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PubMed2026

Emerging Molecularly Defined Bone and Soft Tissue Diagnoses: When Do They Matter?

With the rapid advancement of molecular pathology and the explosion of genomic data, our understanding of neoplasms continues to evolve. In this review, we introduce 3 recently classified mesenchymal neoplasms, the categorization of which was refined based on their underlying molecular genetic profiles. These entities were recently highlighted by the senior author at the United States and Canadian Academy of Pathology Long Course. To underscore the importance of their proper recognition, this review was prepared to reach a broader audience. Recognition of these tumors is particularly important because their mimickers often have markedly disparate prognoses and management strategies, making accurate diagnosis critical. The 3 entities discussed in this study are the following: (1) SRF-rearranged myoid neoplasms (formerly cellular myofibroma), (2) superficial CD34-positive fibroblastic tumors, and (3) kinase-altered spindle cell neoplasms. This review aimed to highlight the key clinicopathologic features of these tumors to facilitate accurate diagnosis, discuss ancillary studies that assist in navigating the differential diagnoses, and outline strategies to avoid common diagnostic pitfalls. Finally, we emphasize when molecular characterization may be necessary to guide diagnosis and support appropriate clinical management.

Humans↗
PubMedDate not supplied

Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging.

Many disorders produce discomfort in the metatarsal region of the forefoot. These disorders include traumatic lesions of the soft tissues and bones (eg, turf toe, plantar plate disruption, sesamoiditis, stress fracture, stress response), Freiberg infraction, infection, arthritis, tendon disorders (eg, tendinosis, tenosynovitis, tendon rupture), nonneoplastic soft-tissue masses (eg, ganglia, bursitis, granuloma, Morton neuroma), and, less frequently, soft-tissue and bone neoplasms. Prior to the advent of magnetic resonance (MR) imaging, many of these disorders were not diagnosed noninvasively, and radiologic involvement in the evaluation of affected patients was limited. However, MR imaging has proved useful in detecting the numerous soft-tissue and early bone and joint processes that occur in this portion of the foot but are not depicted or as well characterized with other imaging modalities. Frequently, MR imaging allows a specific diagnosis based on the location, signal intensity characteristics, and morphologic features of the abnormality. Consequently, MR imaging is increasingly being used to evaluate patients with forefoot complaints. Radiologists should be familiar with the differential diagnosis and MR imaging features of disorders that can produce discomfort in this region.

Diagnosis, Differential↗
PubMed1997

Magnetic resonance chemical shift imaging in bone and soft tissue tumours.

A study was carried out in 14 patients to assess the location and differential diagnosis of bone and soft tissue tumours with a 0.5 Tesla scanner, using water and fat images obtained by the three-point Dixon technique. We compared the magnetic resonance imaging findings obtained with this technique with conventional MRI, T1-T2-weighted images, and gadalinium-diethylenetriamine penta-acetic acid enhanced T1-weighted images. Localisation was better with the three-point Dixon technique than with conventional magnetic resonance imaging. Differentiation between the fat and water component around the tumour was possible. The gadalinium-diethylenetriamine penta-acetic acid enhanced water images were very sensitive to enhancement of the tissue. The three-point Dixon technique is useful when the tumour area is difficult to detect by conventional magnetic resonance imaging and information about its components is needed; these images can be made at the low magnet field.

Adipose Tissue↗
PubMed2004

Benign osteoma with Gardner syndrome: review of the literature and report of a case.

Gardner syndrome, a variant of familial adenomatous polyposis, is an autosomal dominant disease characterized by gastrointestinal polyps that develop in the colon as well as in the stomach and upper intestine (duodenum), multiple osteomas, and skin and soft tissue tumors. Cutaneous findings include epidermoid cysts, desmoid tumors, and other benign tumors. Polyps have a 100% risk of undergoing malignant transformation; consequently, early identification and therapy of the disease are critical. Osteoma is a benign neoplasm of bone tissue that is characterized by slow continuous growth and is the most common accompanying bone lesion seen in Gardner syndrome. The authors report a case of Gardner syndrome that was operated on because of the mandibular osteoma.

Gardner Syndrome↗
PubMedDate not supplied

[Diagnosis and differential diagnosis of extraskeletal, para-articular chondroma of the knee].

