Primary central chondrosarcoma of long bone, limb girdle and trunk: Analysis of 174 cases by numerical scoring on histology.

The aims of this study were: (i) to elucidate clinicopathological characteristics of pcCHS of long bones (L), limb girdles (LG) and trunk (T) in Japan; (ii) to investigate predictive pathological findings for outcome of pcCHS of L, LG and T, objectively; and (iii) to elucidate a discrepancy of grade between biopsy and resected specimens. Clinicopathological profiles of 174 pcCHS (79 male, 95 female), of L, LG, and T were retrieved. For each case, a numerical score was given to 18 pathological findings. The average age was 50.5 years (15-80 years). Frequently involved sites were femur, humerus, pelvis and rib. The 5-year and 10-year disease-specific survival (DSS) rates [follow-up: 1-258 months (average 65.5)] were 87.0% and 80.4%, respectively. By Cox hazards analysis on pathological findings, age, sex and location, histologically higher grade and older age were unfavorable predictors, and calcification was a favorable predictor in DSS. The histological grade of resected specimen was higher than that of biopsy in 37.7% (26/69 cases). In conclusion, higher histological grade and older age were predictors for poor, but calcification was for good prognosis. Because there was a discrepancy in grade between biopsy and resected specimens, comprehensive evaluation is necessary before definitive operation for pcCHS.

Unfiltered xenon light is useful for photodynamic therapy with acridine orange.

We have clarified that photodynamic therapy (PDT) with acridine orange (AO) exerts a rapid and strong cytocidal effect on mouse osteosarcomas, both in vitro and in vivo, and have sought to apply this therapy to patients with musculoskeletal sarcomas, in order to reduce the surgical margin and obtain better limb function after tumor resection in limb salvage surgery. Some clinical studies have reported that the local recurrence rate after limb salvage surgery in patients receiving PDT therapy was less than 10% and that the limb functions recovered to nearly normal in these patients. For these basic and clinical studies, we used a blue light beam filtered from a xenon lamp for the AO excitation, because of its maximal absorption. However, the relationship between the cytocidal effect of PDT and the wavelength or illuminance (lux) of the excitation light in AO-PDT is unknown. Therefore, we investigated the cytocidal effects of AO-PDT on mouse osteosarcoma cells using lights of various illuminances and wavelengths from a xenon lamp. Our results revealed that, while the blue and green filtered lights exerted cytocidal effects depending on their illuminance, orange light exerted no such effect. Blue light showed the strongest cytocidal effect under constant illuminance. However, unfiltered light with 10 times the illuminance of blue light yielded a much stronger cytocidal effect, which was deduced not to be due to DNA injury by ultra-violet light or heat generation by ultra-red light, since a xenon lamp emits little of either light. Based on these results, we conclude that, for effective AO-PDT in clinical practice, strong unfiltered light from a xenon lamp is more effective and feasible than weak filtered blue light.

Malignant solitary fibrous tumor of the thigh accompanied by hypoglycemic coma. A case report.

A case of malignant solitary fibrous tumor of the thigh with liver and lung metastasis, suspicious of non-islet cell tumor-associated hypoglycemia is reported. The patient, a 76-year-old woman, was initially aware of an increasing soft tissue tumor in the left thigh, and episodes of hypoglycemia gradually developed. These frequent episodes ceased after resection of the thigh tumor, which was diagnosed as malignant solitary fibrous tumor. Considering that (i) the primary lesion developed in a rare site, (ii) the tumor was a malignant variant (accompanied by liver and lung metastasis), and (iii) the lesion was accompanied by typical hypoglycemic episodes, this case seemed to be extremely rare.

Migration of the lag screw within the femoral head: a comparison of the intramedullary hip screw and the Gamma Asia-Pacific nail.

OBJECTIVES: To study the functional difference in the performances of sliding femoral head screws by comparing the displacement of the screw in relation to the femoral head in hips treated with the Gamma Asia-Pacific nail (GN) and hips treated with the intramedullary hip screw (IMHS). STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Displacement of the femoral head screw in relation to the femoral head was measured in fifty-six elderly patients with intertrochanteric fractures who were treated with an IMHS or GN. Displacement of the femoral head screw was determined by comparing screw position in the immediate postoperative radiograph with a film taken 3 months after surgery. RESULTS: In the GN group, significant displacement of the screw was observed with 3.8 +/- 3.8 percent translation in the horizontal axis (P < 0.005) and 4.3 +/- 5.1 percent displacement in the vertical axis (P < 0.05) in comparison with the diameter of the femoral head. In comparison, displacement of the femoral head screw was not observed with the IMHS (P = 0.48 for horizontal, P = 0.18 for vertical). Total displacement of the femoral head screw in relation to the femoral head in the GN was twice that observed in the IMHS (P < 0.001). CONCLUSION: These results indicate that the displacement of the femoral head screw of the IMHS was less than the lag screw of the GN. However, it is still unknown whether this smaller displacement of the IMHS is clinically significant for reducing the rate of screw cut-out after surgery.

