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PubMed2004

Imaging of periosteal osteosarcoma: radiologic-pathologic comparison.

PURPOSE: To review the imaging appearance of periosteal osteosarcoma, with pathologic comparison. MATERIALS AND METHODS: Data for 40 pathologically confirmed periosteal osteosarcomas were retrospectively reviewed. Patient demographic data were recorded, and radiographs (n = 40), bone scintigrams (n = 10), angiograms (n = 2), and computed tomographic (CT) (n = 11) and magnetic resonance (MR) (n = 12) images were evaluated for lesion location and size, cortical changes, marrow involvement, and intrinsic characteristics by two musculoskeletal radiologists, with agreement by consensus. Pathology reports were reviewed for presence and predominance of histologic components (fibrous, chondroid, and osteoid), tumor grade, and marrow involvement. RESULTS: There were 25 male (62%) and 15 female (38%) patients with an age range of 10-37 years (average age, 20 years). The most frequent lesion locations were the diaphysis of the tibia (16 patients) or of the femur (15 patients). Radiographs showed a broad-based soft-tissue mass that was attached to the cortex (all patients) and showed cortical thickening (33 patients), cortical scalloping/erosion (37 patients), and/or perpendicular periosteal reaction (38 patients) extending into the soft-tissue mass. Soft-tissue masses were well defined in 91%-100% of cases and surrounded a median of 50%-55% of the cortex. Lesions commonly showed low attenuation at CT (10 patients) and high signal intensity on T2-weighted MR images (10 patients), reflecting the high water content of these largely chondroblastic lesions. Focal areas of adjacent marrow replacement were common at MR imaging (nine patients) but represented reactive changes unless they were in direct continuity with the overlying soft-tissue mass (this was rare, occurring in only one patient, and represented marrow invasion). Review of pathology reports revealed that all lesions contained chondroid tissue, which predominated in 34 patients. CONCLUSION: The radiologic appearance of periosteal osteosarcoma is a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component. Reactive marrow changes are commonly seen at MR imaging, but true marrow invasion is rare.

Adolescent↗
PubMed1997

Strain gradients correlate with sites of periosteal bone formation.

We examined the hypothesis that peak magnitude strain gradients are spatially correlated with sites of bone formation. Ten adult male turkeys underwent functional isolation of the right radius and a subsequent 4-week exogenous loading regimen. Full field solutions of the engendered strains were obtained for each animal using animal-specific, orthotropic finite element models. Circumferential, radial, and longitudinal gradients of normal strain were calculated from these solutions. Site-specific bone formation within 24 equal angle pie sectors was determined by automated image analysis of microradiographs taken from the mid-diaphysis of the experimental radii. The loading regimen increased mean cortical area (+/-SE) by 32.3 +/- 10.5% (p = 0.01). Across animals, some periosteal bone formation was observed in every sector. The amount of periosteal new bone area contained within each sector was not uniform. Circumferential strain gradients (r2 = 0.36) were most strongly correlated with the observed periosteal bone formation. SED (a scalar measure of stress/strain magnitude with minimal relation to fluid flow) was poorly correlated with periosteal bone formation (r2 = 0.01). The combination of circumferential, radial, and longitudinal strain gradients accounted for over 60% of the periosteal new bone area (r2 = 0.63). These data indicate that strain gradients, which are readily determined given a knowledge of the bone's strain environment and geometry, may be used to predict specific locations of new bone formation stimulated by mechanical loading.

Animals↗
PubMed2000

Periosteal osteosarcoma of the jaws: report of 2 cases.

Osteosarcoma (OS) occurs most often in the long bones. OS of the jaws has clinical and biologic aspects different from those of the long bones. They tend to occur at an older mean age, pain and swelling are more typical, and prognosis is more favorable. Nearly all OS shows a very prominent central intramedullary bone component. Only rarely are juxtacortical (peripheral) OS located in the jaws. There are 2 main types of juxtacortical OS, periosteal and parosteal. We present 2 cases of OS of the jaws where the clinical, radiologic, and histologic findings pointed to a diagnosis of periosteal OS. Both patients presented, in fact, with lesions located superficially on the bone surface with no marrow involvement. Both tumors were characterized by the presence of a moderately differentiated chondroblastic tumor with foci of osteoid and bone formation. Periosteal OS should be differentiated microscopically from periosteal chondrosarcoma, intramedullary OS with periosteal extension, high-grade surface OS, and parosteal OS. The clinical differential diagnosis was done, in these cases, for epulis, gingival tumors, peripheral odontogenic fibroma, peripheral ossifying fibroma, pyogenic granuloma, peripheral giant cell granuloma, and mesenchymal malignant tumors.

