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Öztürk R, Zengin UB, Yukruk FA, Yücel K, Öztürk F, Kösemehmetoğlu K. A challenging case of an adamantinoma of fibula with soft tissue mass harboring distinct histopathology. Int Cancer Conf J 2024; 13:209-213. [PMID: 38962053 PMCID: PMC11217246 DOI: 10.1007/s13691-024-00658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/04/2024] [Indexed: 07/05/2024] Open
Abstract
We present a case of adamantinoma that originated from the fibula and had a large soft tissue component measuring approximately 6 cm. Clinical, radiological, and pathological investigations initially suggested that the tumor might be a bone-invading synovial sarcoma. To the best of our knowledge, no other case of fibular adamantinoma with such a large soft tissue component has been reported in the literature.
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Affiliation(s)
- Recep Öztürk
- Department of Orthopaedics and Traumatology, Dr.Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Umut Baran Zengin
- Department of Orthopaedics and Traumatology, Dr.Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Fisun Ardic Yukruk
- Department of Pathology, Dr.Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Kemal Yücel
- Department of Orthopaedics and Traumatology, Dr.Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Furkan Öztürk
- Department of Orthopaedics and Traumatology, Dr.Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Kemal Kösemehmetoğlu
- Faculty of Medicine, Department of Pathology, Hacettepe University, Ankara, Turkey
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Sen S, Kar A, Das A, Naik B. Excision of a Distal Tibial Interosseous Osteochondroma Through Posterolateral Approach: A Case Report. Cureus 2024; 16:e59592. [PMID: 38832143 PMCID: PMC11144583 DOI: 10.7759/cureus.59592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Osteochondromas arising from the interosseous border of the distal tibia are rare, but cases have been reported previously in the literature. In long-standing cases, they can cause a "mass effect" resulting in the deformation of the bones around the ankle joint, mechanical restriction of joint movement, and even degenerative joint disease. Hence, they need to be resected if patients present with such impending complications. Several surgical techniques have been described previously for tumor resection including the anterior approach and the trans-fibular approach, the latter of which required a fibular osteotomy with or without fibular reconstruction. The surgical technique described here utilizes the posterolateral approach to the ankle joint for tumor excision, thus avoiding the need for any osteotomy or fibular reconstruction and reducing the risk of injury to major neurovascular structures. It also reduces the need for long-term immobilization and promotes a faster return to activity.
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Affiliation(s)
- Soumyadip Sen
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
| | - Abheek Kar
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
| | - Abhishek Das
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
| | - Balesh Naik
- Orthopaedics, Apollo Multispeciality Hospitals, Kolkata, IND
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Nunez-Villaveiran T, Zamora P, Masia J, Fernández-Garrido M. Ankle joint salvage surgery with an ipsilateral mid-fibula osteocutaneous free flap and contralateral anterolateral thigh free flap: A case report and literature review. Microsurgery 2022; 42:490-499. [PMID: 35083775 DOI: 10.1002/micr.30864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/01/2021] [Accepted: 01/07/2022] [Indexed: 11/11/2022]
Abstract
The tibiofibular joint can be reconstructed after distal fibular sarcoma salvage surgery to maintain ankle stability and achieve early gait. Classical reconstructive options include ligamentoplasties, arthrodesis, prosthetic replacement, bone grafts, and pedicled ipsilateral or free contralateral fibular bone flaps. We present a novel strategy for reconstruction of the ankle in an elderly patient and a literature review. A 68-year-old man presented with a high-grade myxofibrosarcoma to his distal fibula. Wide resection of the tumor and adjacent structures left a 12 × 12 × 8 cm defect including the distal fibula (10 cm), a 2 cm fragment of the lateral cortex of the tibia, the lateral anterior and superficial posterior compartments, and the lateral compartment. A 3 cm distal fibula remnant was left in the ankle mortice. Reconstruction was performed using a free ipsilateral 13-cm diaphyseal osteocutaneous fibular flap telescoped into the distal fibula remnant and anastomosed to the anterior tibial artery. A pre-bent L-shaped locking plate was used to reconstruct a syndesmotic joint. A 21 × 13 cm suprafascial ALT flap was anastomosed to the proximal stump of the peroneal artery to cover the soft tissue defect. The patient had no complications and was ambulating with full weight bearing by postoperative week 11. He received postoperative chemo and radiotherapy. Three years postoperatively, he is tumor free, has complete ankle ROM and stability, and ambulates with no restrictions. Limb sparing surgery with a functional tibiofibular joint reconstruction should be considered to attain an early functional recovery after distal fibula sarcomas resection.
