It has been reported that the common sites of brown tumors are the jaw, pelvis, ribs, femurs and clavicles. We report our experience in a case of brown tumor of the patella caused by primary hyperparathyroidism. An initial radiograph and CT showed an osteolytic lesion and MR images showed a mixed solid and multiloculated cystic tumor in the right patella. One month after the parathyroidectomy, rapid bone formation was observed on both radiographs and CT images.
Adult ; Bone Density ; Bone Neoplasms/*etiology/radiography/*surgery ; Female ; Humans ; Hyperparathyroidism, Primary/*complications/*surgery ; Parathyroidectomy ; Patella/*pathology/radiography ; Tomography, X-Ray Computed

Bone Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Chondrosarcoma ; diagnostic imaging ; pathology ; secondary ; surgery ; Fingers ; Humans ; Male ; Middle Aged ; Osteochondroma ; pathology ; Radiography

OBJECTIVETo study the histogenesis of giant cell tumor (GCT) and factors related to tumor recurrence, invasiveness and malignant transformation.

METHODSThe clinical features, radiologic classification, surgical approach, pathologic findings, immunophenotypes and follow-up data of 123 cases of GCT were analyzed.

RESULTSThere was a significant correlation between tumor recurrence and radiographic classification (P = 0.032), over-expression of CD147 (P = 0.034) and p53 (P = 0.005), and surgical approach (P = 0.0048) in GCT. The biologic behavior showed no correlation with intramedullary infiltration, cortical bone involvement, parosteal soft tissue extension, tumor thrombi, fusiform changes of mononuclear tumor cells, mitotic count, Ki-67 index, coagulative tumor necrosis, secondary aneurysmal bone cyst formation, and adjoining bony reaction. The positive rate of p63 in stromal cells of GCT (79.7%, 94/118) was significantly higher than that in chondroblastoma (44.7%, 21/47), osteosarcoma (22.2%, 10/45) and other giant cell-rich tumors.

CONCLUSIONSGCT is a bone tumor of low malignant potential. It is sometimes characterized by locally invasive growth, active proliferation, coagulative necrosis, secondary aneurysmal bone cyst and surrounding bony reaction. It is difficult to predict the biologic behavior of GCT. Over-expression of p53 in the tumor cells and CD147 in all components of GCT correlate with tumor invasiveness, recurrence and malignant transformation. Selection of suitable surgical approach with reference to radiologic classification is considered as an important factor in reducing the recurrence rate.

Adolescent ; Adult ; Aged ; Basigin ; metabolism ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; surgery ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; diagnostic imaging ; drug therapy ; metabolism ; pathology ; surgery ; Humans ; Male ; Membrane Proteins ; metabolism ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Phosphoglucomutase ; metabolism ; Radiography ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult

A 58-year-old female patient, diagnosed with adenocarcinoma of the lung, underwent percutaneous vertebroplasty at the L4 vertebral body due to painful spinal metastases. Because of deep venous thrombosis of the left femoral and iliac veins, an inferior vena cava filter had been placed before vertebroplasty. Bone cement migrated into the venous bloodstream and then was being trapped within the previously placed filter. This case illustrates that caval filter could capture the bone cement and prevent it from migrating to the pulmonary circulation.
Adenocarcinoma/secondary ; Bone Cements/*adverse effects ; Embolism/*etiology ; Female ; Humans ; Iliac Vein ; Lumbar Vertebrae/surgery ; Lung Neoplasms/pathology ; Middle Aged ; Pulmonary Embolism/prevention & control ; Spinal Neoplasms/secondary ; *Vena Cava Filters ; *Vena Cava, Inferior ; Venous Thrombosis/radiography ; Vertebroplasty/*adverse effects/methods

