Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors

<p>Abstract</p> <p>Background</p> <p>In the reconstruction of the affected limb in pediatric malignant bone tumors, since the loss of joint function affects limb-length discrepancy expected in the future, reconstruction methods that not only maximally preserve the joint function but also maintain good limb function are necessary. We analysis limb function of reconstruction methods by tumor location following resection of pediatric malignant bone tumors.</p> <p>Patients and methods</p> <p>We classified the tumors according to their location into 3 types by preoperative MRI, and evaluated reconstruction methods after wide resection, paying attention to whether the joint function could be preserved. The mean age of the patients was 10.6 years, Osteosarcoma was observed in 26 patients, Ewing's sarcoma in 3, and PNET(primitive neuroectodermal tumor) and chondrosarcoma (grade 1) in 1 each.</p> <p>Results</p> <p>Type I were those located in the diaphysis, and reconstruction was performed using a vascularized fibular graft(vascularized fibular graft). Type 2 were those located in contact with the epiphyseal line or within 1 cm from this line, and VFG was performed in 1, and distraction osteogenesis in 1. Type III were those extending from the diaphysis to the epiphysis beyond the epiphyseal line, and a Growing Kotz was mainly used in 10 patients. The mean functional assessment score was the highest for Type I (96%: n = 4) according to the type and for VFG (99%) according to the reconstruction method.</p> <p>Conclusion</p> <p>The final functional results were the most satisfactory for Types I and II according to tumor location. Biological reconstruction such as VFG and distraction osteogenesis without a prosthesis are so high score in the MSTS rating system. Therefore, considering the function of the affected limb, a limb reconstruction method allowing the maximal preservation of joint function should be selected after careful evaluation of the effects of chemotherapy and the location of the tumor.</p

Interleukin-8 Producing Malignant Fibrous Histiocytoma with Prolonged Fever

We present a case of malignant fibrous histiocytoma accompanied by prolonged spiking fevers, which disappeared after tumor resection. Sarcoma with fever as a primary symptom is rare. Furthermore, in this case, fever was closely related to the clinical course of the tumor. In order to detect possible production of febriferous substance(s), we used blood and tumor tissue samples to investigate nine candidate cytokines possibly responsible for the fever. Expression of IL-8 mRNA was detected in preoperative peripheral blood mononuclear cells by RT-PCR. Expressions of IL-6, IL-8, IFN-γ and TNF-α mRNAs were also detected in tumor tissue, while IL-1α, IL-1β, IL-2, IL-4 and COX-2 mRNAs were not. We suspected IL-8 to be a causative factor, and examined its localization by immunohistochemical staining, paraffin sections of tumor tissue stained positive for IL-8. Since infiltrating mononuclear cells were positive for IL-8, this may explain the tumor-associated fever. This case involves intratumoral production of IL-8 as a causative factor, and IL-6, IL-8, IFN-γ and TNF-α cytokine production might have resulted from stimulation with a substance(s) derived from tumor tissue, since the fever disappeared postoperatively. To date the patient is alive and in good health for 7 years and 2 months since the surgery

Giant-cell Tumor of the Patella

We report a 38-year old man with a giant-cell tumor in a rare site, the patella. Primary patellar neoplasms are highly unusual. According to a survey by the Bone and Soft Tissue Tumor Committee of the Japanese Orthopaedic Association, of more than 2,126 giant-cell tumors of bone reported since 1972, only 22 were primary patellar neoplasms. We present a case of this rare entity along with its clinical and radiographic features. The first clinical symptom was anterior knee pain. Though anterior knee pain has numerous and varied causes, it is necessary to consider patellar bone tumors in the differential diagnosis

Experience with extendable prostheses for malignant bone tumors in children

In limb reconstruction following resection of malignant bone tumors in children, extendable prostheses are considered to be useful since future leg length correction can be controlled. We evaluated the usefulness of extendable prostheses in 11 such cases. Methods: The study included 11 children aged 7–16 years (mean 11 years) who underwent limb reconstruction using an extendable prosthesis between 1994 and 2008. The follow-up period varied from 1 to 16 years (mean 6 years and 2 months). Nine patients had osteosarcoma, one had a primitive neuroectodermal tumor (PNET) and one had Ewing’s sarcoma. The tumor was located in the distal femur, (n = 6), proximal femur (n = 1), or proximal tibia (n = 4). Functional scores, X-ray images, the number of lengthening procedures, total length gain, complications, and leg length discrepancy were recorded for each patient. Results: The functional scores range from 52% to 96% (mean 84%). X-Ray evaluation revealed fair and poor bone remodeling in three patients each. The mean number of elongation procedures was 2.8 and the mean total length gain was 49.7 mm. The final leg length discrepancy was 29.2 mm. Conclusion: Extendable bone prostheses are useful for reconstruction. According to our experience, this method is indicated in children of at least 10 years of age for whom a future leg-length discrepancy of up to 4 cm is expected and who have a lesion located in the distal femur where the prosthesis can be adequately covered by soft tissue