[Apropos of myositis ossificans (progressive ossifying fibrodysplasia)].
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A case of pseudomalignant osseous tumour of the soft tissues of the finger is reported. The benign diagnosis is confirmed by the histologically characteristic zone phenomenon.
PMO is characterized by the following: no history of antecedent trauma, localized expanding soft tissue mass, peripheral calcification surrounding a radiolucent center on plain radiographs and CT scans, microscopic evidence of zonation, and self limited natural history.
As unrelated complications, peripheral nerve injury and heterotopic ossification (HO) are frequently observed in brain injured patients. Our case presentation is a 24-year-old man who sustained a brain injury in a motor vehicle accident. At two months postinjury he remained at a Rancho Level II and had HO identified in eight joints. Over the next several months, his cognition improved and he demonstrated active movement at the left wrist, but no movement at the right wrist. Plain radiographs and bone scan were consistent with myositis ossification posterior to the right mid-humerus and no fracture was identified. Electromyography revealed a right radial nerve injury below the branch to the triceps. Nine months postinjury, the patient had 4-/5 strength in right wrist extension. A thorough evaluation of all possible etiologies for a given impairment may lead to altered treatment and/or prognosis.
A 5-year-old boy with a painful lesion in the proximal humerus is reported. Plain radiographs suggested the presence of a malignant bone lesion, and CT showed features similar to stress fractures. Pathologically, the changes were that of reactive periostitis.
We report a case of muscle calcification, a rare complication of polymyositis, documented on muscle biopsy and computerized tomography scanning. As the calcification resolved radiologically, marked hypercalcaemia developed requiring forced diuresis.
We present the case of a 4-year-old boy who was the first in his family to be diagnosed as having fibrodysplasia ossificans progressiva, which was radiologically confirmed. The initial recurrence of the swellings, which were completely painless, is highlighted. The bilateral clinodactyly is also noted. It is suggested that when onset and confirmed diagnosis are in early childhood the disease is rapidly progressive.
This is the first reported case of ABC in a reactive lesion of soft tissue. The ABC may be regarded as an unusual type of organization of hematoma encountered in a bone-producing milieu. This would support the current concept that ABC occurring in association with another condition represents a secondary change in a pre-existing lesion.
A seven-year-old boy with mental retardation and congenital skeletal malformations in the thumbs and big toes developed recurrent lumps in the shoulder and interscapular region. The lumps subsided slowly but left severe stiffness in the affected areas. The first biopsy revealed oedema and a chronic inflammatory response with fibromyxoid proliferation of the soft tissue. A second biopsy revealed ossification of muscle and fascia. The patient is a typical case of fibrodysplasia ossificans progressiva, an autosomal dominant inherited disorder characterized by congenital skeletal malformations in toes and fingers and progressive ectopic ossification, often combined with alopecia, deafness and in rare cases mental retardation. The disorder leads to severe physical disability in young age and respiratory and nutritional problems. No effective treatment is known, but it is important to avoid exacerbating factors such as biopsy, operations and intramuscular injections.
MO is a soft-tissue mass, reported only 3 times in the cervical paravertebral area in a search of the literature. We describe an additional case in a 10-year-old girl. We emphasize that in the unusual radial radiopaque roentgenographic image, a malignant tumor could be considered. We also stress that CT scanning can be of great value in establishing the diagnosis. The clinical types and the radiological and pathological features of MO are described in some detail and the "zonal" sign is described.
An eight-year-old boy presented with massive pseudomalignant heterotopic ossification around the upper femur. The mass was completely excised because of severe pain, systemic illness and a flexion contracture at the hip. Symptomatic improvement was swift, but two weeks later the mass had recurred and was even more extensive. During the subsequent 18 months of conservative management he has been free of pain and there has been progressive resorption and remodelling of the heterotopic bone. There is now no limitation of physical activity and movement at the hip is full.