The Tikhoff–Linberg procedure prove to be a useful method for wide resection of a malignant tumour of the shoulder girdle which helps to preserve hand and elbow function http://tiny.cc/qcz5fx #oncology#bonejointj
Ortopedia oncológica
Dr. Ernesto Gibrán González Salinas
martes, 20 de mayo de 2014
Osteochondral lesions of the talus are injuries to the bottom bone of the ankle joint
http://www.aofas.org/footcaremd/conditions/ailments-of-the-ankle/Pages/Osteochondral-Lesion.aspx
Osteochondral lesions of the talus are injuries to the bottom bone of the ankle joint. These injuries are often caused by a traumatic injury. Here’s how orthopaedic foot and ankle MDs assess and treat them:http://bit.ly/1obxJSw
domingo, 18 de mayo de 2014
Mejor amigo, ahora contra el cáncer
http://yucatan.com.mx/imagen/calidad-de-vida-imagen/mejor-amigo-ahora-contra-el-cancer
Mejor amigo, ahora contra el cáncer
Tumores óseos serían atacados primero en canes
El mejor amigo del hombre participará en un esfuerzo por encontrar unos mejores tratamientos para un tipo de cáncer óseo en los niños y en los adultos jóvenes, informan unos investigadores.
Los perros que sufren de osteosarcoma serán tratados con unos medicamentos que ya han sido aprobados por la Administración de Alimentos y Medicamentos (FDA) de Estados Unidos para otros usos, para ver qué tan bien combaten el cáncer óseo, apuntó la Dra. Joy Fulbright, oncóloga pediátrica del Hospital Pediátrico Mercy en Kansas City, según publica HealthDay News.
“Es uno de los cánceres que es del mismo tipo tanto en perros como en humanos, y los perros tienden a poder procesar los medicamentos de forma similar a los humanos”, explicó Fulbright. “Lo ideal sería encontrar un agente que no sea tan tóxico como la quimioterapia que usamos ahora”.
Los médicos esperan hallar fármacos que sean efectivos contra el osteosarcoma tanto en los perros como en los humanos. Y dado que estos medicamentos ya están aprobados por la FDA, es probable que se puedan poner en uso muy rápidamente.
“Usualmente, llevar un medicamento del laboratorio al paciente tarda hasta 15 años”, lamentó Fulbright. “Esperamos reducir ese periodo si podemos hallar un medicamento que ya esté aprobado por la FDA”.
Hallar nuevos tratamientos para el osteosarcoma ha sido un desafío porque es un cáncer poco común en los humanos. Sólo unas 800 personas son diagnosticadas con la enfermedad cada año, de las cuales alrededor de 400 son niños y adolescentes, según la Sociedad Americana Contra El Cáncer (American Cancer Society).
Las tasas de supervivencia a cinco años para las personas diagnosticadas con osteosarcoma antes de que se haya propagado pueden ser tan altas como un 80 por ciento. Si el cáncer se ha propagado, las tasas de supervivencia a cinco años se reducen a entre el 15 y el 40 por ciento, según la sociedad oncológica. “No hemos mejorado la tasa de supervivencia en los últimos 20 años”, dijo Fulbright.
Pero el osteosarcoma es mucho más común en los perros que en las personas. Cada año se diagnostican unos 10,000 casos, según los autores del estudio.
Actualmente, los investigadores están haciendo evaluaciones previas en el laboratorio usando células de osteosarcoma tanto de humanos como de perros.
Entonces, los candidatos farmacológicos más promisorios de esta fase se evaluarán en perros que hayan sido diagnosticados con cáncer óseo, para ver cuáles funcionan mejor con el mínimo de efectos secundarios. Los veterinarios del Colegio de Medicina Veterinaria de la Universidad Estatal de Colorado identificarán candidatos caninos para el estudio, y los tratarán con los fármacos elegidos por los investigadores. No se provocará el cáncer en ningún perro para este estudio. Los perros deben tener un osteosarcoma que haya surgido de forma natural.
Duffee anotó que aunque el estudio se enfoca en un tratamiento humano para el osteosarcoma, también podría llevar a mejores tratamientos para el cáncer óseo en los perros.
De un vistazo
Primeras pruebas
Tras identificar los medicamentos que funcionen en los perros, los médicos esperan pasar a ensayos con humanos usando esos mismos.
Pruebas comunes
Los perros se usan comúnmente en la investigación médica, apuntó Nicole Duffee, directora de educación y asuntos científicos de la Asociación Americana de Ciencias de Animales de Laboratorio (American Association for Laboratory Animal Science).
