Epithelioid and spindle cell haemangioma of bone

A case of epithelioid and spindle cell haemangioma of bone occurring in the proximal femur is presented. The tumour had typical microscopic features with a striking lobular pattern comprising spindled and epithelioid areas with admixed inflammatory cells. The case represents only the eighth reported example of this rare tumour, which appears to fit in the spectrum of epithelioid haemangioma. This is the first case to involve the proximal portion of a long bone. A review of the classification and features of similar vascular tumours of bone is presented.     

Patterns of red marrow in the adult femur

PURPOSE: Conversion of red marrow (RM) to fatty marrow in the skeleton of the lower extremities begins at the distal end, ie, feet, and progresses proximally with distal bone marrow (ie, tibia) being converted more rapidly than proximal bone marrow (ie, femur). However, in an individual long bone, conversion begins in the diaphysis and progresses both distally and proximally (more rapidly toward the distal side). In a normal adult's femur, RM is present in the proximal one third or less. Reconversion of fatty marrow to RM is reported to occur in the reverse order of conversion. We assessed the frequency of various patterns of RM in the adult femur on In-111 leukocyte scans for a better understanding of the bone marrow regeneration process in individual long bones. METHODS: The patterns of marrow activity in the femur shown on In-111 leukocyte scans performed in 354 adults were divided into a) RM limited to the proximal one third or less, b) to the proximal two thirds, c) to the proximal one third and distal one third with no activity in the middle shaft, and d) in the entire femur. RESULTS: There were 207 patients with pattern A, 91 pattern B, 14 pattern C, and 42 pattern D. CONCLUSIONS: A considerably higher number of adults showed pattern B than pattern C. This suggests that regeneration of diaphyseal marrow precedes that of the distal marrow in an individual long bone or possibly that conversion of the latter precedes the former, which is different from that proposed in the literature.     

Pediatric reference data for dual X-ray absorptiometric measures of normal bone density in the distal femur.

OBJECTIVE: Many children at risk for osteoporosis have substantial hip and knee contractures that prevent assessment of bone mineral density in the "usual" region, the proximal femur. As an alternative, bone density may be measured in the distal femur projected in the lateral plane. The purpose of this study was to provide normative reference data useful for interpretation of bone density measures in the distal femur of children and adolescents. SUBJECTS AND METHODS: The study was a cross-sectional, single-observational assessment of 256 healthy children and adolescents between the ages of 3 years and 18 years 6 months (mean, 10 years 5 months). Bone mineral density was measured in the nondominant proximal femur, lumbar spine, and both distal femurs using dual X-ray absorptiometry. RESULTS: We found that bone mineral density increases with age in the cortical, cancellous, and mixed regions of the distal femur, similar to the findings with other regional analyses of bone density. Bone density in the distal femur correlates very highly with bone density in the proximal femur and slightly less well with bone density in the lumbar spine. CONCLUSION: In pediatric patients who have deformities, have experienced trauma, or have undergone surgical procedures that prevent reliable measures of bone density in the proximal femur, bone mineral density may be measured in the distal femur and interpreted relative to the bone mineral density findings in healthy age- and sex-matched controls.     

Clear cell chondrosarcoma: radiographic, computed tomographic, and magnetic resonance findings in 34 patients with pathologic correlation

