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Biomedical subjects

M J Kransdorf

Publications and source records attributed to M J Kransdorf.

At least 19 recordsLinked to original sources
PubMed2000

Primary musculoskeletal tumors of fibrous origin.

Tumors of fibrous origin include fibrous dysplasia (FD), fibroxanthoma (nonossifying fibroma), cortical desmoid, desmoplastic fibroma, fibrosarcoma, and malignant fibrous histiocytosis (MFH). Benign fibrous lesions (FD, fibroxanthoma, and cortical desmoid) frequently demonstrate pathognomonic radiologic characteristics obviating the need for biopsy. Indeed, biopsy of these lesions can occasionally lead to confusion with more aggressive lesions. Desmoplastic fibroma and the malignant fibrous lesions (fibrosarcoma and MFH) often reveal nonspecific imaging features of a solitary nonmineralized lesion with aggressive characteristics. However, imaging is important as with other neoplasms in delineating the extent of involvement for staging purposes. This article reviews the spectrum of clinical characteristics, pathology, imaging appearances, treatment, and prognosis of lesions of fibrous origin in bone.

Bone Diseases↗
PubMed2000

Lesions of unknown histogenesis: Langerhans cell histiocytosis and Ewing sarcoma.

Langerhans cell histiocytosis (LCH) and Ewing sarcoma represent lesions of unknown histogenesis. Both lesions typically affect children and adolescents. Imaging features frequently suggest the diagnosis, and both lesions may demonstrate aggressive characteristics. LCH shows a broader spectrum of imaging findings, depending on lesion activity and location, which are reviewed in this article. Ewing sarcoma typically reveals both osseous and soft tissue involvement, although direct continuity of the components is often not apparent. Knowledge of the spectrum of clinical and radiologic features facilitates early diagnosis and can be used to evaluate the effects of therapy.

Bone Diseases↗
PubMed1999

Liposclerosing myxofibrous tumor: a radiologic-pathologic-distinct fibro-osseous lesion of bone with a marked predilection for the intertrochanteric region of the femur.

PURPOSE: To describe the characteristic features of liposclerosing myxofibrous tumor (LSMFT) of bone. MATERIALS AND METHODS: The radiographs and clinical histories of 39 patients (21 male, 18 female; mean age, 42 years; age range, 15-69 years) with histologically verified LSMFT of bone were retrospectively studied. RESULTS: LSMFT had a predilection for the proximal femur; more than 90% (30 of 33) of the femoral lesions were in the intertrochanteric region. Radiographs showed an indolent growth pattern with a well-defined and often extensively sclerotic margin. The bone contour either was normal or showed mild expansile remodeling. Mineralization within the lesion was not uncommon. Scintigrams showed mild to moderate focal tracer accumulation. Findings at computed tomography reflected those at radiography, whereas magnetic resonance imaging findings were nonspecific. Four (10%) patients had evidence of malignant transformation. CONCLUSION: The radiologic appearance of LSMFT in the intertrochanteric region of the femur is characteristic. The substantial prevalence of malignant transformation associated with LSMFT underscores the need for close observation of this lesion.

Adolescent↗
PubMed1998

Subcutaneous granuloma annulare: radiologic appearance.

OBJECTIVE: Granuloma annulare is an uncommon benign inflammatory dermatosis characterized by the formation of dermal papules with a tendency to form rings. There are several clinically distinct forms. The subcutaneous form is the most frequently encountered by radiologists, with the lesion presenting as a superficial mass. There are only a few scattered reports of the imaging appearance of this entity in the literature. We report the radiologic appearance of five cases of subcutaneous granuloma annulare. DESIGN AND PATIENTS: The radiologic images of five patients (three male, two female) with subcutaneous granuloma annulare were retrospectively studied. Mean patient age was 6.4 years (range, 2-13 years). The lesions occurred in the lower leg (two), foot, forearm, and hand. MR images were available for all lesions, gadolinium-enhanced imaging in three cases, radiographs in four, and bone scintigraphy in one. RESULTS: Radiographs showed unmineralized nodular masses localized to the subcutaneous adipose tissue. The size range, in greatest dimension on imaging studies, was 1-4 cm. MR images show a mass with relatively decreased signal intensity on all pulse sequences, with variable but generally relatively well defined margins. There was extensive diffuse enhancement following gadolinium administration. CONCLUSION: The radiologic appearance of subcutaneous granuloma annulare is characteristic, typically demonstrating a nodular soft-tissue mass involving the subcutaneous adipose tissue. MR images show a mass with relatively decreased signal intensity on all pulse sequences and variable but generally well defined margins. There is extensive diffuse enhancement following gadolinium administration. Radiographs show a soft-tissue mass or soft-tissue swelling without evidence of bone involvement or mineralization. This radiologic appearance in a young individual is highly suggestive of subcutaneous granuloma annulare.

