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A patient presented with an ossifying thigh mass suggestive of myositis ossificans. He had no antecedent trauma to the area. The mass was found to be an ossifying soft tissue metastasis from an occult gastric adenocarcinoma primary. Malignancy, and especially metastatic malignancy, is rarely considered in the differential diagnosis of a radiographic presentation of myositis ossificans.
In five cases of pseudomalignant myositis ossificans a benign diagnosis was suggested by fine-needle aspiration cytology and confirmed by radiographs and the clinical course. Hence, the need of biopsy to exclude malignancy was obviated. The symptoms rapidly resolved in all the patients. Thus, surgery may not be indicated in pseudomalignant myositis ossificans.
The clinical features of seven children with myositis ossificans (circumscripta and progressiva) and radiographic signs of the disease are described. We recommend systematic radiological examination to seek other skeletal malformations for congenital hallux valgus in young children, for it may be the first sign of a myositis ossificans progressiva. The "zone phenomenon" observed on histology, along with differential diagnosis and evolution, is documented. The necessity of a biopsy and different forms of treatment are discussed.
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This clinicopathologic study concerns 21 patients with myositis ossificans, whose ages ranged from 7 to 81 years (average, 40.3 years). The lesions were located in the thigh (10 cases), upper arm (6 cases), and other sites (5 cases). In all patients the lesion was solitary, and in all but one, it was seen within the muscle. Histologically, the lesions exhibited a wide range of histologic features with different amounts of immature fibroblastic cells, osteoid, cartilage, and young or mature bone accompanied by fibrous connective tissue. They could be classified into three types according to the predominant or most striking histologic features. Type I (6 cases) was characterized by highly cellular areas with islands of osteoid, having occasionally been confused with extraskeletal osteogenic sarcoma. Type II lesions (8 cases) consisted mainly of osteoid and young bone rimmed by osteoblasts, in the occasional presence of cellular areas. Type III lesions (7 cases) were made up almost wholly of mature bone and cartilage surrounded invariably by dense fibrous connective tissue. Prognosis was excellent in 17 patients for whom follow-up information was available. Difference between Type I myositis ossificans and extraskeletal osteogenic sarcoma was briefly described, following an additional review of three cases of the latter.
Theories on the etiology and management of myositis ossificans vary greatly. In this article, possible causative factors and treatment options are reviewed. We present a successful treatment regimen for myositis ossificans of the brachialis muscle in a 15-year-old football player. The treatment program emphasizes using joint mobilization and eccentric strengthening early in rehabilitation. The patient regained full elbow range of motion after nine weeks of this rehabilitation program. Follow-up at nine months revealed nearly complete maturation of the heterotopic bone formation, full pain-free range of motion, normal strength, and a safe return to athletic competition.
Histologic, physical and chemical analyses of the excised bony mass from a case of myositis ossificans traumatica were carried out. X-ray diffraction showed that the newly formed bone was an intermediate fluor-hydroxylapatite. Infrared spectroscopy and chemical analysis supported this finding. Contrary to articular free bodies the mineral part of the bony mass from the myositis ossificans investigated was formed most probably in a basic environment.
Myositis ossificans traumatica of the masseter muscle is uncommon. The condition is benign and results in reactive heterotopic bone formation, usually producing limitation of opening of the jaws. Radiographic and microscopic examination can confirm the diagnosis. Treatment of myositis ossificans traumatica of the masseter muscle is surgical, with other modalities used when occurring in other muscles of the body.
Acute traumatic myositis ossifications is uncommon and usually occurs in adolescents and young adults after a significant direct blow to the affected muscle. It is extremely rare in infants, and we have been able to find only two other cases in the English literature. We present two cases of traumatic myositis ossificans in infants who, except for the use of diagnostic ultrasonography, would have been misdiagnosed as having osteomyelitis (Patient 1) and a possible malignancy (Patient 2).
The long-term results of nonoperative treatment of myositis ossificans traumatica have been infrequently reported. We reviewed 83 cases of myositis ossificans seen at the Mayo Clinic from 1950 to 1979 in patients up to 21 years of age. The upper extremity was involved in 31 patients. Follow-up averaged 13 years for 23 of the (74%) patients studied. Football injuries had occurred in 20 of these patients, and the diagnosis was made an average of 3.3 weeks from the time of the initial injury. Observation was the only treatment in 18 of the 31 cases. At follow-up two-thirds of the patients with upper extremity involvement had no problems associated with the disorder, and one-third described some difficulties. Nonoperative treatment remains an accepted management approach for this problem.