Adolescent↗
PubMed2002

Brief exposure to high-dose transforming growth factor-beta1 enhances periosteal chondrogenesis in vitro: a preliminary report.

BACKGROUND: Articular cartilage has limited potential for repair. There have been various attempts aimed at improving the repair process in articular cartilage. Transforming growth factor-beta1 (TGF-beta1) has a stimulatory effect on chondrogenesis in periosteal explants. The purpose of the present study was to determine the effect of brief exposures (i.e., thirty and sixty minutes) of high concentrations of TGF-beta1 on periosteal chondrogenesis. METHODS: Five hundred and seventy-three periosteal explants were harvested from forty-six two-month-old male New Zealand White rabbits. Explants were exposed to 50 or 100 ng/mL of TGF-beta1 for thirty or sixty minutes. The amount of cartilage formed was then determined with use of a standardized six-week agarose culture assay. RESULTS: There was a significant increase in the amount of cartilage formation (p < 0.01), Type-II collagen content (p < 0.05), and sulfate incorporation (p < 0.0001) in explants treated with TGF-beta1. Maximal stimulation occurred following exposure to 100 ng/mL of TGF-beta1 for thirty minutes. There was also an increase in chondrocyte proliferation as measured by [ (3) H-] thymidine incorporation on day 5 of culture (p < 0.049). CONCLUSIONS: The findings of this study indicate that exposure to TGF-beta1 has a stimulatory effect on periosteal chondrogenesis. This stimulatory effect is observed even with a very brief exposure time of thirty minutes. CLINICAL RELEVANCE: A possible clinical application of these findings is exposure of periosteal grafts that are currently utilized clinically to resurface articular defects to TGF-beta1 during the short time between graft procurement and implantation into the joint. This may obviate the need for intra-articular administration of TGF-beta1 and may enhance the ultimate graft incorporation and quality of cartilage repair.

Animals↗
PubMed2001

Periosteal chondroid tumors: radiologic evaluation with pathologic correlation.

OBJECTIVE: The purpose of this study was to determine whether the imaging features of periosteal chondroid tumors correlate with histopathology. MATERIALS AND METHODS: Twenty-two patients (nine women and 13 men; mean age, 33 years) with pathologically proven periosteal chondroid lesions were retrospectively reviewed. The imaging modalities included conventional radiography (n = 17), CT (n = 10), and MR imaging (n = 14). The images were reviewed by two osteoradiologists, with agreement by consensus. Evaluation criteria included lesion location, mineralization, and size; periosteal reaction; and cortical response. Intramedullary extension, adjacent intramedullary edema, soft-tissue edema, and intrinsic characteristics were also evaluated on MR imaging. After the evaluation, a radiologic diagnosis of chondroma or chondrosarcoma was obtained. An experienced osteopathologist who was unaware of the patient's medical history and radiologic findings reviewed all histopathology. Agreement between the radiologic and the histopathologic diagnosis was tested using the kappa analysis. Imaging features were correlated with the pathologic findings, and a statistical analysis was performed. RESULTS: Using strict pathologic criteria, we diagnosed 11 chondromas and 11 chondrosarcomas (nine, grade I; two, grade II). Moderate agreement was reached between the radiologic and the pathologic diagnosis (kappa = 0.55). The size of periosteal chondrosarcomas (range, 3-14 cm; median, 4 cm) was considerably larger than the size of the chondromas (range, 1-6.5 cm; median, 2.5 cm; p < 0.05). Other imaging features did not significantly correlate with benign versus malignant disease at pathology (all p > 0.05). CONCLUSION: A variable overlap existed in the imaging appearances of benign and malignant periosteal chondroid lesions, with size being the most reliable indicator in distinguishing the two lesions. This and the fact that histologic differentiation of the entities can be difficult, suggests that surgical wide excision may be the most appropriate procedure in treating patients with lesions greater than 3 cm.

