Acute displaced femoral shaft fracture in a football player.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
H Thomas Temple
Publications and source records attributed to H Thomas Temple.
A study of retrieved allografts used to replace anterior cruciate ligaments.
PURPOSE: The purpose of the study was the examination of retrieved whole anterior cruciate ligament (ACL) replacement grafts to determine the rate and the extent of cellular replacement and remodeling of the grafts. TYPE OF STUDY: Gross and histopathologic examination of specimens. METHODS: Nine specimens of ACL replacement allografts and 1 autograft were obtained at autopsy and surgical procedures. RESULTS: Examination of these specimens from 20 days to 10 years after transplantation revealed a pattern of revascularization similar to that reported in previous biopsy studies. However, examination of the entire allografts showed that, at 2 years after transplantation, the central portions of the grafts remained acellular and that complete attachment was not present, but was found in a 3.5-year post-transplantation specimen. CONCLUSIONS: Because attachment of the graft to bone tunnel walls required over 2 years, the tunnel remodeling may be explained on a mechanical basis. The remodeling of ACL replacement grafts is a gradual or slow process. Complete remodeling and cellular replacement of the entire graft may require 3 years or longer.
Achilles Tendon↗
Shoulder mass in a 20-year-old man.
Explore the source record for details and available documents.
Adult↗
Allograft reconstruction after resection of malignant tumors of the scapula.
The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.
Adult↗
Imaging of fatty tumors: distinction of lipoma and well-differentiated liposarcoma.
PURPOSE: To review the reliability of computed tomographic (CT) and magnetic resonance (MR) imaging features in distinguishing lipoma and well-differentiated liposarcoma. MATERIALS AND METHODS: CT (n= 29) and MR (n = 40) images and radiographs (n = 28) of 60 patients with histologically verified fatty tumors (35 lipomas and 25 well-differentiated liposarcomas) were retrospectively reviewed in 31 females and 29 males (mean age, 56 years; age range, 1-88 years). Images were assessed for adipose tissue content, and non-fatty component was classified (thin and/or thick septa and nodular and/or globular components) as absent, mild, moderate, or pronounced. Also assessed were signal intensity and tissue attenuation of the fatty components and non-adipose elements. RESULTS: Statistically significant imaging features favoring a diagnosis of liposarcoma included lesion larger than 10 cm (P <.001), presence of thick septa (P =.001), presence of globular and/or nodular non-adipose areas (P =.003) or masses (P =.001), and lesion less than 75% fat (P <.001). The most statistically significant radiologic predictors of malignancy were male sex, presence of thick septa, and associated non-adipose masses, which increased the likelihood of malignancy by 13-, nine-, and 32-fold, respectively. Both lipoma and liposarcoma demonstrated thin septa and regions of increased signal intensity on fluid-sensitive MR images. CONCLUSION: A significant number of lipomas will have prominent non-adipose areas and will demonstrate an imaging appearance traditionally ascribed to well-differentiated liposarcoma. Features that suggest malignancy include increased patient age, large lesion size, presence of thick septa, presence of nodular and/or globular or non-adipose mass-like areas, and decreased percentage of fat composition.
Adipose Tissue↗
Imaging of soft-tissue myxoma with emphasis on CT and MR and comparison of radiologic and pathologic findings.
PURPOSE: To determine the imaging characteristics of soft-tissue myxoma, with emphasis on computed tomographic (CT) and magnetic resonance (MR) imaging findings and pathologic comparison. MATERIALS AND METHODS: Records of 45 pathologically confirmed soft-tissue myxomas in 44 patients were retrospectively reviewed. Patient demographics and radiographs (n = 20), bone scintigrams (n = 2), angiograms (n = 3), and ultrasonographic (US) (n = 6), CT (n = 14), and MR images (n = 33) were evaluated by two musculoskeletal radiologists with agreement by consensus for lesion location, lesion size, and intrinsic characteristics. RESULTS: Soft-tissue myxoma more commonly affected women (59%; average age 52 years) and manifested as a slowly enlarging (64%) painful (51%) mass. Lesions were most frequently intramuscular (82%) and involved the thigh (51%). An appearance similar to that of a cyst was seen at CT (at which the lesions demonstrated low attenuation) and at MR imaging (at which the lesions demonstrated markedly high signal intensity on T2-weighted images) in all cases because of the high water content of mucin that was seen histologically. The true solid architecture of these lesions was best depicted in all cases at US (at which the lesions were hypoechoic, not anechoic) and on MR images obtained with contrast material (at which the lesions demonstrated internal enhancement). A small amount of tissue similar to fat surrounding these intramuscular myxomas (71% at MR imaging) corresponded histologically (70%) to atrophy of surrounding muscle. CONCLUSION: Soft-tissue myxoma often demonstrates characteristic US, CT, and MR imaging findings, including intramuscular location, intrinsic high water content, and a surrounding rim of fat.
Adolescent↗
Surgical treatment of benign bone tumors.
Explore the source record for details and available documents.
Adult↗
From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation.
Chondrosarcoma is a malignant tumor that produces cartilage matrix, and lesions that arise de novo are called primary. Primary chondrosarcoma is the third most common primary malignant tumor of bone, constituting 20%-27% of all primary malignant osseous neoplasms. There are numerous types of primary chondrosarcomas, including conventional intramedullary, clear cell, juxtacortical, myxoid, mesenchymal, extraskeletal, and dedifferentiated. The conventional intramedullary chondrosarcoma is the most frequent type, and it most commonly involves the long bones or pelvis in up to 65% of cases. Although the pathologic appearance varies with specific lesion type, chondrosarcomas grow with lobular type architecture, and these hyaline cartilage nodules demonstrate high water content and peripheral enchondral ossification. Imaging features directly reflect this pathologic appearance, and the various subtypes often show distinctive features. Radiographic findings often suggest the diagnosis of chondrosarcoma because of identification of typical "ring-and-arc" chondroid matrix mineralization (representing the enchondral ossification) and aggressive features of deep endosteal scalloping and soft-tissue extension. These latter features are usually best assessed, as is lesion staging, with computed tomography (CT) or magnetic resonance (MR) imaging. CT is optimal to detect the matrix mineralization, particularly when it is subtle or when the lesion is located in anatomically complex areas. Both CT and MR imaging depict the high water content of these lesions as low attenuation and very high signal intensity with T2-weighting, respectively. Understanding and recognizing the spectrum of appearances of the various types of primary chondrosarcoma allow improved patient assessment and are vital for optimal clinical management including diagnosis, biopsy, staging, treatment, and prognosis.
Academies and Institutes↗