Osteosarcoma Of Femur Research Articles

Progression of Osteosarcoma After High-Dose Methotrexate: Over-Rescue by Folinic Acid

A 16-year-old girl with a distal femur osteosarcoma became pain-free with the first treatment of methotrexate 12.5 g/m 2 and folinic acid 760 mg/m 2 . She was inadvertently given 1275 mg folinic acid after the third dose. Four days later, pain and swelling recurred. Appreciating that this was "over rescue" rather than drug resistance led to the successful use of a further 8 doses of high-dose methotrexate when a suboptimal response was achieved with cisplatinum, Adriamycin, and ifosfamide. This is the first time "over rescue" has been documented in humans from high-dose folinic acid after methotrexate.

Sonographically guided antegrade common femoral artery access.

To evaluate the feasibility of sonographically guided antegrade common femoral artery puncture and superficial femoral artery access. Fifty antegrade common femoral artery punctures and superficial femoral artery access procedures were performed under sonographic guidance alone in 30 consecutive patients (24 male and 6 female; mean age, 55.1 +/- 25.7 years; range, 13-85 years). The indications were (1) insertion of a vascular sheath for balloon angioplasty in 42 attempts (24 patients with lower leg ischemia) and (2) insertion of an angiographic catheter for 1-shot intra-arterial chemoinfusion therapy in 8 attempts (6 patients with distal femoral osteosarcomas). Technical success was achieved in 28 of 30 patients or 48 (96%) of 50 procedures (95% confidence interval, 80.39-98.32). The average procedure time +/- SD (excluding the failures) was 3 +/- 1 minutes (range, 2-6 minutes). In the 2 failures (2 [4%] of 50) in which common femoral artery punctures were accomplished, further superficial femoral artery cannulations were completed under fluoroscopic road map angiographic guidance. A small groin hematoma was noted in 1 patient. No arteriovenous fistula or pseudoaneurysm was encountered. Sonographically guided antegrade common femoral artery puncture and selective cannulation of the superficial femoral artery are feasible and safe. They may be used as adjunctive modalities in difficult cases of common femoral artery access.

Fine needle aspiration biopsy of primary bone tumors.

A review of 66 consecutive fine needle aspiration biopsies of primary bone tumors revealed that 48 (73%) were diagnostic. Twelve (18%) yielded inadequate specimens unsatisfactory for diagnosis, and five (8%) yielded specimens adequate for partial diagnosis. The only error, presumably attributable to sampling error, was an unappreciated dedifferentiated osteosarcoma arising in an otherwise typical giant cell tumor. Fine needle aspiration biopsy obviated the need for open biopsy in 24 patients and simplified surgery in an additional 24 patients by establishing the diagnosis before surgical intervention. A solitary soft tissue recurrence of a giant cell tumor has been the only local recurrence. A review of 26 consecutive patients with osteosarcoma revealed that seven tumors were diagnosed by primary open biopsy. Nineteen patients had fine needle aspiration biopsy, of which 15 were diagnostic and four required supplemental open biopsy. The elapsed time between the initial office visit and the diagnostic confirmation averaged 5 days for patients requiring open biopsy compared with 0 days for patients whose fine needle aspiration biopsy was diagnostic. The total estimated charge for fine needle aspiration biopsy of a distal femoral osteosarcoma was $1060.00 compared with $4312.25 for open biopsy. There have been no local recurrences in patients in either group. Fine needle aspiration biopsy provides an accurate, safe, efficient, well tolerated, and cost-effective method for diagnosing classic primary bone tumors, including osteosarcoma.

Extracortical Bridging Callus After Limb Salvage Surgery About the Knee

The increasing survival of children treated for osteosarcoma has led to an increase in limb sparing surgery. Little published information is available about the postoperative imaging appearance of this technique. Thus, information gleaned from medical records and imaging reviews was correlated with clinical outcome of 19 consecutive children (median age at diagnosis, 12.3 years) treated for distal femoral osteosarcoma with a cemented rotating hinged knee endoprosthesis with porous coated collar. An extracortical bridging bony callus was identified in 16 patients who were followed up after surgery for a median of 2.8 years (range, 1.4-6 years). Extracortical bridging bony callus formation was circumferential in eight and preferentially posterior in nine, and ranged from 0.5 to 0.7 cm in thickness; 14 patients had lucent lines subjacent to the bridging bone. Thirteen patients had good functional use of the surgically treated leg. Five patients had progressive metastatic disease develop. One patient had local disease recurrence 8 months after surgery. Extracortical bridging bone was not identified in three patients, two of whom had infection develop 7 months and 17 months after surgery; both infections required amputation. Extracortical bridging bone preferentially develops posteriorly, along the compression side of the femur, often is associated with subjacent lucency, and seems to reflect increased prosthetic stability.

Solitary, Thin-Walled Cavitary Lung Metastasis of Osteogenic Sarcoma

Three years after removal of a femoral osteosarcoma, a solitary, thin-walled cavitary lesion (diameter 1 cm) appeared in the lung of a young man. When the lesion enlarged, it was resected. Histology showed sarcoma metastasis with central necrosis and involving a peripheral bronchus. Cavitary metastasis can occasionally result from drainage of necrotizing tumor cells via a peripheral bronchus.

