Pelvic Solitary Plasmacytoma: Computed Tomography and Magnetic Resonance Imaging Findings with Histopathologic Correlation

OBJECTIVE: To describe the imaging features of pelvic solitary plasmacytoma and to correlate them with the pathologic grade. MATERIALS AND METHODS: A retrospective study was performed on the imaging features of 10 patients with a histological diagnosis of pelvic solitary plasmacytoma. The imaging studies were assessed for bone expansion, cortical destruction, signal intensity/density of soft tissue mass and enhancement manifestations, which were then correlated to the pathologic grade. RESULTS: The imaging features of pelvic solitary plasmacytoma revealed 3 different types: multilocular type (n = 5), unilocular type (n = 2) and complete osteolytic destruction type (n = 3) on computed tomography and MRI. Pathologically, the tumors were classified into low, intermediate and high grades. Features such as multilocular change, perilesional osteosclerosis, slight expansion, local bone cortex disruptions and masses inside bone destruction, often suggest a low-grade solitary plasmacytoma; complete osteolytic destruction, huge soft tissue mass, and osseous defects imply a higher pathologic grade. CONCLUSION: Pelvic solitary plasmacytoma has various imaging manifestations, while a slight expansile osteolytic feature with multilocular change or homogeneous enhancement highly suggests its diagnosis. The distinctive imaging features of pelvic solitary plasmacytoma are well correlated to the pathologic grade.

Surgical treatment of Giant Cell Tumor / 대한정형외과학회잡지

Giant cell tumor is a predominantly benign condition but often the tumor is locally aggressive and tends to have high rate of recurrence and it can evolve into a malignant tumor. Thus the lesions have a practically difficult therapeutic problem for the orthopaedic surgeon and any method of treatment has not been satisfied. Between March 1984 and March 1993, clinical observation was carried out on 22 cases of giant cell tumor of bone to analyse the recurrence rate and functional evaluation of the joint according to the treatment methods, pathological grade and cortical destruction. The mean follow-up time was 75. 2 months. The recurrence rate of the intralesional excision group was 54.5% and that of the wide excision group was 9%, There was no relationship between the pathologic grade and recurrence rate. There was no recurrent case in the grade I cortical destruction but almost all of recurrence was occurred in the grade I or II cortical destruction. The functional result of the giant cell tumor occurred around the knee joint was that the mean ratings in the intralesional excision group were 79% and in the wide excision group were 51%. In conclusion, to achieve better joint function and less recurrence rate, intralesional or marginal excision with heat using bone cement or with chemical cauterization using phenol and alcohol can be used for cases of radiological grade I or II, and wide excision for grade III.

The Correlation Between the Clinical and Pathological Findings of the Intracranial Ependymomas

The clinical and pathological features were analyzed for 11 cases with intracranial ependymoma treated surgically at the Keimyung University Dongsan Medical Center during the years 1987 to 1992. Tumor histology was reviewed individually and grouped into three categories(Categories I to III) according to the pathologic grade used by Nazar, et al. There were 2 cases(18%) with category I histology, 5(45%) with category II histology, and 4(36%) with category III histology. The high recurrent rate, short recurrent interval, high rate of cerebrospinal fluid seeding and poor outcome were noted in patients with category III histology. The authors also investigated the recurrent interval according to the degree of tumor resection. The mean recurrent interval after surgery was 12 months in cases of subtotal resection and 33 months in a case of total resection. Tumors resected subtotally showed response to radiation and chemotherapy. In conclusion, the pathologic grade and the degree of tumor resection were regarded as important prognostic factors after surgery. Aggressive surgery with chemotherapy or radiotherapy were required in the management of intracranial ependymoma.

A Clinical Study on 37 Cases of Oligodendroglioma

The authors reviewed 37 consecutive cases of histologically proven oligodendroglioma who were treated at the Seoul National University Hospital, between 1979 and 1986. There was a 1.5 : 1 male to female ratio. The age of patients at the time of diagnosis varied between 6 and 64 years(mean 38 years), with 51% in the fourth and fifth decades. The incidence of oligodendrogliomas represented 5% of all brain tumors and 15.5% of all gliomas. All but one were located supratentorially and 54% of them involved the frontal lobe. The mean duration of symptoms prior to the surgery was 27.2 months, but seizures had a considerably longer duration of 6.4 years. The common symptoms were headache(62%), seizures(38%), and motor weakness(22%). The common neurological findings were papilledema(51%), motor dificit(24%), and change in cognition(19%). Six out of 37 cases(16%) presented as the spontaneous intracranial hemorrhage. Calcifications were detected on plain X-ray films of the skull in 19% of patients and fine vascular stains were found on carotid angiograms in 30% of the cases. Brain CT revealed calcification(57%), cyst formation(43%), low density(35%) and heterogenous contrast enhancement(35%). The important factors affecting the prognosis and the recurrence rate were (1) the extent of surgical excision, (2) postoperative radiation therapy, and (3) the pathologic grading. There was a significant difference in the recurrence rate between patients treated with postoperative irradiation and patients treated with surgery alone.