AIM: Extraskeletal chondromas in the region of the knee joint are very rare tumors which may cause diagnostic problems and have concomitant therapeutic consequences. METHOD: In a case report we present the clinical, radiological and histological features of an a extraskeletal chondroma. RESULTS: A 47-year-old female patient presented with an infrapatellar, painless tumor of the knee joint. The clinical features were unspecific. On plain X-ray images, calcifications were visabled within Hoffa's fat pad. An important preoperative imaging procedure was MRI, which showed a well defined mass of 2.5 cm in diameter with a hyperintense signal on fat suppressed images. Subsequent operative therapy involved marginal resection of the tumor. CONCLUSION: The differentiation of this entity especially from myxoid chondrosacroma and synovial chondroamatosis was crucial with respect to an adequate therapy. Further differential diagnoses included heterotopic ossifications, synovial sarcoma, mesenchymoma and soft-tissue osteosarcoma.

Adipose Tissue↗
PubMed2002

FDG-PET for detection of recurrences from malignant primary bone tumors: comparison with conventional imaging.

BACKGROUND: The aim of this study was to assess the diagnostic ability of positron emission tomography using 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG-PET) in the detection of recurrences from malignant primary bone tumors compared with conventional imaging. PATIENTS AND METHODS: In 27 patients (6 osteosarcomas, 21 Ewing's sarcomas), 41 FDG-PET examinations performed for diagnosis or exclusion of recurrent disease were evaluated. Conventional imaging techniques consisted of magnetic resonance imaging of the primary tumor site, thoracic computed tomography, and Tc-99m methylene diphosphonate bone scintigraphy. The reference methods were the histopathological analysis and/or the clinical and imaging follow-up. RESULTS: In 25 examinations reference methods revealed 52 sites of recurrent disease (local n = 7; distant: osseous n = 22, pulmonary n = 13, soft tissue n = 10). On an examination-based analysis FDG-PET had a sensitivity of 0.96, a specificity of 0.81 and an accuracy of 0.90. Corresponding values for conventional imaging were 1.0, 0.56 and 0.82. CONCLUSIONS: The sensitivity, specificity and accuracy of FDG-PET in the detection of recurrences from osseous sarcomas are high. On an examination-based analysis, FDG-PET had a not significantly lower sensitivity in comparison with conventional imaging. However, FDG-PET showed a small advantage in the detection of osseous and soft-tissue recurrences compared with conventional imaging.

Adolescent↗
PubMed1987

Benign osteoblastoma of the temporal bone of an infant.

Benign osteoblastoma is a rare neoplasm of bone tissue most commonly involving the vertebral column and long bones. Occurrence in the calvarium is extremely rare, and no cases in infants have previously been described. We report a case of benign osteoblastoma occurring in the temporal squama of an infant. The clinical features of this type of tumor occurring in the calvarium are briefly discussed.

Age Factors↗
PubMed2006

Characteristics and outcome of infections associated with tumor endoprostheses.

INTRODUCTION: Infection associated with prosthesis used after tumor resection is a common and serious complication. The purpose of the current retrospective study was to describe the course of infection in patients with a tumor endoprosthesis and the determination of risk factors associated with failed limb salvage. MATERIAL AND METHODS: 30 patients with an infection associated with a tumor endoprosthesis were investigated with regard to treatment strategies, number and type of revision operations, duration of hospital stay, determination of risk factors associated with failed limb salvage and final outcome. RESULTS: Limb salvage related to the complication infection was achieved in 19 patients (63.3%). Two-stage reimplantation of an endoprosthesis was successful in 14 patients but subsequently failed in one patient. Out of 11 patients where limb salvage failed, an amputation was performed in 6 patients, a rotationplasty in 4, and stump lengthening procedure in 1 patient. A poor soft tissue condition was a significant (P<0.05) risk factor for failed limb salvage. No patient receiving chemotherapy with a poor soft tissue condition had limb salvage surgery. The mean number of revision operations per patients was 2.6. The mean duration of hospital stay was 68 days. CONCLUSION: Infection associated with prosthesis is a serious complication and is involved with long hospitalization. Limb salvage failed mostly in the case of a poor soft tissue condition. In these cases repeated revision surgery should be avoided and ablative surgery recommended at an early stage. Rotationplasty is an alternative to amputation in the case of an infection of the proximal or distal part of the femur.