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Affiliation(s)
- Teresa Nunez-Villaveiran
- Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paul Zamora
- Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jaume Masia
- Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Manuel Fernández-Garrido
- Plastic and Reconstructive Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Wang J, Du Z, Yang R, Tang X, Guo W. Lateral malleolus en bloc resection for the distal fibula osteosarcoma based on a new classification and proposed reconstruction choice: Analysis of 6 cases prognosis and literature review. Foot Ankle Surg 2020; 26:855-863. [PMID: 31874789 DOI: 10.1016/j.fas.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Amputation has been regarded as the standard surgical treatment for distal fibula osteosarcoma. With the advances in surgery and adjuvant chemotherapy, it have made limb salvage possible. However, the choice of a specific reconstruction procedure is frequently based on the surgeon's preference and it lacks of guidelines and high quality studies with the objective result on the subject. MATERIALS AND METHODS Six patients with the distal fibular osteosarcoma which were received biological reconstruction were retrospectively reviewed at our bone tumor center from November 2003 to November 2015. There were 6 male with a mean age of 24.2 years (range, 12-47 years). The minimum follow-up duration was 53.3 months (median, 96.3 months; average, 108.4 months; range, 53.3-204.1 months). No patient was lost at the last follow-up. All data were obtained from the clinical and radiograph records. Furthermore, the literature review was based on the Google Scholar, Medline, EMBASE and Pubmed databases. The search was performed using the terms "distal fibula", "lower limb tumour", "sarcoma", "fibular metastasis" and "limb-salvage surgery" for the literature review from 1979 to 2017. RESULTS Of the six patients with the final follow-up in the present study, four cases (83.3%, 4/6) achieved excellent prognosis without oncologic complications. A second surgical procedure was performed in two patients, one to treat local recurrence and one to receive metastasectomy due to the pulmonary metastasis. Case 6 received the below knee amputation due to recurrence. All the cases available for functional evaluation at the final follow-up had a mean functional MSTS score of 29.6 (range, 28-30) except case 6 receiving the amputation below the knee. Meanwhile, the VAS evaluation had a mean functional score of 0.2 points (range, 0-1 points). The results of our cohort and literature review illustrated that the patient with the malignant tumor of lateral malleolus could obtain excellent oncological prognosis and ankle function. CONCLUSIONS We have provided treatment recommendations depending on the tumor volume and associated extent and proposed the primary ankle arthrodesis was performed after en bloc resection of Type II and III lateral malleolus osteosarcoma, based on the proposed classification. Furthermore, the patient with the malignant tumor of lateral malleolus could obtain excellent oncological prognosis.
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Affiliation(s)
- Jun Wang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044 Beijing, China.
| | - Zhiye Du
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044 Beijing, China.
| | - Rongli Yang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044 Beijing, China.
| | - Xiaodong Tang
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044 Beijing, China.
| | - Wei Guo
- Peking University People's Hospital, Musculoskeletal Tumor Center, No. 11 Xizhimen South Street, 100044 Beijing, China.
