Bone tumor of the distal femur in a 67-year-old woman

Changes in sagittal and axial plane alignment in medial opening wedge high tibial osteotomy: a prospective observational study

PURPOSE

Deformity correction during high tibial osteotomy is generally based on coronal plane alignment. The aim of this study was to measure changes in sagittal and axial plane alignment following medial opening wedge high tibial osteotomy [mHTO], using pre- and postoperative computed tomography [CT] scans, and correlate them with changes in coronal plane. The secondary objective was to correlate changes in functional outcomes with changes in alignment in each plane. The null hypothesis was that sagittal and axial plane alignment does not change significantly following mHTO.

METHODS

This was a prospective, observational study including 30 patients of isolated medial compartment osteoarthritis of the knee joint, between 30 and 60 years of age. Preoperative and postoperative computed tomography scan of bilateral lower limbs from hip to ankle was performed. Varus angle, mechanical axis deviation [MAD] of the lower limb, medial proximal tibial angle [MPTA], tibial torsion and posterior proximal tibial angle [PPTA] were measured. Visual Analogue Scale [VAS 0-10 cm scale] was used for assessment of pain. Functional outcomes were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 12 Item Short Form Survey [SF 12] and Tegner Lysholm knee scoring scale.

RESULTS

Mean age of patients was 44.59 ± 8.157 years. Mean preoperative varus deformity was 11.13 ± 1.5 degrees, which got corrected to a mean valgus alignment of 3.8 ± 0.93 degrees postoperatively. The mechanical axis deviation was 4.32 ± 1.76 mm lateral to the knee joint center postoperatively. Preoperatively, all knees had external tibial torsion [27.08 ± 2.18 degrees] which was corrected to a mean external tibial torsion of 19.80 ± 3.72 degree after the surgery [P < 0.001]. The overall decrease in sagittal alignment in the present study was 3.70 ± 3.14 degree, 3.97 ± 3.06 degree, 3.92 ± 2.33 degree, for medial, middle and lateral cuts, respectively. There was a significant correlation between change in varus/valgus angle and change in TT and PPTA. Significant positive correlation was seen between change in coronal alignment and functional outcome scores.

CONCLUSION

This study has shown that mHTO significantly changes torsional and sagittal alignment. This is the first study to establish relation between correction in coronal plane and associated changes in sagittal and torsional alignments.

Primary leiomyosarcoma of the spine: an analysis of imaging manifestations and clinicopathological findings

BACKGROUND

Primary leiomyosarcoma of the spine is extremely rare and lacks specific clinical symptoms. This study investigated the imaging manifestations and clinicopathological findings of primary leiomyosarcoma of the spine, aiming to improve the radiologists' understanding of the disease and reduce misdiagnoses.

METHODS

The clinical, imaging, and pathological manifestations in eleven patients with pathologically confirmed primary leiomyosarcoma of the spine were retrospectively analyzed. The imaging features analyzed included lesion location, shape, border, size, and density/intensity, and adjacent bone destruction status, residual bone trabeculae, vertebral compression, and contrast enhancement.

RESULTS

The patients' primary clinical symptom was usually focal pain. Primary leiomyosarcoma of the spine was mostly a solitary lesion and tended to occur in the posterior elements. The tumors had a lobulated shape with osteolytic bone destruction, ill-defined borders, and could involve multiple segments. Computed tomography (CT) examination showed isodense masses. Six patients showed residual bone trabeculae. Two patients had miscellany T2-weighted imaging (T2WI) signals, while the tumor and spinal cord of the remaining patients were isointense on T1-weighted imaging (T1WI) and T2WI. Among the seven patients who underwent contrast-enhanced scanning, six displayed homogeneous enhancement. Eight patients underwent gross-total tumor resection with no recurrence.

CONCLUSIONS

Primary leiomyosarcoma of the spine tends to be a solitary lesion in the posterior elements and appears as a lobulated mass with osteolytic bone destruction and an ill-defined border. The tumor and spinal cord can be isointense on T1WI and T2WI. Contrast-enhanced scanning displays homogeneous enhancement. The lesion tends not to recur after surgical gross-total tumor resection.

PRIMARY LEIOMYOSARCOMA OF BONE: CLINICOPATHOLOGIC AND PROGNOSTIC FACTORS ANALYSIS IN A SINGLE INSTITUTION

Objective

Primary leiomyosarcoma of bone (PLB) is a rare type of malignant bone tumor considered as a variant of the spindle cell sarcomas (SCS). The objective of this study was to analyze the clinicopathologic and the prognostic factors of patients with PLB treated at a single institution.

