Extra-axial soft tissue chordoma of wrist.

Extra-axial soft tissue chordoma is rare. We report a case of extra-axial soft tissue chordoma of the right wrist in an 87-year-old man. The tumor was large, and the cut surface showed multinodular and myxoid appearance. Microscopically, nests of epithelioid and spindle cells were observed in the myxoid matrix. Vacuolated cells were also observed. The tumor cells were diffusely positive for brachyury and cytokeratin 19 on immunohistochemistry, suggesting that the tumor was extra-axial soft tissue chordoma. Extra-axial chordoma is the same entity as chordoma periphericum (parachordoma), as proposed by Laskowski and Dabska.

Multiinstitutional phase II study of neoadjuvant chemotherapy for osteosarcoma (NECO study) in Japan: NECO-93J and NECO-95J.

BACKGROUND: Osteosarcoma is the most frequent primary malignant bone tumor. In Europe and the United States, its prognosis has been greatly improved by the use of multimodal treatment, including preoperative and postoperative chemotherapy as well as surgery. In Japan, however, only a few clinical studies on osteosarcoma have been carried out. METHODS: To evaluate the efficacy of neoadjuvant chemotherapy on nonmetastatic, operable osteosarcoma arising in the extremities, a prospective multi-institutional phase II trial, the Neoadjuvant Chemotherapy for Osteosarcoma (NECO) study, was conducted. Preoperative chemotherapy included high-dose methotrexate (HD-MTX), cisplatin (CDDP), and adriamycin (ADR). If the induction therapy was assessed as not effective, high-dose ifosfamide (IFO) was added to the chemotherapy regimen. A total of 124 patients were enrolled in this trial, and ultimately 113 patients were eligible. RESULTS: The 5-year overall survival (OAS) and event-free survival (EFS) rates in the NECO study were 77.9% and 65.5%, respectively. A good histological response to the induction chemotherapy resulted in favorable OAS (78.7%). The patients assessed as poor histological responders with progressive disease after the induction chemotherapy exhibited comparable outcomes (OAS 89.5%, EFS 68.2%). There were no significant differences between the OAS and EFS rates of the patients in terms of response to preoperative chemotherapy. CONCLUSIONS: We analyzed the results of the intensive neoadjuvant chemotherapy and the effects of adding IFO on patients with osteosarcoma in Japan. The results suggest efficacy of the high-dose IFO addition to the standard three-drug chemotherapy regimen. However, a randomized clinical study is needed to establish the true impact of IFO on patients with osteosarcoma.

Sea urchin spine arthritis of the hand.

PURPOSE: Although rare, hand injury caused by puncture with the sea urchin spine can result in serious complications. To emphasize its clinical significance, this article describes a group of patients who sustained chronic granulomatous arthritis induced by puncture with sea urchin spine (designated sea urchin spine arthritis). METHODS: Five patients who developed sea urchin spine arthritis of the hand after puncture with sea urchin spine were treated at our hospitals. All lesions involved the proximal interphalangeal (PIP) joint (4 index fingers and 1 middle finger). Patients experienced pain, swelling, and discomfort around the site of puncture immediately after the injury. These initial symptoms subsided within a few days, and secondary symptoms including fusiform swelling, limited motion, and mild pain of the PIP joint appeared from 1 to 2 months later. Laboratory tests of inflammation and blood cell counts were negative. Plain radiographs showed soft tissue swelling and osteolysis but no visible spine. Thorough synovectomy of the PIP joint was performed, and the granulation tissue around the joint was also removed. RESULTS: No microorganism was identified from tissue culture or polymerase chain reaction in any of the 5 patients. At a mean follow-up of 21 months, 2 patients exhibited essentially normal active motion of the affected PIP joint, whereas the remaining 3 patients had diminished range of motion. CONCLUSIONS: Diagnosis of sea urchin spine arthritis can be made by history of sea urchin spine injury, a symptom-free period before the development of synovitis, and the absence of laboratory test abnormalities. Neither antibiotics nor nonsteroidal anti-inflammatory agents are effective. Undertaken early enough, thorough synovectomy might avoid complications and obtain favorable results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Fourteen-year results of a reversed vascularized second metatarsophalangeal joint transfer: a case report.

We report a case of free vascularized, second-toe metatarsophalangeal joint transfer in a 34-year-old manual laborer. The metatarsophalangeal joint of the left second toe was transferred to the metacarpophalangeal joint of the right ring finger in a reversed fashion. Fourteen years after surgery the transferred joint is painless and stable and flexion is 80 degrees with extension lag of 52 degrees without arthritic changes on radiographs.

Vascularized bone-marrow allotransplantation in rats prolongs the survival of simultaneously grafted alloskin.

Skin allografts in rats were rejected, even if they were treated with a sub-optimal dose of FK506. However, skin allografts in rats which simultaneously received vascularized limb allografts were rejected more slowly. In this study, the authors examined the reasons why vascularized limb allografts have the ability to induce immunologic tolerance. For investigating which tissue components provide such tolerance, they compared the mean survival times (MST) of skin allografts on the backs of rats (used as an indicator of rejection), which were simultaneously engrafted with vascularized skin allografts, muscle allografts, joint allografts, and limb allografts. In the cases of limb allografts (MST=32.1 days) (these allografts contain bone-marrow cells), the skin allografts survived longer than vascularized skin allografts (MST=23.6 days) or muscle allografts (MST=22.6 days). For ascertaining whether the ability to induce immunologic tolerance of limb allografts was due to bone-marrow cells or not, the authors compared the MST of skin allografts in rats that were simultaneously engrafted with non-irradiated limb allografts, irradiated limb allografts, and bone-marrow cells. The allografted skin in the rats that received non-irradiated limbs (MST=32.1 days) survived longer than irradiated limb allografts (MST=20.3 days) and bone-marrow cells (MST=18.4 days). Limb allografts are, as it were, vascularized bone-marrow allografts. These results suggested that vascularized bone-marrow allografts can facilitate the induction of immunologic tolerance.