scholarly journals Desmoplastic Fibroma: A Case Report with Three Years of Clinical and Radiographic Observation and Review of the Literature

2013 ◽  
Vol 8 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Alexander Nedopil ◽  
Peter Raab ◽  
Maximilian Rudert
Keyword(s):  
Tumor Resection ◽  
Clinical Results ◽  
Ct Scans ◽  
Treatment Modalities ◽  
Desmoplastic Fibroma ◽  
Tumor Extension ◽  
Primary Bone Tumors ◽  
Extra Abdominal Desmoid ◽  
Cortical Involvement

Background: Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue. Case Presentation and Literature Review: A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented. Conclusion: In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.

Diffuse Pigmented Villonodular Synovitis Around the Ankle

2018 ◽  
Vol 108 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Keiichi Muramatsu ◽  
Ryuta Iwanaga ◽  
Yasuhiro Tominaga ◽  
Takahiro Hashimoto ◽  
Toshihiko Taguchi
Keyword(s):  
Ankle Joint ◽  
Tumor Resection ◽  
Tumor Location ◽  
Pigmented Villonodular Synovitis ◽  
Growth Patterns ◽  
Treatment Modalities ◽  
Villonodular Synovitis ◽  
Lateral Incision ◽  
Pigmented Villonodular

Background: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. Methods: Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2–4.6 years). Results: The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4–10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. Conclusions: Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity.

scholarly journals Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Klein ◽  
Yasmin Bakhshai ◽  
Falk Roeder ◽  
Christof Birkenmaier ◽  
Andrea Baur-Melnyk ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Tumor Resection ◽  
Clinical Results ◽  
Fibular Graft ◽  
Microvascular Anastomosis ◽  
First Case ◽  
Common Location ◽  
Skeletal Defects ◽  
Common Diagnosis

Abstract Background Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. Results the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. Conclusions the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

Retrospective analysis of unstaged and staged Gamma Knife surgery with and without preceding embolization for the treatment of arteriovenous malformations

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 57-64 ◽  
Author(s):  
Adam G. Back ◽  
Dennis Vollmer ◽  
Otto Zeck ◽  
Clive Shkedy ◽  
Peter M. Shedden
Keyword(s):  
Retrospective Study ◽  
Retrospective Analysis ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Surgery ◽  
Ct Scans ◽  
Treatment Modalities ◽  
Mr Images ◽  
Obliteration Rate

Object The authors conducted a retrospective study to examine data on rates of obliteration of arteriovenous malformations (AVMs) with use of various combinations of treatment modalities based on Gamma Knife surgery (GKS). The authors believe that this study is the first to report on patients treated with embolization followed by staged GKS. Methods The authors identified 150 patients who underwent GKS for treatment of AVMs between 1994 and 2004. In a retrospective study, 4 independent groups emerged based on the various combinations of treatment: 92 patients who underwent unstaged GKS, 28 patients who underwent embolization followed by unstaged GKS, 23 patients who underwent staged GKS, and 7 patients who underwent embolization followed by staged GKS. A minimum of 3 years of follow-up after the last GKS treatment was required for inclusion in the retrospective analysis. Angiograms, MR images, or CT scans at follow-up were required for calculating rates of obliteration of AVMs. Results Fifty-seven of 150 patients (38%) supplied angiograms, and overall obliteration was confirmed in 43 of these 57 patients (75.4%). An additional 37 patients had follow-up MR images or CT scans. The overall obliteration rate, including patients with follow-up angiograms and patients with follow-up MR images or CT scans, was 68 of 94 (72.3%). Patients who underwent unstaged GKS had a follow-up rate of 58.7% (54 of 92) and an obliteration rate of 75.9% (41 of 54). Patients who underwent embolization followed by unstaged GKS had a follow-up rate of 53.5% (15 of 28) and an obliteration rate of 60.0% (9 of 15). Patients who underwent staged GKS had a follow-up rate of 82.6% (19 of 23) and an obliteration rate of 73.7% (14 of 19). Patients who underwent embolization followed by staged GKS had a follow-up rate of 85.7% (6 of 7) and an obliteration rate of 66.7% (4 of 6). Conclusions Gamma Knife surgery is an effective means of treating AVMs. Embolization prior to GKS may reduce AVM obliteration rates. Staged GKS is a promising method for obtaining high obliteration rates when treating larger AVMs in eloquent locations.

Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis: 30 Patients at a Minimum Follow-Up of 10 Years

2016 ◽  
Vol 30 (06) ◽  
pp. 501-508 ◽  
Author(s):  
Juan Ayala-Mejias ◽  
Benjamin Garcia-Gonzalez ◽  
Luis Alcocer-Perez-España ◽  
Pedro Berjano ◽  
Jorge Villafañe
Keyword(s):  
Test Scores ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Clinical Results ◽  
Ct Scans ◽  
Lachman Test ◽  
Kt 1000 ◽  
Anterior Cruciate

AbstractTo evaluate the relationship between tunnel position and widening and long-term clinical results in anterior cruciate ligament (ACL) reconstruction, a retrospective cohort of 30 patients undergoing ACL reconstruction with double semitendinous plus double gracilis (SAC technique) with longer than 10-year follow-up was selected. CT scans in the first 3 months and at final follow-up was evaluated. Position, angle, and widening of tunnels including Nebelung criteria were recorded in all CT scans. Physical, KT-1000, and clinical evaluation were performed at final follow-up. Outcomes and knee arthritis severity were evaluated at final follow-up. Mean follow-up was 11.2 ± 1.2. At final follow-up, 85 and 57% of tibial and femoral tunnels, respectively, developed some degree of enlargement. Frontal tibial angle (mean) was 72°, sagittal tibial angle 63°, frontal femoral angle 47°, sagittal femoral angle 20°, and tunnels divergence angle 36°. Preoperatively, KT-1000 30L and Lachman test scores were 5.52 and 5.79 respectively. In the last follow-up, 30L and manual Lachman test scores were 0.97 and 1.13, respectively (p < 0.001). In IKDC scale, pivot shift and Jerk tests showed 83 and 84% grade A results, respectively (p < 0.0001). In Fairbank scale, 23% worsened one grade and 27% worsened more than one grade (p < 0.005). Tibial tunnels widened more than femoral tunnels and further dilatation was found between intermediate and final follow-up. Higher incidence of tibial tunnel widening was observed in patients with tunnel verticalization. Tibial tunnel dilation was associated with long-term degenerative changes but not with final knee instability.

scholarly journals Technique and Results after Immediate Orthotopic Replantation of Extracorporeally Irradiated Tumor Bone Autografts with and without Fibular Augmentation in Extremity Tumors

2021 ◽  
Author(s):  
Alexander Klein ◽  
Yasmin Bakhshai ◽  
Falk Roeder ◽  
Christof Birkenmaier ◽  
Andrea Baur-Melnyk ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Tumor Resection ◽  
Clinical Results ◽  
Bone Defects ◽  
Fibular Graft ◽  
Microvascular Anastomosis ◽  
Common Location ◽  
Common Diagnosis ◽  
Bone Autograft

Abstract Background: the reconstruction of the bone defects after the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of an autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods and patients: we were able to include 21 patients with 22 reconstructions. In all cases, the bone tumor was resected with wide margins and irradiated with 300 Gy. The autograft was orthotopically replanted and stabilized by means of osteosynthesis implants. 15 patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a local pedicled fibular interposition. Results: the most common diagnosis was a Ewing-sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months. During follow-up, 59% of patients underwent an average of 2.54 revision surgeries, with the most common reason being pseudarthrosis (6 cases). Complete bony integration of the irradiated autografts was achieved in 81.8% of cases after 13.6 months on average. In case of successful reintegration the autograft was shorter (n.s.). Fibular augmentation with or without microvascular anastomosis/pedicled blood supply did not correlate with the pseudarthrosis rate.Conclusions: the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors maintainable joints. However, these patients should be ready to accept longer treatment periods.

scholarly journals Intracranial solitary fibrous tumor/hemangiopericytoma – A case series

