localized beside lower extremity osteoarticulation could be demonstrated clearly by MRI examination, which is valuable for clinical diagnosis, guiding treatment and follow-up visit.

Adolescent ; Adult ; Female ; Giant Cell Tumors ; pathology ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Tendons ; pathology

OBJECTIVETo investigate diagnostic methods and surgical effect for the treatment of giant cell tumor of tendinous sheath in wrist.

METHODSFrom September 2002 to October 2009, 8 patients with preoperative diagnosis as giant cell tumor of tendinous sheath based on MRI were treated surgically. There were 5 males and 3 females, ranging in age from 16 to 65 years, with an average of 41 years. The disease course ranged from 10 to 72 months with an average of 31 months.

RESULTSThe diagnosis of all the patients was confirmed as giant cell tumor of tendinous sheath by postoperative pathology. All the patients were followed up, and the during ranged from 5 to 48 months (averaged, 34.2 months). One patient recurred and 3 patients got obvious relief of symptoms of median nerve injury. All the patients had significant improvement in wrist function after surgery.

CONCLUSIONPreoperative MRI is helpful for differential diagnosis of giant cell tumor of tendinous sheath. Thorough removal of tumor is very important in prevention of recurrence.

Adolescent ; Adult ; Aged ; Female ; Giant Cell Tumors ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Soft Tissue Neoplasms ; diagnosis ; surgery ; Tendons ; pathology

OBJECTIVETo study the relation of the sex, age, location and chemotherapy with recurrence of the tumor.

METHODSFrom January 2000 to August 2010, 47 patients with giant cell tumor of tendon sheath in upper extremity were retrospectively analyzed. Statistical analysis of sex, age at presentation, lesion location, chemical inactivation, surgical complications, tumor recurrence and pathological findings were explored. There were 28 females and 19 males, ranging in age from 17 to 78 years, with an average of 38.15 years. All the patients underwent surgical excision. Fourteen patients received intraoperative chemically inactive treatment. All the patients had routine follow-up to observe the wound healing, pathological findings,tumor recurrence, and received necessary imaging examinations.

RESULTSAll the patients were followed up, and the duration ranged from 22 to 129 months, with a mean time of 53.89 months. Four patients who received intraoperative alcohol inactivation appeared wound complications such as wound swelling, discharge of necrotic tissue, delayed wound healing. Fifteen patients had active growth of tumor tissue, 1 patient had low-grade malignant giant cell tumor of tendon sheath. The recurrence rate was significantly higher in the group which preoperative X-ray was found to have bone destruction (P = 0.003); patients receiving chemically inactivation had lower risk of recurrence after surgery than patients not receiving chemically inactivation (P = 0.042).

CONCLUSIONThe recurrence rate of giant cell tumor of tendon sheath in upper limb was closely related to tumor growth site, bone destruction and chemical inactivation. Local excision of giant cell tumor of tendon sheath was the effective treatment. How to identify the patients at high risk of recurrence, how to reduce the recurrence rate and the functional restoration after wide resection are the priorities and difficulties of future researches.

Adult ; Female ; Giant Cell Tumors ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Soft Tissue Neoplasms ; pathology ; surgery ; Tendons ; pathology ; Upper Extremity