Methods

We retrospectively reviewed the records of 22 patients with pathologically confirmed PLB. The data collected were: age, sex, tumor size and location, grade and stage of the disease and histopathologic features. Mean age was 45.5 years (range, 17 to 73 y). Location was: upper limb (27.3%), lower limb (68.2%) and pelvis (4.5%). Patients had high grade in 90.9% of the reports. Margins were negative in 77.3% of the cases. Histological reports describe spindly sarcomatous cells arranged in fascicles with increased vascular formation without osteoid or chondroid matrix production. On immunohistochemistry, smooth muscle actin and desmin where positive in all cases.

Results

Mean follow-up time was 73.5 months (range, 5.3 to 331.1 m). We found 22.7% of local recurrence (LR). Distant metastasis (DM) was reported in 9 (40.9%) patients. Lung metastasis was the only DM affected site. Overall survival (OS) rate in 5 years was 59.1%. Predictors of OS were LR and DM.

Conclusions

PLB is an extremely rare malignant bone tumor that has a higher rate of DM and similar OS prognosis compared with other bone sarcomas. Level of Evidence IV, Case Series.

Primary leiomyosarcoma of bone--a clinicopathologic study of 8 uncommon cases with immunohistochemical analysis and clinical outcomes

Primary leiomyosarcoma of bone is a rare and a diagnostically challenging tumor entity. Over a 7-year period, we identified 8 such cases that fulfilled the diagnostic criteria in 6 men and 2 women, with age ranging from 25 to 59 years (mean, 42.7 years). All cases were noted in the lower limbs, including femur and tibia as the commonly involved bones in 4 and 3 cases, respectively. On radiography, the most consistent feature was a solitary osteolytic lesion with cortical destruction, unassociated with matrix formation. On histopathology, all cases showed spindly sarcomatous cells, mostly arranged in fascicles and whorls. Of 8 cases, 6 (75%) were of high grade. Prominent vasculature was noted in 5 cases. Two cases displayed focal mineralization, including calcification and heterotropic woven bone formation in 1 case each, but lacked malignant osteoid or chondroid matrix. One case showed osteoclast-like giant cells. On immunohistochemistry, smooth muscle actin was diffusely positive in all cases (100%), desmin was positive in 6 (75%) of 8 cases, and h-caldesmon was positive in 5 (83.3%) of 6 cases. Five cases underwent surgery, including 3 amputations and 2 wide excisions. One case underwent chemotherapy. On follow-up, 5 cases developed metastasis, including 1 case with another, who died within 17 and 5 months. Leiomyosarcoma of bone is uncommon and diagnostically challenging. An index of suspicion is necessary for this diagnosis, especially in cases of lytic, destructive bone lesions, unassociated with matrix production, that show spindly sarcomatous cells on histopathology. Immunohistochemical analysis, including an optimum panel formed by smooth muscle actin (diffuse positivity), desmin, and h-caldesmon, is necessary for substantiating this diagnosis. Surgery forms the treatment mainstay. The prognosis appears to be dismal.

Primary leiomyosarcoma of extragnathic bone: clinicopathologic features and reevaluation of prognosis

CONTEXT

Leiomyosarcoma most commonly involves the female genital tract and occasionally arises within the retroperitoneum, abdominal cavity, or the soft tissues of the extremity. Presentation as a primary bone tumor is extraordinarily uncommon, potentially leading to misdiagnosis. The prognosis is traditionally thought to be dismal. However, this conclusion is largely based on individual case reports and small series, in some of which the pathologic diagnosis is not well documented.

OBJECTIVE

To review the clinicopathologic features of well-established cases of primary skeletal leiomyosarcoma and reevaluate the prognostic implications thereof.

DATA SOURCES

A National Center for Biotechnology Information PubMed search of the English language literature identified 104 authenticated cases of primary leiomyosarcoma of extragnathic bone. An additional 3 cases are reported and illustrated herein.

CONCLUSIONS

Approximately half of all patients with primary skeletal leiomyosarcoma either presented with metastatic disease or developed metastases within 1 year of diagnosis. The 5-year overall and disease-free survival rates were 59% and 41%, respectively, comparable to that of other skeletal sarcomas. As for other bone and soft tissue sarcomas, high histologic grade and tumor stage are predictive of poor outcome.

Primary leiomyosarcoma of bone: a report on three patients

Primary leiomyosarcoma of bone is a rare aggressive tumor that occurs mainly in older people. It resembles other malignancies clinically and radiologically, and differential diagnosis is based on histopathology, including immunohistochemistry. If leiomyosarcoma is found in bone, the possibility that it is a metastasis from a distant tumor should be investigated. The treatment is surgical excision with wide margins. Here we present three patients who had primary leiomyosarcoma of radius, ilium, and femur, respectively, and who were treated surgically.