Adipose Tissue↗
PubMed1998

Focal myositis.

Focal myositis is a pseudotumor of soft tissue that typically occurs in the deep soft tissue of the extremities, and is a relatively rare lesion. There is a wide clinical spectrum, with approximately one-third of patients with focal myositis subsequently developing polymyositis, and clinical symptoms of generalized weakness, fever, myalgia, and weight loss, with elevation of creatine phosphokinase. We report the case of a patient with focal myositis who subsequently developed myositis ossificans-like features.

Aged↗
PubMed1998

Magnetic resonance angiography of the hand and wrist: evaluation of patients with severe ischemic disease.

Conventional arteriography is considered the standard for the evaluation of patients with severe ischemic disease of the hand and wrist. Magnetic resonance (MR) has been shown to be a reliable noninvasive alternative to conventional arteriography. The authors prospectively evaluated this technology in 11 patients with Raynaud's syndrome and severe ischemic disease of the upper extremity. MR angiograms were compared with results from surgery in seven cases and conventional arteriography in four cases. There was excellent correlation between MR angiography and the results of surgery and conventional arteriography. In all cases, MR correctly predicted the patency or lack of patency of the distal and ulnar arteries, and superficial and deep palmar arches. In three cases, portions of the palmar arches oriented parallel to the plane were not adequately seen. Common and proper digital arteries were incompletely seen with both conventional and MR angiography. MR angiography is a reliable noninvasive method to evaluate patients with severe upper-extremity ischemic disease, accurately depicting the peripheral vessels through the level of the palmar arches. Anatomic vascular depiction is adequate for determination of patency of the major vessels for preoperative evaluation for reconstructive surgery and sympathectomy.

Adult↗
PubMed1997

The use of gadolinium in the MR evaluation of soft tissue tumors.

MRI has emerged as the preferred modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of MR in detection, diagnosis and staging, the use of intravenous contrast in the evaluation of soft-tissue tumors and tumor-like masses remains controversial. The purpose of this review is to highlight these controversies, to put them in perspective, and to make recommendations for the use of gadolinium-enhanced imaging. The following specific areas will be addressed: (1) general considerations in the evaluation of soft tissue tumors, (2) added specificity in diagnosis, (3) response to chemotherapy, (4) evaluation for local recurrence after surgery and/or radiation therapy, and (5) selection of biopsy site.

Adolescent↗
PubMed1996

Percutaneous transpedicular biopsy of vertebral body lesions.

STUDY DESIGN: This prospective study evaluates the use of transpedicular biopsy in obtaining diagnostic tissue from vertebral body lesions. OBJECTIVE: To report the authors' experience of all (N = 32) percutaneous transpedicular biopsies performed between 1990-1994. SUMMARY OF BACKGROUND DATA: Previous articles have discussed the value of open biopsy of the vertebral body using a Craig needle. A large series of closed percutaneous transpedicular biopsies have not been reported. METHODS: The authors evaluated 32 patients (26 outpatients, six inpatients) who underwent transpedicular biopsy for T1-L4 lesions of the vertebral bodies. None of the tumors had an extraosseous component. Biopsy specimens were obtained from 25 lesions using C-arm fluoroscopy; seven were guided by computed tomography. All biopsies were performed with a 14- to 17-gauge bone biopsy needle. RESULTS: The needle passed through the pedicle into the site of disease in all patients, as confirmed by C-arm fluoroscopy or computed tomography. There were 22 malignancies; four isolated compression fractures, two at T6, one at T7, one at T8; four cases of infection or inflammation; and one case each of Paget's disease and myelofibrosis. Two patients required a second biopsy because the tissue sample was suspicious for lymphoma but not diagnostic. All 26 outpatients were discharged after a 2-hour observation period. There were no complications. CONCLUSION: Transpedicular biopsy of deep vertebral body lesions using a bone biopsy needle under computed tomography or fluoroscopy guidance can be performed safely and efficaciously as an outpatient procedure.