Adult↗
PubMed1999

Early muscle-periosteal lesion inhibits fracture healing in rats.

We assessed the effects of muscular detachment from the periosteum on fracture healing, focusing on a muscle-periosteal lesion in the initial healing process. In 30 male Wistar rats we produced a partial osteotomy in the mid-diaphysis of the left femur which was then manually broken. All fractures were reamed and stabilized with a 1.6 mm steel pin. The animals were randomly assigned to 3 groups. In group 1, an extraperiosteal detachment between muscle and periosteum was created in the middle third of the diaphysis. In group 2, an extraperiosteal detachment was created with application of an ePTFE sheath (Gore-Tex expanded polytetrafluoroethylene) around the shaft between muscle and periosteum during the first 2 weeks following fracture. In group 3, the dissection was identical, while the ePTFE sheath was installed after 2 weeks. The rats were killed after 4 weeks, and their bones were evaluated radiographically and mechanically by the three-point bending test. The fractures healed by production of external callus, and radiographs revealed various degrees of periosteal callus with a radiolucent fracture line, most evident after early muscle-periosteal isolation. The callus area was significantly smaller after early muscle isolation, compared to extraperiosteal dissection alone and later tissue isolation. Bending moment and stiffness were also less in this group than in groups 1 and 3, while fracture energy was less than in group 1. No differences in mechanical properties were detected between extraperiosteal dissection alone and late-tissue isolation. This animal study underlines the importance of early muscle-periosteal apposition for fast periosteal healing of diaphyseal fractures.

Animals↗
PubMed1999

Gene-enhanced tissue engineering: applications for bone healing using cultured periosteal cells transduced retrovirally with the BMP-7 gene.

Periosteum has cell populations, including osteoprogenitor and chondroprogenitor cells, that can be grown in cell culture and form both bone and cartilage under appropriate conditions. The authors have shown previously that cultured periosteal cells can be used in the tissue engineering of bone, and they demonstrated substantial bone formation in a rabbit cranial defect model. In the current study, principles of tissue engineering were combined with principles of gene therapy to produce cultured periosteal cells transduced retrovirally with the bone morphogenetic protein 7 (BMP-7) gene to be used in the treatment of bone defects. Human BMP-7 complementary deoxyribonucleic acid was generated from a cell line using reverse transcription polymerase chain reaction and cloned into a retroviral vector plasmid. Retroviral vector particles were then used to transduce New Zealand White rabbit periosteal cells. Transduced periosteal cells demonstrated substantial production of both BMP-7 messenger ribonucleic acid by Northern blot analysis and BMP-7 protein by enzyme-linked immunosorbent assay. These cells were then seeded into polyglycolic acid (PGA) matrices and used to repair critical-size rabbit cranial defects. At 12 weeks, defect sites repaired with BMP-7-transduced periosteal cells/PGA had significantly increased radiographic and histological evidence of bone repair compared with those defect sites repaired with negative control-transduced cells/PGA, nontransduced cells/PGA, PGA alone, or unrepaired defects. Thus, this study demonstrates successfully a tissue engineering approach to bone repair using genetically modified cells.

Animals↗
PubMed1998

[Treatment of avascular necrosis of femoral head by periosteal cell transplantation: an experimental study].

OBJECTIVE: To investigate the effect of periosteal cell transplantation on the repair of avascular necrosis of femoral head (ANFH). On the basis of successful culture of periosteal cells in vitro. METHODS: The tibial periostea of new born dog were excised and cultured under aseptic conditions. Eight adult dogs were used and divided into 2 groups: experimental group and control group. The animal model of ANFH was made by transferring the freed femoral head into the muscle under the ilium on one side in each dog. Two weeks after the establishment of ANFH, the cultured periosteal cells were collected and transplanted into the necrotic femoral heads in the experimental group, and the femoral heads without periosteal cell transplantation served as the control. Six weeks after cell transplantation, the femoral heads were taken out and histological examination was made. RESULTS: There was active bone formation in the experimental group. The new bone was arranged into bone trabeculae, most of which were covered by a monolayer of osteoblasts. Between bone trabeculae were fibrous tissue rich in blood vessels. In the control group, the bone trabeculae withered and remained necrotic. There were fibrous tissues with few blood vessels between bone trabeculae. CONCLUSION: Periosteal cell transplantation can improve the repair of ANFH.