Financiamiento
El estudio, que analiza la enfermedad que ocurre sobre todo en los perros de razas grandes, se está financiando mediante una subvención de 500,000 dólares de la Midwest Cancer Alliance.
sábado, 17 de mayo de 2014
Ankle pain following a football tackle. What is this lucent bone lesion?
Ankle pain following a football tackle. What is this lucent bone lesion?
ANSWER: http://goo.gl/p6MncI
viernes, 16 de mayo de 2014
Chondroblastoma of the Distal Phalanx
http://www.healio.com/orthopedics/journals/ortho/%7B433326f1-2bbb-4829-bbeb-49d71c04a4cc%7D/chondroblastoma-of-the-distal-phalanx
CASE REPORT
Chondroblastoma of the Distal Phalanx
Abstract
El condroblastoma es un raro tumor óseo benigno primaria que usualmente ocurre en las epífisis de los huesos largos. Los autores presentan un ejemplo del diagnóstico y el tratamiento exitoso de esta neoplasia en un lugar extremadamente raro en la falange distal. Se presentan los resultados clínicos y radiográficos después de 68 meses de seguimiento. A 15 años de edad , derecha dominante a mano , niño desarrolla una inflamación dolorosa del dedo anular derecho . Las radiografías revelaron una lesión radiolúcida de la falange distal con la remodelación expansiva del hueso . Una biopsia por escisión se realizó con legrado e Injertos Óseos de la lesión. El diagnóstico de condroblastoma se hizo con base en la evaluación patológica de la biopsia . Sesenta y seis meses después del tratamiento quirúrgico , el paciente estaba libre de recurrencia y metástasis con excelentes resultados clínicos y funcionales . Para conocimiento de los autores , esto representa sólo el caso segundo comunicado del condroblastoma de la falange distal. El diagnóstico de condroblastoma en esta rara localización se realizó mediante análisis patológico de la pieza de resección . Es imprescindible para confirmar el diagnóstico de cualquier espécimen de hueso resecado aún cuando el deseo de una lesión agresiva o maligna es baja. Un tumor que presenta en una ubicación poco habitual puede requerir un cambio en el tratamiento o vigilancia.
Chondroblastoma is a rare, benign primary bone tumor that usually occurs at the epiphysis of long bones. The authors present an example of the diagnosis and successful treatment of this neoplasm in an exceedingly rare location in the distal phalanx. Clinical and radiographic outcomes after 68 months of follow-up are presented. A 15-year-old, right hand–dominant, boy developed painful swelling of the right ring finger. Radiographs revealed a radiolucent lesion of the distal phalanx with expansile remodeling of the bone. An excisional biopsy was performed with curettage and bone grafting of the lesion. The diagnosis of chondroblastoma was made based on pathologic evaluation of the biopsy specimen. Sixty-six months after surgical treatment, the patient was free of recurrence and metastatic disease with excellent clinical and functional outcomes. To the authors’ knowledge, this represents only the second reported case of chondroblastoma of the distal phalanx. The diagnosis of chondroblastoma in this rare location was made by pathologic review of the resection specimen. It is imperative to confirm the diagnosis of any resected bone specimen even when the concern for an aggressive or malignant lesion is low. A tumor presenting in an unusual location may require a change in treatment or surveillance.
The authors are from the Department of Orthopedic Surgery & Rehabilitation (JRG, TPL, JRW) and the Department of Pathology (K-MF), The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
The authors have no relevant financial relationships to disclose.
Correspondence should be addressed to: Thomas P. Lehman, MD, Department of Orthopedic Surgery & Rehabilitation, The University of Oklahoma Health Sciences Center, Williams Pavilion 1380, 920 Stanton L Young Blvd, Oklahoma City, OK 73104 ( Thomas-lehman@ouhsc.edu).
Received: July 22, 2013
Accepted: October 09, 2013
Chondroblastomas are rare tumors that typically occur in the epiphyses of long bones, especially the proximal humerus, proximal and distal femur, and proximal tibia. Few published studies have investigated the clinical entity and all are retrospective in nature.1–6 To the authors’ knowledge, only 1 published report of chondroblastoma in a phalanx of the hand exists in the English literature.1Predictors of local recurrence, metastasis, and patient survival are still being defined.
This tumor is an unusual finding in the distal phalanx. A typical differential for a lesion with this presentation includes epidermal inclusion cyst, enchondroma, giant cell reparative granuloma, aneurysmal bone cyst, unicameral bone cyst, and infection. This case reinforces why the proper diagnosis must always be made not only for immediate treatment, but also for long-term monitoring.
