2002 OITE Question 107

Question

What is preferred treatment of a localized tibial diaphyseal adamantinoma?

1. Wide intercalary tibial resection

2. Wide resection and chemotherapy

3. Radiation therapy and wide resection

4. Through-knee amputation

5. Below-knee amputation 4 cm proximal to the tumor

Figures

Answer (click for answer)

Preferred Answer: 1

Adamantinoma are rare tumor of unknown origin. Occurs primarily in young males between 10 – 30 years of age (most common after skeletal maturity). The tibia is the most common site of involvement. Pts present w/ firm, slowly enlarging mass that produces minimal disability. On other occasions the presenting features will be pain, swelling or pathologic fracture. Histologically, the cells have an epithelial quality and are arranged in a palisading or glandular pattern. Because these tumors are slow growing and have a limited potential for local recurrence or metastasis treatment is wide surgical resection. Adamantinoma is highly radioresistant; chemotherapy has not been shown to be effective.

Reference: Miler MD, Brinker MR Review of Orthopeadics, 3rd edition. pp424-426