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Prajapati A, Gulia A, Hegde P, Puri A. Is minimal reconstruction (meshplasty) adequate to restore ankle function after excision of distal fibula tumors? J Clin Orthop Trauma 2020; 11:467-470. [PMID: 32405211 PMCID: PMC7211805 DOI: 10.1016/j.jcot.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reconstruction modalities described after distal fibula resection varies from no reconstruction to size matched allograft or reconstruction with ipsilateral proximal fibula. Every procedure has their own limitation. We used Prolene mesh to reconstruct lateral restraint (Meshplasty) after distal fibulectomy. QUESTION Is a minimal reconstruction using prolene mesh (meshplasty) adequate to restore ankle stability and function post distal fibula resection? METHOD This retrospective analysis was performed in patients who underwent distal fibulectomy at the tertiary cancer hospital in India, between 01/01/2006 and 31/12/2016. Distal fibulectomy was performed through standard lateral approach. A prolene mesh was anchored to distal tibia and talus using screws or Ethibond sutures. Rehabilitation protocol included below knee cast for 6 weeks followed by gradual full weight bearing mobilization and ankle range of motion. Total 9 patients with mean age of 25 years (range: 13-43) got operated for distal fibulectomy during this period. Mean resection length was 13.3 cm (range: 9-20). RESULTS Seven patients were available for final assessment at a median follow-up duration of 78 months (range: 34-161 months). Two patients developed local recurrence. Two patients developed distant recurrence both died of disease. One patient of GCT developed local recurrence in soft tissue at 30months, which was excised. Another patient of OGS developed local recurrence after 8 months along with distant recurrence. One patient of PNET developed distant recurrence at 3 months. One patient had a valgus deformity at 55 months follow up without any restriction of activity while the others had a stable ankle without any deformity. The mean MSTS score was 28 (24-29). CONCLUSION "Meshplasty" after distal fibulectomy is an easy, reproducible, time and cost effective reconstruction modality with minimal complications. It adequately restores ankle function while providing results comparable to other procedures. LEVEL OF EVIDENCE IV.
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Yoshida S, Murakami T, Suzuki K, Itou S, Watanuki M, Hosaka M, Hagiwara Y. Adamantinoma Arising in the Distal End of the Fibula. Rare Tumors 2017; 9:6823. [PMID: 28458791 PMCID: PMC5379226 DOI: 10.4081/rt.2017.6823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/06/2016] [Accepted: 02/14/2017] [Indexed: 11/22/2022] Open
Abstract
Adamantinoma is a rare, low-grade, malignant bone tumor. It frequently occurs in the tibia but rarely arise in the distal end of the fibula. This study reported a case of adamantinoma arising in the distal end of the fibula, resulting in good prognosis. A 38-year old female felt left ankle pain, and was suspected as having a bone tumor at the distal end of the fibula by X-ray. She was diagnosed as the classical adamantinoma of the fibula by open biopsy. En bloc wide resection of the tumor, primary arthrodesis of the ankle was performed. During the follow-up period of 7 years after the surgery, she has lived without any metastasis and local recurrence. A wide resection and arthrodesis of the ankle joint can provide a good outcome for adamantinoma arising in the end of the fibula.
