External and internal hemipelvectomy: A retrospective analysis of 68 cases.

OBJECTIVES: This study aims to investigate the factors that may be associated with surgical site infection and mortality in pelvic resection surgeries. PATIENTS AND METHODS: A total of 68 patients (40 males, 28 females; mean age: 43±16.2 years; range, 11 to 70 years) who underwent internal or external hemipelvectomy between January 2010 and January 2020 were retrospectively analyzed. We reviewed data concerning histopathological diagnosis, surgical technique, pelvic resection type, tumor size, postoperative infection, duration of follow-up, and mortality. RESULTS: The mean follow-up was 45.5±42.2 months. Among 68 patients, 29 (42.6%) cases underwent external hemipelvectomy and 39 (57.4%) cases underwent internal hemipelvectomy. Reconstruction was performed in 14 (20.6%) patients who underwent internal hemipelvectomy. Of all patients, 61 had primary malignant pelvic tumors and two had metastatic pelvic tumors. Of the other five patients, two had a giant cell tumor, two had a pelvic hydatid cyst, and one had an aneurysmal bone cyst. The three most common pelvic tumors were chondrosarcoma (n=25, 36.7%), osteosarcoma (n=13, 19.1%), and Ewing sarcoma (n=8, 11.8%). Surgical site infections were observed in 34 (50.0%) patients. Of 34 patients, 15 (22.1%) had superficial infections and 19 (27.9%) had deep surgical infections. The superficial and deep infection rates were higher in the external hemipelvectomy group compared to internal hemipelvectomy (p=0.02). Patients with postoperative infection had a mean survival period of 36.0 months compared to 79.8 months in patients without infection (p=0.037). The patients treated with internal hemipelvectomy had a mean survival of 97.0 months compared to 25.7 months in patients treated with external hemipelvectomy (p<0.0001). The effect of Enneking stages of malignant pelvic tumors on survival was investigated using the Kaplan-Meier analysis. Cumulative survival decreased, as the stage progressed (p<0.0001). CONCLUSION: The type of surgical technique affects the possibility of postoperative infection. Postoperative infection, surgical method, and stage of the tumor are associated with survival.

Malignant triton tumor of the gluteal region in a patient unaffected by neurofibromatosis: A case report.

Malignant triton tumor (MTT) is a rare variant of malignant peripheral nerve sheath tumor (MPNST) made up of both malignant schwannoma cells and malignant rhabdomyoblasts. A 26-years-old male patient was admitted with an asymptomatic gluteal mass. Magnetic resonance imaging showed heterogeneous soft tissue mass and he underwent open biopsy. Malignant peripheral nerve sheath tumor was diagnosed. He was given adjuvant chemotherapy following the removal of the tumor with hip disarticulation. The tumor was diagnosed as "malignant triton tumor" based on pathological examination including immunohistochemical studies. There were no signs of metastasis but recurrence was observed at 9 months follow up. MTT is usually associated with Neurofibromatosis 1 and located in head, neck region. In this case sporadic involvement of gluteal region and aggressive behavior of the lesion despite radical surgery was demonstrated.

Parosteal lipoma as a rare cause of peripheral neuropathy and local irritation: A report of 12 cases.

OBJECTIVE: The aim of this study was to evaluate the clinical features and functional results of patients with parosteal lipomas. METHODS: A total of 12 patients (8 females and 4 males; mean age: 45 (10-62) years) with parosteal lipomas who were treated between April 1986 and April 2014, were included into the study. The medical records of the patients were reviewed to analyze the clinical features and functional results of the patients. RESULTS: Of the 12 lipomas, 5 were localized in the proximal arm, 4 in the forearm, 1 in the distal arm, 1 in the distal thigh and 1 in the distal tibia. All patients presented with a progressive, slow-growing mass that was associated with thumb extension weakness in 1 case, and brachialgia-like symptoms in 1 case. Plain radiographs showed a juxtacortical mass in all cases and irregular ossification in 3 cases. In all cases, marginal excision was performed and no clinical recurrence was observed after a mean follow-up of 16 months. CONCLUSION: Parosteal lipomas are uncommon tumors that can be diagnosed with their characteristic radiological features. Parosteal lipomas occurring in the proximal radius may easily cause paralysis of the posterior interosseous nerve or muscle weakness. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Chemotherapy in primary osteogenic sarcoma in patients over the age of forty.

