Similar appearance of different multifocal carpal bone destructing disease entities in 3 patients: A case report

Rationale:Several diseases feature tumors, or tumor-mimicking lesions, that further invade the bone and surrounding joints of the wrist region. Here, we describe 3 rare cases of multiple destructed carpal bones and adjacent joints in different disease entities confirmed via pathologic diagnosis.Patient concerns:All 3 cases were examined between January 2016 and December 2019. Three patients presented with similar clinical manifestations and radiographic features, with multiple osteolytic lesions in the carpal bones and metacarpal bone base.Diagnoses:The 3 cases were diagnosed as diffuse type tenosynovial giant cell tumor, calcifying aponeurotic fibroma, and rheumatoid arthritis.Interventions:Separate, experienced radiologist and pathologist took part in the interpretation and compartmentalization of radiographs and pathological findings, respectively. Even magnetic resonance imaging could not achieve a diagnosis; surgical excision was therefore required, with subsequent pathological assessment for treatment and final diagnosis.Outcomes:functional outcomes also differed among patients, poorest in rheumatoid arthritis patient.lessons:We report 3 rare disease entities, presenting with multifocal osteolytic lesions in the wrist. They all presented with similar clinical manifestations, and the final diagnoses were made via pathological evaluation. Compared with tenosynovial giant cell tumor and calcifying aponeurotic fibroma, rheumatoid arthritis had the poorest outcome.     

Role of multidetector computed tomography in assessment of fibro-osseous lesions of the craniofacial complex

Aim

To assess the role of multidetector CT in assessment of fibro-osseous lesions of the craniofacial complex.

Materials and methods

This study included 25 patients. Their age ranged from 15 to 64 years with a mean age of 37.56 ± 15.17 years. All the studied individuals were chosen selectively regarding complaint (those with known fibro-osseous lesions, facial disfigurement, and facial swelling) regardless of age and gender and examined using MDCT in detection of the lesion, and assessment of the extensions.

Results

In the present study, the cranio-facial fibrous dysplasia represented almost half of the presented cases (48%) followed by osteomas (36%) then ossifying fibroma (12%) and brown tumor (4%). 13 out of 25 cases in this study were pathologically proven to be fibro-osseous lesions and surgically operated. The final diagnosis was made by consensus of imaging, clinical findings and pathological features.

Conclusions

Multi-detector row CT images, including reformations, better delineate craniofacial complex anatomy than do single-detector row CT images. Using multi-slice CT scanning in the craniofacial complex becomes possible to depict the complete path of complex structures.     

卵巢纤维瘤合并腹膜恶性间皮瘤临床病理观察

目的探讨卵巢纤维瘤合并腹膜恶性间皮瘤的诊断与鉴别诊断以及可能的发病机制。方法采用HE染色、免疫组化标记、临床追踪随访并复习文献对卵巢纤维瘤合并腹膜恶性间皮瘤进行观察分析。结果患者女性,60岁。盆腔占位伴大量腹水。组织学上卵巢为巨大纤维瘤,合并腹腔弥漫性上皮样细胞增生,细胞呈乳头状或巢片状分布,异型性不明显,核分裂少见,部分区域肿瘤向脂肪小叶内浸润生长。免疫组化:上皮样细胞MC、CR、D2-40和CK5/6(+),p16和上皮性标记物(-)。结论卵巢纤维瘤合并腹膜恶性间皮瘤罕见,发生机制不清。形态学上容易误诊为卵巢纤维瘤伴弥漫性间皮细胞增生、腹膜或卵巢原发性浆液性肿瘤,免疫标记及临床特征有助于鉴别。     

Elastofibroma dorsi: A soft tissue masquerade

Elastofibroma dorsi (ED) is a soft tissue tumor found in the subscapular region. The pathogenesis of ED is unclear, but may involve a regenerative or reactive hyperproliferation due to mechanical microtrauma. Magnetic resonance imaging (MRI) is preferred to diagnose ED and complete excision is curative. When bilateral, subscapular masses are identified in the elderly patient and MRI characteristics are typical, biopsy and excision can be avoided. Symptomatic EDs should be excised, and recurrence is rare. Three hundred and thirty cases of ED have been reported since 1980. Fourteen case series and 43 isolated case reports involved 263 women and 67 men (F:M ratio = 3.9:1), with a mean age of 62 years (range 6-94 years). Bilateral ED was present in 164 patients and unilateral ED in 157. The reported prevalence in the elderly population ranges from a minimum of 2% to a maximum of 24%.     

Review of Lateral Orbital Wall Ossifying Fibroma

Significant histological overlap exists between fibro-osseous lesions and diagnosis is made on a clinicopathological basis. Ossifying fibroma is a benign fibro-osseous neoplasm of the jaw and craniofacial complex that has generated a degree of controversy regarding diagnosis and classification, especially with respect to the psammomatoid variant. Orbital lesions mainly arise from the paranasal sinuses affecting the medial or inferior orbital wall. Lateral orbital wall ossifying fibroma is, therefore, a rare condition with only a single previous case report. We present a second case of lateral orbital wall ossifying fibroma and a review of the associated literature.     

