Ulnar translocation after excision of a Campanacci grade-3 giant-cell tumour of the distal radius: an effective method of reconstruction.

Between June 2005 and March 2008, 14 patients with a Campanacci grade-3 giant-cell tumour of the distal radius were treated by en bloc resection and reconstruction by ulnar translocation with arthrodesis of the wrist. The mean length of radius resected was 7.9 cm (5.5 to 15). All the patients were followed to bony union and 12 were available at a mean follow-up of 26 months (10 to 49). The mean time to union was four months (3 to 7) at the ulnocarpal junction and five months (3 to 8) at the ulnoradial junction. All except one patient had an excellent range of pronation and supination. The remaining patient developed a radio-ulnar synostosis. The mean Musculoskeletal Tumor Society score was 26 (87%, range 20 to 28). Three patients had a soft-tissue recurrence, but with no bony involvement. They underwent a further excision and are currently well and free from disease. Ulnar translocation provides a local vascularised bone graft to reconstruct the defect left after excision of the distal radius for giant cell tumour. It avoids the need for a microvascular procedure while retaining rotation of the forearm and good function of the hand.

Fibular centralisation for the reconstruction of defects of the tibial diaphysis and distal metaphysis after excision of bone tumours.

We evaluated the results of fibular centralisation as a stand alone technique to reconstruct defects that occurred after resection of tumours involving the tibial diaphysis and distal metaphysis. Between January 2003 and December 2006, 15 patients underwent excision of tumours of the tibial diaphysis or distal metaphysis and reconstruction by fibular centralisation. Their mean age was 17 years (7 to 40). Two patients were excluded; one died from the complications of chemotherapy and a second needed a below-knee amputation for a recurrent giant-cell tumour. A total of 13 patients were reviewed after a mean follow-up of 29 months (16 to 48). Only 16 of 26 host graft junctions united primarily. Ten junctions in ten patients needed one or more further procedure before union was achieved. At final follow-up 12 of the 13 patients had fully united grafts; 11 walked without aids. The mean time to union at the junctions that united was 12 months (3 to 36). The mean Musculoskeletal Tumor Society Score was 24.7 (16 to 30). Fibular centralisation is a durable reconstruction for defects of the tibial diaphysis and distal metaphysis with an acceptable functional outcome. Stable osteosynthesis is the key to successful union. Additional bone grafting is recommended for patients who need postoperative radiotherapy.

Diffuse-type giant cell tumor of the subcutaneous thigh.

Diffuse-type giant cell tumor is an extra-articular form of pigmented villonodular synovitis. The localized form of this lesion (tenosynovial giant cell tumor) is frequent, representing the most common subset arising from the synovium of a joint, bursa or tendon sheath, with 85% of cases occurring in the fingers. The less frequent diffuse-type giant cell tumors are commonly located in the periarticular soft tissues, but on rare occasions these lesions can be purely intramuscular or subcutaneous We report the case of a 26-year-old female with diffuse-type giant cell tumor of the subcutaneous thigh, remote from a joint, bursa or tendon sheath. A review of the literature did not reveal any similar description of a diffuse-type giant cell tumor completely within the subcutaneous thigh, remote from a joint, bursa or tendon sheath. These lesions were initially regarded as inflammatory or reactive processes, but since the identification of clonal abnormalities in these patients, and in view of their capacity for autonomous growth, they are now widely considered to represent benign neoplasms.

CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases.

OBJECTIVES: Although large lesions of the limbs can easily be biopsied without image guidance, lesions in the spine, paraspinal area and pelvis are difficult to target, and benefit from CT guidance to improve the accuracy of targeting the lesion for biopsy purposes. A prospective study of CT-guided core needle biopsies for deep-seated musculoskeletal lesions was conducted at a referral cancer institute over a 4-year period with the aim of assessing the safety and efficacy of the procedure. PATIENTS & METHODS: From January 2000 to December 2003, 136 consecutive CT-guided biopsy sessions were undertaken for musculoskeletal lesions in 128 patients comprising 73 males and 55 females. The following data was recorded in all patients: demographic data, suspected clinicoradiological diagnosis, data related to core biopsy session (date, site, approach, total time required in minutes, number of cores, surgeon satisfaction with adequacy of cores), patient discomfort, complications, histopathology report and number of further sessions if material obtained during the first biopsy session was not confirmatory. The sample obtained during the biopsy session was considered inconclusive if, in the opinion of the pathologist, inadequate or non-representative tissue had been obtained. The diagnosis was considered inaccurate if the final histopathological diagnosis did not match with the biopsy diagnosis, or if subsequent clinicoradiological evaluation at follow up did not correlate with the biopsy diagnosis in those patients who were treated with modalities other than surgery. RESULTS: In 121 patients, a single session was sufficient to obtain representative material, whilst for six patients two sessions, and for one patient three sessions were necessary. The time taken for biopsy, including the pre-biopsy CT examination time, varied from 15 min to 60 min (median 30 min). For 110 bony lesions 116 sessions were required, and for 18 soft-tissue lesions 20 sessions were required. 108 biopsy sessions yielded a diagnosis, whilst 28 were inconclusive (diagnostic yield of 79.41%). Of 108 diagnostic biopsies, five were considered inaccurate (accuracy rate of 95.37%). The overall diagnostic yield and accuracy rate for bony lesions were 81.03% and 95.74%; and those for soft-tissue lesions were 70% and 92.85%. There were two complications with no permanent sequelae. CONCLUSION: CT-guided core needle biopsy is a safe, easy, and effective technique for the evaluation of deep-seated musculoskeletal lesions, with a high rate of diagnostic yield and accuracy. It facilitates definitive therapy without the patient having to undergo a major surgical procedure for diagnosis.

Core needle biopsy for bone tumours.

INTRODUCTION: Percutaneous core biopsy of bone lesions provides early and definitive diagnosis and guides decisions on management. It is an inexpensive examination technique and has negligible complication rates. METHODS: We performed a prospective study of 136 patients who underwent core biopsies for bone lesions over an 18-month period. A Jamshidi (J) needle was used to obtain a core of tissue and specimens were sent for histopathological examination. Biopsy results were analysed for adequacy, ability to yield diagnostic information and for accuracy of diagnosis. RESULTS: The mean age of patients was 27.5 years with a range of 3-72 years. There were 84 males and 52 females in the study. Histopathological diagnosis was obtained in 121 (89%) patients. The specimen was non-diagnostic in 15 patients. Fourteen patients required two attempts and two patients required three attempts at biopsy. Sixty-two of 64 patients (96.9%) who had a confirmed final diagnosis had an accurate J-needle histopathological diagnosis. None of the patients had any major complications. DISCUSSION: Core needle biopsy is an important tool in the evaluation of bone lesions. It is a safe, reliable and accurate procedure and yields diagnostic information in a high proportion of patients. It has several advantages over an open bone biopsy.