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Myositis ossificans of the foot.

A 37-year-old woman with myositis ossificans of the left foot is reported. A faint density was seen on foot radiographs, whereas computed tomography images showed a rim of mineralization inferior to the second and third metatarsal bones. On short tau inversion recovery-weighted magnetic resonance images, a hyperintense lesion was demonstrated with hyperintensity extending to the surrounding soft tissues. The rim of ossification appeared hypointense. Other non-neoplastic soft tissue processes with bone formation such as pseudomalignant osseous tumor of soft tissues, florid reactive periostitis, and bizarre parosteal osteochondromatous proliferation occur more commonly in the foot than myositis ossificans. A differential diagnosis of these lesions including periosteal and parosteal osteosarcoma, periosteal chondroma, and osteomyelitis is discussed.

Adult↗
PubMed1994

Fracture through the bone of traumatic myositis ossificans. A report of three cases.

We describe three cases of traumatic myositis ossificans in which fractures occurred through a mature, quiescent ossification mass. None of the fractures reactivated the original pathological process, no callus was formed and union did not occur. The nonunion became painless over a period of months. This unusual late complication of myositis ossificans seems to require only symptomatic treatment by temporary splintage and subsequent mobilisation. We could find no previous report of a similar case.

Adolescent↗
PubMed1996

Fibro-osseous pseudotumor of the digit: a comparison to myositis ossificans by light microscopy and immunohistochemical methods.

Fibro-osseous pseudotumor of the digit is an unusual cutaneous process characterized histologically by a fibroblastic proliferation admixed with reactive/metaplastic osteoid formation. The osteoid formation can be florid and immature, mimicking the appearance of malignant osteoid-forming neoplasms. Fibro-osseous pseudotumor of the digit has histologic and clinical features in common with myositis ossificans. This has led many to consider the two to be synonymous. We studied three cases of fibro-osseous pseudotumor, compared to five cases of myositis ossificans, using routine light microscopy and a battery of immunohistochemical stains. Both entities displayed a "zoning" pattern of immature spindled areas admixed with more mature areas having osteoid metaplasia. This was more pronounced in myositis ossificans. In each lesion, the spindle cells stained positively for vimentin and actin. CD34 and Factor VIII highlighted the vasculature. No stromal staining for MAK-6 (cytokeratin) or S-100 was identified. Ki-67, a proliferation marker, showed positive staining of the stromal cells in both lesions, which was strongest in the immature spindled areas. The immunohistochemical and histologic similarities of the lesions support fibro-osseous pseudotumor of the digit being a cutaneous variant of myositis ossificans.

Adolescent↗
PubMed1995

Thallium-201 accumulation in myositis ossificans and in juxta-articular ossification.

We present the findings on 201Tl and 99mTc-MDP scintigraphy in three patients suffering from heterotopic ossification (two patients presenting with myositis ossificans and one patient presenting with juxta-articular ossification in combination with myositis ossificans). Since resection of the lesions has to be delayed until stabilization, 99mTc-MDP is often used as a parameter of lesional activity, although it is not optimal. For this clinical problem, we evaluated 201Tl scintigraphy as a marker of metabolic activity. In addition to the well-documented uptake of 99mTc-MDP, marked accumulation of 201Tl was observed in all heterotopic ossification sites. Hence, our results support the use of 201Tl scintigraphy in the therapeutic management and monitoring of conditions associated with ectopic ossification. On the other hand, although myositis ossificans is sometimes clinically, radiographically and even histologically confused with extraosseous osteogenic sarcoma, 201Tl accumulation may not be a helpful factor in the differential diagnosis due to the presence of tracer accumulation in both disorders.

Adult↗
PubMed1998

[Myositis ossificans circumscripta and sequelae of muscular ischemia. 2 cases].

