Neuropathic arthropathy of the shoulder mimicking soft tissue sarcoma.
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Biomedical subjects
Publications and source records attributed to S Kenan.
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Intramuscular myxoma is a distinct benign tumor confined to muscles. This tumor usually favors the thigh and shoulder. We are reporting a case of intramuscular myxoma of the forearm in an elderly female, a very rare site for this tumor. The magnetic resonance features of intramuscular myxoma are described. The differential diagnosis that included acute hematoma, acute abscess, intramuscular synovial cyst, schwannoma and malignant soft tissue tumors with myxomatous degeneration is discussed. The association between intramuscular myxomas and fibrous dysplasia has been emphasized.
We described a case of high-grade surface sarcoma of the radius in a 14-year-old boy. The lesion appeared radiologically benign and was confined to the surface. The tumor was resected. At the time of biopsy both lungs showed diffuse metastases. Following surgery the patient underwent chemotherapy and the lung metastases improved. The pertinent literature was briefly discussed.
Cancer rehabilitation is becoming more of a focus for the field of physiatry due to increased longevity and the side effects of treatment. In order to investigate the rehabilitation needs of patients undergoing limb-sparing procedures, chart analysis was conducted on 17 children treated for primary bone tumors by resection and an expandable endoprosthetic replacement. Each patient underwent a course of postoperative inpatient and outpatient physical therapy and was followed over an average of 2.5 years. Gait training was relatively straightforward and in seven patients required neither orthosis nor ambulatory aid. The other ten patients walked with a knee orthosis, axillary crutches, or both. Until the time came for reoperation to lengthen the implant, a shoe lift of 1in maximum was added to compensate for the limb length discrepancy. These findings compare favorably with the more complex requirements of high proximal amputees with external prostheses, including more difficult gait training and the need for frequent adjustments, as well as prosthetic replacement as the children grow. It is clear that children undergoing limb-sparing surgery have special needs that should be addressed, including early mobilization, gait training, adjustment to repeated brief hospitalizations for lengthening, and continued follow-up to monitor their activity restriction.
A case of eosinophilic granuloma in an unusual location (ischium) is presented. Eosinophilic granuloma, a benign lesion of bone, has many radiographic appearances that vary with location. The flat bone of the skull and pelvis are common sites of involvement. Although the iliac wings and pubic rami are not uncommon sites for such a lesion, the ischium is a rare site. This occurrence prompted us to report this case.
The MRI features of bilateral xanthoma of the achilles tendon in type II hyperlipoproteinemia are reported. MRI has proved to be the best imaging modality available in assessing enlargement of the Achilles tendon. It demonstrates the heterogeneous signal on both T1- and T2-weighted images where the xanthomatous deposits are relatively higher in signal intensity than the tendon itself. MRI also has a potential value in the clinical assessment and therapeutic response of the xanthoma after operative intervention.
We present a patient with parosteal osteosarcoma. The lesion arose at the surface of the femur without involvement of the marrow cavity. Some 24 months following resection of the involved bone, she developed distant metastases with no evidence of local recurrence. Neither the primary nor the metastatic lesions showed high-grade malignancy.
An unusual case of an angiosarcoma that occurred in a bone infarct is presented. A bone infarct may occasionally dedifferentiate to an osteogenic sarcoma or a malignant fibrous histocytoma. However, the association of angiosarcoma with a bone infarct is extremely rare. To the best of our knowledge, there is only one other report of this association in the English literature.
Magnetic resonance imaging (MRI) was performed in six cases of intramuscular myxoma of the extremities and revealed the following characteristics. All tumours were confined to muscle and had a sharply defined border. All had a signal intensity lower than skeletal muscles on T1-weighted images and brighter than fat on T2-weighted images. The signals were homogeneous on both T1- and T2-weighted images. This study did not include contrast enhancement. The diagnosis was confirmed by an open biopsy. All tumours were resected with no recurrence. Diagnosis based on these MRI characteristics was incorrect in two cases of intramuscular ganglia and in a case of intramuscular cysticercus cellulose. MRI features of intramuscular myxoma are typical in the majority of cases. Benign intramuscular lesions that contain mainly fluid can mimic intramuscular myxomas.