OBJECTIVE: In this study, we sought to review the clinical and histopathological features and the chemotherapy regimens in osteogenic sarcoma in patients over 40 years of age, and we aimed at identifying the possible prognostic factors in this particular group of patients. METHODS: We reviewed 287 patients with osteosarcoma treated between the year 1986 and 2010. Patients from this group who met the following criteria were considered eligible for our study; presence of primary OS, had typical histological and radiographic features of OS, no prior history of cancer or any treatment elsewhere and no prior history of preexisting bone abnormalities. RESULTS: The Kaplan-Meier survival curve for the entire group, with a 95% confidence interval, at two and five years showed the survival rates as 76.2% and 72.8% respectively. The surgical margin was a significant factor affecting the survival. Presence of a pathological fracture also had a significant effect on the survival rate. CONCLUSION: Osteogenic sarcoma remains a challenging disease to treat. Despite the expectation that elderly patients may not tolerate aggressive modern chemotherapy as the younger patients, we believe that patients with primary OS over the age of 40 should be treated aggressively with effective chemotherapy and complete surgical excision whenever possible. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Primary malignant fibrous histiocytoma of long bones: long-term follow-up.

OBJECTIVES: This study aims to evaluate patients diagnosed with malignant fibrous histiocytoma and investigate the possible prognostic factors associated with duration of survival. PATIENTS AND METHODS: The study, which was conducted between May 1994 and September 2013, included 14 patients diagnosed as malignant fibrous histiocytoma (12 males, 2 females; median age 48 years; range 17 to 64 years). We evaluated patients' demographic features, location of the pathology, histological findings, surgical margins, and treatment modalities and investigated the effects of these parameters on survival. RESULTS: Femur was the most frequently involved bone, followed by tibia and humerus. The median follow-up duration of the patients was 129 months. We performed limb salvage surgeries in 13 patients and amputation in one patient. Surgical margins were marginal in three patients and postoperative radiotherapy was performed for local control of the disease. Although there was no local recurrence in these patients, distant metastasis developed in two patients, indicating the importance of surgical margin as a significant factor on survival. Five-year survival rate was 81.9% in patients with wide surgical margins and 33.3% in patients with marginal margins. CONCLUSION: Surgical excision with wide margins and adjuvant chemotherapy provided adequate control of the disease and longer survival. The only prognostic factor statistically significantly associated with duration of survival was surgical margins. Neoadjuvant chemotherapy may be used when there is a suspicion of not obtaining adequately wide surgical margin perioperatively due to close association with neurovascular structures.

Thermal necrosis induced by electrocauterization as a local adjuvant therapy in local aggressive bone tumors, what is the safe limit for surgical margins? An experimental study.

OBJECTIVE: In the current study, it was aimed to investigate the temperature change in the cavity wall and pathologic necrosis occurred during cauterization, which was applied at different voltages and time intervals. MATERIALS AND METHODS: The right tibias of 32 male rabbits were used. Three 2-mm-diameter holes were created on the cortical surface of the tibia using a hand-held drill. Using an electrocautery device, 55 mV was applied for 3 and 5 s and 65 mV was applied for 3 and 5 s. Maximum temperatures at 3 and 6 mm distance from the application site were measured. Biopsy specimens obtained at 3 and 6 mm distance from the application site were evaluated microscopically for bone cell viability and periosteal necrosis. RESULTS: Thirty-two rabbits were divided into four groups. In all groups, periosteal bone cells located at the region, extending from the application site to 3 mm distance, died. In this region, application of 55 mV for 3 s caused peripheral necrosis. There were significant differences between the four groups in terms of maximum temperatures measured at 3 mm distance from the application site (p = 0.027). On the other hand, no significant differences were noted between the four groups in terms of maximum temperatures measured at 6 mm distance from the application site (p > 0.05). CONCLUSIONS: Cauterization of the cavity wall in the spray mode at 55 mV for 3 s after tumor resection caused necrosis in the cavity wall, extending from the application site to 3 mm distance. LEVEL OF EVIDENCE: Experimental animal study, Level II.

Management of tumors and tumor-like lesions of the hand: a review of 191 patients.

