The cases of twenty-five patients with Stage-I parosteal osteosarcoma were analyzed to ascertain the incidence of recurrence after forty-two various surgical procedures that produced an intracapsular, marginal, wide, or radical excisional margin. Ten intracapsular resections were followed by local recurrence in each patient. This procedure usually was done to shell-out a presumably benign lesion. Marginal excision was successful in nine of seventeen patients. When a marginal excision was knowingly done to preserve a major neurovascular bundle, the risk of recurrence was less (three of eleven) than when it was done to shell-out a presumptively benign lesion (five of six). The fourteen procedures that achieved wide margins obtained local control--that is, there was no recurrence--in each patient. There was one radical procedure without recurrence.
We reviewed 14 patients with primary bone tumors of the proximal tibia whose plain radiographs suggested possible posterior soft tissue extension. Four tumors extended posteriorly and displaced the major vessels on angiography. However, high resolution computed tomography (CT) showed the normal popliteus muscle lying between the tibia and the major vessels in three instances. When CT was equivocal, angiography in the lateral projection with the knee flexed was helpful for further evaluation. Index Terms: Bone, neoplasms—Muscle—Computed tomography.
Chordoma is the second most common primary malignant tumor of the spine. These tumors rarely metastasize but are considered malignant and, when present in younger individuals, can be aggressive. In the setting of unresectable primary, recurrent, or metastatic tumors the current armamentarium of adjuvant therapy for this condition is very limited. Recent research, however, has identified potential targets for immunotherapy, including the tumor associate antigens High Molecular Weight Melanoma Associated Antigen (HMW-MAA) and B7H3. The goal of this investigation was to correlate expression of B7H3 and HMW-MAA in chordoma tumors with disease severity and clinical outcome. Tissue MicroArrays (TMA) were constructed using an automated arrayer to include 70 conventional chordoma tumors obtained from archives at our institution. Triplicate cores (0.6 mm in diameter) from each sample were created and two sets of cores were created for each chordoma specimen. One triplicate sample was incubated in a closed humid chamber with a pool of HMW-MAA-specific mAb, while the other was incubated with mAb specific for B7H3. Samples were washed in PBS and incubated with a secondary antibody for one hour. Staining was evaluated independently by two researchers and scored using validated systems. A retrospective chart review was performed for each chordoma specimen to determine demographic data, disease course, disease status at final follow-up and mortality. Clinical outcomes were then correlated to the expression of HMW-MAA and B7H3 within the chordoma lesions. Kaplan-Meier curves and Cox proportional hazard regression analysis were utilized to facilitate comparisons. Chordoma tumors from 70 patients were included in this study. Average age at the time of presentation was 57.4 years (31–88 years). Average follow-up was 5.5 years (3.6 months-21 years). Forty-three patients developed recurrences and 10 had metastatic disease. Twenty-three patients (33%) had died of disease at the time of final follow-up. Ninety-seven percent of chordoma tumors stained positive for B7H3 while 44% stained positive for HMW-MAA. No correlation could be drawn between clinical course, recurrence rate, or mortality and tumor expression of B7H3 and HMW-MAA. Kaplan-Meier analysis did demonstrate a shorter survival time for patients whose tumors stained positive for HMW-MAA compared to those whose tumors were negative for the antigen. The goal of this investigation was to correlate expression of B7H3 and HMW-MAA in chordoma tumorswith disease severity and clinical outcome. Results indicate that expression of HMW-MAA may be predictive of more aggressive disease and shorter survival. HMW-MAA and especially B7H3, in light of its near universal expression in the chordoma tumors studied here, may serve as potential targets for adjuvant immunotherapy.
We reviewed the cases of seventy patients with chondroblastoma who were treated at the Istituto Ortopedico Rizzoli between 1949 and 1983 and found that the proximal end of the humerus was the most common location (eighteen), with the proximal end of the femur (fifteen), distal end of the femur (fifteen), and proximal end of the tibia (twelve) being the other frequently involved sites. Sixty-three of the patients were between eleven and thirty years old. Fifty-eight patients sought medical attention because of an aching pain, usually referred to the adjacent joint. Fifty patients were followed for two years or longer after treatment. Seven patients had a local recurrence: four were successfully treated with a repeat curettage and one, by two subsequent marginal excisions; one was advised to have a repeat curettage; and the seventh was advised to have a resection and arthrodesis of the knee. The final functional results were considered to be excellent in forty-seven of the fifty patients who were followed for two years or more.