BACKGROUND: The relationship between surgical margin and local recurrence (LR) in osteosarcoma patients with poor responses to chemotherapy is unclear. Moreover, the incidences of LR according to three different resection planes (bone, soft tissue, and perineurovascular) are not commonly known. METHODS: We evaluated the incidence of LR in three areas. To assess whether there is a role of surgical margin on LR in patients resistant to preoperative chemotherapy, we designed a case (35 patients with LR) and control (70 patients without LR) study. Controls were matched for age, location, initial tumor volume, and tumor volume change during preoperative chemotherapy. RESULTS: LR occurred at the soft tissues in 18 cases (51.4%), at the perineurovascular tissues in 11 cases (31.4%), and at the bones in six cases (17.2%). The proportion of inadequate perineurovascular margin was higher in the case group than in the control group (p = 0.01). Within case-control group (105 patients), a correlation between each margin status and LR at corresponding area was found in the bone (p < 0.001) and perineurovascular area (p = 0.001). CONCLUSIONS: LR is most common in soft tissues. In patients showing similar unfavorable responses to chemotherapy, the losses of perineurovascular fat plane on preoperative magnetic resonance imaging may be a valuable finding in predicting LR.
Adolescent ; Bone Neoplasms/*pathology/radiography/*surgery ; Case-Control Studies ; Chi-Square Distribution ; Female ; Humans ; Male ; Neoplasm Recurrence, Local/*pathology ; Neoplasm, Residual/pathology ; Osteosarcoma/*pathology/radiography/*surgery

Tumor-induced osteomalacia (TIO), or oncogenic osteomalacia (OOM), is a rare acquired paraneoplastic disease characterized by renal phosphate wasting and hypophosphatemia. Recent evidence shows that tumor-overexpressed fibroblast growth factor 23 (FGF23) is responsible for the hypophosphatemia and osteomalacia. The tumors associated with TIO are usually phosphaturic mesenchymal tumor mixed connective tissue variants (PMTMCT). Surgical removal of the responsible tumors is clinically essential for the treatment of TIO. However, identifying the responsible tumors is often difficult. Here, we report a case of a TIO patient with elevated serum FGF23 levels suffering from bone pain and hypophosphatemia for more than three years. A tumor was finally located in first metacarpal bone by octreotide scintigraphy and she was cured by surgery. After complete excision of the tumor, serum FGF23 levels rapidly decreased, dropping to 54.7% of the preoperative level one hour after surgery and eventually to a little below normal. The patient's serum phosphate level rapidly improved and returned to normal level in four days. Accordingly, her clinical symptoms were greatly improved within one month after surgery. There was no sign of tumor recurrence during an 18-month period of follow-up. According to pathology, the tumor was originally diagnosed as "lomangioma" based upon a biopsy sample, "proliferative giant cell tumor of tendon sheath" based upon sections of tumor, and finally diagnosed as PMTMCT by consultation one year after surgery. In conclusion, although an extremely rare disease, clinicians and pathologists should be aware of the existence of TIO and PMTMCT, respectively.
Bone Neoplasms ; blood ; complications ; diagnostic imaging ; pathology ; surgery ; Female ; Fibroblast Growth Factors ; blood ; Follow-Up Studies ; Humans ; Hypophosphatemia ; blood ; diagnostic imaging ; etiology ; pathology ; surgery ; Mesenchymoma ; blood ; complications ; diagnostic imaging ; pathology ; surgery ; Metacarpal Bones ; Middle Aged ; Neoplasms, Connective Tissue ; blood ; complications ; diagnostic imaging ; pathology ; surgery ; Osteomalacia ; blood ; diagnostic imaging ; etiology ; pathology ; surgery ; Phosphates ; blood ; Radiography

OBJECTIVETo study the clinical manifestations, radiologic findings, pathologic diagnosis and differential diagnosis of primary osteosarcoma in elderly patients.

METHODSTwelve cases of primary osteosarcoma occurring in patients older than 60 years were encountered during the period from 1985 to 2010. The clinical manifestations, radiologic features and pathologic findings were studied and the follow-up data were analyzed.