INTRODUCTION: Non-traumatic myositis ossificans circumscripta is a relatively rare, well defined entity. The pathogenic role of ischemia in its development is discussed. EXEGESIS: We report two cases of myositis ossificans circumscripta that occurred in the hamstring muscle respectively 22 and 35 years after ischemic muscular injury in the same site. Clinical and radiologic informations and follow-up were reexamined, showing that patients are usually young and that the disease is equally distributed between both genders. Though the lesion may develop in various muscle, it is preferentially observed in proximal sites. Most patients have a history of localized pain or tenderness accompanied by swelling of the affected site. Following a 5- to 12-week increase, the soft-tissue mass is less sensitive and better defined. It may also resolve in less than 3 years. CONCLUSION: Results of X rays, computerized tomography, MR imaging and biopsy are reviewed. Histologically, this lesion main feature is peripheral bone maturation within three areas. Mechanisms (traumatic or not) underlying these lesions are unknown. To our knowledge, only one published case would be comparable to ours. Proliferation followed by change in mesenchymal cells leading to heterotopic ossification must be regarded as a consequence of either ischemia or repeated micro-trauma occurring during muscle shortening.

Follow-Up Studies↗
PubMed1985

Myositis ossificans in an adolescent following sports injury.

Myositis ossificans, an abnormal formation of new bone in an injured muscle, can occur in young athletes involved in contact sports. Recognition and appropriate therapy can reduce associated disability. This report illustrates the condition and reviews the clinical manifestations and available therapeutic modalities.

Adolescent↗
PubMed1975

[Lockjaw in progressive myositis ossificans].

Frequency, symptomatology, course and therapy of myositis ossificans progressiva are described by means of literature references and personal observation in a patient. The patient was born in 1935 and the disease manifested itself for the first time in 1956 in the right sternocleidomastoid muscle. Despite surgery total trismus could not be prevented and later-on muscles and connective tissue of other areas ossified, too.

Adult↗
PubMed1984

Early diagnosis of myositis ossificans with Tc-99m diphosphonate imaging.

Myositis ossificans is primarily a disorder of young adults, whereby an area of muscle mass undergoes progressive ossification. The authors review a case in which the patient's presentation was somewhat atypical, and where the course of disease was unusually prolonged. Examination of the soft tissue lesion using Tc-99m diphosphonate bone scans was helpful in establishing the diagnosis and in determining the full extent of the process early in its evolution.

Adult↗
PubMed1982

[Diagnostic and therapeutic aspects of myositis ossificans (author's transl)].

Diagnosis of localised myositis ossificans is difficult in the initial stage. A history of trauma is frequently missing. Clinical symptoms point in the direction of osteomyelitis or soft tissue abscess. Sonotomography is useful for localisation and delineation of the lesion. Biopsy is the only reliable method to establish the diagnosis. Conservative treatment is recommended until the process is inactive. Radiographic follow-up will demonstrate the expected massive calcification and scintigraphic follow-up at 6-monthly intervals will eventually prove the metabolic inactivity of the lesion necessary for successful operation. Surgical removal of the calcified tumor will become necessary in cases of continued pain or significant functional limitations of the involved extremity.

Biopsy↗
PubMed1989

[Progressive myositis ossificans--a case report].

A case of myositis ossificans in a 28 year old male is reported. He had been found to have ossification of the right sternocleidomastoid muscle at birth. Subsequently both thighs, abdominal muscles of the right side and facial muscles on both sides were similarly affected. X-ray findings, biopsied specimens and biochemical changes were in accord with those reported in the literature, though involvement of facial muscles and the heart had not been previously reported. The presence of several congenital malformations gives support to the important role of heredity in the pathogenesis of this disease. EHDB brought some relief in this case, and may be of prophylactic value in the prevention of ossification due to postoperative trauma of a planned temporo-mandibular operation.

Adult↗
PubMed1998

[Diagnostic problems of circumscribed myositis ossificans: presentation of an atypical case].

The authors report the case of a 22-year-old female suffering from thigh pain for 5 months. The first diagnosis considered was circumscribed myositis ossificans but the duration of symptoms and the radiological aspect mimicking some malignant features led to consider parosteal sarcoma as a possible diagnosis. Surgical resection was therefore requested and histological analysis confirmed the diagnosis of circumscribed myositis ossificans. This case emphasizes the difficulty in differentiating circumscribed myositis ossificans from a slowly growing tumor as both can be associated with increasing pain and a malignant radiological aspect. A surgical approach is therefore frequently necessary for definitive diagnosis and treatment.

