Arthroscopic Resection of Distal Clavicular Osteochondroma: A Case Report.

CASE: A 23-year-old boy presented with a 3-month history of right shoulder pain. Radiographs and computed tomography showed an exostosis on the inferior aspect of the distal clavicle. It was osteotomized and removed by arthroscopy. The histological examination confirmed the diagnosis of osteochondroma. The patient was found asymptomatic with full range of motion in the last clinical control at 1 year of follow-up. CONCLUSION: This case report shows an arthroscopic resection of distal clavicular osteochondroma achieving complete resection of the tumor with an excellent clinical outcome. The technique offers a direct view of the inferior aspect of the clavicle and preserves the acromioclavicular joint.

Report of a case of giant cell ependymoma with unusual clinical and pathological presentation.

Giant cell ependymoma (GCE) is a very uncommon variant of ependymoma, known for having varying degrees of nuclear pleomorphism. There are only 34 reported cases of GCE in the English literature. We describe an additional case of a young woman who presented with a tumor located in sacral soft tissue, which was not connected to the spinal cord and did not show additional lesions in the central nervous system. Complete tumor resection was performed and no recurrences or metastasis were detected after 5 months of follow-up. Only one of all the reported GCE was located in the sacral subcutaneous region, where ependymomas are rarely found and usually have myxopapillary histology. Ours is the second report showing microscopic features of GCE in the soft-tissue region. GCE should be considered in the differential diagnosis of lumbosacral subcutaneous tumors to avoid misdiagnosing it as a malignant lesion. Since GCE could be an extraspinal extension of an intraneural ependymoma, it would be important to evaluate whether it is connected to the spinal cord.

Technical aspects of core needle biopsy and fine needle aspiration in the diagnosis of bone lesions.

OBJECTIVE: Percutaneous needle biopsy is an effective and safe technique for obtaining diagnostic material from bone lesions. STUDY DESIGN: We describe the technical details of fine needle aspiration and core needle biopsy performed in our laboratory of orthopedic pathology. RESULTS: With these procedures, we obtained accurate diagnosis in 83% of 7,375 cases, sent by different orthopedic centers in our country, over a period of 21 years (1986-2007). CONCLUSION: We describe the percutaneous needle procedure (fine needle aspiration, core needle biopsy), the handling of the materials in detail, the different cytological techniques, as well as the advantages of the procedures and how to avoid its disadvantages. We believe that accurate diagnosis with bone needle biopsy mainly depends on the training of the surgical cytologist and the pathologist, who must integrate all the knowledge on the clinical data, image diagnosis, histological procedures and the experience in the histopathological interpretation of bone lesions.

Expression of heat shock proteins in osteosarcomas.

AIMS: Heat shock proteins (HSPs) protect cells against stress-associated injuries and are overexpressed in several malignant tumours. We investigated the potential roles of HSP27, HSP60, and HSP70 in conventional and low grade central osteosarcoma. METHODS: Expressions of HSP27, HSP60, and HSP70 were analysed using immunohistochemistry on tissue sections from 52 cases of conventional osteosarcoma and 21 cases of low grade central osteosarcoma. We evaluated the expression of each protein and examined its relationship with clinicopathological parameters. RESULTS: We found significantly different expressions of HSP27 and HSP70 between conventional and low grade central osteosarcoma [34.6% versus 4.8% (p = 0.008), 88.5% versus 14.3% (p < 0.001)]. However, HSP60 was highly expressed in both kinds of osteosarcoma (92.3% versus 85.7%). In conventional osteosarcoma, a higher expression of HSP27 was significantly related to distant metastasis (p = 0.034) and histological subtype [osteoblastic versus non-osteoblastic (p = 0.041)]. The expressions of HSP60 and HSP70 were not significantly related to any tested clinicopathological parameter. CONCLUSIONS: HSP27 and HSP70 may be used as differential markers to distinguish conventional and low grade central osteosarcoma. HSP27 may be used as a possible prognostic marker in conventional osteosarcoma cases.