Osteosarcorna With Deeply Eosinophilic Rhabdomyoblast Cells in a Lung Metastatic Focus A Case Report

In a ten-year-old boy with left femoral osteosarcoma, the diagnosis of osteosarcoma was established through bone biopsy. Chemotherapy was administered, but episodes of recurrence and metastasis occurred. In July 1989, a second lung metastatic focus was resected. Histopathologic examination of this metastatic focus showed widespread cross-striation together with osteoid formation. A comparable case seems not to have been reported in the literature.

Sporadic Amplification of the MYC Gene in Human Osteosarcomas

The MYC proto-oncogene has been shown to be overexpressed in several types of sarcomas, including some osteosarcomas. In most cases, the overexpression is due to gene amplification. The total number of osteosarcoma patients studied, however, remains too small to derive any conclusions regarding the true prevalence and the possible clinical significance of MYC gene amplification. To address the issue more thoroughly, we studied 27 specimens from 25 patients with high-grade osteosarcoma (16 primary, 11 metastatic; 11 adult, 14 pediatric) for MYC gene alterations by Southern blot analysis. Two of 27 specimens (7%) showed MYC gene amplification: a primary fibrohistiocytic osteosarcoma of the femur in a 37-year-old man showed threefold amplification, and a primary Paget's osteosarcoma of the tibia in a 60-year-old man showed fourfold amplification. None of the specimens tested showed MYC gene rearrangement (zero of 27) or activating point mutations at the PvuII site in MYC exon-1 (zero of 26). Hence, the MYC gene is amplified in a subset of osteosarcomas. The possible clinical or biological significance of MYC gene amplification in osteosarcoma may warrant further investigation.

MR Imaging of Transarticular Skip Metastases from Distal Femoral Osteosarcoma

We describe a case in which magnetic resonance (MR) imaging of a distal femoral osteosarcoma showed transarticular skip metastases in the proximal tibia. These lesions were not found by conventional radiography, bone scintigraphy, or CT. Since detection of transarticular skip metastases has an important influence on surgical management, MR imaging of metaphyseal osteosarcomas should always include the bone on the opposite side of the joint.

Osteosarcoma of the femur associated with pregnancy

Osteosarcoma of the femur associated with pregnancy

Local radiotherapy combined with systemic chemotherapy in 3 children with osteosarcoma of an extremity

Three boys with osteosarcoma of tibia or femur were locally irradiated with 97.5-100 Gy. Additionally they got chemotherapy according to T4-protocol. After 14-26 month two of them relapsed within, the third below the radiation field. There were no serious side effects of radiotherapy. In spite of amputation and chemotherapy they all developed metastases of lung within 18, 19 or 81 months. Two of them died and one is living with disease. We were not able to cure our three patients by combination of radiotherapy and chemotherapy. Radiotherapy is to date no adequate alternative to radically surgery. Only extraordinary cases should be treated by irradiation.

The prognosis in osteosarcoma.

Multifactorial analysis of patients with osteosarcoma of the distal femur and proximal tibia, recorded in the Swedish Cancer Registry during 1958 through 1968, disclosed a 5-year survival of 15.1% for femoral osteosarcomas and 38.1% for tibial tumours. The prognosis was better in adults than in children and better in males than in females. Tumour size, soft tissue involvement, the presence of pathological fracture and the duration of symptoms before treatment influenced the prognosis. The best treatment for the tibial lesions was high amputation alone, whilst for the femoral tumours primary ablative surgery was not superior to combined high-dose radiotherapy and delayed amputation. The main cause for the higher survival rate for tibial neoplasms seemed to be the fact that they were less advanced on admission than those of the distal femur. The findings emphasize the importance of early diagnosis and treatment for improved survival.

AMPUTATION IN OSTEOSARCOMA

1. The question whether amputation for lower femoral osteosarcoma should be by disarticulation of the hip or through the upper femur to leave a stump is discussed.2. Sixty-eight such patients are reviewed. Thirty were treated by disarticulation and thirty-eight by through-femur amputation.3. There was a 16 per cent incidence of stump recurrence after through-femur amputation, but none after disarticulation. Comparison of survival was not conclusive.4. Disarticulation of the hip is advised.

AMPUTATION IN OSTEOSARCOMA

1. The question whether amputation for lower femoral osteosarcoma should be by disarticulation of the hip or through the upper femur to leave a stump is discussed. 2. Sixty-eight such patients are reviewed. Thirty were treated by disarticulation and thirty-eight by through-femur amputation. 3. There was a 16 per cent incidence of stump recurrence after through-femur amputation, but none after disarticulation. Comparison of survival was not conclusive. 4. Disarticulation of the hip is advised.

A Case of H. P. O. A. Secondary to Above Knee Amputation Due to Osteosarcom

This case report include possible metastatic lung cancer and associatec H. P. O. A. after above knee amputation due to osteosarcoma.The case is a 34 years old male.Chief complaint: clubbed fingersPresent history: The patient noticed swelling of the left knee and limp since November 1969 and was visited our clinic on January 5 1970. The diagnosis of osteosarcoma of left femur was made, and above knee amputation was performed.On July 8, 1970 chest X-ray showed questionable lung metastasis and was admitted to the department of first internal medicine. X-ray survery of whole body was done. New periosteal bone thickening of 0.5mm to 2.0mm was found in diaphysis of tibia, radius, ulna, metacarpal, metatarsal and phalanx. Examination of blood chemistry showed no abnormality in liver function.However there were decreased albumin level in serum and slight depression of pulmonary functions. In the measurement of clubbed fingers, there was apparent hypertrophy of distal phalanx as compared to healthy person.

Osteo-Sarcoma of the Femur and Lung

Osteo-Sarcoma of the Femur and Lung