RESUMEN
Extensive osteoarticular allografts have been used for knee reconstruction, but because of their composite nature and the technical difficulty of the procedure, complication and failure rates have been high. There are few records of long-term results in the literature. In this report, a 19-year-old man with a large aggressive giant cell tumour of the left distal femur was treated in 1976 by en bloc resection, massive femoral allografting and ligamentous reconstruction. Follow-up after 18 years showed no recurrence of the tumour, excellent incorporation of the graft and good knee function, which allowed the patient to work 9 hours a day on his feet without pain.
Asunto(s)
Trasplante Óseo , Ligamentos Colaterales/cirugía , Neoplasias Femorales/cirugía , Fémur/trasplante , Tumor Óseo de Células Gigantes/cirugía , Articulación de la Rodilla , Adulto , Neoplasias Femorales/epidemiología , Estudios de Seguimiento , Tumor Óseo de Células Gigantes/epidemiología , Humanos , Articulación de la Rodilla/fisiología , Masculino , Rango del Movimiento Articular , Factores de Tiempo , Trasplante HomólogoRESUMEN
The authors report the results of a histological and ultrastructure study of a case of a protuberant dermatofibrosarcoma evolving for the last 25 years with 27 relapses. Histologically the tumour is dermic, non-encapsulated, invading the hypodermis right from the beginning and mainly made up of fusiform cells which often have a storiform appearance and proliferate in a varying degree of collagenous stroma which includes an oedematous or myxoid component. During the course of the evolution of this tumour, there were zones of cystic degeneration, but in the last 10 relapses in 1978 and 1979, we noted the predominance of cellular and compact zones with an increase in the number of mitoses. The ultrastructure study showed tumour cells containing a fairly well developed endoplasmic reticulum in the cytoplasm, a prominent Golgi apparatus and some pinocytic vesicles. Some of the cells also contained lysosomes and phagolysosomes, whereas others contained cytoplasmic filaments and contractile elements. The nuclei were in general elongated and irregular. Sometimes the cytoplasmic membrane was covered by an amorphous substance with a membranoid appearance. Between the cells sometimes there were junctions of the tight kind. In conclusion, the authors consider that this tumour has the histological characteristics of a protuberant dermatofibrosarcoma and at the ultrastructure level, it is made up of cells which put it in the group of myofibroblastic and histiocytic proliferating lesions.