OBJECTIVES: In this study, we aimed to investigate the incidence of benign and malignant hand tumors, localization and management approaches. PATIENTS AND METHODS: Between March 1986 and October 2008, 191 consecutive patients (86 males, 105 females; mean age 35.06 years; range 1 to 96 years) who were diagnosed with tumors or tumor-like lesions of the hand in our clinic were retrospectively analyzed. Patients with only intraosseous ganglion cysts were included in the study. RESULTS: The most common lesion was enchondroma (n=59, 30.89%). A giant-cell tumor of the tendon sheath was the most common benign soft tissue tumor (n=30, 15.70%). Alveolar rhabdomyosarcoma was the most frequent malignant soft tissue lesion (n=5, 2.61%). The most common non-metastatic malignant lesions of the bone were chondrosarcomas (n=6, 3.14%). Of the patients with chondrosarcoma, two were diagnosed with primary lesions, and four were diagnosed with chondrosarcoma when benign cartilaginous lesions underwent malignant transformation during follow-up. Metastases to the hand were seen in six patients. CONCLUSION: The incidence of benign tumors of the hand is higher than malignant tumors. Since hand tumors may affect several parts of the body, diagnosis and treatment are best provided through a multidisciplinary approach.

Solitary epithelioid hemangioendothelioma of the metacarpal.

Hemangioendotheliomas are vascular tumors which have an intermediate clinical behavior between hemangiomas and angiosarcomas. The epithelioid subtype of hemangioendothelioma, which is rarely seen in bone, has the potential to metastasize and may be confused radiologically with benign or malignant lesions. A metacarpal origin of this tumor is extremely rare. In this article, we present a 42-year-old female case with an hemangioendothelioma in the second metacarpal which was initially managed as a benign lesion before the patient was referred to our center. The potential malignant nature of epithelioid hemangioendothelioma has been ill-defined. We recommend excision with a wide surgical margin. Amputation may be necessary to perform excision in bones such as the metacarpals or phalanges.

Surgical management of grade I chondrosarcoma of the long bones.

The aim of this study was to compare the rates of local recurrence according to surgical treatment options in low-grade chondrosarcomas of the long bones. A retrospective review was made of 30 consecutive patients (12 male, 18 female) with a mean age of 40.7 years (range: 16-69 years) with intramedullary low-grade chondrosarcoma of the long bones treated either by intralesional curettage or wide resection at our institution between 1995 and 2011. The mean overall follow-up was 74 months (range : 24-186 months). There was no difference in local recurrence rates between patients treated with intralesional resection or wide resection (p = 0.98). Intralesional curettage seems to be feasible in selected cases to reduce the patient's postoperative morbidity in Grade I chondrosarcoma cases.

Bone tumors of the clavicle: risk of malignancy in the elderly and safe needle biopsy.

The clavicle is a rare site for bone tumors and little is known from the limited literature about the prognostic factors and management techniques, including biopsy. The method of biopsy is controversial in the clavicle because of the risk of injury to the neighboring neurovascular structures. Twenty patients with clavicular lesions were retrospectively reviewed with clinical, radiological, and histopathological reports. A needle biopsy was planned in the presence of an osteolytic lesion providing nonforceful entry of the needle, detailed knowledge obtained about the local anatomy, and known availability of an oblique angle for the needle entry away from vascular structures. A needle or tru-cut biopsy was performed for preoperative histopathological diagnosis in 6 selected patients with no complications. Considering the histological diagnosis and prevalence of clavicular bone tumors, benign and malignant lesions had a similar prevalence rate; however, malignant tumors occurred in an older (>50 years) population (P=005). Statistical analysis revealed that the best cutoff point for age for discriminating malignant lesions was 50 years with high sensitivity. The main concern for these patients is primary lesion site treatment and symptom palliation. Every clavicular lesion in patients older than 50 years should be considered as malignant unless proven otherwise. This article demonstrates that needle biopsy can be performed safely in selected lesions with particular attention to cross-sectional local anatomy during needle insertion.

Spinal osteochondroma: a report on six patients and a review of the literature.