2020 ◽  
Vol 11 ◽  
pp. 414
Author(s):  
Chi-Man Yip ◽  
Shu-Shong Hsu ◽  
Wei-Chuan Liao ◽  
Szu-Hao Liu ◽  
Yung-Shang Lin ◽  
...  
Keyword(s):  
Solitary Fibrous Tumor ◽  
Adjuvant Radiotherapy ◽  
Tumor Resection ◽  
Case Series ◽  
Extent Of Resection ◽  
Treatment Modalities ◽  
Total Resection ◽  
Initial Surgery ◽  
Fibrous Tumor

Background: Intracranial solitary fibrous tumor/hemangiopericytoma (HPC) is a rare and aggressive tumor. We conducted this retrospective study to investigate the outcome of patients after treatment, the efficacy of postoperative adjuvant radiotherapy, and the factors not conducive to total resection. Methods: We conducted a retrospective review of the medical records of patients harboring fresh intracranial solitary fibrous tumor/HPC treated from January 2009 to December 2019 in our hospital. We reviewed their clinical presentations, radiologic appearances, tumor size and location, extent of resection, estimate intraoperative blood loss, treatment modalities and results, and duration of follow-up. Results: There were seven consecutive patients (three males and four females). The ages of the patients at the time of diagnosis ranged from 35 to 77 years (mean: 52.86 years). Five patients (71.43%) got tumor bigger than 5 cm in dimension and only 1 patient (14.29%) underwent gross total tumor resection in the first operation without complication. Five patients (71.43%) underwent postoperative adjuvant radiotherapy. Follow-up period ranged from 4.24 to 123.55 months and the median follow-up period was 91.36 months. Three patients had favorable outcome with Glasgow Outcome Scale (GOS) equal to 4; four patients had unfavorable outcome with GOS equal to 2 or 3. No mortality was happened. Conclusion: Gross total tumor resection in the initial surgery is very important to achieve a better outcome. Massive intraoperative bleeding and venous sinus or major vessels adjoining are factors not conducive to total resection. Radiotherapy can be administered as adjuvant therapy for cases showing an aggressive phenotype or not treated with gross total resection.

scholarly journals Radiotherapy for Desmoplastic Fibroma of Bone: A Case Report

2003 ◽  
Vol 11 (1) ◽  
pp. 90-93 ◽  
Author(s):  
HL Nag ◽  
R Kumar ◽  
S Bhan ◽  
BS Awasthy ◽  
PK Julka ◽  
...  
Keyword(s):  
Case Report ◽  
Relevant Literature ◽  
Benign Tumour ◽  
Treatment Modalities ◽  
Histopathological Diagnosis ◽  
Desmoplastic Fibroma ◽  
Surgical Options ◽  
Rare Benign Tumour

Desmoplastic fibroma is a rare benign tumour of bone. Diagnosis is not easy and is often made by excluding other tumours. Histopathological diagnosis of this tumour is also sometimes not easy. The treatment modalities for this tumour are non-uniform and often controversial. In the present case surgical options were left aside because the patient did not consent to surgery, so radiotherapy was used, with success at 3-year follow-up. This case is presented here along with a review of relevant literature.

scholarly journals Elastofibroma: clinical results after resection of a rare tumor entity

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
Hakan Pilge ◽  
Tobias Hesper ◽  
Boris Michael Holzapfel ◽  
Peter Michael Prodinger ◽  
Melanie Straub ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Tumor Resection ◽  
Shoulder Girdle ◽  
Clinical Results ◽  
Clinical Findings ◽  
Thoracic Wall ◽  
Significant Difference ◽  
Reduction Of Pain ◽  
Tumor Entity

Elastofibroma (EF) is a benign proliferation of connective tissue and is typically located at the dorsal thoracic wall. Most patients complain about pain during motion in the shoulder girdle. The aim of our study was to evaluate the outcome after surgical treatment of EF. This study provides an overview of typical clinical findings, diagnostics and pathogenesis of this rare entity. In this retrospective study we analyzed data of 12 patients (6 male, 6 female) with EF treated in our institution between 2004 and 2012. The mean follow-up was 4.7 years (range: 5 months to 7.5 years). All tumors were found to be unilateral and all patients had a negative medical history for EF. Visual analogue scale and range of motion (ROM) was documented pre- and postoperatively. In all patients indication for surgical resection was pain or uneasiness during movement. There was no statistically significant difference in ROM of the shoulder between pre- and postoperatively but all patients reported significantly less pain after surgical resection. Patients benefited from tumor resection by a significant reduction of pain levels and improvement of the motion-dependent discomfort.

