Total en bloc spondylectomy is worth doing in complete paralysis spinal giant cell tumor, a minimum 1-year follow-up.

OBJECTIVE: To investigate the neurological recovery of Frankel A spinal giant cell tumor (GCT) patients after they had received a Total En Bloc Spondylectomy (TES). MATERIALS AND METHODS: We retrospectively recorded data of three patients (two females) with mobile spine GCT (T6, T10, and L2) Enneking stage III with complete paralysis before surgery, who had undergone TES in our institute from January 2018 to September 2020. The duration of neurologic recovery to Frankel E was the primary outcome. The intra-operative blood loss, operative time, operative-related complications, and the local recurrence were the secondary outcomes. RESULTS: The duration of suffering from Frankel A to TES surgery was 2 months for the T6 patient, 3 weeks for the T10 patient, and 1 month for the L2 patient. Three patients had achieved full neurological recovery to Frankel E within 6 months after TES (T6 for 5 months, T10 for 3 months, and L2 for 3 months). The average blood loss was 2833.33 ml and the mean operative time was 400 min. Up until the last follow-up (13-25 months), no evidence of local recurrences had been found in any of the three patients. CONCLUSION: Frankel A spinal GCT patients can achieve full neurological recovery after TES, if the procedure is performed within 3 months after complete paraplegia. TES can effectively control any local recurrences.

Prognostic and risk factors in patients with metastatic bone disease of an upper extremity.

BACKGROUND: The aim of this study was to evaluate survival of metastatic bone disease of an upper extremity, and to identify the prognostic factors that influence survival. METHODS: Patients with metastatic bone disease of an upper extremity between 2008 and 2015 were reviewed from the database of a tertiary university hospital. RESULTS: Of 102 patients, 48 males and 54 females with a median age of 61 (range, 28-82 years), the humerus (64.7%), clavicle (13.7%), and scapula (12.7%) were the common sites for bone metastasis of an upper extremity. Fifty-nine (57.8%) presented with pathologic fracture. No history of cancer was found in 76.5% of patients. The mean onset of metastatic bone disease after the first diagnosis of primary cancer was 4.74 ± 14.07 months (range, 0-84 months). Lung (31.4%) was the most common primary cancer followed by liver (14.7%), breast (12.7%), thyroid (7.8%), and renal (3.9%). Eighty-two cases (80.39%) died from the disease such that the median survival was 4.08 months (95% CI 2.57-6.17). The significant risk factors were the type of primary tumor (P < 0.001, HR = 4.44; 95% CI, 1.99-9.90) and ECOG performance status (P = 0.021, HR = 2.11, 95% CI 1.12-3.99). CONCLUSIONS: Patients with metastatic bone disease of an upper extremity have a limited life expectancy. The type of primary tumor and ECOG performance status were the important prognostic factors that influenced overall survival. Our data help in the management of patients, families, and doctors, so as to avoid over- or under-treatment.

Fatal peripheral T-cell lymphoma following intramuscular tuberculosis of the forearm.

Intramuscular tuberculosis (TB) is a rare disease, and lymphoma may occur following a bout of TB. We report on an unusual presentation of peripheral T-cell lymphoma that occurred after an infiltrative lesion of intramuscular TB of the forearm in an immunocompetent host. To our knowledge, this is the first case where TB of a muscle presenting as an infiltrative lesion instead of an abscess developed into peripheral T-cell lymphoma.

Prognostic factors and clinical outcomes in synovial sarcoma of the extremities.

AIMS: To evaluate the clinical outcomes and identify which prognostic factors influence the clinical outcomes of synovial sarcoma patients at a tertiary university hospital in Thailand. METHODS: Patients with synovial sarcoma of the extremities between 1997 and 2007 were reviewed from the database of the Musculoskeletal Oncology Unit, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand. RESULTS: Of 41 patients, 23 males (56%) and 18 females (44%) with a median age of 39 (range, 1-78 years), 18 (44%) had metastasis at the first diagnosis and 23 (56%) had only a localized tumor. The 5-year overall survival of all the patients was 36%; 64% in patients with localized disease and 0% in patients with metastasis at first diagnosis. In all 23 patients (56%) died of the disease at a median duration of 11 months (range 3-47 months). All patients with metastases died at a median 9 months (range 1-41 months). Metastasis at first diagnosis influenced overall survival for patients with synovial sarcoma (P < 0.001). According to a univariate analysis, the significant adverse factors were biphasic histological subtype and an inadequate surgical margin of the definitive surgery (P < 0.05). CONCLUSION: Synovial sarcoma is still a disease with a poor prognosis. Distant metastasis at initial diagnosis is a significant adverse prognostic factor for overall survival. A biphasic histological subtype and an inadequate surgical margin are significant adverse prognostic factors in localized synovial sarcoma.

Tissue imprint for intra-operative evaluation of musculoskeletal tumors.

OBJECTIVE: To evaluate the usefulness of an intra-operative tissue imprint as a role to provide a provisional diagnosis in patients with musculoskeletal tumors. MATERIAL AND METHOD: 118 patients underwent surgical treatment for musculoskeletal tumors. Tissue imprints from suspected tissues were conducted in all of the patients and the results were compared with the final permanent section. RESULTS: The usefulness of the imprint slides (i.e., the diagnostic yield) was 88.14%. The respective, overall sensitivity, specificity, accuracy, positive and negative predictive value was 93.75%, 100%, 96.15%, 100% and 90.90%. CONCLUSION: Tissue imprinting is a useful method for intra-operative evaluation of adequacy and provides a provisional diagnosis of the musculoskeletal tumors lesions.