Our clinical experience on calcaneal bone cysts: 36 cysts in 33 patients.

BACKGROUND: Solitary bone cysts are lesions of benign nature with fluid content. The frequent locations for these cysts are the proximal femur or humerus. Rarely, they may occur in locations such as the calcaneus, mostly in adults. We have reported the second largest case series of calcaneal bone cysts. MATERIALS AND METHODS: Thirty-six calcaneal cysts in 33 patients, 3 of which showed bilateral involvement, diagnosed, and followed between 1995 and 2008 in our clinic were retrospectively evaluated. RESULTS: The third most common location was the calcaneus, with cysts in 36 (14%) patients. The age range of the patients was 13-74 years (mean, 37.9 years). The complaints of the patients upon presentation to the hospital were heel pain in 16 patients (44.4%). Eighteen patients (50%) underwent surgical treatment, of these ten patients (27.7%) were treated with curettage and autogenous iliac wing grafting. CONCLUSIONS: Simple bone cysts with the location of calcaneus are not a rare entity. According to our series, simple bone cysts have been shown to be typically located in the calcaneus bone in middle-aged patients in particular. Furthermore, in such patients, heel pain is considerably severe, which is a symptom to be kept in mind in differential diagnosis. Curettage and autogenous grafting is the successful method of treatment and it provides good results.

Primary muscular hydatidosis mimicking soft tissue tumour: a report of five cases.

Primary muscular hydatidosis is rare and usually presents as an asymptomatic, slowly growing mass mimicking a soft tissue tumour. Adequate preoperative planning and wide excision is recommended, as incomplete excision may lead to anaphylactic reactions and local recurrence. It should be considered in the differential diagnosis of soft tissue tumours especially in regions endemic for the parasite.

Surgical treatment of malignant tumours of the sacrum.

AIMS: We assessed the results of surgical treatment of malignant sacral tumours and aimed to supply information on incidence and distribution of these lesions. METHODS: Forty-six malignant cases out of 65 tumours of the sacrum were assessed retrospectively. Three of the patients did not accept treatment. Surgical treatment was applied to 23 (65.2%) of the remaining 43 patients. Surgical techniques used were resection and PMMA (polymethylmethacrylate) application through a posterior approach, sacral reconstruction, and resection through a combined posterior and anterior approach. RESULTS: Twelve of the lesions were primary while 34 were secondary. Among the primary sacrum tumours, the most common was chordoma (six cases, forming 9.2% of all the sacral lesions). Of a secondary sacral lesions, nine cases of breast carcinoma were found, forming the most common group. The recurrence rate was 23.3%. CONCLUSIONS: Chordoma was the most common primary sacral tumour, but found no incidence of giant cell tumour which has been previously reported as the second most common primary sacral tumour. We believe the posterior approach for resection of the tumour is sufficient in most instances and lumbopelvic instability must be prevented by reconstructive procedures.

The use of polymethylmethacrylate in the management of hydatid disease of bone.

Hydatid disease of bone is rare. It probably represents between 0.5% and 4% of all human hydatid disease and, in about 60% of patients, affects the spine or pelvis. Between 1986 and 1998, we treated 15 cases of bone hydatidosis. Curettage, swabbing with povidone iodine and filling the defect with polymethylmethacrylate (PMMA) were carried out in ten patients. Three of these had a recurrence after five years, but seven had no signs of relapse during a mean follow-up of 52 months. We believe that the combination of antihelminthic therapy, wide resection and the use of PMMA gives the best outcome in the treatment of bone hydatidosis.

Osteoid osteoma of the pubic bone. Report of a case.

Osteoid osteoma involves the pubic bone in exceptional cases. In this case report, a 23 year-old male patient with osteoid osteoma of the pubic bone, was presented. He was complaining of right groin pain, occurring nocturnally and being relieved by rest and analgesics. Radiographic examination revealed a small lesion in the right pubic bone. The patient was treated surgically, and the nidus was excised. The result of the histopathological examination was "osteoid osteoma". At 1 year postoperatively, recurrence was not seen. It was concluded that, if osteoid osteoma was located in an unusual site, more detailed radiographic examination should be done for exact localization, before the operation.

