Aggressive osteoblastoma: a case report involving a unique chromosomal aberration.

Osteoblastomas are rare bone-producing neoplasms that generally occur in the young and can be misdiagnosed as an osteosarcoma if correlation with clinical history, radiology, and histology is not carefully considered or if the several variants of osteoblastoma are not recognized. These variants lie on a morphologic spectrum between conventional osteoblastoma and osteosarcoma. Aggressive osteoblastoma is one such subtype. As the name implies, the histologic features of aggressive osteoblastoma may appear malignant, and its biologic behavior may separate it from conventional osteoblastoma. We report a case of aggressive osteoblastoma occurring in the femoral diaphysis of a 12-year-old girl; this osetoblastoma was dyssynchronous from the radiologic appearance and a diagnostic challenge. Cytogenetic evaluation of the neoplasm revealed a pseudodiploid clone with a balanced translocation involving chromosomes 4, 7, and 14. Using the premise that cytogenetics might be useful as a diagnostic tool for a more specific classification, we reviewed the literature in order to compare our findings with known chromosomal aberrations.

Distal ulna giant cell tumor resection with reconstruction using distal ulna prosthesis and brachioradialis wrap soft tissue stabilization.

This is a surgical technique report concerning the treatment of a 32-year-old male who had a giant cell tumor of distal ulna with suspected metastatic disease to the lungs. Three curettage procedures and a Darrach procedure were performed at an outlying facility. Upon the fourth reoccurrence, the patient was referred to our facility. It was established that the patient needed a distal ulna en bloc resection. To accommodate his activity requirements, reconstruction of the sigmoid notch and distal ulna was undertaken using a prosthesis. Soft tissue stabilization of the prosthesis was a challenge due to his previous procedures. This was accomplished using a brachioradialis tendon wrap.

Are fibula strut allografts a reliable alternative for periarticular reconstruction after curettage for bone tumors?

Bone tumors occurring in periarticular locations may cause a substantial risk of subchondral fracture and collapse. Poly-methylmethacrylate has been used for reconstruction in these instances because of its immediate structural stability. Allogeneic graft allows for biologic incorporation and remodeling, but it takes longer. Adding a fibula strut graft to the construct seems to provide structural stability during incorporation of the particulate graft. Seventeen of 22 (77.3%) patients returned to their full preoperative level of function after this procedure. We believe adding fibula strut to particulate allograft when using the buttress technique provides structural integrity and biologically active reconstruction, while maintaining a recurrence rate similar to those described for other reconstruction techniques.

Locking versus standard plates for allograft fixation after tumor resection in children and adolescents.

PURPOSE: This investigation was undertaken to assess the performance of locking plates in comparison to standard compression plates for allograft fixation after resection of malignant primary skeletal tumors. METHODS: Using a computerized database, patients younger than 18 years who had undergone resection of malignant skeletal tumors with allograft reconstruction from January 1998 through June 2004 were identified. Demographic, oncological, surgical, and follow-up data were collected, and comparison of outcomes with regard to allograft-host junction healing between locking and standard compression plates was undertaken. RESULTS: Thirty-nine patients meeting the inclusion criteria were identified. Homogeneity of the study group with regards to age, sex, diagnosis, adjuvant therapy, and presence of metastases allowed for evaluation of allograft-host union as a relatively independent variable. Nine patients in the locking plate group (75%) united after the index procedure at an average of 13.1 months. Fifteen patients (55.6%) with compression plates healed after the initial reconstruction at an average of 14.6 months. Complications and secondary procedures were noted. CONCLUSIONS: Results of this investigation suggest that use of locking plates for allograft-host junction fixation is associated with improved union rates and less need for additional operations when compared with standard compression plates.

Improved survival for sarcomas of the wrist and hand.

PURPOSE: To evaluate survival characteristics of malignant hand tumors compared with those occurring in other musculoskeletal locations over a 30-year period. METHODS: Patients were identified through a computerized database maintained at the authors' institution over the past 30 years. Each patient's records were reviewed retrospectively. Diagnoses were categorized and survival data for patients with hand malignancies were compared with those of patients having similar tumors in other musculoskeletal sites by using multivariate statistical analysis. RESULTS: The most common malignancies were epitheloid sarcoma, synovial sarcoma, and malignant fibrous histiocytoma. Improved survival during the follow-up period was found for hand malignancies versus those occurring in other musculoskeletal sites as a whole, and this difference was statistically significant. No significant survival benefit was identified for individual tumors. CONCLUSIONS: Patients presenting with primary malignancies of the hand may survive longer than those with similar tumors in other musculoskeletal locations TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level II.