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Affiliation(s)
- Shinichirou Yoshida
- Department of Orthopedic Surgery, Miyagi Cancer Center, Natori.,Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai
| | | | - Kentarou Suzuki
- Department of Orthopedic Surgery, Miyagi Cancer Center, Natori
| | - Shigemi Itou
- Department of Diagnostic Pathology, Miyagi Cancer Center, Natori, Japan
| | - Munenori Watanuki
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai
| | - Masami Hosaka
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai
| | - Yoshihiro Hagiwara
- Department of Orthopedic Surgery, Tohoku University Graduate School of Medicine, Sendai
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Recurrent adamantinoma in the thoracolumbar spine successfully treated by three-level total en bloc spondylectomy by a single posterior approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S514-21. [PMID: 25337858 DOI: 10.1007/s00586-014-3625-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Adamantinoma is a low-grade primary malignant bone tumour with slow growth and local recurrence. Its occurrence in the spine is extremely rare, particularly with multilevel involvement. This paper wants to present the first case involving a patient with recurrent thoracolumbar spinal adamantinoma, who underwent a successful three-level spondylectomy for en bloc resection. METHODS A 24-year-old man with osteolytic masses of T11 and T12 vertebral bodies was performed curettage by a posterior approach in 2008. The pathology report showed the excised neoplasm was a rare adamantinoma. This patient underwent a tumorectomy again because of its local recurrence nearly 3 years later. In 2012, it was unfortunately revealed that the excised tumour had relapsed and had spread to the L1 vertebral body. Due to its repeated recurrence and aggressive lesion, total en bloc spondylectomy (TES) for this malignant tumour was thought to be the best option for preventing repeated recurrence and possible cure. TES for T11-L1 thoracolumbar spine was performed and spinal reconstruction was completed with instrumentation and a titanium mesh cage through a one-stage single posterior approach. RESULTS After three-level TES, neurological deficits of the patient demonstrated good recovery and no evidence of adamantinoma recurrence or deformity was found at 2-year follow-up. CONCLUSIONS This is the first case involving multilevel thoracolumbar spinal adamantinoma with repeated recurrence to be successfully treated by three-level TES by a single posterior approach.
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8
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Lateral ankle stabilization after distal fibular resection using a novel approach: a surgical technique. Clin Orthop Relat Res 2014; 472:1262-70. [PMID: 24442838 PMCID: PMC3940766 DOI: 10.1007/s11999-013-3408-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/22/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND After tumor resection involving the distal fibula, the method for recreating stability of the lateral ankle remains controversial. Many reconstructive options exist, including allograft reconstruction and arthrodesis; however, each of these approaches has significant potential disadvantages. DESCRIPTION OF TECHNIQUE The distal fibula is resected as necessary to obtain negative margins for local control of the neoplasm. Reconstruction of the lateral ankle ligamentous complex is performed using the peroneus brevis tendon to reestablish lateral and anterior stability of the tibiotalar joint. The peroneus brevis tendon is transected proximally at it myotendinous junction and then sutured to the calcaneofibular and anterior talofibular ligaments in sequence and then tenodesed to the lateral distal tibia with suture anchors and a staple. METHODS We present three patients who underwent distal fibulectomy for tumors originating in the distal fibula. All patients who have undergone the reconstruction being described are included within this cohort study. The patients were assessed clinically and radiographically at a range of 14 months to 9.5 years (average, 4.8 years) for functional recovery, return of range of motion, stability of the ankle, and imaging evidence of arthrosis and instability. RESULTS There were no episodes of instability or early progression to arthrosis. In addition, all patients obtained excellent ankle stability and range of motion on examination, but two had complications. One sustained a traumatic fracture to the base of the fifth metatarsal that healed with nonsurgical treatment and another who underwent further fibular shortening and bursectomy at the tip of the residual fibula with complete relief of his symptoms. CONCLUSIONS Reconstruction of the lateral ankle after distal fibular resection is possible using the peroneus brevis tenodesed to the distal tibia and sutured to the remnants of the calcaneofibular and anterior talofibular ligaments as described in this surgical technique. In this small group, we found that patients were able to return to normal daily activities without instability or progression to tibiotalar arthrosis at short term; however, longer followup and larger series of patients are called for to confirm these findings.
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Thakur GB, Jain M, Bihari AJ, Sriramka B. Transfibular excision of distal tibial interosseous osteochondroma with reconstruction of fibula using Sofield's technique - A case report. J Clin Orthop Trauma 2012; 3:115-8. [PMID: 26403450 PMCID: PMC3872801 DOI: 10.1016/j.jcot.2012.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022] Open
Abstract
Osteochondromas arising from the interosseous border of the distal tibia and involving distal fibula are uncommon. Considering its proximity to the ankle joint, early excision of this deforming distal tibial osteochondroma is done to avoid the future risk of pathological fracture of the distal fibula, ankle deformities and syndesmotic complications. We present a 16-year-old young girl with thinning and deformed distal fibula, secondary to an osteochondroma arising from the distal tibia which was managed with transfibular excision of mass and reconstruction of distal fibula using square nail by shoefields technique.