Partial sacral resection and reconstruction with bone cement. Discussion of an operative experience.

Sacral resection is often the only way for effective palliation of the severe pain in tumors involving sacrum. However the operation hardly seems to be acceptable with the reported operative times, blood losses and complication rates. A case of retrorectal leiomyosarcoma invading sacrum, with severe pain resistant to combined irradiation and chemotherapy is reported. The tumor was removed with resection of the right two thirds of S2, S3 and S4, and the sacrum was reconstructed with bone cement. Complete relief of the pain was obtained with no postoperative complications. It is concluded that incomplete resection of the sacral vertebrae should be performed for sacral root pain palliation if other methods fail. Bone cement reconstruction seems to be a valuable alternative to muscle flaps in covering sacral defects.

Giant cell tumor of bone.

Seventy-two cases of giant cell tumor (GCT) of bone were diagnosed in our clinic between 1986 and 1998. The mean age of the patients was 35 (range: 11 to 63 years) and the female to male ratio was 1.3:1. Fifty-four percent of the cases had involvement about the knee (distal femur, upper tibia, and upper fibula). Four patients had a malignant form of the disease and another four had the disease before closure of the physis. There was no case of multicentric involvement. Nine patients presented with pathological fracture. Forty-seven patients had histological grading done. Twenty three (49%) had grade I, 17 (36%) had grade II, and seven (15%) had grade III disease. The mean follow-up time was 59.6 months (range: 24 to 142 months) for patients at least two years follow-up. There was a 33% complication rate.

Management of sacrococcygeal chordomas.

A total of 16 patients in our clinic (six women, ten men; mean age 54.87 years, range 38-78 years) were diagnosed as having a sacrococcygeal chordoma. Pain was the presenting symptom in all patients. In five patients, the chordoma was inoperable. A total of 11 patients were followed-up for a mean period of 64.8 months (range 7-152 months). Five patients were lost to follow-up (3 in the operable group and two in the inoperable group). The three remaining inoperable patients received radiation therapy. The eight remaining operable patients underwent a total of 12 operations (four anterior and posterior, eight posterior only). Five of these patients received adjuvant radiotherapy and two patients received both radiotherapy and chemotherapy. In follow-up, eight patients had evidence of disease and one patient remained disease-free. Problems encountered during therapy and follow-up included urinary incontinence (72%), rectal incontinence (36%), wound infection (36%), and lower extremity muscle weakness (36%). Two patients died from metastases to the lung. Of the remaining nine patients, eight were ambulatory, with seven needing support to walk. One patient was unable to walk at all due to lower extremity muscle weakness.

Leiomyosarcoma of the great saphenous vein.

Primary malignant tumours of the great saphenous vein are extremely rare with only 15 cases reported in the English literature since 1919. We report a patient who survived 5.5 years after treatment with surgery and chemotherapy before dying from lung metastases.

Squamous cell carcinoma arising in chronic osteomyelitis.

Squamous cell carcinoma (SCC) is a rare but well-documented complication of chronic osteomyelitis. Between February 1991 and March 1999, 13 cases (12 men and one woman) of SCC arising in chronic osteomyelitis were diagnosed and treated in our clinic. Mean age was 56.5 (38-70) years. Twelve patients underwent amputation and one underwent limb salvage. Average follow-up was 56 (24-121) months. Among the 13 patients two died of the disease. Treatment of choice for these tumours has been amputation.

Tumors of the foot and ankle: analysis of 196 cases.

