Length of symptoms before referral: prognostic variable for high-grade soft tissue sarcoma?

Background: It is commonly assumed patients with high-grade soft tissue sarcomas who are diagnosed and treated quickly after the first onset of symptoms fare better than those with longer symptoms before treatment. The literature contains no substantive data to support this assumption for soft tissue sarcomas, particularly for high-grade lesions.

Questions/purposes: We examined selected potential prognostic factors for high-grade soft tissue sarcoma and determined whether the time from first symptom to diagnosis has an impact on survival or disease-free survival and whether subcutaneous sarcomas are diagnosed more quickly than deep sarcomas.

Biopsy of soft tissue masses: evidence-based medicine for the musculoskeletal tumor society.

Unlabelled: The literature contains a number of controversies regarding key questions: (1) When is a biopsy indicated? (2) How should the biopsy be placed? (3) How should the biopsy be performed and which has the greatest diagnostic accuracy? (4) Who should perform the biopsy? (5) What clinical parameters present the greatest diagnostic difficulty? Using PubMed and Google Scholar we performed English-language literature searches of clinical studies reporting biopsy of soft tissue masses. Thirty-two studies met the inclusion criteria but were only able to address three of the five questions the authors had hoped to evaluate. Available evidence suggests open biopsy has the highest diagnostic accuracy over core needle biopsy, which was higher than fine needle aspiration.

Diagnosis and treatment of joint-related tumors that mimic sports-related injuries.

Tumors involving the joint or having symptoms in the joint are rare. Both joint-related tumors and sports-related injuries can affect young, active patients, and their symptoms often overlap. Sports medicine specialists rarely encounter synovial conditions, so expertise in this area is difficult to establish.

Tumors masquerading as hematomas.

Suboptimal patient management can occur when malignant soft tissue tumors with internal hemorrhage masquerade as simple hematomas. We retrospectively reviewed 31 patients with malignancies who had diagnostic delays averaging 6.7 months (range, 1.

Does length of symptoms before diagnosis of sarcoma affect patient survival?

It generally is accepted that earlier diagnosis of sarcoma is associated with a better disease-free survival. Because the legal community is convinced this is true, a delay in cancer diagnosis is a frequent source of medical malpractice lawsuits. We asked whether symptom duration before diagnosis affected sarcoma outcome.

Indeterminate pulmonary nodules in patients with sarcoma affect survival.

We prospectively studied 331 sarcoma patients treated between April 1999 and December 2004 to see if small, indeterminate pulmonary nodules are of prognostic significance. Seventy-one (21%) had indeterminate pulmonary nodules on initial spiral CCT. Twenty of 71 (28%) patients with indeterminate nodules progressed with metastatic disease.

Multifocality and multifocal postradiation sarcomas.

Unlabelled: Hypothetically, any site in a radiation portal has potential for late malignant transformation. Secondary malignant neoplasms may occur after almost any index cancer has been treated with radiation and/or chemotherapy. The incidence of secondary malignant neoplasms, histopathology, time delay, radiation dose, cytotoxic agents, age and type of initial malignancy, and outcome all negatively impact cancer survivors.

The impact of previous surgical manipulation of subcutaneous sarcoma on oncologic outcome.

Unlabelled: We prospectively followed 106 consecutive patients referred for surgical treatment of nonmetastatic subcutaneous soft tissue sarcoma to assess whether prior surgical manipulation had an impact on local control and/or disease-free survival. 10 patients had no previous surgical treatment; 11 had only a previous biopsy, 75 had a previous attempted excision, and 10 were referred after the tumor had recurred locally. Histologic grade was inversely associated with overall survival and disease-free survival.

Bone graft alternatives in the treatment of benign bone tumors.

Most bone grafting procedures are done during spinal fusion and to treat patients with skeletal trauma. Very few studies have addressed the bone grafting of skeletal defects after benign bone tumor excision. Contained defects have been treated with autogenous bone grafts, fresh-frozen allografts, freeze-dried allografts, demineralized bone matrix, and ceramic materials.

Soft-tissue lumps and bumps.

Soft-tissue masses of the extremities and torso are a common problem encountered by the orthopaedic surgeon. Although these soft-tissue masses are often benign, the orthopaedic surgeon must be able to recognize the features key to differentiating benign and malignant masses. An understanding of the epidemiology and clinical presentation of soft-tissue masses is needed in order to outline a practical approach to evaluation and surgical management.

Evaluation of the patient with carcinoma of unknown origin metastatic to bone.

Metastatic carcinoma to bone of uncertain primary origin is a common clinical diagnostic scenario. I present a simple and effective staging system to identify primary malignancies. The role of clinical history, physical examination, laboratory studies, and limited radiographic studies are critical to the success of this diagnostic strategy.

Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow.

Background: The treatment of unicameral bone cysts varies from open bone-grafting procedures to percutaneous injection of corticosteroids or bone marrow. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous injection of a mixture of demineralized bone matrix and autogenous bone marrow for the treatment of simple bone cysts.

Methods: Twenty-three patients with an active unicameral bone cyst were treated with trephination and injection of allogeneic demineralized bone matrix and autogenous bone marrow.

Karnofsky performance score as a predictor of survival in soft tissue sarcoma.

Forty-six consecutive patients with nonmetastatic, large, high-grade soft tissue sarcomas were treated with surgical resection and radiation therapy but no adjuvant chemotherapy. Clinical and radiographic followup ranged from 36 to 90 months (mean, 50 months). One patient died of unrelated causes 10 months after the completion of radiation and surgery, leaving the oncologic outcome of 45 patients to be evaluated.

Local progression after operative treatment of metastatic kidney cancer.

The cases of 78 patients with osseous metastases from kidney cancer were reviewed to determine the rate of local progression after operative resection as compared with more traditional intralesional procedures. Group I consisted of 41 (53%) patients who were treated with intralesional procedures involving internal fixation with or without curettage or polymethylmethacrylate. Of the 41 patients, additional operations were recommended for 17 (41%) of the patients who had local osseous progression.

Indications for operative treatment.

The importance of careful assessment of clinical, biomedical, and radiographic factors in the indications for operative treatment are stressed in this article. The indication for surgical resection of solitary lesions versus simple stabilization are compared and contrasted. The biologic behavior of various types of tumors is emphasized.

Ewing's sarcoma of the pelvis. Long-term survival and functional outcome.

Fifty patients with Ewing's sarcoma of the pelvis were treated using a multidisciplinary approach; followup of surviving patients averaged 137 months (range, 40-276 months). The addition of surgical resection to the multidisciplinary treatment for all patients was associated with improved survival compared with survival of patients treated with chemotherapy and radiation therapy alone; the addition of surgery to the treatment regimen of 37 patients without metastases also was associated with improved survival. There were no significant differences between the surgical and nonsurgical groups in terms of tumor size, stage of disease, patient age, duration of symptoms before diagnosis, or anatomic site.

The diagnosis and management of soft tissue sarcomas of the extremities in the adult.

Soft tissue sarcomas are uncommon malignancies found in 2/100,000 Americans. The accurate early diagnosis, adequate surgical resection and radiation treatment is associated with a good prognosis in low-grade sarcomas and a fair prognosis in high-grade sarcomas. This monograph will discuss the principles of diagnosis, clinical presentation, adequate surgical management, radiation therapy principles and role of chemotherapy in adult patients with soft tissue sarcomas of the superficial trunk and extremities.

Extraskeletal Ewing's sarcoma.

Background: Ewing's sarcoma usually is identified as a primary malignancy of bone affecting children and young adults. Extraskeletal Ewing's sarcoma is rare, and very few data are available addressing optimal surgical and oncologic treatment modalities.

Methods: The authors chose to review retrospectively 24 patients with extraskeletal Ewing's sarcoma treated at the study institution with modern multimodality therapies.

Early histologic appearance of human patellar tendon autografts used for anterior cruciate ligament reconstruction.

Nine patients underwent second-look arthroscopy and biopsy between 3 and 8 weeks after anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon. All nine biopsies were taken from the central region of the graft. Every biopsy revealed viable cells in two different patterns.

Paclitaxel (Taxol) plus doxorubicin plus filgrastim in advanced sarcoma: a phase II study.

The authors evaluated the novel chemotherapeutic regimen of paclitaxel (Taxol, Bristol-Myers Squibb, Princeton, NJ, U.S.A.

Surface-based hemangioma of bone: three case studies and a review of the literature.

Three cases of surface-based hemangiomas were reviewed. The cases illustrate the plain film and magnetic resonance imaging findings of these benign tumors, which can appear quite aggressive, mimicking more aggressive neoplasms. Each of the patients underwent en bloc excision, and pathologic evaluation to determine the diagnosis.

Tissue matrix protein expression in human osteoblasts, osteosarcoma tumors, and osteosarcoma cell lines.

Treatment for osteosarcoma is problematic because there are no prognostic markers. Diagnosis is primarily limited to cytologic grading. Oncogenesis alters cell structure therefore osteoblast tissue matrix proteins (extracellular matrix, cytoskeletal, intermediate filament, and nuclear matrix proteins), components of the cell substructure, are candidates for osteosarcoma markers.