scholarly journals A Rare Case of Ewing’s-like Adamantinoma of Tibia Managed by Limb Salvage Surgery Using Long Segment Ilizarov Bone Transport: A Case Report and Review of Literature

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
T K Jeejesh Kumar ◽  
Puneeth K Pai ◽  
Priyavrata Rajasubramanya
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Rare Case ◽  
Salvage Surgery ◽  
Treatment Protocol ◽  
Bone Transport ◽  
Molecular Techniques ◽  
Limb Salvage Surgery ◽  
Appropriate Treatment ◽  
Ilizarov Bone Transport

Introduction: Adamantinoma is a rare low-grade malignant tumor in young adults. Recent advances in molecular techniques have shown different variants with discordance between genotype and phenotype. This poses a challenge in diagnosis and management. Ewing’s-like adamantinoma is one such variant. The appropriate treatment protocol for this dedifferentiated tumor remains to be established. Here, we present a rare case of Ewing’s-like Adamantinoma treated with limb salvage surgery using three step Ilizarov technique with good results. Case Report: A 38-year-old lady presented at our OPD complaining of recent onset pain and gradual increase in size over a long standing swelling in the right lower tibia. Radiologically was diagnosed as Ewing’s but was not responsive to chemotherapy. A Tru-Cut biopsy showed histological picture of dedifferentiated adamantinoma. Immunohistochemistry showed CD99 positivity. FISH revealed (11;22) translocation confirming Ewing’s-like adamantinoma. She was managed with wide excision followed by staged Ilizarov distraction-osteogenesis and bone transport to correct the 13 cm discrepancy in bone length. There have been no signs of recurrence on post-resection follow-up of 2 years. Patient attained full range of knee and ankle movements. Conclusion: The controversy as to what constitutes the difference between adamantinoma-like Ewing’s and Ewing’s-like adamantinoma persists despite technological advances. The appropriate treatment protocol remains to be established. Ilizarov three step techniques provide a feasible alternative to amputation while circumventing the difficulties of large bone reconstruction in the distal tibia. Keywords: Adamantinoma, Ewing’s-like, Ilizarov, bone transport, dedifferentiated, malignant bone tumor.

scholarly journals Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Jungo Imanishi ◽  
Masayuki Tanabe ◽  
Taisei Kurihara ◽  
Tomoaki Torigoe ◽  
Jun Kikkawa ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Induced Membrane ◽  
Prosthetic Reconstruction ◽  
Custom Made ◽  
Distal Femoral Resection ◽  
Femoral Resection

Abstract Background Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. Case presentation A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned. Conclusions This case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

scholarly journals Temporal Hemiarthroplasty for Distal Femoral Osteosarcoma in Early Childhood: A Case Report

2020 ◽  
Author(s):  
Jungo Imanishi ◽  
Masayuki Tanabe ◽  
Taisei Kurihara ◽  
Tomoaki Torigoe ◽  
Jun Kikkawa ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Induced Membrane ◽  
Prosthetic Reconstruction ◽  
Custom Made ◽  
Distal Femoral Resection ◽  
Femoral Resection

Abstract Background: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection. Case Presentation: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femurunderwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate, and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.Conclusions: This case report provides an example of limb salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

scholarly journals Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: A case report

2020 ◽  
Author(s):  
Jungo Imanishi ◽  
Masayuki Tanabe ◽  
Taisei Kurihara ◽  
Tomoaki Torigoe ◽  
Jun Kikkawa ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Length ◽  
Limb Salvage Surgery ◽  
Induced Membrane ◽  
Prosthetic Reconstruction ◽  
Custom Made ◽  
Distal Femoral Resection ◽  
Femoral Resection

Abstract Background: Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection.Case Presentation: A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate, and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.Conclusions: This case report provides an example of limb salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.

Malawer limb salvage surgery for large chondrosarcoma of scapula with functional outcome – A case report

2020 ◽  
Vol 4 (2) ◽  
pp. 76
Author(s):  
Supratim Bhattacharyya ◽  
KP Kunhi Mohammed ◽  
PrafullaKumar Das ◽  
BharatBhusan Satpathy
Keyword(s):  
Case Report ◽  
Functional Outcome ◽  
Limb Salvage ◽  
Salvage Surgery ◽  
Limb Salvage Surgery

scholarly journals Radical change in osteosarcoma surgical plan due to COVID-19 pandemic

2020 ◽  
Vol 13 (7) ◽  
pp. e237197
Author(s):  
Czar Louie Lopez Gaston ◽  
Johann Proceso Pag-ong ◽  
Emilleo Dacanay ◽  
Albert Jerome Quintos
Keyword(s):  
Limb Salvage ◽  
Proximal Humerus ◽  
Salvage Surgery ◽  
Hospital Setting ◽  
Patient Discharge ◽  
Radical Change ◽  
Limb Salvage Surgery ◽  
Short Hospital Stay ◽  
Team Meetings ◽  
Appropriate Treatment

A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.

scholarly journals A Case Report of Limb Salvage Surgery with Scapular Flap for Osteosarcoma of Proximal Humerus.

2003 ◽  
Vol 52 (4) ◽  
pp. 738-741
Author(s):  
Masakazu Murata ◽  
Kenji Kumagai ◽  
Masahiko Suzuki ◽  
Sou Morooka ◽  
Hiroyuki Shindo ◽  
...  
Keyword(s):  
Case Report ◽  
Limb Salvage ◽  
Proximal Humerus ◽  
Salvage Surgery ◽  
Limb Salvage Surgery ◽  
Scapular Flap
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