Odontogenic Fibroma, Including Amyloid and Ossifying Variants

Sixty-five cases of odontogenic fibroma (OdonF) are herein presented having been segregated into peripheral, extra bony tumors (n = 40) and tumors arising in bone or centrally (n = 25). All cases were characterized microscopically by a fibrous proliferation that varied within and between cases in cellularity and collagen fibril diameter, with intermixed odontogenic epithelial islands and cords. All central lesions presented as well demarcated radiolucencies and resorption of contiguous tooth roots was a common finding. These intraosseous lesions were of the WHO type; the so-called nonWHO type was excluded as all lesions with this diagnosis were devoid of an epithelial component and could be reclassified as other soft tissue fibrogenic tumors. Neither the central tumors nor the peripheral lesions recurred following enucleation/curettage, with a mean follow-up of 4 and 3.4 years respectively. Three distinct microscopic variations were encountered in this series: (1) two cases of OdonF with giant cell reaction, (2) two instances of OdonF with ossifying fibroma; and (3) four instances of OdonF with odontogenic ameloblast-associated protein (ODAM), an amyloid-like protein found deposited adjacent to epithelial cords plus CD1a+/S-100+ Langerhans dendritic cells entwined around the epithelial element. A single instance of the odontogenic fibroma-like hamartoma/enamel hypoplasia syndrome has been included in this series.     

Recurrent calcifying aponeurotic fibroma of the thumb: case report

We present an unusual case report of an aggressive, recurrent calcifying aponeurotic fibroma of the thumb in an adult man with invasion into the distal and proximal phalanges, the skin, the radial and ulnar neurovascular bundles, and the tendons, treated with amputation and an immediate toe-to-thumb transfer.     

颅面部骨化性纤维瘤的CT诊断

目的探讨颅面部骨化性纤维瘤的CT表现,提高其诊断准确性。方法回顾性分析经手术病理证实的13例颅面部骨化性纤维瘤患者的CT资料。结果13例中病变起源于筛窦9例,额窦2例,蝶窦1例,上颌骨额突1例;12例首发病例多呈卵圆形,形态规则,1例复发病例形态不规整。CT表现．13例于骨窗上均呈密度不均匀的“磨玻璃”样略高密度或高密度肿块影（与脑实质比较）,内部均可见大小不等的囊变区,5例伴点状更高密度影,9例肿瘤周边可见特征性“蛋壳样”骨壳形成,其中6例于其内侧可见到环形或弧线形低密度影。结论CT是颅面部骨化性纤维瘤的首选检查方法,尤其是CT骨窗对提高该病诊断的准确性具有重要价值。     

Immunohistochemical expression of mast cell tryptase in giant cell fibroma and inflammatory fibrous hyperplasia of the oral mucosa

This study analysed the immunohistochemical expression of mast cell tryptase in giant cell fibromas (GCFs). In addition, the possible interaction of mast cells with stellate giant cells, as well as their role in fibrosis and tumour progression, was investigated. For this purpose, the results were compared with cases of inflammatory fibrous hyperplasia (IFH) and normal oral mucosa. Thirty cases of GCF, 30 cases of IFH and 10 normal mucosa specimens used as control were selected. Immunoreactivity of mast cells to the anti-tryptase antibody was analysed quantitatively in the lining epithelium and in connective tissue. In the epithelial component (p = 0.250) and connective tissue (p = 0.001), the largest mean number of mast cells was observed in IFHs and the smallest mean number in GCFs. In connective tissue, the mean percentage of degranulated mast cells was higher in GCFs than in IFHs and normal mucosa specimens (p < 0.001). Analysis of the percentage of degranulated mast cells in areas of fibrosis and at the periphery of blood vessels also showed a larger mean number in GCFs compared to IFHs and normal mucosa specimens (p < 0.001). The percent interaction between mast cells and stellate giant cells in GCFs was 59.62%. In conclusion, although mast cells were less numerous in GCFs, the cells exhibited a significant interaction with stellate giant cells present in these tumours. In addition, the results suggest the involvement of mast cells in the induction of fibrosis and modulation of endothelial cell function in GCFs.     

Peripheral cemento-ossifying fibroma--a case report

Peripheral cemento-ossifying fibroma (PCOF) is a relatively common gingival growth of a reactive rather than neoplastic nature whose pathogenesis remains uncertain. It predominantly affects adolescent & young adults with greater prevalence around 28 years. We report in this study, the clinical case of a 47-year-old female patient who was asymptomatic, with the disease duration of 2 years and was followed up for 6 months post-surgically showing gingival health, normal radio-opacity of bone without any recurrence. Clinical, radiographical and histological characteristics are discussed and recommendations regarding differential diagnosis, treatment and follow-up are provided. The controversial varied nomenclature and possible etiopathogenesis of PCOF are emphasized.