Adolescent↗
PubMedDate not supplied

[Neoplasm mortality in women in reproductive age (15 to 49 years) in the State of São Paulo, Brazil, from 1991 to 1995].

OBJECTIVE: To describe the mortality owing to neoplasms in women of reproductive age (15 to 49 years) in the State of São Paulo, Brazil, from 1991 to 1995. METHODS: A list of all deaths and their underlying causes, coded according to the International Classification of Diseases, 9 th revision, and estimates of the female population according to age groups were provided by the SEADE Foundation. Specific coefficients for 100 thousand women for each year as well as the medians of the coefficients related to 5 years, and the percentage of underlying causes of death by subgroups were calculated. RESULTS: In young women (15 to 29 years) highest rates were found for the subgroup "Malignant neoplasm of lymphatic and hematopoiethic tissues", followed by the subgroup "Malignant neoplasm of bones, connective tissue, skin and breast". In women aged 30 to 49 years, the leading underlying causes of death were those included in the last subgroup, followed by the subgroups "Malignant neoplasm of genitourinary organs", "Malignant neoplasm of digestive organs and peritoneum", and "Malignant neoplasm of lymphatic and hematopoietic tissues". The highest specific rates of underlying causes of death for women aged 15-29 were myeloid and lymphoid leukemias, and for women aged 30-49 were in decreasing rank," breast cancer"; "uterine cervix cancer" and "not specified uterine part cancer"; "stomach cancer"; "tracheal, bronchial and lung cancer" and "ovarian and other uterine annexes". CONCLUSION: Preventive measures to eliminate or lower the risk factors exposure and to promote early diagnosis and prompt treatment of these neoplasms should be enhanced in order to avoid possible future pregnancy complications and to prolong survival of women of reproductive age.

Adolescent↗
PubMed2002

Magnetic resonance imaging of benign bone lesions: cysts and tumors.

A benign bone lesion may have a typical appearance on plain radiographs. This is the case with benign cortical defects and osteochondroma. With most other lesions, cross-sectional imaging is needed to complete the study of the tumor. The nidus of osteoid osteoma is well demonstrated on computed tomography, but magnetic resonance imaging also will show the nidus in most cases. Magnetic resonance imaging is considered the modality of choice for evaluation of other benign musculoskeletal lesions because it is highly sensitive to changes in the signal intensity of bone marrow and adjacent soft tissues. It provides useful information for diagnosis of the lesion as in primary or secondary aneurysmal bone cyst, chondroblastoma, osteoblastoma, fibrous dysplasia, and osteofibrous dysplasia, and it helps differentiate these lesions from osteomyelitis, Langerhans' cell histiocytosis, and stress fracture. Bone scanning is most useful for depicting multiple silent lesions as may be seen in multiple osteochondromatosis, nonossifying fibromas, and polyostotic fibrous dysplasia.

Adolescent↗
PubMed2000

Plate fixation of prostheses after segmental resection for bone tumours.

This study investigated the concept of using plates to attach endoprostheses to bone after segmental resection for bone tumours in an animal model. Titanium alloy plates integrated with the prosthesis and coated with hydroxyapatite were attached to bone by screws. This type of uncemented fixation relied on the induction of periosteal bone formation into and around the plates to secure the implant to bone. Two, three, and six-slotted plate designs were investigated. On retrieval, each plate was securely fixed by new bone. Bone apposition on the external surface of the plates occurred through a combination of periosteal bone production, invasion of bone through slots in the plate, and bone growth over the ends of the plates. Most plates became incorporated into a remodelled cortex. Higher bone turnover rates (microm day(-1)) were seen in bone in the slots of the plate compared with normal cortical bone turnover (p < 0.05). Significantly higher rates of turnover were measured beneath slotted parts of the plates compared with regions below the unslotted parts (p < 0.05). The cross-sectional area of bone surrounding the six-plate implant design was significantly higher than that of the three-plate (p < 0.05) and two-plate (p < 0.05) designs. In addition, significantly more bone formed adjacent to the six-plated implant design compared with that in the contralateral limb (p = 0.002). However, no significant difference was found when the total cortical area around the three-plated design was compared with that of the contralateral limb (p = 0.63). In contrast, significantly less bone was measured adjacent to the two-plate design than in the untreated limb (p = 0.001). Image analysis also demonstrated increased cortical porosity adjacent to the six-plate design compared with the three-plate (p = 0.004) and two-plate (p < 0.05) designs. Finite element analysis demonstrated that the six and three-plate designs increased the second moment of area compared with that in the left tibia (p = 0.003 and 0.066, respectively). However, the attachment of the more flexible two-plate design did not significantly increase the second moment of area compared with that in the contralateral limb (p = 0.235). It was concluded that due to both mechanical and biological effects, the hydroxyapatite-coated plate designs generated new bone that enhanced fixation and encouraged plate integration into the load-bearing structure of the cortex. This method of fixation may be an alternative to the use of intramedullary cemented stems in patients requiring bone tumour implants and may be the only way to preserve the joint in difficult cases where only short segments of bone remain.

