Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies.

Objective: To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate?

Materials And Methods: This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies.

Soft tissue angiofibroma: a case report.

Soft tissue angiofibroma is a recently described neoplasm that typically presents as a slowly growing, painless mass in the soft tissues of the lower extremities. Cytogenetic and molecular studies have identified a recurrent t(5;8) translocation. Treatment is simple excision.

Giant cell tumor of bone.

Giant cell tumor (GCT) of bone is one type of giant cell-rich lesion of bone. This benign mesenchymal tumor has characteristic multinuclear giant cells. Mononuclear stromal cells are the physiologically active and diagnostic cell type.

Low-dose neoadjuvant external beam radiation therapy for soft tissue sarcoma.

Purpose: For soft tissue sarcoma, neoadjuvant external beam radiation therapy (EBRT) to 50 Gy has the same local control (LC) and overall survival as postoperative radiation therapy (PORT) to 60 Gy, but with increased wound complications. We examined whether low-dose neoadjuvant EBRT would decrease acute toxicity while maintaining LC.

Methods And Materials: From 1971 to 2008, 1,765 patients with nonmetastatic soft tissue sarcoma were treated with radiation therapy at Massachusetts General Hospital.

Factors predicting local recurrence, metastasis, and survival in pediatric soft tissue sarcoma in extremities.

Background: Pediatric soft tissue sarcomas are rare and differ from those in adults regarding the spectrum of diagnoses and treatment. Sarcomas in extremities may have different prognoses from those located elsewhere.

Questions/purposes: We sought risk factors predicting local recurrence, metastasis, and overall survival and asked whether radiation and chemotherapy influenced local recurrence, metastasis, and overall survival.

An effective preoperative three-dimensional radiotherapy target volume for extremity soft tissue sarcoma and the effect of margin width on local control.

Purpose: There is little information on the appropriate three-dimensional (3D) preoperative radiotherapy (XRT) volume for extremity soft-tissue sarcomas (STS). We retrospectively analyzed the pattern of local failure (LF) to help elucidate optimal field design.

Methods And Materials: We analyzed the 56 patients who underwent computed tomography-planned XRT for Stage I to III extremity STS between June 2000 and December 2006.

Role of sentinel lymph node biopsy in the staging of synovial, epithelioid, and clear cell sarcomas.

Background: Soft tissue sarcomas generally have a
Methods: 29 patients with nonmetastatic synovial, epithelioid, and clear cell sarcomas who underwent SLNB were examined.

Radiation therapy for control of soft-tissue sarcomas resected with positive margins.

Purpose: Positive margins (PM) remain after surgery in some soft-tissue sarcoma (STS) patients. We investigated the efficacy of radiation therapy (RT) in STS patients with PM.

Methods And Materials: A retrospective chart review was performed on 154 patients with STS at various anatomic sites with PM, defined as tumor on ink, who underwent RT with curative intent between 1970 and 2001.

Treatment and outcome of 82 patients with angiosarcoma.

Background: Angiosarcomas are an uncommon type of malignancy that are generally thought to behave usually in a locally aggressive fashion; they often metastasize to distant sites.

Methods: Patients with a diagnosis of angiosarcoma treated at our institution between 1980 and 2006 were analyzed for patient demographics, tumor characteristics, multimodality treatment, and outcomes.

Results: A total of 82 patients were divided into those with primary and advanced disease.

Primary periosteal lymphoma--rare and unusual.

We describe a primary periosteal lymphoma that involved only the periosteum without affecting the adjacent medulla or the regional lymph nodes. No other lymphomatous foci were found in either the distant lymph nodes or viscera. This unusual presentation simulates the imaging appearance of surface lesions of bone, namely benign and malignant tumors, and departs from the typical appearance of primary lymphoma of bone.

Tumors of the shoulder girdle: a review of 194 cases.

The upper extremity is the third most common site of primary bone and soft-tissue tumors. The purpose of this study was to determine the types and prevalence of bone and soft-tissue tumors that occur in the shoulder girdle and to identify physical findings that may be indicative of malignancy. This is a retrospective review of 194 consecutive neoplasms of the shoulder girdle seen by the senior author from 1996 through 2000.

A novel surgical procedure for bridging of massive bone defects.

BACKGROUND: Bony defects arising from tumor resection or debridement after infection, non-union or trauma present a challenging problem to orthopedic surgeons, as well as patients due to compliance issues. Current treatment options are time intensive, require more than one operation and are associated with high rate of complications. For this reason, we developed a new surgical procedure to bridge a massive long bone defect.

Metaphyseal fibrous defects.

Nonossifying fibromas and fibrous cortical defects are the most common benign lesions of the skeletal system. They are frequently detected incidentally on radiographs taken for an unrelated reason. The diagnosis is routinely made solely on the basis of the history, physical examination, and radiographic appearance.

A solitary lesion of talus with mixed sclerotic and lytic changes: Rosai-Dorfman disease of 25 years' duration.

Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is an unusual form of histiocytic disorder predominantly affecting children and young adults. Bone lesions are infrequent. We describe a 63-year-old woman with a solitary lesion of the talus which was misdiagnosed for 25 years.

Clinical outcome in chordoma: utility of flow cytometry in DNA determination.

Study Design: A retrospective review of 100 patients with chordoma of the lumbar spine and sacrum. Twenty-three patients had flow cytometry data available and a minimum follow-up period of 5 years.

Objectives: To determine whether DNA content and cell cycle analysis were associated with patient outcome.