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PubMed1983

The role of computed tomography in diseases of the musculoskeletal system.

Computed tomography has added another dimension to the evaluation of musculoskeletal disease. The ability to discern subtle differences in tissue densities and the capability of viewing structures in the axial plane has greatly aided the resolution between normal and pathologic tissue and the appreciation of the anatomic relation between normal and pathologic structures. This paper deals with the application of CT in the evaluation of neoplastic, inflammatory, traumatic, metabolic, and congenital diseases of the musculoskeletal system.

Ankle Injuries↗
PubMed1999

Primary desmoplastic small cell tumor of soft tissues and bone of the hand.

Desmoplastic small cell tumor (DSCT) is a high-grade malignant neoplasm that shows polyphenotypic differentiation. Its almost exclusive involvement of serosal surfaces (particularly peritoneum) has led to the consideration of a putative "mesothelioblast" as the cell of origin. Although an extraserosal case involving the brain (presumably arising from the dura) has been reported, to date no case primary in the bone or soft tissues has been documented. The authors describe a 34-year-old man who presented with a 3-year history of pain in the right hand and a recently noted mass in the hypothenar area. Open biopsy followed by wide en bloc excision in combination with index ray resection was performed. Subsequently, the patient underwent ipsilateral axillary lymph node dissection. Extensive radiologic workup at the time of presentation and 12 months later revealed no tumor in the chest or abdomen. The patient was treated with an HD-CAV chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine, ifosfamide, etoposide) and was free of tumor until 18 months later, at which time he developed multiple metastases in the lungs. Currently, he is alive with tumor and in poor condition. The histologic sections of the mass displayed the characteristic features of DSCT involving bone and soft tissue. Immunohistochemical stains showed positivity of the tumor cells for muscle marker (desmin), neuroendocrine markers (chromogranin, synaptophysin), and epithelial markers (keratins CAM5.2, AE1:AE3, epithelial membrane antigen). Chimeric transcripts were detected by reverse transcriptase-polymerase chain reaction, indicating the presence of EWS-WT1 gene fusion, which is characteristically associated with DSCT. Sequence analysis showed in-frame fusion of EWS exon 9 to WT1 exon 8--a variant not documented in any other case. This is a unique example of DSCT primary in bone and soft tissues, which raises interesting questions about the histogenesis of this tumor type and its relationship to other small round cell tumors. Although the "mesothelioblast" hypothesis as the origin of DSCTs is attractive, it does not account for the tumors that are located in the brain or, as in this patient, in the soft tissues and bone. In addition, this patient demonstrates a rare variant of EWS-WT1 gene fusion not described in DSCT involving serosal surfaces.

Adult↗
PubMed1995

Microvascular techniques in limb-sparing surgery.

Microvascular techniques allowing free tissue transfer have expanded the indications for limb salvage in tumor patients. Preoperative planning should predict the type of deficit anticipated. Specific techniques for soft tissue, skeletal, neurovascular, and composite tissue transfer are discussed. While demanding, the use of living autogenous tissue gives the potential for biologic adaptivity and life-long durability.

Adult↗
PubMedDate not supplied

Bone tissue in adrenal myelolipoma: a case report.

This paper describes a case of adrenal myelolipoma with an unusual characteristic: the presence of bone spicules. The lesion was associated with an accessory adrenal gland containing foci of myeloadiposis. The authors believe that myelolipoma and myeloadiposis are closely associated and are in fact the expression of a single process that is both focal (myeloadiposis) and diffuse (myelolipoma). The process consists of the differentiation of choristomatous primitive mesenchymal cells into hematopoietic tissue, adipose tissue and, in rare cases, bone tissue.

Adrenal Gland Neoplasms↗
PubMed1984

[Computed tomography in orthopedic radiology].

CT offers specific advantages in the evaluation of complex spine trauma and pelvic injuries, particularly to evaluate fractures of the acetabulum. Spinal stenosis and lumbar disc herniation are conclusively demonstrated by CT and lumbar myelography thus becomes superfluous. Femoral and tibial torsion may be estimated with high accuracy by CT. CT is of definite value in the evaluation of bone neoplasms, and chronic inflammatory diseases of the spine and pelvic bones, especially for the determination of the tumor extent and soft-tissue pathology.

Acetabulum↗
PubMed1994

Limb-salvage surgery for treatment of sarcomas of the extremities.

The management of patients with sarcomas of the appendicular skeleton with limb-sparing surgery has become the standard of care. This is the result of advances in the understanding of the biology and staging of tumors, improvement in reconstructive techniques, and development of effective adjuvant chemotherapy and radiotherapy. A limb-sparing approach is applicable to virtually any bone lesion, whether low grade or high grade, and to all of the common primary soft-tissue sarcomas.

Adult↗
PubMed1990

Psammomatous melanotic schwannoma. A distinctive, heritable tumor with special associations, including cardiac myxoma and the Cushing syndrome.