Animals↗
PubMed2002

Periosteal donor site regeneration in rats.

Periosteal regeneration was investigated in two periosteal donor sites of the femur. The periosteum was taken from the femur epiphyses and diaphyses of 32 rats. The animals were sacrificed 1, 2, 3, 4 and 8 weeks after periosteal stripping. Intense cell proliferation occurred in the first week. After two weeks, a thick tissue layer formed by osteoblasts and undifferentiated cells was seen at the two donor sites. Eight weeks after, the periosteum had the same aspect as that from the right femur, which was used as control. Histomorphometric analysis showed that periosteal regeneration was significantly different between epiphyses and diaphyses. Periosteal regeneration at donor site located in epiphyses presented greater proliferation and better osteogenic activity than that observed in diaphyses.

Animals↗
PubMed1991

[Periosteal osteosarcoma of the femur: a pathological and ultrastructural study].

A femoral, diaphyseal tumor was found in a 17-year old male, and the diagnosis of periosteal osteosarcoma was made, based on the typical radiological and pathological findings. Microscopic observation on a resected specimen revealed that the tumor was covered with the intact periosteal fibrous layer and did not extend beyond the periosteum. The adjacent cortex was free of tumor. These findings indicated that the tumor originated from the periosteal cambium layer, which lies between the periosteal fibrous layer and the cortex. For transmission electron microscopic examination, the tissue was obtained at open biopsy. Ultrastructurally, no specific cell of periosteal osteosarcoma was found. Although most types of osteosarcoma cells were identified in the tumor (osteoblast-like, chondroblast-like, fibroblast-like, primitive mesenchymal-like, osteoclast-like and so on), the ultrastructural characteristics were of wide variety and of low malignancy.

Adolescent↗
PubMed1989

Neochondrogenesis in free intra-articular, periosteal, and perichondrial autografts in horses.

Periosteal autografts were obtained from the medial aspect of the proximal portion of the tibia, and perichondrial autografts were obtained from the sternum. Using arthroscopic visualization, each autograft was placed as a loose body into 1 tarsocrural joint in 6 young horses (2 to 4 years old). Horses were hand-walked daily, starting the day after surgery, for a total of 6 h/wk for 8 weeks. Eight weeks after autograft implantation, radiographs were taken of each tarsocrural joint and were interpreted with regard to mineralization in the transplanted autografts. Autografts were then surgically removed, and examined macroscopically and microscopically for viability, size, and production of chondroid tissue. All autografts appeared viable and most had evidence of growth. Longest-by-shortest axis value, cross-sectional area, and perimeter were greater in perichondrial autografts than in their periosteal counterparts in 3 horses, but the difference was not significant. Neochondrogenesis was observed in 5 of 6 periosteal grafts and in 1 of 6 perichondrial grafts. Furthermore, the amount of chondroid tissue produced in periosteal autografts was significantly (P less than 0.05) greater than that produced in the 1 perichondrial graft. The chondroid tissue produced by periosteal autografts had morphologic and matrical staining properties similar to those of hyaline cartilage.

Animals↗
PubMed1989

Periosteal bone formation elicited by partially purified bone morphogenetic protein.

A small amount of partially purified, water-soluble murine osteosarcoma-derived bone morphogenetic protein (BMP) was implanted into the dorsal muscles of mice in combination with calf skin gelatin or collagen as carriers. Changes in the ribs adjacent to the implants were then chronologically observed. On implantation of BMP with gelatin, the gelatin was rapidly absorbed and no ectopic bone formation was observed, but periosteal cellular proliferation with subsequent formation of periosteal cartilage and bone was seen in ribs adjacent to the implant. Implantation of the same amount of BMP fraction or gelatin alone as controls did not result in either any ectopic bone formation in situ or any periosteal bone formation in adjacent ribs. Implantation of BMP with collagen resulted consistently in both ectopic bone formation in situ and periosteal bone formation in adjacent ribs. These results suggest that BMP is diffusible in vivo and is capable of eliciting a response from periosteum to stimulate periosteal bone formation.