RESULTSThe sites of involvement included long bones (number = 7), ilium (number = 1), craniofacial bones (number = 2) and soft tissue (number = 2). Radiologic examination showed a mixture of osteosclerotic and osteolytic lesions in 10 patients, soft tissue lesions with high-density areas in 2 patients and soft tissue lesions with periosteal reaction in 8 patients. Histologically, most cases showed features of conventional osteosarcoma. There were 2 cases of malignant fibrous histiocytoma-like osteosarcoma, 2 cases of chondroblastic osteosarcoma and 1 case of well-differentiated intraosseous osteosarcoma. Immunohistochemical study played little role in pathologic diagnosis. Ten patients had undergone amputation, including one patient who had received adjuvant chemotherapy beforehand. Nine patients had follow-up information available. Three of them died of lung metastasis and 1 died of cardiovascular disease.

CONCLUSIONSPrimary osteosarcoma rarely occurs in elderly patients and can easily be missed. Correlation with clinical, radiologic and histologic features is important for arriving at a correct diagnosis.

12E7 Antigen ; Aged ; Antigens, CD ; metabolism ; Bone Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Cell Adhesion Molecules ; metabolism ; Chondrosarcoma ; pathology ; Diagnosis, Differential ; Female ; Femoral Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Follow-Up Studies ; Humans ; Ilium ; Lung Neoplasms ; secondary ; Lymphoma ; pathology ; Male ; Middle Aged ; Osteitis Deformans ; pathology ; Osteosarcoma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Radiography ; Soft Tissue Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

OBJECTIVETo study the clinicopathologic and immunohistochemical features of mesenchymal chondrosarcoma.

METHODSThe clinical and histologic features of 23 cases of mesenchymal chondrosarcoma were analyzed. Immunohistochemical study was also performed in 14 of the cases.

RESULTSThe age of patients ranged from 12 to 47 years. Fourteen of them occurred in males. Thirteen cases involved the bony skeleton and 5 cases affected the soft tissue. The patients presented with pain and/or swelling. Histologically, the tumor consisted of a mixture of undifferentiated small round cells and hyaline cartilage. Transition between the two components was demonstrated and growth plate-like cartilage was observed. Immunohistochemical study showed that the small round cells were positive for Sox9 (14/14), CD99 (12/14), vimentin (6/14), CD56 (4/14), CD57 (4/14), neuron-specific enolase (3/14) and desmin(1/14). They were negative for Coll-II, S-100 protein, epithelial membrane antigen, pan-cytokeratin, synaptophysin, chromogranin A, CD34 and c-erbB2.

CONCLUSIONSMesenchymal chondrosarcoma is a rare malignant tumor. Thorough histologic examination, when coupled with immunohistochemical findings, is helpful in arriving at a correct diagnosis.

12E7 Antigen ; Adolescent ; Adult ; Antigens, CD ; metabolism ; Bone Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Cell Adhesion Molecules ; metabolism ; Child ; Chondrosarcoma, Mesenchymal ; diagnostic imaging ; metabolism ; pathology ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Lung Neoplasms ; secondary ; Male ; Mediastinal Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Orbital Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Radiography ; SOX9 Transcription Factor ; metabolism ; Vimentin ; metabolism ; Young Adult

BACKGROUND AND OBJECTIVEAfter chemotherapy was used to treat patients with malignant bone tumors in 1970s, amputation, which was the typical intervention in the 1980s, has been substituted with limb-sparing surgery. This article reported the surgical indications, operative methods, operative effects, and complications of prosthetic replacement of the proximal humerus after the resection of bone tumors.

METHODSFrom April 2004 and December 2008, prosthetic replacement was performed in 18 patients with proximal humerus tumors, including 7 patients with osteosarcoma, 5 patients with chondrosarcoma, 3 patients with giant cell tumor (GCT) of the bone, 1 patient with GCT of the bone combined with an aneurysmal bone cyst, and 1 patient with metastatic bone tumors. Using the Enneking staging system, 7 osteosarcomas and 3 chondrosarcomas were at stage Ib, and 3 GCTs and 2 chondrosarcomas were at stage Ib. The patient with metastatic bone tumors reported severe pain.

