PMC6815582_01
T2-weighted MRI showing a huge extraskeletal mass of pelvic Ewing sarcoma at diagnosis (a) and good response after preoperative chemotherapy (b).
CRIOR2019-9024643.001.jpg
PMC6815582_01_CRIOR2019-9024643.001.jpg
fig1
Magnetic resonance imaging (MRI) showed an extraosseous bulging mass (Figure 1(a)). MRI after chemotherapy resulted in remarkable tumor reduction (Figure 1(b)).
Plain radiographs showing serial changes of implanted UDPHAp, just after surgery (a), at 1 month after surgery (b), 9 months (c), 1 year 2 months (d), 2 years 1 month (e), and 5 years 10 months (f).
CRIOR2019-9024643.002.jpg
PMC6815582_01_CRIOR2019-9024643.002.jpg
fig2
The defect after fibular resection was filled with six 2 cm-long column-shaped UDPHAp implants and one 1 cm-long column-shaped UDPHAp implants (Figure 2(a)). A plain radiograph at one month after surgery revealed new bone formation in the gap between the remaining proximal fibula and the implanted UDPHAp, and a callus-like structure around the centrally implanted UDPHAp (Figure 2(b)). Bony union between each UDPHAp implant was observed 5 months after surgery, and slight proximal migration of the remaining distal fibula was identified without ankle valgus deformity (Figure 2(c)). Resorption of implanted UDPHAp was identified, and partial remodeling of the bone marrow cavity could be seen 1 year 2 months after surgery (Figure 2(d)). Absorption of implanted UDPHAp and new bone formation had progressed 2 years 1 month after surgery, and a bone marrow cavity was partially formed in the implanted UDPHAp (Figure 2(e)). A radiograph at final follow-up (5 years 10 months after surgery) demonstrated almost complete absorption of the implanted UDPHAp and clear formation of the cortex and bone marrow in the resected part of the fibula (Figure 2(f)).
Plain radiograph of the patient's whole legs in a standing position at 5 years 10 months showing regeneration of the left fibula.
CRIOR2019-9024643.003.jpg
PMC6815582_01_CRIOR2019-9024643.003.jpg
fig3
The length between the femoral head and the medial malleolus of tibia is equal on both sides, although there is a 1.5 cm limb length discrepancy due to tumor resection and pelvic reconstruction (Figure 3).