Epithelioid hemangioma of bone

Epithelioid hemangioma of bone is a rare type of angiomatous tumor. We report a documented case of epithelioid hemangioma occurring in the distal femur of a 35-year-old man. The clinical, radiographic, MR imaging and histologic findings of the tumor are described. Radiographs showed a well-defined expanding, osteolytic lesion in the diaphysis of the femur. MR imaging showed the lesion to have low signal intensity on T1-weighted images and intermediate signal intensity on T2-weighted images. Grossly the lesion was multiloculated with a dark brown, jelly-like content. To characterize the imaging appearances of epithelioid hemangioma, we reviewed the available literature on the subject. Received: 14 February 2000 Revision requested: 28 March 2000 Revision received: 31 May 2000 Accepted: 1 June 2000     

Parosteal osteoma of the iliac bone

A 33-year-old patient with a 2-year history of intermittent pain in the right gluteal region and thigh presented with a large sclerotic lesion of the iliac bone. From the findings on radiography, scintigraphy, CT and MRI, a giant parosteal osteoma was suspected. The histological examination confirmed the diagnosis. Since the lesion was extensive it was observed with periodic follow-up examinations. At present, 5 years after the diagnosis, the patient is asymptomatic and imaging studies show that the lesion persists with reduction of sclerosis and size. The tumor was on the surface as well as intramedullary – only one other case with such a distribution is known to us – and it was also in the iliac bone.     

Intraosseous lipoma of the humeral head: MR appearance

Intraosseous lipoma is the rarest benign primary bone tumor. We report a case of juxtaarticular intraosseous lipoma in the humeral head of a 50-year-old man. Roentgenographic, computed tomographic (CT), magnetic resonance (MR), scintigraphic, and histologic findings of this case are presented.     

MRI of complete rupture of the pectoralis major muscle

 Rupture of the pectoralis major muscle is a rare clinical entity. Only few reports have discussed its MRI or CT features. We have reviewed the imaging features of four cases of complete rupture of the pectoralis major muscle. One case of acute injury underwent surgical repair. MRI is useful in delineating the site and extent of the rupture in relation to the musculotendinous junction, which will help the surgeons with possible treatment options and surgical planning. Because of the complex anatomy of the pectoralis major muscle near its insertion on the humerus and the signal characteristics of hematoma and edema in the muscle, axial T2-weighted images were most valuable for the evaluation of acute and subacute injuries. Axial T1-weighted images were helpful in delineating chronic injuries. CT is inferior to MRI for direct visualization of muscle rupture.     

Capillary hemangioma of the sphenoid sinus with intrasellar and parasellar extensions

Capillary hemangiomas are benign vascular tumors usually diagnosed in infancy and involving skin and soft tissues. We report a rare case of an adult capillary hemangioma of the left sphenoid sinus extending into the intrasellar and parasellar regions. A 71-year-old woman presented with complaints of headaches and diplopia. Magnetic resonance imaging revealed a T2-hyperintense mass-like lesion involving the left posterior ethmoid and sphenoid sinuses and left cavernous sinus, that had extended into the intrasellar and parasellar regions. Dynamic contrast-enhanced computed tomography revealed enhancing vessel-like structures within the lesion during the arterial phase, which were observed to expand further in the late phase of the examination. This characteristic feature indicated increased vascularity, suggesting the presence of a capillary hemangioma. The patient underwent endoscopic resection via the endonasal transpterygoid approach, and the lesion was diagnosed histopathologically as a capillary hemangioma. To aid diagnosis and clinical management, radiologists should be aware of the imaging findings related to capillary hemangiomas.     

Intraorbital lobular capillary hemangioma (pyogenic granuloma)

A 44-year-old man with a history of a foreign body in his right eye visited our hospital. On computed tomography a well-enhanced mass with low attenuation septal walls and a capsule was detected in the right orbit. On magnetic resonance imaging the mass showed inhomogenous high intensity on T2-weighted images and low intensity on diffusion-weighted images. The mass was histopathologically diagnosed as a lobular capillary hemangioma. This is the first report about image findings of lobular capillary hemangioma in the orbit.     