INTRODUCTION: Osteochondromas are the most common benign tumour of the bone. They occur in two forms as solitary and hereditary multiple form. Osteochondromas are generally located on the metaphysis of the long bones. From 1 to 4% of osteochondromas occur in the spine. Spinal osteochondromas can cause cord and root compression and also be asymptomatic. In the diagnosis of osteochondromas, radiological methods are very important. PURPOSE OF STUDY: Because spinal osteochondroma is very rare, other benign and malign tumours should be kept in mind during differential diagnosis. In this paper, six patients with spinal osteochondral lesions were evaluated at our orthopaedic oncology department. PATIENTS: Between 1986 and 2009, six patients, four males, two females with an average age of 31.2 (9-65) were diagnosed with spinal osteochondroma at our clinic. Although one patient was diagnosed following another complaint, five patients were suffering from pain. In addition, four patients had swelling and one patient had neurological symptoms. Five patients were treated surgically, and the sixth one was followed conservatively. DISCUSSION: The patients with spinal osteochondral lesions applied with mostly pain and swelling at the dorsal of the vertebrae. Because neurological symptoms are rarely seen, radiological examination is of great importance in diagnosis. CONCLUSIONS: Patients suffering from spinal osteochondroma, due to the risk of secondary chondrosarcoma, must be closely evaluated both clinically and radiologically. If necessary, the patient must be treated surgically following histopathological diagnosis.

Benign fibrous histiocytoma of the hand: a case report and literature review.

Benign fibrous histiocytoma (BFH) of the bone is a rare benign lesion characterised by the presence of fibroblasts and histiocytes. Fibrohistocytic lesions involving bone with identical histological appearances are common during childhood such as fibrous cortical defect. However, BFH is very rare and can only be differentially diagnosed with its presentation, localisation and radiologic features. Here we describe a 33-year-old man with BFH in a rare location, a phalanx. To our knowledge this is the second reported case of a BFH involving the proximal phalanx of the thumb in an adult. We report clinical, radiologic and histological findings of the case and briefly review the literature on the subject.

[Chondroblastoma of the metatarsal bone and its 17-year follow-up]. / Metatarsal yerlesimli kondroblastom ve 17 yillik takibi.

Chondroblastoma is a rare bone tumor of cartilaginous origin. Metatarsal involvement is very rare, with a few cases. We presented a case of chondroblastoma localized in the fourth metatarsal bone. The patient presented with persistent pain of eight-month duration on the lateral side of his foot, which developed after an inversion ankle sprain. Radiological examination showed a large osteolytic lesion with sclerotic margins in the fourth metatarsal bone. The lesion was treated with extra-articular curettage and autogenous bone grafting. During a 17-year follow-up, the patient had no complaints, and there were no clinical or radiological findings of local recurrence or metastasis.

Tumours and tumour-like lesions of the patella: a report of eight cases.

We report eight cases of tumours and tumour-like lesions of the patella. Six lesions were primary and two were metastatic, both originating from adenocarcinoma of the rectum. Patients with anterior knee pain related with a tumourous condition usually have significant delay in diagnosis. The importance of considering a neoplastic condition for the common complaint of anterior knee pain, and recognising the patellar tumour with plain radiographs is stressed. In our series, all patients had positive findings on plain lateral radiographs of the patella and we recommend a simple lateral roentgenogram for the initial diagnostic work up for a suspected patellar tumour. Further imaging modalities should be used for accurate staging and histological diagnosis of the lesion.

Primary leiomyosarcoma of bone: a report on three patients.

Primary leiomyosarcoma of bone is a rare aggressive tumor that occurs mainly in older people. It resembles other malignancies clinically and radiologically, and differential diagnosis is based on histopathology, including immunohistochemistry. If leiomyosarcoma is found in bone, the possibility that it is a metastasis from a distant tumor should be investigated. The treatment is surgical excision with wide margins. Here we present three patients who had primary leiomyosarcoma of radius, ilium, and femur, respectively, and who were treated surgically.

The use of fibular autograft and ankle arthrodesis for aggressive giant cell tumor in the distal tibia: a case report.

The case describes successful distal tibial resection, fibular autograft, and ankle arthrodesis in two patients who had giant cell tumor in the distal tibia. At long-term followup, the patients had no pain and no limitation in daily or low-impact recreational activities. In conclusion, due to the large resection that is often necessary for aggressive tumors, fibular autograft and ankle arthrodesis may be a useful method in the distal tibia.

Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur.

