Immunohistochemical study of a case of malignant müllerian mixed tumor in comparison with the activity of normal uterine tissue

A case of malignant Müllerian mixed tumor of the uterus, exhibiting a histology of heterologous osteosarcomatous differentiation, is presented. Special emphasis is placed on the characteristic immunohistochemical reactivity of the tumor tissue in comparison with that of normal uterine tissue in the proliferative phase. Keratin, cytokeratin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and human chorionic gonadotropin (HCG) were found only in the carcinomatous element. However, neuron specific enolase (NSE), S-100 protein (S 100) and vimentin were identified in almost all tumor tissue elements. Desmin and actin were not stained in any elements. Myoglobin was only detected weakly in the squamous carcinomatous element. Undifferentiated cell element, composed of small, round, spindle, or polygonal cells showed positive reactions to NSE and S 100, but not to any other antibodies. As compared to the reactivities of the normal proliferative endometrium, the glandular epithelial cells were positive with NSE, S 100, vimentin and CEA, but the stromal cells were only positive with vimentin. Such a multitudinous and concomitant expression of antigenicity to the different tumor elements indicates a close relationship to its mesodermal Müllerian origin, and NSE, S 100 and vimentin might be most adequate indicators of these types of tumors.

Benign osteoblastoma

A case of benign osteoblastoma is presented with a description of the typical clinical, radiographic, and pathologic features associated with osteoblastoma. The recommended treatment is tumor excision with avoidance of radiation therapy.

Benign osteoblastoma of the maxilla

A new case of benign osteoblastoma of the maxilla has been presented and the clinical, radiographic and histologic features of the lesions previously reported in the literature have been discussed.

Evaluation of benign acetabular lesions with excision through the Ludloff approach

Six patients with poorly defined chronic hip symptoms (length of time from initial symptoms to definitive diagnoses ranged from four months to three years) were eventually found to have benign lesions in the region of the acetabular fovea. All of these patients had seen multiple physicians including orthopedic surgeons before the definitive diagnosis was made. Four lesions were not visualized on routine roentgenographs. Various imaging modalities were necessary to demonstrate and localize these lesions. Excision through an anteromedial approach (Ludloff) in five cases required minimal dissection, operative time, and blood loss. The approach does not compromise definitive surgery (external or internal hemipelvectomy) in the unlikelihood that the lesion is found to be malignant.

[Osteoid osteoma in childhood: apropos of 6 cases]

Six cases of children diagnosed as having osteoid osteoma with different localization are reviewed. They constitute 0.04% of all those admitted to the paediatrics department. The average age is 8 1/12 years and three exists a male predominance over the female in the proportion of 2/1. The clinic has shown it self through characteristic pain, with nocturnal paroxysms, which disappears with aspirin, in addition to functional impotence and muscular atrophy. In the case of vertebral localization, scoliosis was detected. Both, the radiography and the computerized axial tomography showed to be efficient for the diagnosis, which was confirmed anatomo-pathologically in the case operated on. The evolution was satisfactory in all of them.

Subperiosteal osteoid osteoma of the distal phalanx of the thumb

Osteoid osteomas have been subgrouped into subperiosteal, cancellous, and cortical. The occurrence of subperiosteal osteoid osteoma of the hand is rare. The location in the distal phalanx of the thumb has not been described. The case reported illustrates the unusual presentation and radiographic features of subperiosteal osteoid osteoma.

Benign osteoblastoma of the orbit

Benign osteoblastoma is a rare lesion of the orbit--only five cases have been described previously. The usual location is in the vertebral column and to a lesser extent in the skull. Although it is an invasive lesion, recurrences have not been reported after en bloc excision. The authors report a 10-year-old boy who presented with upper lid swelling, proptosis, and hypophthalmia. A computed tomography (CT) scan showed a calcified mass in the superior orbit which had eroded through the roof, and magnetic resonance imaging (MRI) showed a well-circumscribed mass between the periorbita and dura. A transcranial approach was used to remove the tumor, and the roof reformed with polypropolene. He has been followed for 18 months without recurrence.