Adult↗
PubMed1996

Parosteal osteosarcoma: value of MR imaging and CT in the prediction of histologic grade.

PURPOSE: To evaluate the use of magnetic resonance (MR) imaging and computed tomography (CT) for predicting the histologic grade of parosteal osteosarcomas. MATERIALS AND METHODS: Sixty parosteal osteosarcomas were analyzed for tumor size and location, presence of a cleavage plane, intramedullary extension, soft-tissue mass (distinct from ossified mass), and the presence and pattern of ossification. Axial and longitudinal views were evaluated for specific osseous sites within the bone. Tumors were classified as low grade (grade 1) or high grade (grades 2-3). RESULTS: There were 32 low-grade lesions and 28 high-grade lesions. Average maximal lengths of low- and high-grade tumors were 7.7 and 15.0 cm, respectively. A cleavage plane was present in 20 (62%) low-grade and 19 (68%) high-grade lesions. On cross-sectional images, intramedullary extension was present in 13 (41%) low-grade and 14 (50%) high-grade lesions. A focal soft-tissue mass distinct from the ossific matrix was identified in 25 (89%) high-grade lesions and in only two (6%) low-grade lesions. All 17 high-grade lesions evaluated with MR imaging were of predominantly high signal intensity on T2-weighted images. CONCLUSION: A poorly defined soft-tissue component distinct from the ossific matrix is the most distinctive feature of high-grade parosteal osteosarcoma and may be an optimal site for biopsy.

Adolescent↗
PubMed1996

The use of gadolinium in the MR evaluation of musculoskeletal tumors.

Magnetic resonance (MR) imaging has emerged as the preferred modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of MR in diagnosis and staging, the use of intravenous contrast in the evaluation of musculoskeletal lesions remains controversial. The purpose of this review is to highlight these controversies, to put them in perspective, and to suggest recommendations for the use of gadopentetate dimeglumine. The following specific areas will be addressed: (a) evaluation of soft-tissue tumors, (b) diagnosis of low-grade chondrosarcoma and the use of contrast material in identification of intraosseous metastases, (c) monitoring response to chemotherapy, (d) evaluation for local recurrence after surgery and/or radiation therapy, and (e) selection of biopsy site.

Biopsy↗
PubMed1995

Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location.

OBJECTIVE: The purpose of this study was to determine the relative prevalence, age at presentation, sex distribution, and skeletal distribution of malignant soft-tissue tumors and to ascertain the relative frequency of these tumors in specific anatomic locations and age groups among a population of patients in a large pathologic consultation service. MATERIALS AND METHODS: The computer diagnoses of 39,179 lesions occurring in 38,484 patients seen by soft-tissue pathologists at the Armed Forces Institute of Pathology during the 10-year period from January 1, 1980, to December 31, 1989, were retrospectively reviewed. All lesions were placed in one of 121 major categories in accordance with the classification system used by the World Health Organization and coded to one of 32 anatomic locations, such as hand, wrist, forearm, and so forth. Age and sex also were recorded. For purposes of analysis, all lesions were placed in one of 10 categories: hand and wrist, upper extremity, proximal limb girdle (axilla and shoulder), foot and ankle, lower extremity, hip and buttocks region, head and neck, trunk, retroperitoneum, and other lesions. The study group included 31,047 mesenchymal lesions, of which 12,370 were malignant. RESULTS: More than 80% of malignant tumors were classified into eight diagnostic categories: malignant fibrous histiocytoma (24%), liposarcoma (14%), leiomyosarcoma (8%), malignant schwannoma (6%), dermatofibrosarcoma protuberans (6%), synovial sarcoma (5%), fibrosarcoma (5%), and sarcoma, not classified further (12%). Approximately 79% of all malignant tumors were classified into five diagnoses for each age and location. With the distal upper extremity (hand and wrist) as an example, 50% of malignant lesions in the 16-25-year-old group were classified as epithelioid sarcoma (29%), malignant fibrous histiocytoma (13%), and synovial sarcoma (8%). For the same location but for children 5 years old or younger, almost 50% of malignant tumors were classified as infantile fibrosarcoma. CONCLUSION: Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the location of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.

Adolescent↗
PubMed1995

Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location.