RESULTSThe follow-up ranged 5-61 months (mean, 29 months) and showed that 1 patient with osteosarcoma died 19 months after surgery. Local recurrence presented in 1 patient with GCT, 1 patient had inner infection in the area of surgery, and 2 patients had shoulder subluxation after the operation. There was no prosthetic loosening in any patient. The abduction angle of the shoulder was 8 degrees-35 degrees, and circumgyrate angle was 18 degrees-25 degrees, with flexion 35 degrees-90 degrees and extension 25 degrees-42 degrees. According to the functional score developed by the International Society of Limb Salvage, scores ranged between 18 and 29 points, with an average of 24 points.

CONCLUSIONSThe prosthesis replacement for the patients with bone tumors in the proximal humerus is an appropriate procedure with satisfactory therapeutic outcomes; however, many complications should be noted and long-term therapeutic effect needs further investigations.

Adolescent ; Adult ; Arthroplasty, Replacement ; Bone Neoplasms ; diagnostic imaging ; pathology ; surgery ; Chondrosarcoma ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; diagnostic imaging ; pathology ; surgery ; Humans ; Humerus ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Osteosarcoma ; diagnostic imaging ; pathology ; secondary ; surgery ; Prosthesis Implantation ; Radiography ; Range of Motion, Articular ; Young Adult

OBJECTIVEto study the clinicopathologic features and differential diagnosis of low-grade central osteosarcoma (LGCOS).

METHODSnine cases of LGCOS were retrieved from the archival consultation files. The clinical, radiologic and pathologic features were analyzed, with literature review.

RESULTSthe mean age of the patients was 31 years. The male-to-female ratio was 3:6. All of the patients presented with painful mass and/or swelling. The sites of involvement included thigh (n = 4), tibia (n = 1), fibula (n = 1), cervical vertebra (n = 1), lumbar vertebra (n = 1) and maxilla (n = 1). Radiologic examination showed mixed lytic/blastic lesions with soft tissue shadow in 5 cases and associated periosteal reaction in 3 cases. The tumors were treated by surgical excision, with no adjuvant therapy given. The duration of follow up ranged from 2 to 43 months. Four cases had recurrence which occurred at 8 to 25 months after the operation. Gross examination showed that the tumors were fragmented on submission in 5 cases and en bloc in 4 cases. They had solid and firm cut surface, with various degree of grittiness. Histologically, LGCOS was characterized by the presence of hypocellular fibroblastic stroma associated with focal osteoid production. The spindly tumor cells showed mild degree of nuclear pleomorphism, with occasional mitotic figures demonstrated in all of the 9 cases. The newly formed neoplastic woven bone did not have any osteoblastic rimming. The bony trabeculae were slender and seam-like. Parallel arrays of woven bone were seen in 6 cases. Some of the bony trabeculae appeared irregularly branched and curved. The tumor cells permeated adjoining pre-existing bony trabeculae and bone marrow in all cases. Three cases also showed soft tissue involvement.

CONCLUSIONSLGCOS often posses important diagnostic pitfalls due to the relatively bland-looking tumor cell morphology and associated large woven or longitudinal seams of lamellar-like bone. Thorough understanding of the histologic features, when coupled with clinical and radiologic findings, are essential in arriving at a correct diagnosis.

Adolescent ; Adult ; Bone Neoplasms ; diagnostic imaging ; pathology ; surgery ; Diagnosis, Differential ; Female ; Fibrous Dysplasia of Bone ; pathology ; Fibula ; diagnostic imaging ; Histiocytoma, Benign Fibrous ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; diagnostic imaging ; pathology ; surgery ; Radiography ; Radionuclide Imaging ; Reoperation ; Thigh ; diagnostic imaging ; pathology ; Young Adult