Epithelioid hemangioma of bone

Although no specific radiographic appearance has emerged to date for the epithelioid subtype of hemangioma, these lesions most typically exhibit well-defined osteolysis. Other relatively common features include surrounding sclerosis, cortical expansion and cortical destruction. We present a case of epithelioid hemangioma of the spine with an unusual radiological appearance which to our knowledge has not previously been reported: diffuse sclerosis of the involved vertebral body. The diffuse sclerosis seen in this case resembles the osteosclerotic process seen not only in benign entities such as subacute and chronic osteomyelitis, but also in malignant lesions such as osteoblastic metastatic disease and lymphoma. Received: 28 July 2000 Revision requested: 8 September 2000 Revision received: 5 December 2000 Accepted: 6 December 2000     

Postradiation sarcomas of the pelvis after treatment for uterine cervical cancer: review of the CT and MR findings of five cases

Objective. To characterize the radiologic features of postradiation sarcomas arising in the pelvic bones following treatment for uterine cervical carcinoma. Design and patients. Five patients who developed postradiation sarcomas in the pelvic bones following radiation therapy for carcinoma of the uterine cervix within the irradiated field were evaluated. Pelvic radiographs, computed tomography (CT) and magnetic resonance (MR) imaging were undertaken in all patients. Histologic confirmation of the tumor type was obtained. Results. Three patients whose tumors were characterized as an osteosarcoma, an angiosarcoma and a malignant fibrous histiocytoma (MFH) showed a large round or oval mass mainly in the sacroiliac joint which extended into the posterior gluteal soft tissues. In a fourth patient an osteosarcoma developed in the central ilium extending widely into the soft tissues both anteriorly and posteriorly, with calcified areas within the extraosseous mass. The fifth patient had a MFH which showed osteolytic destruction of the cortex of the acetabulum, and minimal soft tissue extension. There were no specific features or signal intensity changes on MR imaging to differentiate these cases from primary sarcomas. Conclusion. Postradiation sarcoma must be considered in patients with uterine carcinoma when a soft tissue mass is seen in the previously irradiated field, especially if the mass is posterior to the sacroiliac joint and the latent period is more than 5 years. Received: 3 May 2000 Revision requested: 14 July 2000 Revision received: 28 July 2000 Accepted: 20 November 2000     

Posttraumatic osteochondral defect of the distal tibia

Osteochondral fracture of the distal tibia is an uncommon injury. We report two cases in which ankle trauma resulted in an elongated osteochondral defect in the distal tibia, and we describe the radiographic, scintigraphic, computed tomographic, magnetic resonance, and arthroscopic findings.     

Granular cell tumor of the subcutis: CT and MRI findings

Three cases of granular cell tumor (GCT) of the subcutis are presented. Computed tomography showed a mass isodense with muscle with an ill-defined margin. Magnetic resonance imaging showed a mass with inhomogeneous low signal intensity on both T1- and T2-weighted images. Another characteristic feature of subcutaneous GCT is its attachment in part to muscle. Histological examination confirmed the diagnosis in all cases. Received: 20 July 1998; Revision requested: 12 October 1998; Revision received: 30 October 1998; Accepted: 16 November 1998     

Myxolipoma mimicking a cystic tumor

 We report a patient with a myxolipoma that appeared as a cystic mass on ultrasonography, computed tomography, and magnetic resonance imaging.     