Animals↗
PubMed1997

[Experimental study of the effect of motion on repairing defect of articular cartilage following autogenous periosteal graft].

In order to investigate the effect of motion on repairing articular cartilage defect following autogenous periosteal graft, sixty adult rabbits were divided randomly into three groups: out-cage motion (OCM), in-cage motion (ICM) and immobilization (IMM). A defect of the articular cartilage, 1 cm x 0.5 cm in size, was made in the patellar-groove of femur of each hind limb. Free autogenous periosteal graft from the proximal tibia was sutured on the base of the left defect, while the right limb was served as control. The animals were sacrificed at 4, 8 and 12 weeks, respectively, after operation. The regeneration of the cartilage implanted was observed through gross, histology, histochemical assay and electronic microscope. The influence of different amount of motion on the chondrogenesis from the periosteal implant was also compared. The result showed that the hyaline cartilage produced from periosteal implant could be capable to repair full-thickness of articular cartilage. From statistical study, there was significant difference between OCM and ICM groups (P < 0.05), ICM and IMM (P < 0.05) as well as OCM and IMM (P < 0.01). It was suggested that the periosteal graft was effective in repair of defect of articular cartilage and the amount of motion was important for chondrogenesis.

Animals↗
PubMed1996

Periosteal ganglion: a report of three new cases including MRI findings and a review of the literature.

OBJECTIVE: To clarify the clinicopathological features of periosteal ganglion. DESIGN: Three patients with periosteal ganglion were studied clinicopathologically. PATIENTS: One patient was selected from the files of our institute and two from a consultation file. RESULTS AND CONCLUSION: All three lesions were located over the medial aspect of the tibia. Plain radiographs showed cortical erosions of varying degrees and mild periosteal reaction of the medial side of the tibia. MR images demonstrated well-circumscribed lesions overlying the cortical bone of the tibia, shown as low-intensity areas on T1-weighted images. On T2-weighted images, lesions were homogeneous, lobulated, and showed a characteristic markedly increased signal intensity. These findings are helpful in making a diagnosis of periosteal ganglion. Each patient had an uneventful clinical course after an excision involving the wall of the ganglion, the adjoining periosteum, and the underlying sclerotic cortical bone.

Aged↗
PubMed2001

Florid reactive periostitis and bizarre parosteal osteochondromatous proliferation: pre-biopsy imaging evolution, treatment and outcome.

OBJECTIVE: To report on the imaging evolution of florid reactive periostitis (FRP) and bizarre parosteal osteochondromatous proliferation (BPOP) of the phalanges of the hands from prospective diagnosis to operation and on postsurgical outcome. DESIGN AND PATIENTS: Three patients (2 female, 1 male; age range 11-34 years) presented with a swollen digit of the hand. Following presumptive radiographic diagnosis of FRP, they were closely observed both clinically and radiographically until operation. All three patients had radiographs of the involved digit, and one patient had an MR imaging examination. The interval between presumptive diagnosis and operation ranged from 2 to 8 months. Following operation, the patients have been clinically followed for 9-13 months (mean 10 months). RESULTS: In each of the patients, maturing of periosteal reaction without bone destruction was observed within 1-2 weeks of the presumptive diagnosis of FRP. Periosteal reaction was initially minimal in relation to the extent of soft tissue swelling and subsequently became more florid. In one patient, the lesion ossified, became adherent to the phalanx, and had an "osteochondromatous" appearance. In another patient, periosteal reaction was seen on both sides of the phalanx with an intact phalanx. In the sole patient who had MR imaging, edema was seen in the phalanx distal to the symptomatic site and the metacarpal proximal to the symptomatic site. CONCLUSIONS: Close clinical and radiographic correlation permits an accurate pre-biopsy diagnosis of FRP. The first follow-up radiograph taken within 2 weeks usually provides re-assurance of the accuracy of the diagnosis. FRP may progress to BPOP. Arbitrary antibiotic treatment can be avoided, and a planned surgical approach can be adopted.