scholarly journals Idiopathic and radiation-induced myxofibrosarcoma in the head and neck—case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Bin Zhang ◽  
Miao Bai ◽  
Runfa Tian ◽  
Shuyu Hao
Keyword(s):  
Head And Neck ◽  
Tumor Resection ◽  
Diagnosis And Treatment ◽  
Treatment Modalities ◽  
Total Resection ◽  
Extensive Resection ◽  
History Of ◽  
Radiation Induced ◽  
Reasonable Choice

Abstract Background Myxofibrosarcoma (MFS), especially radiation-Induced MFS (RIMFS) in the head and neck, is an extremely rare malignant fibroblastic tumor. The diagnosis and treatment of MFS remain great challenges. In the present study, we presented one case of RIMFS. Combined with previous literature, the clinical features, essentials of diagnosis, and treatment modalities of MFS in the head and neck were reviewed to better understand this rare entity. Case presentation We reported a case of RIMFS under the left occipital scalp in a 20-year-old girl with a history of medulloblastoma surgery and radiotherapy in 2006. A total tumor resection was performed with preservation of the overlying scalp the underlying bone, and no adjuvant therapy was administered after the first operation. The postoperative pathological diagnosis was high-grade MFS. The tumor relapsed 6 months later, and then, a planned extensive resection with negative surgical margins was carried out, followed by radiotherapy. No relapse occurred in a 12-month postoperative follow-up. Conclusions Planned gross total resection (GTR) with negative margins is the reasonable choice and footstone of other treatments for MFS. Ill-defined infiltrated borders and the complicated structures make it a great trouble to achieve total resection of MFS in the head and neck, so adjuvant radiotherapy and chemotherapy seem more necessary for these lesions.

Tentorial Meningiomas: Clinical Results in 81 Patients Treated Microsurgically

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 108-118 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Dietmar Stolke
Keyword(s):  
Tumor Resection ◽  
Clinical Results ◽  
Tumor Location ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Presenting Symptoms ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Neuroimaging Data

Abstract OBJECTIVE: Even during the microsurgical era, tentorial meningiomas present a formidable surgical challenge when tumor involves critical neurovascular structures. We report our experience with tentorial meningioma with regard to clinical presentation, diagnostic workup, microsurgical technique, complications, and follow-up results. METHODS: In a retrospective study, we reviewed the medical charts, neuroimaging data, and follow-up data of patients treated microsurgically for tentorial meningioma in our department between January 1989 and June 2002. Patients were routinely scheduled for clinical and radiological follow-up 6 months and 1 year after surgery. Thereafter, follow-up was performed every 1 or 2 years on the basis of the results of each follow-up examination. RESULTS: The main presenting symptoms of the patients (69 women and 12 men) were headache (75%), dizziness (49%), and gait disturbance (46%). The leading neurological signs were gait ataxia (52%) and cranial nerve deficits (28%). Extent of tumor resection was Simpson Grade I in 29 patients, Grade II in 45 patients, Grade III in 1 patient, Grade IV in 4 patients, and unknown in 2 patients. Permanent surgical morbidity and mortality were 19.8 and 2.5%, respectively. Clinical and magnetic resonance imaging follow-up was available in 74 patients for a period ranging from 1 to 13 years (mean, 5.9 yr). Of these, 64 patients (86%) have resumed normal life activity. Seven patients had tumor recurrence and four underwent reoperation. CONCLUSION: Careful preoperative planning of the surgical approach tailored to tumor location and extent is a prerequisite to achieve radical microsurgical tumor resection with minimal morbidity and mortality. Resection of an infiltrated but patent venous sinus is not recommended.

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