In long bones, the most common site for metastases is the proximal femur. For lesions involving this region, osteosynthetic devices frequently fail, and for this reason, endoprosthetic reconstruction may be the optimal choice for treatment. Here, we present a series of 44 patients in whom 45 endoprosthetic reconstructions were performed for metastatic disease. In 28 patients (63.63%), endoprosthetic reconstruction was performed for pathologic fractures, and in 16 patients (36.37%), it was performed for impending fractures indicated by complaints of pain and problems with walking. Full weight bearing was achieved in the early postoperative period in 72.09% of our patients, and sufficient pain control was obtained in all patients. Four patients did not survive past the first 72 hours after surgery, and 11 more patients died within 2 months after surgery. A total of 29 patients (65.9%) survived to the 2-month follow-up visit, and of these, only 12 patients (27.2%) survived past the first postoperative year. We believe that in patients with metastatic disease in the proximal femur, endoprosthetic reconstruction can provide early and stable fixation with pain reduction and good functional results.

Secondary chondrosarcoma in cartilage bone tumors: report of 32 patients.

BACKGROUND: Secondary malignancies arising from benign bone tumors are rare. Their recognition and diagnosis are difficult, and their slow growth and late recurrence require long-term follow-up. In this study, malignant transformation rates of various histological types of benign cartilage-forming bone tumors in large series were evaluated. METHODS: Between 1986 and 2004, a retrospective analysis of 627 cartilage-forming benign bone tumors revealed that 32 patients had malignant transformation. Of the 32 patients, 14 had solitary osteochondromas, 10 had multiple osteochondromas, 6 had a solitary enchondroma, 1 had Ollier's disease, and 1 had Maffucci's syndrome. The patient with Ollier's disease had two chondrosarcomas, and one patient with multiple osteochondroma had three chondrosarcomas. The cases were included in the study only when complete clinical documentation, radiological records, and histological analyses were available. RESULTS: The rate of malignant transformation for cartilage-originating tumors was 5.1% (solitary osteochondromas 4.2%, multiple osteochondromas 9.2%, solitary enchondromas 4.2%). The average time between the initial diagnosis and malignant transformation was 9.8 years. The most common site of involvement was the proximal portion of the femur. The tumors generally were well differentiated. The mean follow-up period was 57.3 months. Five patients (15.6%) died of tumor recurrence or metastasis at an average of 20.6 months. One patient is alive with tumor at 104 months. CONCLUSIONS: Cartilage-forming benign bone tumors are rather prone to undergo malignant transformation. Although malignant transformation of a benign bone tumor is a rarely encountered situation, orthopedic surgeons should be cautious while following patients with a benign bone neoplasm. Early recognition and appropriate surgical treatment are required to achieve successful outcomes. The rate of local recurrence in secondary chondrosarcomas depends not only on adequate surgical treatment but also on the localization and histological grade.

Embolization of benign and malignant bone and soft tissue tumors of the extremities.

PURPOSE: To reveal the effectiveness and reliability of preoperative, curative, and palliative embolization of benign and malignant bone and soft tissue tumors of the extremities. MATERIALS AND METHODS: Diagnostic angiography was performed on 35 patients (14 females, 40%; 21 males, 60%) between 6 and 70 years of age (mean, 32 years) who were referred to our digital subtraction angiography (DSA) unit between March 2000 and March 2004, and had extremity bone or soft tissue tumors. Among 17 patients who were initially assessed to be appropriate for angiographic embolization, DSA-assisted intra-arterial embolization was performed on 11 pre-operatively, and 6 curatively or palliatively. Effectiveness of the procedure was evaluated using imaging modalities, including angiography, X-ray, computed tomography, and magnetic resonance imaging as well as with post-operative findings. RESULTS: Among the 11 patients that underwent pre-operative embolization, 10 showed a significant reduction in intra-operative and early post-operative bleeding. Additionally, manipulation and excision of the tumors during surgery were easier as a result. Partial or full remission occurred in 3 of 6 patients that underwent lesion embolization. Two other patients had surgical procedures after finding their lesions had increased in size. In one patient with stable lesion size, cranial metastasis was discovered later. CONCLUSION: Pre-operative, palliative, and curative selective/superselective intra-arterial embolization is an effective and potentially developing method for benign and malignant, hypervascularized bone and soft tissue tumors of the extremities, when it is performed by an experienced team with proper embolizing agents.