RESUMEN
INTRODUCTION: Giant cell tumor of the distal fibula is a very rare condition. The treatment of advanced tumors at this location can be challenging and has been described in the literature only in single cases. MATERIALS AND METHODS: We report on a patient with a stage III giant cell tumor, according to the classification of Campanacci, of the distal fibula after en bloc resection and distal fibula reconstruction with a long bone graft from the iliac crest in a second procedure. The syndesmosis was reconstructed with a periosteal flap, the capsule and ligaments with local scar tissue. RESULTS: Fifteen years after the initial treatment the patient is free of local recurrence and demonstrates an excellent clinical outcome without any signs of instability, loss of function or osteoarthritis of the ankle joint. CONCLUSION: We suggest the method to be worthwhile for treatment of this uncommon lesion in terms of recurrence and functional outcome.
Asunto(s)
Neoplasias Óseas/cirugía , Trasplante Óseo/métodos , Peroné , Tumor Óseo de Células Gigantes/cirugía , Ilion/trasplante , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Femenino , Estudios de Seguimiento , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Tumor Óseo de Células Gigantes/patología , Humanos , Estadificación de Neoplasias , Procedimientos Ortopédicos/métodos , Radiografía , Procedimientos de Cirugía Plástica/métodos , Medición de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Articulación del Tobillo/fisiopatología , Cartílago Articular/fisiopatología , Condrocitos/fisiología , Metabolismo Energético/fisiología , Interleucina-1/fisiología , Articulación de la Rodilla/fisiopatología , Osteoartritis/fisiopatología , Técnicas de Cultivo , Femenino , Glicosaminoglicanos/metabolismo , Humanos , Masculino , Proteoglicanos/metabolismo , Valores de Referencia , Regeneración/fisiologíaRESUMEN
Many studies have shown increased anabolic activity in osteoarthritic cartilage and have suggested changes in the cellular phenotypes of articular chondrocytes. Most of these studies relied on non-quantitative technologies, which did not allow the estimation of the relative importance of the different differentiation phenomena. In the present study, we developed and used quantitative PCR assays for collagen types I, II(total), IIA, III, and X as marker genes indicating cellular synthetic activity (collagen type II) as well as differentiation pattern of chondrocytes (collagen types I, IIA, III, and X) and quantified these genes in normal, early degenerative, and late stage osteoarthritic cartilage in parallel. At first sight, our results confirmed previously published data showing hardly any expression of collagen genes in normal and significantly enhanced expression in osteoarthritic cartilage. This included collagen types II, III, and IIA, but also collagen types I(alpha1) and X. However, if one considers the ratios of the various markers of chondrocytic differentiation in comparison to collagen type II, the main synthetic product of differentiated chondrocytes, no shift in the cellular phenotype was detectable. In fact, expression ratios remained constant or were even decreased in osteoarthritic cartilage. Our results confirm that normal adult human articular chondrocytes display hardly any expression activity of the collagen types investigated, whereas osteoarthritic chondrocytes show very increased synthetic activity. The largely unchanged ratios of collagen subtypes investigated indicate that no general shift in the cellular phenotype does occur in osteoarthritic cartilage as suggested by previous investigations.
Asunto(s)
Condrocitos/patología , Condrocitos/fisiología , Osteoartritis de la Rodilla/patología , Osteoartritis de la Rodilla/fisiopatología , Adulto , Anciano , Biomarcadores , Cartílago Articular/patología , Cartílago Articular/fisiopatología , Diferenciación Celular , Colágeno Tipo I/genética , Colágeno Tipo II/genética , Colágeno Tipo III/genética , Colágeno Tipo X/genética , Expresión Génica , Humanos , Persona de Mediana Edad , Fenotipo , Polimerasa TaqRESUMEN
The prevalence of osteoarthritis (OA) is lower in some joints, i.e., the ankle, than in the knee. We have compared the cartilages from these two joints of the same limb in adult donors (matched pairs). Our data to date suggest that there are metabolic, biochemical and biomechanical differences between the cartilages of the two joints. The current study has focused on extending the metabolic studies comparing the response of chondrocytes to Interleukin-1beta (IL-1beta) and osteogenic protein 1 (OP-1) by analyzing changes in sulfate incorporation into glycosaminoglycans (GAGs) as a measure of proteoglycan (PG) synthesis. Human adult chondrocytes from normal knees (tibiofemoral) and ankles (talocrural) joints cultured as explants both responded to IL-1beta after 72 h by decreasing PG synthesis; however, the IC50 for the knee chondrocytes was 6.2 pg/ml, while that for the ankle was 35 pg/ml. When the explants were incubated for 72 h with IL-1beta and allowed to rebound without IL-1beta, synthesis of PG was significantly elevated by ankle chondrocytes within five days; knee chondrocytes were unable to significantly increase synthesis even after eight days. However, in both knee and ankle, application of OP-I enhanced PG synthesis in the rebound phase. In response to IL-1, an upregulation of proteinase activity was detectable by an increase in the neoepitopes proteolytically-generated by both aggrecanase and matrix metalloproteinases (MMPs), in the deep zone of the knee cartilage. Stromelysin and collagenase were upregulated as well. The data emerging from these studies confirm that the ankle is less responsive to catabolic stimulation and more responsive to anabolic stimulation following IL-1 removal. These differences in metabolic activity between the cartilages of the two joints could in part help to explain their differences in susceptibility to OA.