An update of diagnostic strategies using molecular genetic and magnetic resonance imaging techniques for musculoskeletal tumors
Leiden University, Leyden, South Holland, Netherlands Current Opinion in Rheumatology
(Impact Factor: 4.89).
01/2000; 12(1). DOI: 10.1097/00002281-200001000-00013
Rheumatologists may be incidentally confronted by bone and soft tissue lesions presenting in and around joints that require early recognition and appropriate referral. The diagnostic and therapeutic management of patients with musculoskeletal tumors is critically dependent on a multidisciplinary approach. Advances, particularly in the fields of histopathology, molecular (cyto)genetics and radiologic imaging techniques, have resulted in significant improvements in reaching a correct (differential) diagnosis, essential for implementing optimal treatment modalities. Magnetic resonance imaging is becoming increasingly important in planning preoperative and postoperative management strategies, and should precede all invasive procedures. Improvements in the fields of immunohistochemistry, together with the realization that certain tumor groups may be associated with specific genetic alterations, has significantly improved diagnostic accuracy. Additionally, the presence of certain genetic alterations within the tumoral genome have been found to be of prognostic value, and the hereditary context recognized for a number of specific bone and soft tissue tumors should be taken into account in the management of a patient with such a neoplasm. It is envisaged that an increasing understanding of the molecular biology and histogenesis of individual musculoskeletal tumor types will lead to tailor- made therapeutic options and consequently prognostic improvements. This update serves to highlight some important recent developments in fundamental and diagnostic aspects of musculoskeletal tumors.
Available from: J.J. Verlaan
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ABSTRACT: Low-grade surface tumours of bone may theoretically be treated by hemicortical resection, retaining part of the circumference of the cortex. An inlay allograft may be used to reconstruct the defect. Since 1988 we have performed 22 hemicortical procedures in selected patients with low-grade parosteal osteosarcoma (6), peripheral chondrosarcoma (6) and adamantinoma (10). Restricted medullary involvement was not a contraindication for this procedure. There was no evidence of local recurrence or distant metastasis at a mean follow-up of 64 months (27 to 135). Wide resection margins were obtained in 19 patients. All allografts incorporated completely and there were no fractures or infections. Fractures of the remaining hemicortex occurred in six patients and were managed successfully by casts or by osteosynthesis. The functional results were excellent or good in all except one patient. Hemicortical procedures for selected cases of low-grade surface tumours give excellent oncological and functional outcomes. There was complete remodelling and fewer complications when compared with larger intercalary procedures. The surgery is technically demanding but gives good clinical results.
Available from: Pancras C W Hogendoorn
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ABSTRACT: Musculoskeletal tumors often present an imaging dilemma to the clinician. This dilemma occurs not only because primary musculoskeletal
malignancies are less common than tumors of other organ systems, such as lung or gastrointestinal, but also because of the
vast array of possible pathologies reflecting the many different types of mesenchymal tissue. This chapter concentrates on
imaging neoplasia of the extremities (see Chapter 58 for Soft Tissue Sarcoma).
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