Leiomyosarcomas of Vascular Origin in the Extremity

Between 1996 and 2006 a total of 278 patients with soft tissue Leiomyosarcoma were treated at our centre. We identified 16 patients (5.8%) where the tumour directly arose from the blood vessels. These tumours were studied to determine their prognosis and behaviour. All tumors were in the lower limbs: 11 from the femoral vein, 3 popliteal vein, and 2 from the posterior tibial vein. Mean tumour size was 10.4 cm (3 to 33). Histological grade was high in all patients. Surgical treatment was amputation in one, excision with or without vascular reconstruction in 12 followed by radiotherapy, and 3 patients had no surgery because of advanced disease at diagnosis. Seven out of the 16 patients (44%) had metastasis at diagnosis, and five patients without metastasis at diagnosis rapidly developed metastases at a median time of 5 months from diagnosis (2–30 months). The overall survival of the patients at 5 years was 25% which was considerably worse than those with nonvascular leiomyosarcoma. We conclude that patients with leiomyosarcoma of vascular origin have a very high risk of metastases and poor prognosis when treated in the conventional way

Wound Complications Following Resection of Adductor Compartment Tumours

Purpose Limb salvage surgery of soft tissue sarcomas is associated with both a risk of local recurrence and wound complications. Although the lower limb appears to be at greater risk of wound-related morbidity, few studies separate anatomical compartments. We believe that the adductor compartment of the thigh has a particularly high rate of complications and so performed a retrospective analysis of all soft tissue sarcomas arising in this region undergoing limb salvage

Elastofibroma Dorsi: An Uncommon Benign Pseudotumour

Elastofibroma dorsi is an uncommon benign soft tissue pseudotumour usually located at the lower pole of the scapula, deep to serratus anterior, and often attached to the periosteum of the ribs, presenting with long history of swelling and occasionally pain and discomfort. This lesion is usually seen in patients over the age of 50 years and is not uncommonly mistaken as a malignant tumour because of its size and location deep to the periscapular muscles. Review of the orthopaedic oncology database of 17 500 patients revealed that there were 15 patients with elastofibroma dorsi. There were 12 males and 3 females, mean age at diagnosis of 68.4 years range 51–79 years. The diagnosis was confirmed by MRI in 3 patients, excision biopsy in 3 patients, trucut biopsy in 8 patients and open biopsy in 1 patient. Eight patients had excision of the lesion which was symptomatic. There have been no recurrences. We highlight the clinical and radiological presentation of elastofibroma dorsi to increase awareness of its existence and management

Growth in the Lower Limb Following Chemotherapy for a Malignant Primary Bone Tumour: A Straight-Line Graph

Purpose. The aim of this paper was to assess the growth in the unaffected lower limb of children who had received chemotherapy for a malignant primary bone tumour around the knee

A Comprehensive Audit of Professional Development for K-12 School Leaders in the Commonwealth of Virginia

The intent of this paper is to provide a mixed-methods audit of professional development provided to K-12 school leadership in Virginia\u27s diverse landscape to include identification of providers, funding, effectiveness, and expectations. In the Commonwealth of Virginia, geographical, political, and socio-economical differences across 132 school divisions cause variability in leaders\u27 experiences with professional development. A mixed-methods approach was used, including a review of current literature, an online survey, virtual interviews, and virtual focus group discussions. This data collection results in a comprehensive audit of professional development provided to school leaders in Virginia\u27s diverse landscape. The study defines effective professional development for school leaders and considers commonalities and disparities of school leaders\u27 experience with professional development, including divisions\u27 commitment to funding, leaders’ access to providers, and leaders’ exposure to traditional and emerging content topics in order to provide recommendations to Virginia Commonwealth University\u27s School of Education as an external provider of professional development for school leaders

‘‘Two-Week Waits”—Are They Leading to Earlier Diagnosis of Soft-Tissue Sarcomas?

Introduction. The ‘‘two-week wait” was established as a potential means of diagnosing malignant tumours earlier. This paper investigated whether these clinics are leading to earlier diagnosis of malignant soft-tissue lumps. Method. We identified all referrals to our centre from a database over a 4-year period. Results. 2225 patients were referred to our unit for investigation of a soft-tissue mass. 576 (26%) were referred under the ‘‘two-week wait” criteria. 153 (27%) of which were found to have a malignant or borderline malignant diagnosis. 1649 patients were referred nonurgently. 855 (52%) of which were diagnosed with a malignant or borderline lesion. The average size at diagnosis was 9.4 cm with no difference in size between the different referral routes. Conclusion. There is little evidence that the two-week wait clinic is leading to earlier diagnosis of soft-tissue sarcomas with the majority still being referred nonurgently