The overall spectrum of hemangiomas involving long tubular bones is exemplified by three cases, the first being medullary, the second periosteal, and the third intracortical. The clinical presentation was progressive pain at the site of the lesion in all cases. The medullary hemangioma involved the distal shaft of the humerus and was entirely radiolucent. The periosteal tumor was exceptional in that it affected the proximal shaft of the tibia in contrast to the seven previously reported cases that involved the midshaft of the bone. The intracortical hemangioma was in the tibia, the site of all three previously reported cases. Hemangioma of bone may show variable roentgenographic patterns related to the anatomic location and the type of involved bone. The final diagnosis is dependent on histologic evaluation.
The Swarm rat chondrosarcoma has been the subject of extensive biochemical studies. However, to our knowledge, there are no previous reports in the literature on transplantation of this tumor into bone. This article describes the natural history of the tumor when implanted into the bone of the rat, and correlates its histological growth pattern with its radiological appearance. Our results showed that the tumor grows slowly in the bone. The rate of intramedullary growth, however, was variable and was not the same in all the animals. Its growth pattern resembles human chondrosarcoma, with extensive invasion of the marrow and cortex. In the first few weeks after implantation, the only radiological changes noted were mild medullary radiopacities. At a later stage, 12-14 weeks postimplantation, as the tumor infiltrated the bone, significant radiological abnormalities were observed in the medullary cavity and cortex. Periosteal reaction was seen after the tumor invaded the cortex with the production of a soft-tissue mass. Distant dissemination was rare; only 1 of 24 rats developed pulmonary metastases. The Swarm rat chondrosarcoma is a well-differentiated malignant tumor that histologically resembles well-differentiated human chondrosarcoma. Transplanted into bone, it may be useful as an experimental model for comparative studies with human chondrosarcoma.
We report two cases of fibromyxoma, one affecting the iliac crest and the second involving the proximal shaft of the tibia. Fibromyxoma is a rare neoplasm related to benign fibrous tumors and is characterized by exuberant, extracellular, ground substance production. Its histologic appearance is benign and distinctive and can be readily distinguished from that of myxoid chondrosarcoma or chondromyxoid fibroma. The radiographic picture is, however, difficult to interpret, and the entity can be easily mistaken for other tumors.
A case of chondroblastoma involving the right acetabulum and superior pubic ramus in a 60-year-old man has been presented. Tissue was obtained by open biopsy. The clinical and radiographic characteristics of chondroblastoma in general, and this tumor in particular, were discussed. The histopathology and differential diagnosis were also considered. The relatively uncommon site of the tumor and its occurrence in an older patient made the radiographic diagnosis difficult, and other possibilities were discussed.
A case of primary liposarcoma of bone involving the glenoid region of the right scapula in a 57-year-old man is presented. The diagnosis was confirmed by open biopsy. The differential diagnoses have been considered. To the best of our knowledge, this may be the first reported case of primary liposarcoma of bone in the scapula.
Eight bone tumors with associated transarticular invasion of the sacroiliac joints are described. All invaded the true synovial joint and spread to the opposing bone. One tumor was benign, and the other seven were malignant. Five of the seven were primary and two were metastatic cancer. One, a myeloma, invaded the disc spaces between the fourth and fifth lumbar vertebrae and the fifth lumbar vertebra and sacrum as well as the sacroiliac joint. The right facet joints of the two vertebrae were also invaded. After a thorough search of the literature, we find that the sacroiliac joint is the most common joint to be invaded by tumors. This is followed by the vertebral disc spaces and, last, the facet joints. Apart from these joints, we were unable to find any radiographic documentation of other joints being transarticularly invaded by tumors. We noted that there is a direct relation between transarticular tumor spread and joints that lack mobility and that certain tumors, benign and malignant, tend to invade these joints.
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Limb-sparing surgery has a definite role in the treatment of osteosarcoma in children. Increased survival, however, raises problems of limb-length discrepancy and prosthetic longevity. The concept of an expandable adjustable prosthesis addresses the problem of leg-length discrepancy. The problem of prosthesis longevity will require further long-term evaluation of current designs and methods of fixation, as well as the development of a permanent prosthesis or biologic replacement. At skeletal maturity, the expandable prosthesis may either be maintained or substituted with another implant or biological alternative if warranted by the clinical situation.