Periosteal Ewing's sarcoma.

Periosteal Ewing's sarcoma is an uncommon, but well documented origin of this malignant condition with radiographic signs, different from intramedullary growing tumours. Imaging modalities like CT or MRI supply proof of macroscopically intact endosteal cortical surface and free medullary cavity in long bones affected by this periosteal type of malignancy. Definite confirmation is valid after a careful microscopic investigation of the resected specimen. The prognosis of this type of Ewing's sarcoma may be more favourable than that of the central type. Early diagnosis and therapy are thus essential. A clinical survey of six observations is given.

[The radiological findings in adamantinoma of the long tubular bones]. / Radiologische Befunde beim Adamantinom der langen Röhrenknochen.

The radiological findings of adamantinomas of long bones are described in 22 patients. The diagnosis was confirmed by a team of experts (pathologist, radiologist, orthopaedic surgeon) of the "Bone tumour study group" at the German Cancer Research Center. There were 12 male and 10 female patients aged 5 to 67 years (most commonly in the second and third decade). In 21 patients the tibia was involved and in one patient the fibula. The tumour was nearly always in the diaphysis (20 cases). The most striking radiological feature was a diaphyseal lesion confined to the bone showing multicentric translucencies. The latter showed surrounding or central ring shaped or focal areas of increased density. The lesions tended to be longitudinal, averaging 11 cm (between 3 and 25 cm). All lesions showed a sclerotic margin separating it from normal bone, at least over part of the lesion. Expanding lesions were mostly separated from the soft tissues by a bony rim (18 cases).

Appendicular skeletal tumours coined by odontogenic terms.

Two intriguing tumours in the appendicular skeleton are coined by odontogenic terms: the "adamantinomas" and "cementomas" (or "cementifying fibromas"). Both are extremely rare, mainly the latter. Eight verified observations are presented here: five adamantinomas and three cementomas. Whereas in adamantinomas, the localization and radiographic picture was very typical in all cases, only one cementoma was found in the metaphysis of a long tubular bone in our survey. Diaphyseal tibial localization in one, and metacarpal in the another patient are the first two atypical localizations, described for this tumor in the world's medical literature. Angiography is characteristic for a benign expansive lesion and should be carried out in all cases. An "en bloc" resection is the intervention of choice for both these entities.

Tumours and tumour-like lesions of scapula.

A retrospective study of 68 cases of tumours and tumour-like lesions related to the scapula, included in the registry of the Bone Tumour Reference Centre at the Institute of Pathology/University Clinics, Basle, has been carried out. Each case was evaluated for lesion entity, activity and location, age and sex of the patient, and, in 49 files with available radiographic documentation (mostly plain films), for radiologic appearance, with the aim to predict the histologic diagnosis or at least the correct dignity of the lesion. Statistically most frequent were cartilaginous tumours. More than 1/3 of all cases were osteochondromas, which demonstrated mostly a typical appearance. They were encountered predominantly in the first 3 decades in males and were located most often in the body of the scapula. 1/4 of all cases were chondrosarcomas, which were prevailing in the 4th-7th decades, but were occasionally found at a younger age too. Chondrosarcomas were located mainly at the lateral scapular margin over the inferior angle and in the acromion and coracoid process and their appearance ranged from typical to falsely benign. 1/3 of the cases represented a number of other benign and malignant histological entities.

[Herniation pits]. / Herniation pit.

"Herniation pit" is a benign bone affection described first in 1982 by Michael J. Pitt et al. It is located typically in the proximal anterior and upper quadrant of the neck of the femur and develops as a result of the mechanical action of pressure of the adjacent articular capsule and synovialis. On the X-ray picture it is seen as a lighter spot which is relatively well defined, surrounded by a narrow margin of sclerotic bone; it is either round or oval and usually not more than 1 cm in diameter. In the authors' group of 100 patients selected at random from patients who had an X-ray picture of the hip joint taken during the last three years for different indications a herniation pit was found in six patients--4 women and 2 men. In one patient the finding was bilateral. This result is practically consistent with the 5% in the normal adult population, as reported in the world literature. In clinical practice the herniation pit is in the majority asymptomatic and is only an incidental finding during X-ray examination of patients with unexplained pain in the hip joint. Its importance is thus above all that it may be mistaken for other usually oncological bone affections such as osteoid, osteoma, Brodie's abscess, intraosseous ganglion or skeletal metastases of carcinoma.

[Osteoid osteoma on the floor of the acetabulum: pitfalls of diagnosis and therapy.]. / Osteoidní osteom dna acetabula: úskalí diagnostiky a lécby.