The authors report a case of chondroblastoma in the ring finger distal phalanx in a 15-year-old boy that was successfully treated with curettage and bone grafting. At 68-month follow-up, the patient was disease-free and had an excellent clinical and functional outcome. This diagnosis was made by pathology and emphasizes the necessity of getting a biopsy specimen for confirmation of diagnosis.
Case Report
A 15-year-old, right hand–dominant boy presented with increasing pain and swelling of his right ring finger for 3 months after a minor injury. His medical history was significant for lymphoma, which was in remission. The right ring finger was enlarged around the distal phalanx, consistent with pseudoclubbing. No erythema or fluctuance were observed. The finger was tender on palpation. Range of motion was normal except for 0° to 75° at the distal interphalangeal joint. Two-point discrimination and light touch sensation were normal. Radiographs showed a radiolucent lesion with expansile remodeling of the bone (Figure 1). Laboratory evaluation revealed no evidence of infection.
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Figure 1:
Anteroposterior (A) and lateral (B) radiographs of the right ring finger at initial presentation showing expansile lytic lesion of distal phalanx.
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Curettage of the specimen revealed yellowish-brown gelatinous material that was sent for pathology and culture. The void was filled with autogenous distal radius bone graft.
Pathology showed a moderately cellular chondroid neoplasm with round to polygonal tumor cells, scattered “chicken-wire” type calcifications, and scattered osteoclast type giant cells (Figure 2). On immunohistochemistry, the giant cells were positive for CD68 and the tumor cells were inconclusive for S100. Cultures were negative. A diagnosis of chondroblastoma was made based on the histologic findings. Chest computed tomography was obtained and negative for metastasis.
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Figure 2:
Photomicrograph of biopsy specimen, with solid arrows represent giant cells and dashed arrows represent spindle cells (original magnification, ×100) (A). Photomicrograph showing pleomorphic stromal cells in cartilaginous matrix (original magnification, ×400) (B).
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He was able to obtain employment with full use of his right hand. He noticed a minor cosmetic difference. At 68-months follow-up, the diameter of the right finger distal to the distal interphalangeal joint was greater than the other digits. Radiographs showed a small well-circumscribed lucency at the tip but no clear evidence of recurrence (Figure 3). He had normal sensation. Distal interphalangeal joint range of motion was 0° to 85° (Figure 4). Grip and pinch strength were equivalent with the contralateral side.
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Figure 3:
Anteroposterior (A) and lateral (B) radiographs of the right ring finger showing consolidation of the defect at final follow-up.
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Figure 4:
Clinical photographs of patient at final follow-up showing dorsal (A), volar (B), and lateral (C) views of the right ringer finger.
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Discussion
Chondroblastoma is a benign tumor of bone that accounts for 1% of primary bone tumors.3 However, it is the most common epiphyseal tumor seen in children.6 It typically occurs at the epiphysis of long bones. The current case represents only the second report of this rare occurrence in a phalanx. Based on his age and medical history and the location of the lesion, etiologies including an epidermal inclusion cyst, giant cell reparative granuloma, aneurysmal bone cyst, unicameral bone cyst, enchondroma, lymphoma recurrence, and chronic infection were believed to be more likely. Treatment for these diagnoses is similar, but long-term follow-up is necessary to verify the absence of recurrence in chondroblastoma. It is also imperative to perform chest imaging to look for the presence of metastases when a diagnosis of chondroblastoma is made.
Few reports of chondroblastoma of the hand exist. In 2008, Garin and Wang1reported a series of 10 tumors, only 1 of which was distal to the carpus. Interestingly, the tumor was found in the ring finger distal phalanx, which is identical to this case. The patient reported by Garin and Wang1 was a 17-year-old boy who was treated with curettage and bone grafting. The lesion recurred at 5 months. Repeat curettage, burring, and bone grafting were performed, and they reported the patient was disease-free at 5.5 years follow-up.1 To the current authors’ knowledge, this is the only other reported case of a chondroblastoma of phalanx in the hand. The current case is similar in presentation and treatment, except no recurrence occurred and no repeat surgical intervention was necessary. Garin and Wang1 did not provide any clinical or functional outcome information.
