[Conventional epiphyseal chondrosarcoma of childhood and adolescence: a case report]. / Konventionelles epiphysäres Chondrosarkom des Kindes- und Jugendalters: ein Fallbericht.

INTRODUCTION: Conventional chondrosarcoma is the second most common primary malignant bone tumor and usually occurs at older adult ages. It is rare in childhood and adolescence. CASE HISTORY: This case report presents the treatment course of a 13-year-old boy with a symptomatic chondrogenic tumor of the right distal femur. Histopathologically, an epiphyseal intermediate-grade chondrosarcoma (G2) was diagnosed. DISCUSSION: Based on the following case, potential radiological and histopathological differential diagnoses, such as chondroblastoma or chondroblastic osteosarcoma, are discussed against the background of current standards in orthopedic oncology.

[Hemipelvectomy for pelvic sarcomas]. / Hemipelvektomie bei Sarkomen des Beckens.

BACKGROUND: Hemipelvectomy is an important technique for the treatment of pelvic sarcomas. OBJECTIVES: Presentation of the technical overview, as well as surgical and oncological outcomes of sarcoma patients treated with pelvic tumor resections and treatment recommendations. METHODS: Retrospective analysis of 160 patients treated by pelvic tumor resection for chondrosarcoma between 1977 and 2014. RESULTS: Chondrosarcoma was the most common diagnosis leading to pelvic tumor resection in this collective (38%). The mean patient age at operation was 49 years. 44 patients were treated for G1, 83 patients for G2 and 33 patients for G3 or dedifferentiated chondrosarcoma. The mean tumor diameter was ≥10 cm in 76.1% of cases. Limb salvaging operations were possible in 82.5% of patients. The most common reconstruction technique was hip transposition (38.7%). Clear resection margins were achieved in 86.9% (R0). Local recurrence was observed in 22.5%. Distant pulmonal metastasis was diagnosed in 25% of patients. Grading-specific survival was 81.8% for G1, 59% for G2 and 24.2% for G3 or dedifferentiated chondrosarcoma with a mean survival of 84.4, 89 and 69.4 months respectively. CONCLUSIONS: Pelvic tumor resection with clear margins is the most important known positive predictive local factor affecting overall outcomes, in addition to uncontrollable factors such as grading and tumor size. Defect reconstruction depends on multiple factors such as patient age and adjuvant therapy. The stage of the disease has the greatest impact on overall survival rates and should be considered when contemplating pelvic tumor resections in sarcoma patients.

Ultra-short stem anchorage in the proximal tibial epiphysis after intercalary tumor resections: analysis of reconstruction survival in four patients at a mean follow-up of 56 months.

INTRODUCTION: Tumors localized in the proximal tibial meta-diaphysis often lead to osteoarticular resections. MATERIALS AND METHODS: In this study, we retrospectively reviewed four patients who underwent intercalary tumor resection and reconstruction using an ultra-short stem in the proximal tibial epiphysis, a procedure that to our knowledge has not been reported in literature so far. RESULTS: At the time of operation, the mean patient age was 26.2 years. Three patients were male and one was female. Patients were diagnosed with osteosarcoma in two cases, Ewing's sarcoma and malignant fibrous histiocytoma of bone in one case each. In all cases, wide tumor resections were achieved (osteotomy 3-3.5 cm below the tibia plateau joint surface, mean resection length of tibial bone 18 cm) at a mean time of operation of 198.8 min. Two superficial wound-healing disorders occurred, leading to one surgical revision in each case. One local tumor recurrence occurred 12 months after operation in a patient who discontinued his adjuvant chemotherapy. This patient died of disease, 31 months after operation. Three patients are alive with no evidence of disease at a mean follow-up of 56 months. Walking is not impaired and light sports activities have been reported in all cases. The mean MSTS score is 28/30. CONCLUSIONS: Therefore, we report this reconstruction technique to be considered for special indications where the functional outcome can be improved by preservation of the knee joint in tumors of the proximal meta-diaphyseal tibial region.

[Osteosarcoma and chondrosarcoma of the pelvis and lower extremities]. / Osteo- und Chondrosarkome des Beckens und der unteren Extremitäten.

A wide tumor resection is essential in the therapy of primary malignant bone tumors to minimize the risk of local recurrence and ensure long-term survival. While chondrosarcoma is mainly treated surgically, osteosarcoma therapy consists of both chemotherapy and surgical resection of the tumor. While endoprosthetic replacement after hemipelvectomy tends to be associated with high infection rates and has been superseded by hip transposition and composite osteosynthetic replacements, the use of megaendoprosthetic tumor prostheses is the most common reconstruction technique when the extremities are affected. Biological reconstruction or ablative procedures are reserved for special indications. Overall, the reconstruction techniques presented in this article manage to ensure limb salvage in most patients. Functional outcome, however, greatly depends on the tumor size and site as well as postoperative residual soft tissue coverage.