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Affiliation(s)
- Gopa Bandhu Thakur
- Professor, Department of Orthopaedics, Hitech Hospital, Rourkela, Odisha 769002, India
| | - Mantu Jain
- Assistant Professor, Department of Orthopaedics, Hitech Hospital, Rourkela, Odisha 769002, India,Corresponding author. House no 14, Gujrati Colony, Dinanath Lane, Rourkela, Odisha 769001, India. Tel.: +91 7587109806.
| | - Amar Jyoti Bihari
- Senior Resident, Department of Orthopaedics, Hitech Hospital, Rourkela, Odisha 769002, India
| | - Bhavna Sriramka
- Resident, Department of Anesthesia, Ispat General Hospital, Rourkela, Odisha 769002, India
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Perisano C, Marzetti E, Spinelli MS, Graci C, Fabbriciani C, Maffulli N, Maccauro G. Clinical management and surgical treatment of distal fibular tumours: a case series and review of the literature. INTERNATIONAL ORTHOPAEDICS 2012; 36:1907-13. [PMID: 22527336 DOI: 10.1007/s00264-012-1536-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 03/20/2012] [Indexed: 12/01/2022]
Abstract
PURPOSE Study reports clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours. METHODS Nine patients with distal fibular tumours were observed between 2005 and 2010. A PubMed search was performed using the terms "fibula", "lower limb tumour [cancer]", "sarcoma", "Ewing", "peroneal", "fibular metastasis", and "limb-salvage surgery". RESULTS In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 tumours. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40-100 % in case of malignancies. CONCLUSIONS Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain, limping, and pathological fractures; in malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.
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Affiliation(s)
- Carlo Perisano
- Department of Orthopedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, L go A Gemelli 1, 00168 Rome, Italy.
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Mavrogenis AF, Galanakos S, Savvidou OD, Papagelopoulos PJ. Adamantinoma of the tibia mimicking a benign cystic lesion: a case report. Clin Podiatr Med Surg 2010; 27:157-65. [PMID: 19963177 DOI: 10.1016/j.cpm.2009.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adamantinoma of the long bones is a rare primary malignant bone tumor accounting for less than 1% of all primary malignant bone tumors. Most typical imaging findings include heterogeneous osteolytic cortical lesions showing multiple sharply circumscribed lucent zones of various sizes with sclerotic bone surroundings, interspersing between, and extending above and below the lucent zones by the thinning and bulging cortex. Advanced or recurrent lesions may be associated with destruction of the cortex and soft tissue extension. In this article, the authors present a case report of a patient with a distal tibia adamantinoma mimicking a benign cystic lesion.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, Attikon University General Hospital, Athens University Medical School, 15123 Amarousio, Athens, Greece
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12
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Reconstruction after wide resection of the entire distal fibula in malignant bone tumours. INTERNATIONAL ORTHOPAEDICS 2009; 35:87-92. [PMID: 20039038 DOI: 10.1007/s00264-009-0931-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 11/29/2009] [Accepted: 11/30/2009] [Indexed: 12/16/2022]
Abstract
In this study we present a series of patients (n = 11) with resection of the entire distal fibula in the case of sarcoma or metastasis. Moreover, we describe a new method to restore ankle stability with a tibiotalocalcaneal arthrodesis using a retrograde hindfoot nail (n = 4) in contrast to tibiotalar arthrodesis with screws (n = 5). The screw fixation failed in two patients due to osteopoenic bone. The crucial benefits of an arthrodesis with a retrograde nail are a stable arthrodesis, intramedullary stabilisation of the tibia and avoidance of extrinsic material in the wound area. An arthrodesis with a retrograde nail is a good alternative for reconstruction after a wide distal fibula resection. The additional arthrodesis of the subtalar joint was not associated with worse functional results in the MSTS and TESS scores.