Adult↗
PubMedDate not supplied

Myelofibrosis associated with prominent periosteal bone apposition. Report of two cases.

Myelofibrosis is a myeloproliferative disorder that is characterized by splenomegaly and bone marrow replacement by fibrous tissue. The predominant radiographic feature is osteosclerosis; however, in rare instances, periosteal bone apposition or periostitis is apparent in the metaphysis of the distal femura and proximal tibiae. It has been suggested that periostitis, when associated with fever and bone pain, is indicative of more aggressive disease. We report this unusual radiographic finding and its similar appearance to hypertrophic osteoarthropathy in two patients with myelofibrosis. In our patients, the presence of periosteal bone apposition did not correlate with increased disease aggressiveness.

Aged↗
PubMed2006

Periostitis ossificans (Garrè's osteomyelitis) radiographic study of two cases.

BACKGROUND: Periostitis Ossificans (PO) is a non-suppurative type of Osteomyelitis, commonly occurring in children and young adults, in mandible. The most common cause for PO is periapical infection of mandibular first molar. Radiographically PO is characterized by the presence of lamellae of newly formed periosteal bone outside the cortex, giving the characteristic appearance of "onion skin". CASE REPORTS: Two male children 11 years of age reported to the Department of Oral Medicine with a painless and persistent bony hard swelling in the mandible, with a short duration (Figs 1, 5). Both the patients had grossly decayed mandibular permanent first molar tooth with periapical infection and buccal cortical plate expansion (Figs 2, 6). The radiographic study revealed different appearances, the Orthopantomograph of case I showed a single radiopaque lamella outside the lower cortical border, without altering original mandibular contour (Fig. 3) and in case II showed a newly formed bony enlargement on the outer aspect of the lower cortical border without altering the original mandibular contour (Fig. 7). Occlusal radiograph of both the patients showed two distinct radiopaque lamellae of periosteal bone outside the buccal cortex (Figs 4, 8). Kawai et al. classified PO of mandible into type I and type II, based on whether the original contour of mandible is preserved or not. Each type is further classified into two sub types (Table 1). In case I, the orthopantomographic appearance is characteristic of type I-1 (Fig. 3), but the appearance in occlusal radiograph is characteristic of type I-2 (Fig. 4). In case II, the appearances in both the radiographs are characteristic of type I-2 (Figs 7, 8). CONCLUSIONS: Apart from the typical onion skin appearance, PO shows various other radiographic appearances. The radiographic appearance of Periostitis Ossificans may reflect the duration, progression and the mode of healing of the disease process. The radiographic classification of PO depends on the type of radiographs taken for evaluation.

Child↗
PubMed1987

Periostitis in hypertrophic osteoarthropathy: relationship to disease duration.

The relationship of periostitis to disease duration in primary hypertrophic osteoarthropathy and the association of periostitis with cardiopulmonary disorders (secondary type) were studied in order to define distinguishing features between the two. Radiographic skeletal surveys were performed in 24 patients with hypertrophic osteoarthropathy to analyze pattern (single layer, multilayered, irregular) and site of involvement (diaphysis, metaphysis, epiphysis). The six patients with primary hypertrophic osteoarthropathy and the 11 patients with cyanotic congenital heart disease had thicker, more widespread periostitis involving the diaphysis, metaphysis, and epiphysis, in contrast to abnormalities in the seven patients with hypertrophic osteoarthropathy secondary to carcinoma of the lung. Average cortical bone widths as determined by radiogrammetric measurement of the second metacarpals were significantly greater for the patients with primary hypertrophic osteoarthropathy (8.9 +/- 6.0 mm) and cyanotic congenital heart disease (8.5 +/- 6.4 mm) as compared with the patients with bronchogenic carcinoma (6.0 +/- 3.9 mm). Correlation of radiographic patterns with duration of disease confirms that thicker, more extensive alterations are indicative of long-standing disease. The periostitis of hypertrophic osteoarthropathy is therefore not dependent on the primary or secondary nature of the disease but principally on its duration.

Adolescent↗