Two cases of lymphangiosarcoma arising in a chronic lymphedematous extremity following mastectomy (Stewart-Treves syndrome) were reported with not only standard histology, but also special study on the ultrastructure and immunohistology. These cancers developed as a result of chronic lymphedema of the involved limb following mastectomy 15 and 16 years ago, respectively, for breast carcinoma. Immunohistologic and electron microscopic examinations proved that this tumor originates in the vascular endotheliocytes, even though they are clinically chronic lesions apparently derived from the lymphatic vessels. This sarcoma develops multicentrically in an edematous arm and spreads out rapidly, so prognosis is quite discouraging in those patients. They need to be radically surgically treated without hesitation; hence, amputation, not limb-saving surgery, should be indicated.
Nine patients with osteosarcoma were treated by chemotherapy combined with caffeine and surgery. All primary tumors showed complete histological response to preoperative chemotherapy consisting of three intraarterial infusions of cisplatin and caffeine without/with doxorubicin and two systemic high-dose methotrexate combined with vincristine. Limb-salvage surgery was performed in eight patients with marginal procedure, which led to the preservation of good limb function. Below-knee amputation was done in one patient with calcaneal osteosarcoma. There has been neither local recurrence nor lung metastasis in seven patients with conventional osteosarcoma during a median follow-up period of 28 months. Lung metastases leading to death were observed in one patient with small-cell osteosarcoma despite complete destruction of the primary tumor by preoperative chemotherapy. Chemotherapy combined with caffeine administration deserves further extensive and large-scale study in osteosarcoma.
Total knee arthroplasty (TKA) was carried out on both knee joints for spontaneous bony ankylosis due to rheumatoid arthritis (RA). Preoperative fixation angles were 40 degrees . First, the peroneal nerve was released prior to TKA. Quadriceps snip was performed to evert the patella laterally. Bilateral TKAs were carried out using a stabilized prosthesis. The results showed full extension to 70 degrees flexion at 3 years after the surgery. Absence of pain, maintenance of stability, and walking ability were achieved, without any significant complication. Total knee arthroplasty following takedown of a spontaneous ankylosed knee is an effective procedure under appropriate knee conditions.
Perineuriomas are usually benign soft-tissue tumors that arise from perineurial cells of the peripheral nerve sheath. Low-grade malignant perineurioma is a rare type of perineurioma, presenting with infiltrative growth, low mitotic activity, and a lack of necrosis. This report describes a case of low-grade malignant perineurioma in a 60-year-old man who presented with a growing tumor on the dorsal side of his left wrist. The tumor was surgically excised and showed no adhesion to the surrounding muscle and no continuity with nerves. There was no evidence of recurrence or metastases 12 months after surgery. Histology indicated that the tumor contained hypercellular and hypocellular areas with spindle-shaped cells proliferating in storiform patterns or perivascular whorling. There was moderate infiltrative growth into the surrounding tissue. There was an evident central infarction but no coagulative necrosis. Mitotic figures were observed at 5/10 high-power fields. On immunohistochemistry tumor cells were found to be positive for epithelial membrane antigen, glucose transporter protein 1, and claudin-1. Approximately 18.4% of tumor nuclei were labelled for Ki-67. Interphase fluorescence in situ hybridization on paraffin sections indicated a loss of chromosome 13. This suggests that chromosome 13 abnormalities could also be involved in perineurioma with low-grade malignant potential.
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