Objective To describe the radiographic features of clear cell chondrosarcoma (CCCS), including the computed tomographic (CT) and magnetic resonance (MR) findings, and to correlate them with the histopathologic findings.Design and patients A retrospective review was carried out of 72 patients with histopathologically confirmed CCCS. Imaging studies were available for 34 patients: conventional radiographs (n=28), CT scans (n=14), and MR images (n=15). Radiographic studies were reviewed by three radiologists who rendered a consensus opinion; the studies were correlated with the histopathologic findings.Results Of the 34 patients with imaging studies, 30 were male and 4 were female (mean age 38.6 years; range 11–74 years). Twenty-two lesions were in long bones (15, proximal femur; 1, distal femur; 1, proximal tibia; 5, proximal humerus) and 11 were in flat bones (5, vertebra; 4, rib; 1, scapula; 1, innominate). One lesion occurred in the tarsal navicular bone. Typically, long bone lesions were located in the epimetaphysis (19/22) and were lucent with a well-defined sclerotic margin and no cortical destruction or periosteal new bone formation. More than one-third of the long bone lesions contained matrix mineralization with a characteristic chondroid appearance. Pathologic fractures were present in six long bone lesions (4, humerus; 2, femur). Lesions in the proximal humerus were more likely to have indistinct margins (4/5) and extend into the diaphysis. Flat bone lesions were typically lytic and expansile and occasionally demonstrated areas of cortical disruption. Typically, matrix mineralization, when present, was amorphous. MR imaging, when available, was superior to conventional radiographs for demonstrating the intramedullary extent of a lesion as well as soft tissue extension. CT images better delineated the presence of cortical destruction and the character of matrix mineralization patterns. CCCS lesions were typically low signal intensity on T1-weighted images and moderately or significantly bright on T2-weighted images. Areas of lesion heterogeneity on T1- and T2-weighted images and on post-gadolinium T1-weighted images corresponded pathologically to areas of mineralization, intralesional hemorrhage, and cystic changes. Adjacent bone marrow edema was typically absent (12/15) or only minimally observed in a few cases (3/15). No cases examined with MR imaging demonstrated periosteal new bone formation.Conclusions CCCS typically presents radiographically as a geographic lytic lesion located in the epimetaphyseal region of long bones. Most commonly lesions are found in the proximal femur, followed by the proximal humerus. Lesions within the proximal humerus may exhibit more aggressive features. Lesions in the axial skeleton are typically expansile and destructive, often with soft tissue extension and lack of mineralization. MR imaging may show the presence or absence of bone marrow edema.     

Multicentric osteosarcoma with long-term survival

We present a 14-year-old girl with multicentric osteosarcoma who has survived for over 9 years to date. The patient first noticed right knee pain in 1992. Radiographs showed a destructive and sclerotic lesion of the right distal femur. Similar small sclerotic lesions were seen in the proximal metaphysis of the right femur, proximal site of the right humerus, and mid-posterior of the left humerus. A diagnosis of multicentric osteosarcoma was made on a biopsy of the right distal femur. The sclerotic lesions of the bilateral humeri disappeared after systemic chemotherapy (T-20), and thus wide excisions of the right distal femur and proximal femur were performed in 1993. New lesions appeared in the left iliac bone and the first lumbar vertebra on bone scintigraphy 24 months after the first surgery. Chemotherapy and wide excisions of the left iliac bone and the first lumbar vertebra were performed. The patient was well at the latest follow-up in April 2003, with no evidence of local recurrence or distant metastasis, but recently renal dysfunction appeared.     

"Bounce at the Bell": a novel program of short bouts of exercise improves proximal femur bone mass in early pubertal children

Objectives: To examine the effects of a simple and inexpensive physical activity intervention on change in bone mass and structure in school aged children. Methods: Fifty one children (n = 23 boys and 28 girls; mean age 10.1 years) participated in "Bounce at the Bell" which consisted of 10 counter-movement jumps 3x per day (total ∼3 min/day). Controls were 71 matched children who followed usual school practice. We assessed dietary calcium, physical activity, physical performance, and anthropometry in September and after 8 months of intervention (June). We measured bone mineral content (BMC) and bone area at the lumbar spine, total body, and proximal femur. Proximal femur scans were also analysed for bone geometry and structural strength using the hip structural analysis program. Lean and fat mass (g) were also calculated. Results: Groups were similar at baseline and did not differ in weight, height, total body, lumbar spine, proximal femur, or femoral neck BMC. Control children had a greater increase in adjusted total body BMC (1.4%). Intervention children gained significantly more BMC at the total proximal femur (2%) and the intertrochanteric region (27%). Change in bone structural parameters did not differ between groups. Conclusions: This novel, easily implemented exercise program, took only a few minutes each day and enhanced bone mass at the weight bearing proximal femur in early pubertal children. A large, randomised study of boys and girls should be undertaken powered to test the effectiveness of Bounce at the Bell in children at different stages of maturity, and in boys and girls independently.     

Intraarticular osteochondroma of shoulder: a case report

Osteochondroma is a cartilage-capped osseous protrusion that arises from the surface of a bone. Osteochondroma occurs mostly in the metaphysis of long tubular bones such as the femur, tibia, and humerus. Osteochondroma is rare in the diaphysis and in the epiphysis. There was only one case in which a patient had a limited range of motion in the shoulder joint due to an intraarticular osteochondroma of the proximal humerus. We present a rare case of intraarticular osteochondroma involving the proximal humerus with pathologic findings and imaging features on computed tomography and magnetic resonance imaging.     