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Abstract
Adamantinoma is rare, representing less than 1% of all primary malignant bone tumours. It is a slow growing low grade malignant tumour which is often clinically, radiologically and histologically mistaken for many other tumours like Ewing's sarcoma, synovial sarcoma, fibrosarcoma, metastatic carcinoma, fibrous cortical defect and osteofibrous dysplasia. Adamantinoma commonly occurs in the tibia. It is also known to occur in the fibula, femur, humerus, radius and ulna. Adamantinoma of the foot is extremely rare. There are few reported cases of metatarsal and cuneiform bone involvement. To our knowledge adamantinoma of the calcaneum has not been previously reported in the literature. We report the case of a male patient, aged 33 years, who was treated for adamantinoma of the calcaneum and followed for 16 years highlighting the difficulty in diagnosis and management of this rare tumor occurring at a rare site.
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Van Rijn R, Bras J, Schaap G, van den Berg H, Maas M. Adamantinoma in childhood: report of six cases and review of the literature. Pediatr Radiol 2006; 36:1068-74. [PMID: 16906392 DOI: 10.1007/s00247-006-0272-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 06/01/2006] [Accepted: 06/04/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adamantinoma is a rare slow-growing malignant bone tumour. OBJECTIVE To describe the imaging appearances of six childhood cases and review the published literature. MATERIALS AND METHODS The database of the Working Group on Paediatric Oncology, Academic Medical Centre/Emma Children's Hospital Amsterdam, was searched for cases of adamantinoma. Additionally a literature study was performed to identify cases of adamantinoma in childhood. RESULTS We identified six local cases of adamantinoma of the long bones, two boys (age 3 and 8 years) and four girls (mean age 8.8 years, range 3.0-14.0 years). The location of the tumour was the tibia in five and the tibia and fibula in one patient. In two patients initially a different diagnosis was made, which led to a delay in appropriate treatment. None of the children showed pulmonary metastases and all underwent total gross resection. On follow-up (mean 6.1 years, range 1.6-12.0 years) all children remained disease-free. Besides a discussion of our six patients, imaging features, histopathology, surgical approach and a literature review of childhood adamantinomas is presented. CONCLUSION Although the incidence of adamantinoma is low, it is important to recognize this rare bone tumour, since in the early stages of the disease adequate treatment will result in an excellent prognosis.
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Affiliation(s)
- Rick Van Rijn
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, Amsterdam, Zuid-Oost 1105 AZ, The Netherlands.
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Papagelopoulos PJ, Savvidou OD, Mavrogenis AF, Galanis EC, Shaughnessy WJ, Unni KK, Sim FH. Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors. Clin Orthop Relat Res 2005:209-18. [PMID: 16056051 DOI: 10.1097/01.blo.0000164356.99795.a2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Four children and six adults required en bloc resection of the lateral malleolus for malignant tumors. There were four osteosarcomas, three chondrosarcomas, two Ewing's sarcomas, and one adamantinoma. Surgical margins were wide in seven patients, marginal in two, and intralesional in one. A primary ankle arthrodesis was done in four adults and bracing without any reconstruction was done in four children and two adults. During a mean followup of 14.5 years (range, 3-30 years), there were two local recurrences (two of 10 patients) after a marginal excision and an intralesional excision. One patient had reoperation for a skip osteosarcoma lesion in the proximal fibula. Other complications included chronic osteomyelitis, a lateral talus subluxation and cavovarus deformity, and recurrent ankle instability and degenerative changes of the ankle. At the latest followup, all 10 patients showed no evidence of disease. Five patients who had primary or late ankle arthrodesis had a Musculoskeletal Tumor Society and International Society of Limb Salvage functional score of 28 points (92%), and two adolescents who had postoperative bracing alone had a functional score of 24 points (80%). The three remaining patients had a salvage amputation. LEVEL OF EVIDENCE Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
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16
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Fuiko R, Mühlbauer M, Sulzbacher I, Trattnig S, Ritschl P. Lesion of the right proximal tibia in a 12-year-old boy. Clin Orthop Relat Res 2004:266-71. [PMID: 15043129 DOI: 10.1097/00003086-200401000-00046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Reinhard Fuiko
- Department of Orthopaedics Hospital Gersthof, Vienna, Austria.