An unusual case of myositis ossificans about the shoulder in an 11-year-old girl is presented. The purpose in describing this case is twofold: (a) to illustrate the difficulty in making the diagnosis when it presents in an unusual clinical fashion and (b) to demonstrate the potential use of the computed tomography scan as an aid in diagnosing the condition at a relatively early stage in its course.
Myositis ossificans progressiva (MOP) is a rare condition of which we report a case in a 13-year-old girl with involvement of the cervical paraspinal and periscapular muscles. No ectopic ossifications were visible on plain radiographs. Computed tomography disclosed diffuse inflammation. Plain radiographs of the toes confirmed the diagnosis by visualizing characteristic bone abnormalities. Knowledge of the digital abnormalities seen in MOP is important to avoid unnecessary diagnostic investigations, most notably a surgical biopsy, which may trigger a flare of the disease. The prognosis is guarded.
Myositis ossificans (MO) is a disorder characterized by the intramuscular proliferation of fibroblasts and osteoblasts, with subsequent deposition of bone and cartilage. A typical clinical presentation involves traumatic injury to a young adult, usually localized to the thigh, buttock, or upper arm, with resultant MO and mildly restricted range of motion in adjacent joints. Rarely, MO is associated with peripheral neuropathies involving the radial, median, sciatic, and sural nerves. The authors present an unusual case of MO causing a brachial plexopathy. To their knowledge, this is the first description of such a presentation.
Intraabdominal myositis ossificans (IMO) is a rare benign disorder characterized by reactive bone formation in intraabdominal soft tissue that should be distinguished from a malignant condition. We retrospectively searched our patient records and report 9 new cases of IMO. The lesions occurred in 7 men and 2 women with a mean age of 50 years (range, 24--76 years), 5 of whom had previous abdominal surgery. Histologically, all the cases were similar, consisting of a reactive mesenchymal process in adipose tissue. Mitosis was observed, but with no atypical forms, and the lesions lacked malignant cytologic features. IMO is an uncommon benign lesion that develops relatively rapidly. The pathogenesis is related to intraabdominal surgical procedures, but the exact mechanism remains to be determined.
OBJECTIVE: To present a case of myositis ossificans traumatica (MOT) in a hockey player. Serial X-ray studies allow the reader an opportunity to observe MOT in its earliest through fulminated stages. CLINICAL FEATURES: A 20-yr-old hockey player was subjected to an acute blow to the lateral thigh. Copious amounts of swelling soon developed. The patient was unable to skate. X-rays were initially performed 4 hr after the injury and demonstrated a hugh mass developing in the thigh at that time. INTERVENTION AND OUTCOME: The player was inappropriately treated with deep tissue massage and heat at the time of injury. It is believed that this led to the fulmination and advanced degree of MOT development. Immobilization allowed for resorption of the calcific density of the ossified structure. CONCLUSION: Proper care of acute trauma is essential in disorders of this nature. Ice, immobility and recognition of when a possible MOT lesion is developing is essential when dealing with contact sports.
Myositis ossificans progressiva is a rare disorder of young adults characterized by ossification of the connective tissue of the voluntary muscles and ligaments. Although it is trauma-related, up to 40-60% of these patients have no history of previous injury. A young female with marked kyphosis and ankylosis of the spine presented with a recent onset of a rapidly growing painful mass over the anterior aspect of her left shoulder. She received an excisional biopsy but recurrent ossification developed soon after. It then spread to the biceps muscle with subsequent contracture deformities of the shoulder and elbow joints. A plain radiogram of her spine revealed similar characteristics of ankylosing spondylitis. However, the final diagnosis was made by the pathognomonic ectopic ossification of muscles and para-articular soft tissue. Despite poor response of the established constracture, the painful mass did respond well to prednisolone treatment within 2 months, in terms of size and consistency.
Myositis ossificans circumscripta (MOC) is a rare benign disorder characterized by heterotopic ossification of soft tissues. We report a case in a 21-year-old male who presented with knee pain after strenuous physical activity. Evidence of inflammation of the knee and a hard swelling in the subquadricipital area were the main physical findings. The initial plain radiographs showed a subpatellar soft tissue mass containing flocculent calcifications. Over the next 2 months, the calcific deposits organized into a calcified mass. Magnetic resonance imaging findings were nonspecific, with a mass within the vastus medialis muscle generating low signal on T1 images and high signal on T2 images, without postgadolinium enhancement. Computed tomography showed several calcific deposits arranged in a ring, strongly suggesting MOC. Histological examination of a biopsy specimen confirmed this diagnosis. Alendronate therapy given for 6 months was followed by marked clinical improvement, obviating the need for surgery.