Artikel
Adamantinoma of typical and atypical localisation
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Autoren
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B. Ulmar
- Orthopädische Abteilung Rehabilitationskrankenhaus ULM, RKU Orthopädische Klinik mit Querschnittgelähmtenzentrum, Ulm
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G. Delling
- Hamburg
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W. Puhl
- Ulm
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K. Huch
- Ulm
| Veröffentlicht: | 13. Juni 2005 |
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Gliederung
Text
Introduction
Adamantinomas are low-grade tumors of unknown histological origin and rare prevalence. The development in the diaphyses and metaphyses of the long bones, prevently the tibia is usual. The histological aspect is typical but varies enough to account for uncertainty about their histiogenesis.
Material and Methods
We report a 16 year old female with a swelling of the left lateral metatarsals and a 46 years old female with pain in projection of the left ventral tibia.
Results
The diagnostic work-up including biopsy revealed in both patients an adamantinoma. In the younger female the 4th and 5th metatarsals, in the older female the left tibia was affected. In the younger female a subtotal en-bloc resection of the metatarsal 5 and a total resection of the metatarsal 4 was performed. The reconstruction of the 5th metatarsal was done with an autologous bone graft and a plate-screw osteosynthesis. In the older female a segmental resection of the left tibia diaphysis was done. The tibial reconstruction was performed with a contra-lateral fibula blockgraft, fitted intramedullary in the tibia. An additional plate-screw osteosynthesis and a external fixateur was done. The further follow-up was uncomplicated. Actually (May 2005), both patients are well and 73 months and 24 months after intervention clinically free of disease.
Discussion
Both cases are concordant to previous cases with long cases of symptoms prior to surgery, the variable histological patterns, and the characteristic appearance in diagnostic work-up. The tibia has been described by many authors as the typical localisation. Only a few cases of Adamantinomas at the short bones, and only one additional case of an Adamantinoma at the metatarsals (Van Haelst, 1965) are described. However van Haelst concluded, that he was probably dealing with a Ewing Sarcoma. The current management in both cases suggest, that in adamantinoma a wide en-bloc resection of the tumor is effective in local tumor control. However, the possible effect of theses treatment on long-time survival remains unclear.
