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| Year : 1985 | Volume
: 31
| Issue : 1 | Page : 57-8 |
Adamantinoma of tibia (a case report).
Surana SS, Mogra NK, Dube MK, Dhruva AK
How to cite this article:
Surana S S, Mogra N K, Dube M K, Dhruva A K. Adamantinoma of tibia (a case report). J Postgrad Med 1985;31:57 |
Adamantinoma of tibia is a rarely encountered neoplasm of dispute histogenesis and variable clinical course. Fischer[3] found the microscopic similarity of the tumor with that of adamantinoma of jaw and labelled it as adamantinoma of tibia. The present case is described because of its rare occurrence.
Mrs. S.K., aged 35 years, was admitted at Jhunjhnu Hospital with gradually increasing, painful swelling in the lower half of left leg far the last 2 months. On examination, a painful swelling was found; It was about 4 x 2 x 1 cm in size, firm, tender and situated on the anterolateral aspect of the middle one-third of the left leg. The regional lymph nodes were not palpable. X-ray examination revealed a finely trabeculated, osteolytic lesion having well-defined margins in the shaft with osteosclerotic changes and the lesion was eccentrically situated.
Biopsy with currettage was done. On gross examination, the tumor was found to be grayish white and firm with attached fibromuscular tissue. On cutting, the tumour was found to be greyish-brown and homogenous with areas of cystic degeneration; foci of haemorrhage were present.
The microscopic examination revealed masses of epithelial like cells with minimal nuclear atypia, arranged in cords and islet formations, surrounded by dense fibrous stroma. The cells were slightly oval to spindle shaped; the cytoplasm was light pink and the cytoplasmic borders were distinct at places [Fig. 1]. Thus, a diagnosis of adamantinoma of tibia was made.
Adamantinoma of the long bones is an uncommon tumour arising from tibia, humerus, femur. ulna, fibula and capitate bones.[4],[9] Approximately 100 cases of admantinoma of the long bones have been reported so far.[4]
Histological and electron microscopic studies confirm the epithelial origin of the tumour. Fisher[3] proposed that the tumour arises from the misplaced nests of epithelial cells (enamel germ layer of teeth) during the early embryonic development. However, Dockerty and Meyerding[2] suggested that implantation of cutaneous basal cells into bone as a result of trauma is the main factor. Further, Lichenstein[7] considered it as a dermal inclusion tumour of the bone. Certain morphological and histochemical evidence supports its vascular origin.[4],[5] Because of the biphasic histological pattern, it was considered as a variant of synovial sarcoma.[6] Vinogradova[10] suggested its mesenchymal origin based on tissue culture studies.
The clinical course differs in many patients, as the tumor may behave as a benign or locally malignant entity.[1] However, metastasis has also been reported.[1],[8] No evidence of regional or distant metastasis could be observed in the present case.
The treatment of choice is local resection, of the tumour.[7] Simple currettage, as carried out in the present case, has a great risk of recurrence. Others prefer to do' amputation, to avoid the increased chances of metastasis in delayed untreated cases, specially looking to the malignant potentiality of the tumour.[4],[9]
| 1. | Baker, P. L., Dockerty, M. B. and Coventry, M. B.: Adamantinoma (so-called) of the long bones. Review of the literature and report of 3 new cases. J. Bone and Joint Surg., 36A: 704-720, 1954.  |
| 2. | Dockerty, M. B. and Meyerding, H. W.: Adamantinoma of the tibia. Report of 2 new cases. J. Amer. Med. Assoc., 119: 932-937, 1942. |
| 3. | Fischer, B.: Uber ein primares Adamantinom der Tibia. Frankfurt. Zeitschr. f. Path., 12: 422-441, 1913. Quoted by Huvos and Marcove.[4] |
| 4. | Huvos, A. G. and Marcove, R. C.: Adamantinoma of long bones. A clinicopathological study of 14 cases with vascular origin suspected. J. Bone and Joint Surg., 57A: 148-154, 1975. |
| 5. | Johnson, L. C.: Congenital pseudoarthrosis, adamantinoma of long bone and intracortical fibrous dysplasia of the tibia. In, "Proceedings of the American Academy of Orthopaedic Surgeons." J. Bone and Joint Surg., 54A: 1355, 1972. |
| 6. | Lederer, H. and Sinclair, A. J.: Malignant synovioma simulating "adamantinoma of the tibia." J. Pathol. & Bacteriol., 67: 163-168, 1954. |
| 7. | Lichtenstein, L.: Dermal inclusion tumours in bone (so-called adamantinoma of limb bones). In, "Bone Tumours". 4th Edition, The C. V. Mosby Company, Saint Louis, 1972, pp. 343-348. |
| 8. | Mangalik, V. S. and Mehrotra, R. M. L.: Adamantinoma of the tibia. Report of a case. Brit. .1. Surg., 39: 429-432, 1952. |
| 9. | Moon, N. F.: Adamantinoma of the appendicular skeleton. A statistical review of the reported cases and inclusion of 10 new cases. Clin. Orthop. & Rel. Res, 43: 189-213, 1985. |
| 10. | Vinogradova, T. P.: O sosudistom genez tak nazyvaemykh adamantinom (pervichnykh epitelial'nykh opukholei) dlin-nykh trubchatykh kostei. Arkh. Patol,. 31: 14-24, 1969. Quoted by Huvos and Marcove.[4] |
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