Benign vertebral hemangioma: MR-histological correlation

Objective: To explain the magnetic resonance (MR) appearance of benign vertebral hemangioma by correlating MR and histological findings from autopsy specimens. Design: Sagittal T1- and T2-weighted spin-echo images were obtained in 83 spine specimens. Focal lesions consistent with vertebral hemangioma at macroscopic examination of sagittal anatomical sections were sampled for histological and quantitative analysis. At histology, the proportion of surface area occupied by adipocytes, vessels and edema, and hematopoietic cells was determined (point-counting method) in normal marrow areas and in lesion areas whose signal intensity was either high and intermediate (pattern A) or intermediate and high (pattern B) on T1- and T2-weighted images, respectively. Results: Nine lesions were sampled and corresponded to cavernous hemangioma at histology. The proportion of surface area occupied by adipocytes was statistically significantly higher in pattern A (78.1%) than in pattern B lesion areas (42.7%) and than in normal marrow areas (47.5%). The proportion of surface area occupied by vessels and interstitial edema was statistically significantly higher in pattern B (47.0%) than in pattern A lesion areas (15.5%) and than in normal marrow areas (0). Conclusion: The presence of high signal intensity on T1- or T2-weighted images of vertebral hemangioma is related to the amount of adipocytes or vessels and interstitial edema, respectively. Received: 8 September 2000 Revision requested: 29 December 2000 Revision received: 27 March 2001 Accepted: 18 April 2001     

Surface-based hemangioma of bone: three case studies and a review of the literature

Three cases of surface-based hemangiomas were reviewed. The cases illustrate the plain film and magnetic resonance imaging findings of these benign tumors, which can appear quite aggressive, mimicking more aggressive neoplasms. Each of the patients underwent en bloc excision, and pathologic evaluation to determine the diagnosis. To date, there has been no evidence of recurrence.     

A case of a small-sized cavernous hemangioma in the right ventricle - an incidental finding

A cardiac cavernous hemangioma is a rare, primary, benign tumor that is usually diagnosed in young or middle-aged patients. In this article, we report the case of a 71-year-old male patient whose doctors incidentally discovered a heart tumor on his transthoracic echocardiography. Triple-phase computed tomography (CT) (pre-contrast, arterial and portal venous) missed the lesion, and magnetic resonance imaging (MRI) revealed a small, oval tumor attached to the wall of the right ventricle. The tumor was successfully removed surgically, and the patient recovered after 2 weeks. A histopathological examination resulted in the diagnosis of a benign cavernous hemangioma.     

Diabetic muscle infarction: radiologic evaluation

 Objective. Diabetic muscle infarction (DMI) is frequently misdiagnosed clinically as abscess, neoplasm, or myositis, and is often biopsied. Clinical and radiologic findings are presented here to enable the radiologist to suggest the correct diagnosis. Design and patients. Four patients with severe diabetes mellitus presenting with acute thigh pain, tenderness, and swelling were evaluated by imaging techniques and biopsy. Results and conclusions. Edema in the affected muscles was seen in two patients with MRI studies. Femoral artery calcification and mild muscle swelling was present in one patient who underwent CT. Decreased echogenicity was seen in the involved muscle in a patient studied with ultrasound. Serum enzymes were normal or mildly elevated in three patients (not reported in one). Biopsy demonstrated necrosis and regenerative change in all cases. MRI, although nonspecific, is the best imaging technique to suggest the diagnosis of DMI in the appropriate clinical setting, thereby obviating biopsy.     

MRI对直肠海绵状血管瘤的临床应用价值

目的:分析直肠海绵状血管瘤的MRI表现,探讨MRI对直肠海绵状血管瘤的临床应用价值.方法:搜集经手术及病理证实的直肠海绵状血管瘤8例,均行MRI平扫及增强检查,回顾性分析其MRI表现.结果:8例(100％)均表现为直肠壁明显增厚,以黏膜下层增厚为著,T2WI及FS-T2WI呈显著高信号.7例(87.5％)直肠系膜内可见...     

Rare spindle cell hemangioma of bone: Case report and literature review

Spindle cell hemangioma is a rare benign hemangioma. It is mainly found as small soft tissue nodules in the distal extremities, especially in the hands. The manifestation in bone is extremely rare. We present a case of spindle cell hemangioma of bone in the frontal bone. We also reviewed the literature to find the common imaging findings of intraosseous hamangiomas. The main manifestations of X-ray and CT were osteolytic lesions with soap bubble-like changes, and soft tissue mass formation. Magnetic resonance imaging mainly showed a lobulated mass with clear boundary, uneven hyperintense on T2WI, and obvious enhancement on contrast-enhanced scan. Surgical excision is curative. While this lesion is rare, it can be considered in the differential diagnosis if the characteristic imaging features are present.     