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17
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Abstract
Lateral ligamentous instability may result after an inversion injury to the ankle. Although it generally responds well to nonsurgical treatment, recurrent cases may warrant surgical intervention. There is extensive literature detailing various procedures designed to restore lateral ankle stability. We describe a case in which a patient had a distal fibulectomy for multiple symptomatic osteochondromas, with reconstruction of the lateral ligament complex using peroneus brevis tendon. The patient subsequently disrupted this surgical construct with a severe inversion injury and had recurrent lateral ankle instability. The lateral ligament complex then was reconstructed using a tibiotalar bone-tendon allograft directed to counteract inversion forces. Fourteen years after the procedure, the patient remains satisfied with a painless, stable ankle. The described technique provides a salvage reconstruction of the lateral ligament complex using allograft tissue, in the unique setting of an absent fibula and deficient peroneus brevis tendon.
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Affiliation(s)
- Edwin P Su
- Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA
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18
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Putnam A, Yandow S, Coffin CM. Classic adamantinoma with osteofibrous dysplasia-like foci and secondary aneurysmal bone cyst. Pediatr Dev Pathol 2003; 6:173-8. [PMID: 12574919 DOI: 10.1007/s10024-002-8812-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2002] [Accepted: 10/10/2002] [Indexed: 10/27/2022]
Abstract
Adamantinoma, a rare bone lesion of the tibia and fibula, has two distinct variants, classic adamantinoma and osteofibrous dysplasia-like adamantinoma. Composite lesions have not been described. Aneurysmal bone cyst is a benign cystic lesion which may also occur in the tibia and fibula. We report an unusual case of classic adamantinoma with osteofibrous dysplasia-like areas and foci of secondary aneurysmal bone cyst with prominent giant cells. A lesion was diagnosed in a 17-year-old girl with a 14-year history of a slowly enlarging left tibial mass and increasing deformity. Pathologically, the predominant pattern was classic adamantinoma, with minor foci of osteofibrous dysplasia-like adamantinoma and areas of secondary aneurysmal bone cyst with abundant multinucleated giant cells. We report the clinical, radiologic, and pathologic features of this case, and summarize lesions associated with secondary aneurysmal bone cyst. To our knowledge, the association of adamantinoma with secondary aneurysmal bone cyst has not been previously reported.
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Affiliation(s)
- Angelica Putnam
- Department of Pathology, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, UT 84132-2501, USA
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19
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Abstract
Ten cadaver specimens were used to study the effect of distal fibular resection and ligamentous repair on ankle laxity. The distal fibula was resected sequentially at three levels. Talar tilt and anterior drawer were measured on stress radiographs after resection and then after ligament repair. Sequential resection of the distal fibula caused a progressive increase in talar tilt and anterior drawer at each cut level (p < 0.5), regardless of whether the ligaments were repaired or not. Ligament repair significantly decreased talar tilt at cuts above the ATFL insertion and decreased anterior drawer at cuts at the tibiotalar level, but these values did not approach control values.
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Affiliation(s)
- R B Jones
- University of Tennessee-Campbell Clinic, Department of Orthopaedic Surgery, Memphis 38103, USA
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