Chordomas are rare neoplasms originating from notochordal remnants. They usually affect the midline and the standard treatment consists of surgery and radiotherapy. The present study investigates the expression of survivin, DR4 and DR5 to evaluate potential molecular targets for future therapy-strategies.

The study-group included 33 chordomas obtained from 21 male and 9 female patients. At time of diagnosis the patients’ age ranged from 24 to 80 years (51.9 ys.). Tumours were located on the scull-base, in the sacral/coccygeal area and the column in 13, 10, and 7 cases, respectively. Tumour-volume, known in 16 cases, ranged from 3.6 to 668.2 cm3 (mean size 130.7cm3). Immunohistochemistry was performed with antibodies against survivin, DR4, DR5. The staining pattern (cytoplasmic and/or nuclear), percentage of positive tumour-cells and staining-intensity were evaluated.

Histologically the tumours were classified as classic, chondroid and dedifferentiated chordomas in 27, 2 and 1 case, respectively. Survivin expression was obtained in 87.5% of the cases. The staining pattern was cytoplasmic in all cases and an additional nuclear staining was detected in two. Staining-intensity was predominantly weak. In 87.9% of cases DR4 staining was investigated in more than 10% of the tumour-cells. The immunoreaction was cytoplasmic (87.9%) and a nuclear staining was additionally detected in two cases. The staining-intensity was predominantly weak. In 81.8% of the chordomas DR5 staining was obtained in more than 10% of the tumour-cells. The staining pattern was cytoplasmic (84.4%) and in one case cytoplasmic and nuclear. The staining-intensity was predominantly moderate.

We hypothesise, based on the availability of new chemo- or immunotherapeutic agents like Mapatumumab (agonistic human monoclonal antibody to DR4, tested in solid tumours) and YM155 (new small-molecular inhibitor of survivin, tested in solid tumours and lymphoma), that survivin, DR4 and DR5 may act as potential molecular targets in future therapy of chordomas.

Introduction: Ruptures of the glutaeus minimus tendon at the greater trochanter may be a reason for persisting pain after total hip replacement. The aim of this study was to investigate the frequency of the rupture of the glutaeus minimus tendon at the greater trochanter in patients with osteoarthritis of the hip.

Patients and Methods: From May until August 2004, total hip joints were implanted in 67 conscutive patients with osteoarthritis of the hip joint. 54 of the operations were done with a standard Watson-Jones approach. 13 patients were operated with a minimal invasive approach without visualisation of the gluteaus minimus tendon. For the minimal invasive approach only patients with a normal appearance ot the X-ray of the greater trochanter were selected. The integrity of the insertion of the glutaeus minimus tendon was recorded during the operation with the Watson-Jones approach und compared to the X-ray findings.

Results: There were 8 complete and 13 partial ruptures of the glutaeus minimus tendon in 54 patients with the Watson-Jones approach. The mean age of the patients with rupture was 75.0 years compared to 67.2 years of the patients without rupture.The Y-rays ot the hip in two planes showed osteophytes at the greater trochanter in 18 (86 %) with a ruptur and in no patient without a ruptur. The frequnece of a complete or partial rupture of the glutaeus minimus tendon was at least 31% in the 67 patients of this study.

Conclusion: Ruptures of the glutaeus minimus tendon are common in patients with osteoarthritis o thi hip but it is unknown whether it is necessary to reinsert the tendon during the implantation of an artificial hip joint.