Adult↗
PubMed1983

Myositis ossificans circumscripta: computed tomographic diagnosis.

Computed tomography was performed in five patients with myositis ossificans circumscripta. In three cases, and possibly four, CT scans obtained during the active stage of the pathologic process demonstrated findings that in general corresponded to the "zone phenomenon" seen on histology, although a distinct peripheral ring of ossification was not always present. In these patients, CT was useful in limiting the differential diagnosis and obviating surgery. In the fifth patient, with long-standing myositis ossificans, CT showed complete ossification indicative of the mature phase of the pathologic process and was helpful in planning surgical resection.

Adolescent↗
PubMed1988

Bone formation in experimental myositis ossificans. Light and electron microscopy study.

The development of ectopic ossification in experimental myositis ossificans of the rabbit thigh was studied. The right hind limb of 25 rabbits was immobilized with the knee in extension. Once a day the limb was passively mobilized for 2-3 minutes. The animals were killed 3, 5, 7, 14, 21, 28 and 35 days after the beginning of the experiment. Specimens for light and electron microscopy were obtained from both hind limbs. Extensive necrosis and fibrosis were observed in the right vastus intermedius muscle during the first week. Proliferation of chondrocytes and osteoblasts with newly formed woven bone and cartilage formation were found in the periosteum within 7 and 14 days after the beginning of the experiment. Intensive enchondral ossification and hard calcified tissue were observed later. It was evident that bone formation in this experimental model started in the periosteum after necrosis of the adjacent skeletal muscle. Therefore the temporal and spatial relationship of traumatic changes in the periosteum and muscle seems important for the development of myositis ossificans.

Adenosine Triphosphatases↗
PubMed1996

Myositis ossificans of the chest wall.

We report the unusual case of a young man with progressive pain in the thoracic wall. The radionuclide bone scan revealed an increased uptake, and the bone roentgenogram, a calcified soft-tissue mass. Based on computed tomography findings, biopsy was avoided, and evolution was favourable for myositis ossificans. Although rare, myositis ossificans is one of the potential causes of thoracic pain, not to be mistaken for a malignant or infectious lesion.

Adult↗
PubMed1994

An experience of ischemic limb salvage associated with myositis ossificans of the left thigh.

A case of ischemic limb salvage associated with myositis ossificans of the left thigh in a 66-year-old man was reported. The patient had a medical history of cerebral palsy and a cervical spinal cord injury, and had an operative past history of hip arthroplasty for fracture of the left femoral neck 10 years before. He showed ischemic symptoms such as paleness, coldness, and loss of the left dorsal arterial pulsation in the left toe, and had a rapidly growing mass in the left thigh. Roentgenography and computed tomography showed a mass 10 cm by 10 cm by 8 cm in size with severe calcification in the left quariceps muscle. Occlusion of the left common femoral artery was found in the arteriogram. Surgery was carried out in order to establish an accurate diagnosis and to rescue the left lower limb. The arterial pulsation was recovered as the result of completely resecting the left quariceps muscle tumor. The pathohistological diagnosis was of myositis ossificans in the quariceps muscle of the thigh. Etidronate disodium was administered in order to prevent a recurrence postoperatively. The patient has been well for the 13 months since surgery.

Aged↗
PubMed1976

[On myositis ossificans localisata and its operative treatment (author's transl)].

We observed 52 patients with myositis ossificans localisata partly of a traumatic, neurogenic or morbid (inflammable) origin. The fact that preferably young men are concerned in cases of traumatic and neurogenic myositis ossificans localisata is certainly not only caused by their increased exposition to trauma, but also by disposition. For indication and operative treatment it is necessary to classify as well as radiologically III different stages of development as respective groups of muscles. In posttraumatic and neurogenic cases relapses post operationem may probably be avoided in case, there is a radiological stage III (total development of muscle ossification).

Adolescent↗