Chondroblastoma was first identified in the proximal humerus by Codman7 in 1931 as a chondromatous variant of giant cell tumors. A decade later, Jaffe and Lichtenstein8 renamed it a benign chondroblastoma. This was done to emphasize the chondroblastic nature of the lesion and to distinguish it from the classic giant cell tumor of bone.8 Patients often present with pain, but this is not a universal finding. The male to female prevalence is approximately 2 to 1.9 It occurs most often during the second decade of life.9 Curettage can be curative, but a local recurrence rate of 10% to 35% is reported.1–3 No clear genetic marker has been identified, but studies have shown links to chromosomes 5 and 8, as well as p53 mutations.10 Male gender is the only known risk factor for the development of a chondroblastoma. Malignant chondroblastomas are rare and are associated with a dismal prognosis. The lungs are the most common site of metastatic disease, which occurs in less than 1% of cases.9 For this reason, a chest computed tomography scan is recommended as part of the diagnostic work-up for metastatic disease.
CD68 is a glycoprotein found in the cytoplasmic granules in a range of different cells. It is particularly useful as a marker for the various cells of the macrophage lineage, including histiocytes, giant cells, and osteoclasts. S-100 is a protein found in the cells of neural crest origin, including chondrocytes.11 Despite the inconclusive S-100 in the current case, the rest of the histological evidence was sufficient to make the diagnosis of a chondroblastoma.
Most chondroblastomas occur in the long bones.1–6 As recently as 2009, Sailhan et al3 reported a series of 87 tumors; of which 24 were located in the proximal tibia, 23 in the proximal femur, 19 in the proximal humerus, and 8 in the distal femur. In 2000, Ramappa et al6 reported 47 tumors; of which 11 were in the proximal tibia, 10 in the proximal humerus, and 8 in the proximal femur, and 4 in the distal femur. Neither study identified a single lesion distal to the radius. The pooled data from multiple reports suggests a prevalence of 23.7% in the proximal tibia, 20.4% in the proximal femur, 19.7% in the proximal humerus, and 13.2% in the distal femur, with it rarely occurring distal to the radius in the upper extremity.1–6
Chondroblastoma With Secondary Aneurysmal Bone Cyst of the Capitate /
http://www.healio.com/orthopedics/journals/ortho/%7B7ce70398-8d2a-40e3-a9fd-b921e60edad6%7D/chondroblastoma-with-secondary-aneurysmal-bone-cyst-of-the-capitate
CASE REPORT
Chondroblastoma With Secondary Aneurysmal Bone Cyst of the Capitate
Abstract
El condroblastoma es un tumor benigno que se presenta típicamente en la epífisis de un hueso largo . Sólo ha habido 2 casos reportados de condroblastoma implican el hueso grande . Este es el primer informe del condroblastoma con un quiste óseo aneurismático secundario que impliquen el hueso grande . Un hombre de 33 años de edad se presentó con un 3- años de historia de dolor e inflamación en la muñeca derecha . La radiografía y la tomografía computarizada mostraron un área radiolúcida y sin calcificación de la matriz dentro del hueso grande . La resonancia magnética reveló una señal homogénea, que fue baja en las imágenes ponderadas en T1 y alta en las imágenes potenciadas en T2 y mostró sólo una ligera mejora. Sobre la base de los hallazgos de imagen , los autores optaron por biopsia por escisión . El tumor óseo en el hueso grande se exploró a través de un abordaje dorsal dividiendo los tendones extensores . Legrados Después de repetidas , sustituto de injerto óseo mediante aloinjerto óseo estaba lleno en el hueso grande . Histológicamente , los autores diagnostican este tumor como un condroblastoma con un quiste óseo aneurismático secundario. En la final de 2 años de seguimiento , no hubo evidencia de la unión ósea , el rango de movimiento , y la recuperación y sin evidencia de recidiva . Aunque la repetición de condroblastoma es ocasionalmente informó , el principal tratamiento es curetaje intralesional e injerto óseo . Rebabas de alta velocidad, el fenol, el cemento óseo , y la criocirugía se ha informado a reducir la recurrencia local. La extirpación completa del hueso carpiano parece ser un tratamiento excesivo .
Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment.
The authors are from the Department of Orthopaedic Surgery (ES, JI, TA, NS, HH) and the Department of Pathology (TK), Graduate School of Medicine, University of Yamanashi, Yamanashi, Japan.
The authors have no relevant financial relationships to disclose.
Correspondence should be addressed to: Jiro Ichikawa, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan ( jichi@sb4.so-net.ne.jp).
Received: June 21, 2013
Accepted: October 09, 2013
miércoles, 14 de mayo de 2014
Discusión entre pares / masculino 14 años antecedente de caida de una bicicleta evolucionando../ Comentarios!!!
masculino 14 años antecedente de caída de una bicicleta evolucionando con fx en terreno previamente dañado donde se observa cortical medial lesionada con respeto de la fisis d crecimiento 4 semanas posterior se observa la destrucción completa de ambas corticales con respeto de la fisis de crecimiento
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