A retrospective assessment was performed on 196 tumors of the foot and ankle [out of 1786 bone and soft tissue tumor cases, (10.9%)] between March 1986 and March 1996 in the Ankara University Department of Orthopedics and Traumatology Tumor Section. Mean age was 28 years (range 3 to 75 years). Of the 196 foot and ankle tumor cases, 171 (87.2%) were benign, and 25 (12.8%) were malignant. One hundred ninety-four (98.9%) were primary tumors and 2 (1.1%) were metastatic tumors. One hundred thirty-six (69.4%) originated from bone, whereas 60 (30.6%) originated from soft tissue. The most frequent foot and ankle tumors were osteosarcoma among malignant osseous tumors, squamous cell carcinoma among malignant soft tissue lesions, solitary exostosis among benign osseous tumors, and xanthoma and giant cell tumor among benign soft tissue tumors. Mean follow-up time was 21.3 months (12 to 90 months). One hundred forty (71.4%) of the patients underwent various operations while the remaining 56 (28.6%) were treated conservatively. Of the 140 surgical cases, 13 (9.3%) had a recurrence, 3 (2.1%) died, and 124 (88.6%) had a clinical cure. For most of the patients who required surgery, nonaggressive procedures were sufficient while amputations were required for 14 patients.

Osteoid osteoma: the results of surgical treatment.

Between 1987 and 1999 we diagnosed and treated 110 patients with osteoid osteoma. Sixty patients were younger than 20 years. One hundred and four patients had characteristic pain at night. The mean duration of symptoms before surgery was 16 months. One hundred and four symptomatic patients were treated operatively with either wide resection or curettage. Ninety-one patients had immediate and complete relief of pain. The average follow-up was 2.5 years.

Spontaneous regression of aneurysmal bone cyst. A case report.

Generally, aneurysmal bone cyst is considered to be a benign lesion that occurs rarely. Its etiology and treatment vary considerably, but curettage and grafting is the widely accepted treatment. Due to the nature of the disease recurrence is always expected. It rarely regresses and we report here a case that showed an improvement spontaneously after open biopsy. Follow-up for more than 4 years has shown no progression.

Primary hemangiopericytoma of bone located in the tibia.

Primary hemangiopericytoma of the bone is a rare tumor. We describe a patient with primary hemangiopericytoma of the tibia treated by surgery. The clinical and radiological features of this tumor are described. The radiological and histopathological different diagnosis of hemangiopericytoma is discussed.

Unicameral bone cyst of the patella. A case report.

We present a case of a simple bone cyst in the patella in a women of 33 years. We were only able to find one similar case in the literature.

Primary lymphoma of bones.

Primary malignant lymphoma of bone (PLB) is an uncommon tumour. A survey of 278 primary malignant cases in our clinic showed that 20 cases of PLB were registered between 1986 and 1997. Fourteen of the 20 cases underwent surgical excision. The mean follow-up time was 36.3 months. The rate of response to treatment was 65% with a rate of complete recovery of 55%. The clinical stage of tumours correlated well with the prognosis. Our results seem worse than most of the series in the literature. A high proportion of stage IV disease and pathological fractures at presentation may be a factor.

The clinical value of flow cytometric DNA content analysis in patients with soft tissue sarcomas.

Purpose. The purpose of this study was to evaluate: (1) the correlation between grade and ploidy or S-phase fraction (SPF), (2) the prognostic value of DNA flow cytometric study in soft tissue sarcomas.Patients /Methods. In all, 47 tissue samples from soft tissue sarcoma patients, surgically treated in the same center, were included. Flow cytometric analyses were performed according to a modified version of the original method of Hedley et al.Results. DNA ploidy status could be determined in 44 samples out of 47 (success rate 94%). Of these 44, S-phase fraction could be calculated in 34 samples (77%). In the study group as a whole, aneuploidy was significantly correlated with high grade. Survival analyses were carried out in 21 patients with soft tissue sarcoma, all surgically treated in the same center, without chemotherapy or radiotherapy. In univariate analyses, DNA ploidy was found to be a significant factor for overall survival (OAS) and metastasis-free survival MFS. Mean OAS for aneuploid tumors and diploid tumors were 35 and 65 months (p=0.034), and mean MFS 23 and 61 months, respectively (p=0.005) .Discussion.There is a relation between histological grade and ploidy in soft tissue sarcomas. It appears that low-grade tumors are generally diploid, whereas high-grade tumors tend to be aneuploid. In a subgroup of patients treated only with surgery, DNA ploidy was found to be an important factor for predicting OAS and MFS.