Adamantinoma of the tibia. Report of two cases

Adamantinoma of long bones. A clinicopathologic study of 85 cases

A study of 85 adamantinomas of long bones revealed that 70 were in the tibia (11 of which also involved the fibula), six were in the femur, three were in the ulna, two were in the humerus, two were in the fibula, one was in the radius, and one arose in the soft tissue anterior to the tibia. Most patients presented with pain and swelling and were aged 10 to 30 years. The histologic appearance was that of epithelial islands in a fibrous stroma, usually with a prominent vascular pattern and a transition between the two. Twenty-six (31%) patients had recurrent local disease, 13 (15%) developed lung metastasis, and six (7%) had lymph node metastasis. Nine patients with lung metastasis had preceding recurrent local disease. Risk factors for recurrent or metastatic disease included male sex, pain, symptoms of less than 5 years' duration, and initial treatment by biopsy, curettage, excision, or resection. The only histologic feature associated with an increased recurrence rate was lack of squamous differentiation. Eleven patients died of their disease, and seven are alive with metastatic disease. Forty-one patients were still alive without disease 1 month to 47 years after treatment. Our results indicate that amputation or, when technically feasible, wide en bloc resection is the treatment of choice. All patients require long-term follow-up for evidence of local recurrence or lung metastasis.

Adamantinoma associated with fibrous dysplasia

Three cases of adamantinoma of the tibia, seen in one hospital over a period of 7 years, are described. They illustrate the difficulty in differentiating this lesion from fibrous dysplasia on radiographic and histological grounds. Thermography may help in the differential diagnosis.

Adamantinoma of long bones: clinical, pathological and ultrastructural features

The clinical, pathological and ultrastructural features of two cases of tibial adamantinoma are described. Both lesions showed identical features with a mixed histological picture exhibiting baseloid, tubular and squamous differentiation and a prominent stromal (mesenchymal) component. By light microscopy there appeared to be an intimate relation between the epithelial and mesenchymal components. By electromicroscopy the cellular constituents of these components could be readily distinguished. In the former the cells contained tonofilaments and desmosomes which were associated with basement membrane material. In the latter (mesenchymal component) none of these features was notes, instead the cells appeared similar to fibroblasts and occasional myofibroblasts.

Adamantinoma of the tibia -- a case report and a statistical review of reported cases

A case of adamantinoma of the tibia is reported. A 70-year-old man complained of a painful swelling over the lower front of the right tibia. Roentgenograms showed an oval well-circumscribed, multilocular cystic lesion. Curettage and bond grafting were performed, and 17 months later the patient is in good condition. Microscopically the tumor tissue consisted mainly of epithelial islands with an palisading at the periphery and a loose reticular pattern in the center of the tumor cell nests, showing a close resemblance to the ameloblastoma of the jaw bones. Electron micrographs revealed the epithelial nature of the tumor cells, l.e., a continuous basal lamina, desmosomes and bundles of microfilaments, probable tonofilaments. One hundred fifty six cases of this peculiar primary skeletal bone tumor previously reported in the literature were reviewed and discussed.