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Differential diagnosis of pediatric musculoskeletal masses.

MR imaging plays a major role in the evaluation of children with soft tissue and bone tumors. While the imaging characteristics of these lesions are often nonspecific, MR imaging provides valuable information on the extent of disease and relationship of tumors to the neurovascular bundle and other vital structures. This article reviews the radiographic and MR imaging appearances and clinical presentations of a wide range of musculoskeletal masses that occur in children.

Bone Cysts↗

A case of benign metastasizing leiomyoma with multiple metastasis to the soft tissue, skeletal muscle, lung and breast.

Benign metastasizing leiomyoma (BML) is composed of well-differentiated smooth muscle cells and dense connective tissue. BML affects middle-aged women who have had previous hysterectomies due to a histologically benign-appearing uterine leiomyoma. We report here on a case of BML from the uterine leiomyoma in a 39-year-old woman that involved the soft tissues, skeletal muscles, lungs and breasts. She underwent a hysterectomy for the uterine leiomyoma, double oophorectomy for hormonal ablation and lung wedge resection to confirm the diagnosis. The microscopic findings of the breast and lung tumor were similar to those of the benign uterine leiomyoma. Therefore, we consider that these lesions were breast and pulmonary metastases of the uterine leiomyoma. We report here on a rare case of benign metastasizing uterine leiomyoma that involved the soft tissue, skeletal muscles, lungs and breasts, and we include a review of the relevant literature.

Adult↗

The sternomastoid island myocutaneous flap for oral cancer reconstruction.

OBJECTIVE: To evaluate the usefulness of the sternomastoid island myocutaneous flap for reconstruction of defects after excision of oral cancer. PATIENTS: One hundred eleven superiorly based sternomastoid island myocutaneous flaps were used for one-stage primary reconstruction in 110 consecutive patients with oral cancer during a 53-month period from June 1985 to November 1989. RESULTS: Ninety-eight patients had radiation therapy before surgery. One hundred six flaps were used for mucosal lining of the mouth and six flaps were used for providing skin cover. Flap-related complication developed in 38 patients (34.5%). Total flap loss occurred in eight patients (7.3%). Radical irradiation before surgery significantly increased flap-related complications. Low-molecular-weight dextran did not improve flap survival. After a minimum follow-up of 24 months, nine patients (8.2%) had recurrences in the ipsilateral neck. The flap could easily reach the oral cavity without producing tension on the suture line. The flap also did not produce excessive bulk in the mouth or on the face. CONCLUSION: In a selected group of patients with a clinically N0 neck, the sternomastoid island myocutaneous flap is oncologically safe and it gives satisfactory cosmetic and functional results with no lasting morbidity.

Adolescent↗

Tc-99m MDP uptake in retroperitoneal malignant peripheral nerve sheath tumor and its metastases.

Extraosseous uptake of Tc-99m MDP has been reported in various pathologic conditions. Because of the opportunity of make an additional diagnosis, extraskeletal distribution of tracer should be inspected in every case. Malignant peripheral nerve sheath tumor (MPNST) is a rare type of neurogenic tumor. Its main clinical manifestation is a mass with or without pain. MPNST can be seen in all 4 extremities, the trunk, head and neck regions, but most commonly occur in the thigh, buttocks, and supraclavicular regions. Presented here is a rare case of MPNST in which Tc-99m MDP uptake by the primary lesion and metastases were clearly demonstrated on bone scintigraphy.

Humans↗

Congenital smooth muscle hamartoma of the skin.

A 2-month-old white girl had a congenital, tan-colored, slightly elevated, 3 x 2-cm plaque on the left midback. Clinically, the lesion was suspected to be a solitary mastocytoma. Rubbing the lesion produced a transient erythema and edema that was similar to Darier sign seen in mastocytoma. Analysis of a skin biopsy specimen revealed a smooth muscle hamartoma; special stains did not show evidence of increased numbers of mast cells. This relatively uncommon condition can be confused with a variety of other cutaneous diseases. Light microscopic examination of a skin biopsy specimen establishes the diagnosis. A review of the approximately 50 cases reported in the literature showed that there is no known associated systemic involvement or malignant transformation. The clinical lesions usually become less prominent with time.

Biopsy↗

[Exophthalmos secondary to a lateral rectus muscle metastasis].

CASE REPORT: 60-year-old male, with metastatic adenocarcinoma of the rectum-sigmoid colon, who developed exophthalmos due to a tumour in the lateral rectus muscle, compatible with a diagnosis of metastasis. DISCUSSION: Metastasis in the extraocular muscles are very uncommon, but should form part of the differential diagnosis of any patient presenting exophthalmos, since although the majority of patients with such metastasis have a previously diagnosed malignant tumour, there are cases where they lead to the diagnosis of the primary tumour.

Adenocarcinoma↗