Combined effects of bisphosphonate and radiation on osteosarcoma cells.

UNLABELLED: Antitumour effects of third-generation bisphosphonates (BPs), such as zoledronic acid (ZOL), and the combined effects of ZOL with other anticancer agents against osteosarcoma cells have been reported previously. The aim of this study was to identify further combined antitumour effects using BPs and radiation in osteosarcoma cell lines. MATERIALS AND METHODS: Cell proliferation, cell cycle analysis, and nuclear morphology were examined in each osteosarcoma cell line divided into three groups (ZOL alone, radiation alone and the ZOL/radiation combination). RESULTS: Combined therapy (low-concentration ZOL and low-dose radiation) had significant growth inhibitory effects compared to the use of ZOL or radiation individually. Flow cytometric analysis revealed an increase in cells in the sub-G(1) phase by combined treatment, and apoptotic cells were also observed. CONCLUSION: These findings suggest that combination therapy using BPs and radiation may be a promising therapy for osteosarcoma, producing fewer side effects and complications in the near future.

Evaluation of clinical outcomes and prognostic factors for synovial sarcoma arising from the extremities.

BACKGROUND: Synovial sarcoma is an uncommon tumor and remains a disease with poor prognosis. Although several prognostic factors have been previously reported, prognostic factors associated with synovial sarcoma are conflicting. This study was undertaken to evaluate our institutional clinical outcomes and to determine prognostic factors for synovial sarcoma. MATERIAL/METHODS: A series of 17 patients with synovial sarcoma arising from the extremities surgically treated between September 1979 and April 2005 was analyzed retrospectively. Data regarding patient age, sex, primary tumor site, primary tumor size, histologic subtype, management of primary tumor (surgery, chemotherapy, radiotherapy), microscopic surgical margins, previous treatment at other hospitals for synovial sarcoma and follow-up information were recorded. Furthermore, statistical analysis of survival rates and prognostic variables were examined. RESULTS: The mean and median follow-up time were 82.4 months and 79.0 months, respectively. Seven of 17 patients (41.2%) initially underwent inappropriate unplanned surgery at other hospitals. The surgical margins of the definitive surgery at our hospital were adequate in all patients. The local recurrence and metastasis rates after definite surgery with adequate surgical margins at our hospital were 5.9% and 35.3%, respectively. The 5-year and 10-year overall survival rates were 88.2% and 79.4%, respectively. A statistically significant adverse prognostic factor was undergoing initial surgical resection at other hospitals (p=0.02). CONCLUSIONS: Initial surgical treatment with adequate surgical margins by experienced surgeons for synovial sarcomas, preferably at specialized hospitals, should be considered to increase local control and improve outcome and survival.

Characteristic appearance of large subcutaneous gouty tophi in magnetic resonance imaging.

The development of multiple large tophi in patients with gout is rare. We report magnetic resonance (MR) and histological features of large subcutaneous tophi in a 32-year-old male patient with no known arthritis. His subcutaneous lesions were confused with a neoplastic process, evaluated by MR imaging, and surgically excised after biopsy. The honeycomb-like appearance on the gadolinium-enhanced images may reflect the characteristic multilobular structure of the tophi composed of avascular urate deposits and surrounding vascularized granulation tissue.

Acridine orange excited by low-dose radiation has a strong cytocidal effect on mouse osteosarcoma.

The study was conducted to clarify the cytocidal effect of combination therapy consisting of administration of acridine orange (AO), which is a photosensitizer, and radiation therapy using in vitro and in vivo mouse osteosarcoma models. The results revealed that AO combined with low-dose X-ray irradiation of about 1-5 Gy had a strong cytocidal effect on the cultured mouse osteosarcoma cells regardless of their chemosensitivity, and that this combination therapy inhibited growth of the in vivo mouse osteosarcoma by induction of tumor necrosis. This effect was inhibited by L-histidine, but not by mannitol. These findings suggested that AO might be excited by X-rays and kill osteosarcoma cells through the release of singlet oxygen, which is toxic to living cells. This mechanism is similar to that of photodynamic therapy with AO.