OBJECTIVE: The purpose of this study was to determine the specific diagnoses, relative prevalence, and the age, sex, and skeletal distribution of benign soft-tissue tumors and to ascertain the relative frequency of these tumors in specific anatomic locations and age groups among a population of patients in a large pathologic consultation service. MATERIALS AND METHODS: The computer diagnoses of 39,179 lesions occurring in 38,484 patients seen by the Armed Forces Institute of Pathology soft-tissue pathologists during the 10-year period starting January 1, 1980, and ending December 31, 1989, were retrospectively reviewed. All lesions were placed in one of 121 major categories in accordance with the classification system used by the World Health Organization and coded to one of 32 anatomic locations such as hand, wrist, and forearm. Age and sex of the patients were also recorded. For purposes of analysis, all lesions were placed in one of 10 categories: hand and wrist, upper extremity, proximal limb girdle (axilla and shoulder), foot and ankle, lower extremity, hip and buttocks region, head and neck, trunk, retroperitoneum, and other lesions. The study group included 31,047 mesenchymal lesions, of which 18,677 were benign. RESULTS: Approximately two thirds of soft-tissue tumors were classified into seven diagnostic categories: lipoma and lipoma variants (16%), fibrous histiocytoma (13%), nodular fascilitis (11%), hemangioma (8%), fibromatosis (7%), neurofibroma (5%), and schwannoma (5%). Approximately 80% of all benign tumors were placed in seven diagnostic categories for each age and location. In the retroperitoneum, for example, approximately half the benign lesions in the 16- to 25-year old group were fibromatosis (20%), schwannoma (14%), and neurofibroma (13%). For the same location in children 5 years old or younger, almost two thirds of the benign tumors were lipoblastoma (37%) or lymphangioma (26%). CONCLUSION: Despite the large number of pathologic possibilities, most benign soft-tissue tumors are classified into a small number of specific diagnostic categories. These may be further defined when the location of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist the radiologist in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.

Adolescent↗
PubMed1995

Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging.

The aneurysmal bone cyst is the result of a specific pathophysiologic change, which is probably the result of trauma or a tumor-induced anomalous vascular process. In approximately one third of cases, the preexisting lesion can be clearly identified. The most common of these is the giant cell tumor, which accounts for 19-39% of cases in which the preceding lesion is found. Other common precursor lesions include osteoblastoma, angioma, and chondroblastoma. Less common lesions include fibrous dysplasia, fibroxanthoma (nonossifying fibroma), chondromyxoid fibroma, solitary bone cyst, fibrous histiocytoma, eosinophilic granuloma, and even osteosarcoma. Interestingly, some of the controversy surrounding this lesion may be the result of a change in how the lesion was defined by Lichtenstein in 1953, when intramedullary lesions were added to the previously described juxtacortical (superficial) lesions. Members of the AFIP have suggested that many of the intramedullary lesions in which no previous lesion can be identified may represent giant cell tumors of bone. Their similarity to proved giant cell tumors in skeletally immature patients can be striking and seems more than coincidental. Appropriate treatment of an aneurysmal bone cyst requires the realization that it results from a specific pathophysiologic process, and identification of the preexisting lesion, if possible, is essential. Clearly an osteosarcoma with superimposed secondary aneurysmal bone cyst change must be treated as an osteosarcoma, and giant cell tumor with secondary features of aneurysmal bone cyst would be expected to be more likely to recur locally. The vast majority (approximately 80%) of patients presenting with aneurysmal bone cystlike findings are less than 20 years old. More than half of all such lesions occur in long bones, with approximately 12-30% of cases occurring in the spine. The pelvis accounts for about half of all flat bone lesions. Most patients present with pain and/or swelling, with symptoms usually present for less than 6 months. The imaging appearance of aneurysmal bone cyst reflects the underlying pathophysiologic change. Radiographs show an eccentric, lytic lesion with an expanded, remodeled "blown-out" or "ballooned" bony contour of the host bone, frequently with a delicate trabeculated appearance. Radiographs may rarely show flocculent densities within the lesion, which may mimic chondroid matrix. CT scanning will define the lesion and is especially valuable for those lesions located in areas in which the bony anatomy is complex, and which are not adequately evaluated by plain films. Fluid-fluid levels are common and may be seen on CT scans and MR images.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Cysts, Aneurysmal↗