Biomedical subjects
Publications and source records attributed to I Yaghmai.
Neurofibromatosis is seen in association with elephantiasis neuromatosa and overgrowth of abnormal bones, but rarely with subperiosteal hemorrhage. This is a secondary finding after severe or minor trauma to the periosteum, which is abnormally loose from mesodermal dysplasia. The clinical, plain radiographic, and angiographic findings of 2 cases of massive subperiosteal hemorrhage are presented, and the literature reviewed.
Angiography was done in 38 cases of pathologically-confirmed fibrous-tissue tumor. All benign fibromatous tumors and one case of desmoid fibroma were angiographically normal. A great spectrum of angioarchitecture exists in fibrosarcomas, whether they are of bone or soft-tissue origin. Heterogeneous vascularity was seen in 55% of these cases, and was related to the cell composition of the tumor. There exists a close relationship between the number of vessels in a tumor and its degree of clinical and histopathological malignancy. The most vascular part of a tumor is the least differentiated and should be used for biopsies. Angiography can be used for the grading of fibrosarcomas, and probably for assessing clinical prognosis.
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Myositis ossificans circumscripta is the heterotopic formation of nonneoplastic bone and cartilage in soft tissue. These benign lesions can mimic more serious lesions, both radiographically and histopathologically. Recognition of the benign character of myositis ossificans is imperative in order to avoid mutilating surgical procedures. Five cases are presented with emphasis on angiographic signs which differentiate this lesion from histopathologically similar lesions. Three of these are illustrated, along with an example of an osteosarcoma for comparison. The angiographic manifestations of myositis ossificans differ in the various phases of the disease. In the active stage, the lesions have numerous fine vessels causing a diffus stain. Malignant tumors such as osteosarcoma, extraosseous osteosarcoma, and fibrosarcoma, which are included in the differential diagnosis, often present clearly defined pathologic vessels as well as arteriovenous shunts, venous lakes, amputated vessels, invasion of large arteries and veins, and large abnormal draining veins. In the healing stage, the lesions are usually avascular, and there is no difficulty in differentiating this condition from malignant bone lesions with the sole exception of well differentiated parosteal osteosarcomas. In these cases, the plain radiographic features are most important in arriving at the correct diagnosis.
Arteriography was carried out in 64 cases of pathologically confirmed osteosarcoma to evaluate the angiographic features of this lesion. This investigation proved that a variety of angioarchitectures exist in osteosarcomas, mainly related to the histologic type of tissue as well as the degree of differentiation of a tumor. Fibroblastic and chondroblastic osteosarcomas proved to be less vascular than the osteoblastic type, while the most differentiated tumor appeared to be the least vascular. This technique proved useful in choosing the proper site, or sites, for biopsy as well as for determining the intra- and extraosseous extension of the tumor. Instances were also encountered in which it was of assistance in differentiating osteosarcoma from pathologically similar bone lesions.
Ten male patients with pelvic lipomatosis are herein reported and the clinical and radiological features of the disease are reviewed. The main criteria for the preoperative diagnosis of pelvic lipomatosis include: a) radiolucency of the pelvic soft tissues with a normal to slightly increased vascularity on pelvic arteriography; b) deformity and anterior deviation of the urinary bladder together with various degrees of obstructive uropathy; and c) tubular narrowing of the rectum and upward displacement of the sigmoid colon and small intestine. The associated symptoms are usually variable degrees of dysuria, constipation, and frequently hypertension. Surgical excision of the pelvic lipomatous tissue is of limited value in the management of this disease.
The clinical, pathologic, and roentgenographic features of macrodactylia fibrolipomatosis described are based on 40 cases from the literature and five cases seen by the authors. This condition previously has been described as macrodactyly, megalodactyly, macrodystrophia lipomatosa, dactylomegaly, and local gigantism. We believe macrodactylia fibrolipomatosis is the best term because it describes the characteristics which separate this condition from other forms of macrodactyly. Macrodactylia fibrolipomatosis is a form of macrodactyly noticed soon after birth. Usually affected are multiple adjacent digits on the lateral aspect of the hand or the medial aspect of the foot, although a single digit may be involved. Roentgenograms show bony enlargement, often with medial deviation in the hand and lateral deviation in the foot. The soft tissues ventral to the affected bones are diffusely enlarged and are predominantly of fat density, commonly mixed with bands of denser connective tissue. The cause of this rare condition is obscure but it may be related to fibrofatty tumors, often found at surgery, impinging on nerves supplying the enlarged digits.
Two cases of malignant giant cell tumor originating within the soft tissues of the thigh are reported. In both instances, angiography demonstrated hypervascular masses with arterial and venous abnormalities indicative of an aggressive malignancy. The histopathologic appearance of the lesions was similar to that of osseous giant cell tumors. The clinical and radiographic features of this rare entity are briefly reviewed.
A 46-year-old man had a large noncalcified tumor in the wall of the thoracic esophagus narrowing its lumen by projection of numerous firm nodular masses. The pathologic diagnosis was chondrosarcoma. Malignant degeneration of a tracheobronchial cartilaginous remnant is the main consideration in this first recorded case of esophageal chondrosarcoma.
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The medical records, conventional radiographs, bone scans and pelvic CT scans obtained in 50 consecutive patients with malignant lesions involving the osseous pelvis were retrospectively reviewed. In 21 patients with primary bone tumors or with osseous involvement from adjacent pelvic neoplasms, CT provided additional information, in 17 patients (80%) which had direct bearing in the clinical management. CT was less useful in 29 patients with bony metastases. Although more information was obtained, this was of clinical significance in only 12 patients.
Bone-mineral measurements using quantitative computed tomography (QCT) are commonly based on comparisons with solutions in water of known concentrations of K2HPO4. In this paper are described theoretical and experimental studies that have led to the conclusion that large systematic errors can arise in these measurements, depending on the soft-tissue and fat concentrations in the vertebral spongiosa. In the case of single energy scanning, such large errors have been identified to be due to the varying water content (displacement effect) in the calibration samples and the varying fat content in the region of interest (ROI) within the patient. In the case of dual energy scanning, the error arises because when normalized to that of water, the mass attenuation coefficient of fat increases with photon energy while the reverse is true for K2HPO4. Our studies have also revealed that total trabecular bone density (which includes the mineral, soft tissue, and fat) can be much more accurately determined by the dual energy QCT method than bone mineral alone. This finding is especially interesting since there have been several reports in the literature suggesting that bone density rather than bone-mineral content is a better predictor of the risk of osteoporosis-related fractures.