Animals↗
PubMed2002

Radiologic appearance of primary jaw lesions in children.

BACKGROUND: The jaw (an unusual site of primary tumors in children and adolescents) has lesions often found incidentally by dentists on routine panoramic radiographs or during examination of a child who has swelling or tooth pain. OBJECTIVE: This pictorial seeks to familiarize pediatric radiologists with the radiographic appearance of a variety of primary jaw lesions. MATERIALS AND METHODS: We retrospectively searched institutional records for cases of primary jaw lesions in children and adolescents. Jaw lesions were characterized as: I, well-circumscribed radiolucent lesions; II, lesions with mixed or variable appearance; III, poorly circumscribed radiolucent lesions; and IV, radiopaque lesions. RESULTS: Although most oral and maxillofacial lesions in children are benign, a broad spectrum of tumors was identified; lesions may occur in patients with unrelated prior malignancy. CONCLUSION: Because radiologic studies may identify jaw lesions and direct further care, familiarity with the appearance of these entities is prudent.

Bone Cysts↗
PubMed2005

Reconstruction of defects following bone tumor resections by distraction osteogenesis.

INTRODUCTION: The authors present the results of nine patients (two females, seven males) who had bone tumors that were treated with en bloc resection and distraction osteogenesis between 1991-2000. MATERIALS AND METHODS: The average age of the patients was 19.3 years (14-42 years). The histological diagnosis was osteosarcoma in four cases, Ewing's sarcoma in two, giant cell tumor in one, osteofibrous dysplasia in one and osteoblastoma in one. A uniplanar external fixator was applied to one case and circular external fixator to the other eight cases. RESULTS: The average follow-up period was 59.1 months (27-129 months). The external fixator was removed at an average of 18.1 months (range, 4-19 months). The average bone defect after resection was 14 cm (8-24 cm) and the average external fixation index, distraction index, and maturation index were 31.5 (18.7-40.0), 11.2 (10.9-11.2) and 17.8 (7.5-32.7), respectively. The function of the affected leg was excellent in four patients, good in three, fair in one and poor in one according to the Enneking scoring system. We did not observe any early consolidation or osseous binding in the defect area in any patient. Frequent complications were pin tract infection and non-union at the docking site. CONCLUSION: Our results indicate that the Ilizarov method allows effective restoration of bone defects in the treatment of bone tumors despite various disadvantages.

Adolescent↗
PubMed2006

Intercostal neuralgia caused by a parosteal lipoma of the rib.

Parosteal lipoma is an extremely rare benign tumor that is composed mainly of mature adipose tissue, and it has an intimate relationship to the underlying periosteal bone. We believe that only three cases have been previously reported that have described parosteal lipoma of the rib. Although parosteal lipoma is asymptomatic, motor and sensory function deficits have been reported that were caused by the tumor compressing the neuromuscular bundles in the proximal forearm and the sciatic nerve. We present here an exceedingly rare case of intercostal neuralgia caused by a parosteal lipoma of the rib.

Adipose Tissue↗
PubMed2006

Benign primary tumours of the ribs.

Benign primary tumours of the ribs are rare and may be identified during the investigation of a clinically suspected abnormality or as an incidental finding. This review describes the spectrum of benign tumours that can involve the rib and illustrates the radiographic, computed tomography (CT) and magnetic resonance (MR) imaging appearances that may facilitate diagnosis.

Bone Cysts, Aneurysmal↗