Intramedullary chondroid tumors of bone: correlation of abnormal peritumoral marrow and soft-tissue MRI signal with tumor type

 Objective. To determine whether enchondromas and chondrosarcomas can be differentiated on the basis of peritumoral MR signal abnormality. Design. STIR and T2-weighted MRI images were retrospectively assessed for the presence and extent of abnormal peritumoral marrow and soft-tissue signal. The cause of the peritumoral signal abnormality was determined by histologic correlation with resection specimens. The presence or absence of bone destruction was noted. Patients. Twenty-three patients were studied: ten with enchondromas (three men, seven women; ages 33–73 years) and 13 with chondrosarcomas (seven men, six women; ages 25–88 years). Results. Abnormal peritumoral marrow signal was present on STIR images around none of 10 enchondromas and all of 13 chondrosarcomas (P<0.0001). The marrow signal abnormality corresponded histologically to fine marrow fibrosis in all cases. Adjacent abnormal soft-tissue signal was present on STIR images around none of ten enchondromas and eight (62%) of 13 chondrosarcomas (P=0.0026). Abnormal soft-tissue signal was more common around high-grade than low-grade chondrosarcomas (100% vs 38%, P=0.028), and was more extensive (mean extent 28 mm vs 8 mm; P>0.04). In the subset of tumors without bone destruction, peritumoral marrow signal abnormality was present around none of ten enchondromas and all of five chondrosarcomas (P=0.0003); abnormal soft-tissue signal was present around none of ten enchondromas and two of five chondrosarcomas (P>0.05). Conclusion. Abnormal marrow or soft-tissue signal around a chondroid tumor is suggestive of chondrosarcoma, even in the absence of bone destruction. STIR images are necessary for adequate detection of peritumoral signal abnormalities.     

Longitudinal stress fractures of the tibia: diagnosis by magnetic resonance imaging

 Objective. Previous works describe magnetic resonance (MR) imaging characteristics of stress fractures. Diagnosis of the atypical, longitudinal type of stress fracture has been reported using computed tomography (CT). This report focuses on MR imaging of longitudinal stress fractures of the tibia. Materials and methods. Six cases are presented in which a longitudinal linear abnormal marrow signal was detected in the middle and distal parts of the tibial shaft. Five patients were imaged using a 1.5 Tesla MR unit. Axial, sagittal and coronal T1 and T2-weighted or fat suppressed proton density fast spin echo images were obtained in all but one patient. One patient was imaged using a 0.5 Tesla MR unit with axial and coronal T1- and T2-weighted sequences. Initial conventional radiographs seen at clinical presentation were interpreted as normal in all cases. Two patients underwent radionuclide bone scan, and one patient was imaged with CT prior to MR imaging. Results. In each instance, MR imaging demonstrated linear marrow signal abnormalities orientated along the long axis of the tibial shaft. Endosteal and periosteal callus was identified on axial images. In all cases, MR imaging clearly demonstrated a fracture extending through one cortex with abnormal signal in both the marrow cavity as well as adjacent soft tissues indicating edema. Conclusion. MR imaging was shown to be excellent for demonstration of fracture lines, callus, and marrow and soft tissue abnormalities seen in association with longitudinal stress fractures.     

肠系膜血管瘤1例及文献复习

目的探讨肠系膜血管瘤的MRI表现,提高对肠系膜血管瘤的认识。方法回顾性分析1例经手术证实的肠系膜血管瘤病人MRI资料并行文献复习。结果 MRI检查显示下腹部及盆腔巨大、呈扇形分布的囊实性肿块,于T_1WI、T_2WI及精准频率反转恢复序列信号混杂,其内可见多发线样分隔,呈蜂窝样改变;病变边缘于T_2WI还可见多发细小血管流空影,邻近肠管受压移位,局部肠壁与病变分界不清。结论肠系膜血管瘤的影像表现较具特异性,熟悉肠系膜解剖结构及血管瘤的特征性影像表现有助于本病的诊断,确诊需依赖病理组织学检查。