The authors present the case of a rare localization of an osteoid osteoma on the floor of the acetabulum and describe the pitfalls of diagnosis and treatment of this benign tumour. On the case-history of an 11-year-old patient they demonstrate that it is correct to use radical surgery of this tumour in a rare localization. In the world literature so far only eight cases of osteoid osteoma in the area of the acetabulum are described. All authors agree that radical surgery is indicated. Key words: osteoid osteoma.

[Aggressive chondroblastoma]. / Agresívní chondroblastom.

The authors report three observations of rather extensive aggressive chondroblastoma and draw attention to difficulties of histological diagnosis, which result out of a less typical histological picture, in which signs of differentiation into cartilaginous tissue may be missing. Differential diagnosis may be facilitated by proper recognition of the cytologic character of chondroblasts by the positivity of S-100 protein, and by proving characteristic properties of chondroblasts in electronmicroscopic examination. In treating this type of tumors an increased risk of local recurrence (in one of our patients) and aggressive behaviour to surrounding tissues should be considered, exceptionally pulmonary metastases may develop, as was the case in one of our presented patients.

[Osteosarcoma - Clinical, Radiological and Histologic Evaluation of Preoperative Chemotherapy in Correlation with Long-term Survival.]. / Osteosarkom - klinické, radiologické a histologické hodnocení úcinku predoperacní chemoterapie ve vztahu k dlouhodobému prezívání nemocných.

This paper evaluates the clinical, radiological and histomorphologic effect of neoadjuvant chemotherapy in 37 patients with II B osteosarcomas. The results are compared according to the type of surgery, local recurrence and lung metastasis at a minimal follow up of five years in patients who underwent surgery at the orthopedic clinic in Prague Bulovka in 1982 - 1992. All patients continued with adjuvant chemotherapy after surgery. Bad clinical response (increase of circumference, decrease in range of motion and increase of pain) correlated with the bad histologic response evaluated according to the COSS criteria. Accurate evaluation of a complete radiological documentation (tumor calcification on plain radiographs and CT scans, decrease of tumor volume on plain radiographs and CT scans or MRI and the disappearance of pathologic vascularisation) can quite precisely estimate a good response to preoperative chemotherapy and indicate limb sparing surgery. The radiological evaluation, especially of an incomplete record, does not always fully correlate with the histomorphologic response. Good prognosis for long term survival was observed in patients with a more then 80% tumor cell necrosis. CT scans or MRI performed immediately before the beginning and at the end of preoperative chemotherapy are necessary for a reliable evaluation of tumor calcification and intramedullar tumor spread. The persistence or disappearance of pathologic vascularisation seems to be the most significant marker to evaluate residual vital tumor cells. A good radiological response enables a safe indication for a limb sparing procedure as an alternative to amputation. The radiological evaluation must be correlated with different histomorphologic osteosarcoma subtypes as well as with possible changes, especially in vascularisation, due to an incorrect biopsy or pathologic fracture. Key words: osteosarcoma, neoadjuvant chemotherapy, long term survival, indication for limb salvage.

[Primary retrofascial abscess in the iliopsoas muscle caused by salmonella enteritidis.]. / Primární retrofasciální absces iliopsoatického svalu zpusobený Salmonelou enteritidis.

This case report and review of literature demonstrates a rare entity of a primary retrofascial abscess in the iliopsoas muscle caused by Salmonella enteritidis, that progressed into the iliac fossa. It is of importance to the orthopedic surgeon in his differential diagnosis of hip pain and vertebrogenic disorders. It can also resemble other infectious diseases or tumors as it occurs mainly in young or imunosuppressed individuals. The primary and secondary etiology of this disease and it's different names are discussed together with the underlying bacteria. Clinical, laboratory and radiological findings are compared as well as the outcome of different types of treatment. When clinically suspecting this disease it is useful to confirm it with sonography and then perform CT scans for accurate planing of surgery. n the initial phase a CT guided drainage together with antibiotics and exceptionally only conservative treatment can cure the patient. In delayed cases it is necessary to preform an open drainage and cases with fatal outcomes have also been reported mainly in secondary abscesses. If early diagnosed and properly treated, this disease can be easily managed, therefore we have to keep it in mind in our differential diagnosis of indicated cases. Key words: primary pyogenic retrofascial abscess of the iliopsoas muscle, iliac fossa abscess, nontuberculous psoas abscess, psoitis, Salmonella enteritidis, clinical diagnosis, radiological diagnosis, surgical treatment, antibiotic treatment, ethiology.

[Aggressive fibromatosis in the extremities]. / Problematika agresivní fibromatózy lokalizované na koncetinách.

The authors demonstrate in a group of 10 patients treated in the course of 15 years the rare incidence of aggressive fibromatosis of the extremities and the large number of relapses after surgery. They also emphasize the necessity of detailed preoperative examination, priority of a surgical approach, as compared with radiotherapeutic procedures, and the possibility of skeletal and vascular reconstruction after radical surgery.