Schwannoma, a benign tumor of peripheral nerve sheath, infrequently contains melanin and even less frequently features psammoma bodies. Forty schwannomas that displayed both findings were obtained from 31 patients, aged 10 to 63 years. Seventeen patients (55%) had the complex of myxomas, spotty pigmentation, and endocrine overactivity, a familial syndrome. Six (19%) had multiple tumors. Tumor sites included posterior spinal nerve roots (11 tumors), alimentary tract (11 tumors), and bone (three tumors). Two-thirds of the neoplasms caused symptoms. Grossly, the tumors were black, brown, or blue, encapsulated, and solid or spongy. Microscopically, they were circumscribed but incompletely encapsulated; they contained spindle and epithelioid cells, melanin, psammoma bodies, and fat. The spindle cells were arranged in interlacing fascicles, and exhibited whorling and occasional nuclear palisading. Immunostaining revealed that the tumors were positive for S-100 protein and vimentin and negative for glial fibrillary acidic protein, actin, and keratin. Ultrastructurally, the cells features elongated processes, continuous basal lamina, melanosomes, and intercellular long-spacing collagen. Twenty-one patients (68%) were alive without evidence of the neoplasm; two of these each had two local recurrences. Seven patients died, three (10%) as a result of metastasis. Three patients were lost to follow-up.

Acromegaly↗
PubMed1991

The calcaneus: normal and abnormal.

The calcaneus is the largest tarsal bone. Many congenital and acquired disorders affect the bone. Primary disorders arise in the calcaneus itself, whereas secondary disorders arising in the neighboring soft tissues extend into and affect the calcaneus indirectly. Among the primary lesions, congenital, traumatic, infectious, hematologic, neoplastic, and other miscellaneous disorders constitute the majority, whereas various arthritides and soft-tissue neoplasms that arise adjacent to the bone constitute the important secondary calcaneal disorders. Radiographic features of many disorders of the calcaneus are disease-specific and thus diagnostic. This article describes a wide spectrum of calcaneal disorders and illustrates their salient radiographic features. This knowledge should facilitate radiographic diagnosis of various calcaneal disorders encountered in clinical practice.

Bone Diseases↗
PubMed1983

A clinical comparison of 99mTc-DPD and two 99mTc-MDP agents.

Two hundred and fifty-seven patients were studied with bone-seeking radiopharmaceuticals. They were randomly divided into three groups. Two groups were injected with two different 99mTc-methylene diphosphonates from two manufacturers (MDP 1 and MDP 2) and the third group with 99mTc-dicarboxypropane diphosphonate (DPD). DPD was found to be superior with respect to blood clearance, femur to soft tissue ratio and subjectively assessed image quality. There seemed to be no marked differences between the bone-seeking agents in the visualisation of pathological foci. The image quality seemed to be better in the MDP 2 group than in the MDP 1 group but they were similar in other respects. The femur to soft tissue ratio decreased with increasing age in the DPD group but not in the MDP groups. With all agents worsening of scan quality with increasing age was noted and the image quality was better with men than with women. When short incubation times of radiopharmaceuticals were used before injection, the bone to soft tissue ratio was lower and the scan quality was poorer than with incubation times longer than 20 min.

Adult↗
PubMed2004

The role and limitations of radiofrequency ablation in treatment of bone and soft tissue tumors.

Percutaneous radiofrequency ablation (RFA) has evolved as an alternative therapy for treatment of certain patients with liver tumors. This novel image-guided intervention is a minimally invasive form of therapy with negligible morbidity. RFA has also been used for treatment of selected patients with renal and lung malignancies who may not be suitable surgical candidates. With the exception of osteoid osteomas, surgical management remains the treatment of choice for primary bone and soft tissue tumors. The role of RFA in definitive treatment of sarcomas has not been investigated. However, RFA has replaced surgery for treatment of osteoid osteomas and can play a role in palliation of painful bone and soft tissue tumors.

Bone Neoplasms↗
PubMed2004

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) in the hand.

PURPOSE: The purpose of this study was to review our experience with a benign surface bone lesion referred to as bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, named for the pathologist who described it in 1983. The lesion may be confused with a variety of tumors, particularly solitary osteochondromas, which are rare. METHODS: The files in the Department of Pathology at the Hospital for Joint Diseases were reviewed over a 21-year period for all surface bone lesions involving the tubular bones in the hand. There were a total of 10 cases of BPOP compared with only a single case of an osteochondroma. RESULTS: Radiographs generally showed a well-marginated uniformly dense mass arising from the surface of the affected bone without any disruption in its bony architecture. Surgical excision is the definitive treatment and included the fibrous pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and any area of the cortex of the host bone that appeared abnormal. Although in the medical literature the recurrence rate for BPOP is high, we had only one recurrence in our series. CONCLUSIONS: BPOP is a benign surface bone lesion that may be confused with benign and malignant tumors. Although there is a cleavage plane between the lesion and host bone, we recommend excising the pseudocapsule over the lesion, any periosteal tissue beneath the lesion, and decorticating any abnormal-appearing areas in the underlying host bone. This may explain the low recurrence rate in our series.

Adult↗