Spinal osteoblastoma in an 11-year-old boy

An 11-year-old boy with pain in the right sacroiliac region was treated conservatively for six months. During this time, decreased pinprick sensation in the right thigh, shortening of the right leg, and scoliosis developed. Multiple plain films of the spine had shown no abnormality. A bone scan revealed an abnormality in the lumbar spine, and CT showed a destructive lesion. An osteoblastoma was completely resected and the child has remained well for four years.

Rapidly developing scoliosis in an adolescent due to spinal osteoblastoma. A case report

A benign osteoblastoma of the spine should be considered a possible cause of painful scoliosis, especially in young adults. This report concerns a 17 year old patient with a lesion of the second lumbar vertebra where her painful progressive scoliosis was mistaken as idiopathic. Considering pain as a common presentation for the osteoblastoma, the diagnosis can be made early through X-rays, bone scan and computed tomography. The only adequate therapy is total removal of the tumor and the surgeon should make every effort to resect this lesion in sano to achieve permanent relief of pain and full alignment of the spine.

Aneurysmal bone cyst. A review of 123 cases including primary lesions and those secondary to other bone pathology

A group of 639 bone lesions was reviewed in order to study the features of the aneurysmal bone cyst and its association with other conditions. A diagnosis of primary aneurysmal bone cyst not associated with any other bone lesion was made in 87 patients. In 36 additional patients the gross and microscopic changes of aneurysmal bone cyst were identified as part of some other solid bone lesion. Fourteen of these additional cases were associated with giant cell tumor (96 cases studied), six with chondroblastoma (41 cases studied), three with chondromyxoid fibroma (45 cases studied), two with nonossifying fibroma (68 cases studied), four with osteoblastoma (61 cases studied), one with fibrosarcoma (50 cases studied), three with fibrous histiocytoma (45 cases studied), two with osteosarcoma (100 cases studied), and one with fibrous dysplasia (42 cases studied). The age, site, and sex distribution of the cases associated with another lesion compares closely with that of the solid lesion concerned, supporting the concept that the aneurysmal bone cyst component is secondary.

Benign osteoblastoma of the spine in childhood

Osteoblastoma of the spine is a rare but important cause of back pain in children. Ten children with this tumor were treated at the Alberta Children's or Foothills Hospital in Calgary, Alberta, between 1974 and 1986. There were seven boys and three girls; the age at diagnosis ranged from 2 to 16 years (average 11 years). In nine patients the tumor involved the posterior vertebral elements. One of the cervical lesions was in the vertebral body. Three patients had tumor in the extradural space. The commonest symptom was pain in the back and neck. Bone scans were positive in all patients, and computerized tomography scans were abnormal in the eight patients who had this imaging performed. Nine children were treated with laminectomy and removal of the abnormal pedicle and facet. Two patients required two operations each because of incomplete tumor excision at the first operation; in these, subsequent surgery gave complete relief of symptoms and radiographic studies showed no further tumor. In three other patients, tumor removal was incomplete, and one patient received postoperative radiation therapy. Bone grafts were placed in four patients. The diagnosis of benign osteoblastoma was confirmed histologically in nine patients. The outcome was good in all cases, with excellent pain relief. The follow-up period has varied from 8 to 153 months (average 66 months) and there have been no recurrences. Based on this experience, complete excision of spinal osteoblastomas is recommended whenever possible. However, a satisfactory outcome may be achieved following incomplete excision and bone grafting.

Osteoblastoma in the very young: report of two cases

Two cases of tumors caused by osteoblastoma in children less than 3 years old are presented. This report points out that although most osteoblastomas appear in patients less than 30 years old, it is uncommon for the lesion to present in the very young. The authors note that osteoblastoma should be considered in the differential diagnosis of a lytic lesion because patients may be too young to communicate their complaints.

Primary osteosarcoma of toe phalanx: first documented case. Review of osteosarcoma of short tubular bones

A case of a sclerosing variant of osteosarcoma of a toe phalanx is reported in a 28-year-old man. This represents the first reported case of osteosarcoma of any kind at this site. This is based on a review of 4,214 cases of conventional osteosarcoma. The reason for the extraordinary rarity in toe or hand phalanges is unknown although osteosarcoma is the second most common primary tumor of bone. Since the neoplasm had minimal signs of cytologic anaplasia, it was originally mistaken for and treated as an osteoid osteoma. The lesion recurred and extended into soft tissues. Reevaluation revealed the tumor to be an osteosarcoma, sclerosing variant with "normalization" of nuclei. The lesions that this tumor should be distinguished from are osteoid osteoma and osteoblastoma.

Recurrent osteoblastoma of the carpal hamate

A case of recurrent osteoblastoma of the hamate is reported. Curettage and bone grafting is usually followed by recurrence. Wide excision of the tumor is the treatment of choice if anatomically feasible.

Immunocytochemical analysis of the human osteoclast: phenotypic relationship to other marrow-derived cells

The immunocytochemistry of the osteoclast, which is known to be derived from a circulating mononuclear precursor cell of bone marrow origin, is controversial. In this study, we have determined the antigenic phenotype of human osteoclasts in fetal and adult (Paget's disease, giant cell tumour of bone) specimens using a large number of monoclonal antibodies which react with granulocytes and mononuclear phagocytes. We have identified antibodies which reacted with human osteoclasts including CD13, CD15 and several groups of anti-macrophage antibodies. All the antibodies which reacted with osteoclasts are also known to react with monocytes or macrophages. Other marrow elements such as granulocytes, megakaryocytes and platelets were also commonly stained. Expression of myeloid and platelet antigens on osteoclasts shows that they are phenotypically related to these cells and is in keeping with the origin of osteoclast precursors from the pluripotential haemopoietic stem cell. Only a proportion of osteoclasts in fetal bone preparations were stained by CD15 antibodies, suggesting that subsets or different populations of osteoclasts, which can be identified by monoclonal antibodies, may be present in bone.

Nerve fibres in osteoid osteoma

Many authors have attempted to explain the mechanism of pain in osteoid osteoma and, in the past, several histological studies have been carried out with the specific aim of verifying the existence of nerve fibres within the tumour. The histochemical procedures based on the affinity of nerves for silver stains have made it possible to demonstrate the presence of fine nerve fibres disposed alongside and around the vessels. An analogous study was conducted to confirm this and to supply further morphological and functional information useful for an understanding of the genesis of pain. The study involved three cases of osteoid osteoma using both traditional histochemical procedures and electron microscopy. The latter, in particular, allowed us to confirm the myelinic nature of the nerve fibres observed under optic microscopy. Based on these observations, the authors present a hypothesis on the function of the nerve fibres in the mechanism of pain stimulation.

Prostaglandin synthesis by osteoid osteoma and osteoblastoma

Osteoid osteomas are characterized clinically by a pattern of nocturnal pain which is exquisitely sensitive to salicylates. Etiology for the pain has been ascribed by previous investigators to the presence of nonmyelinated nerve fibers or to the effect of prostaglandins. In an effort to corroborate the potential role of prostaglandins in mediating the pain associated with this tumor, we have determined the concentration of prostaglandins E2, F2 alpha, 6-keto-F1 alpha, and thromboxane B2 utilizing radioimmunoassay of extracts of homogenated tumor tissue. Results were compared with similar extracts of normal bone and a variety of other osseous tumors. The increased concentrations of prostaglandin E2 found in cases of osteoid osteoma and osteoblastoma confirm studies of explants of these tumors previously recorded in the literature.

[Studies on internal pressure and oxygen tension of bone tumors and tumor conditions. II--Growth rate, internal pressure and oxygen tension in bone lesions]

Internal pressure and oxygen tension were measured in 24 patients with bone tumors and tumorous conditions. High internal pressure were observed in most of the rapidly growing lesions. The internal pressure of slowly growing and non-growing lesions were not significantly different from those of normal bone marrow. Oxygen tension was commonly higher in the rapidly growing lesions than in simultaneously obtained peripheral venous samples from the same patients. A high correlation was found between internal pressure and the growth rate of the bone lesions in this study. These data suggest that internal pressure and oxygen tension of the lesions reflect the degree of blood supply to the bone tumors and tumorous conditions.

Eighteen-year anamnesis of osteoid osteoma--a diagnostic problem?

The 18-year history of osteoid osteoma in a woman aged 43 is presented. The typical physical and radiographic findings are described. Total removal of the tumor resulted in prompt and permanent relief of symptoms. Diagnosis, histopathology, differential diagnosis, treatment, and prognosis of the tumor are discussed.