Proximal femur in biological profile estimation – Current knowledge and future directions

This review presents an overview of the forensic utilities of the proximal femur in the existing literature. The proximal epiphysis of the femur bone is characterized as a skeletal structure that articulates with an acetabulum of a pelvic bone, forming the hip joint and generally accounted for one-fourth of the whole femoral length. Features that are seen in proximal femora include femoral head, fovea capitis, neck, greater and lesser trochanters, and proximal shafts. These can be viable alternatives for assessing the following biological parameters: stature, sex, age, and ancestry. Therefore, if the proximal femur is the only skeletal element that is available for examination, all four of the constituent parts of a biological profile of an unknown individual can be retrieved from analyzing proximal femora using quantitative approaches.     

Dual-photon bone mineral density in the proximal femur: correlation by site

Using 153Gd dualphoton absorptiometry, bone mineral density (BMD) was measured in three areas of the proximal femur-the femoral neck, Ward's triangle and the greater trochanter-in 129 females referred for possible osteoporosis. In addition, lumbar spine bone density was determined. Lumbar spine BMD was significantly greater than any regional proximal femoral BMD (p less than 0.0001). Ward's triangle was significantly less than the trochanteric region (p less than 0.01) and both Ward's triangle and the greater trochanter were significantly less than the femoral neck (p less than 0.0005). Correlations within the three regions of the proximal femur are considerably higher than those between the spine and the proximal femur regions. This suggests that measurement of all three areas of the proximal femur is not essential for a satisfactory assessment of proximal femoral mineral content. In particular, since Ward's triangle is strongly correlated with the greater trochanter and the femoral neck, it may rationally be excluded from analysis of proximal femoral bone density.     

Estimation of parameters affecting the uptake of 99mTc-methylenediphosphonate in rat femur with model simulation

The uptake of 99mTc-methylenediphosphonate (MDP) in different parts of rat femur was simulated using a local three-space model for tracer transfer. The model consisted of bone blood, bone ECF-space and space for tracer deposition. The measured 99mTc-MDP concentration in the systemic blood and the local bone blood flow measured by 131I-macroaggregated albumin microspheres were used as input parameters. The measured blood flow values were 6.3, 3.1 and 15.3 ml/100 g/min for proximal, middle and distal femur, respectively. The model parameters that gave the best fit to measured 99mTc-MDP uptake curves in computer simulation showed that bone blood flow, volume of ECF-space, permeability surface area product and accretion constant from ECF-space to space for tracer deposition were highest in distal and lowest in middle femur. The values corresponded to peak extraction fractions of 0.38, 0.62, and 0.31 for proximal, middle and distal femur, respectively. We conclude that the simulation gives acceptable model parameters, and indicates applicability of a similar model into clinical quantitative bone scintigraphy.     

骨原发性恶性纤维组织细胞瘤影像诊断

目的探讨骨原发性恶性纤维组织细胞瘤(BMFH)影像表现及诊断要点。方法回顾性分析6例经病理确诊为BMFH的X线、CT及MRI表现。结果4例侵犯单骨,2例侵犯多骨。溶骨型4例,混合型2例。股骨下端3例,肱骨上端1例,楔骨1例,横突1例,共侵犯12个骨骼。6例均有骨及骨皮质明显破坏,以溶骨性破坏为主,2例病灶周围有轻度骨硬化。全部病例均有软组织肿块,巨大肿块2例,局限性肿块4例,1例肿块内可见散在小钙化影。全部病例未见骨膜反应,3例合并病理性骨折。结论原发性BMFH好发于长骨干骺端或骨端,多见于股骨下端及胫骨上端。虫蚀状或大片状溶骨性骨质破坏,巨大软组织肿块,无骨膜反应,是其影像学特点,诊断需密切结合临床和病理。     

PET/CT and MRI of intra-osseous haemangioma of the tibia

Intra-osseous haemangioma is a rare, benign neoplasm that usually involves the vertebrae and craniofacial bones. Furthermore, its occurrence in the long bones is extremely rare. We report the findings of fluorine-18-fludeoxyglucose ((18)F-FDG) positron emission tomography (PET)/CT and MRI in a patient with intra-osseous haemangioma in the proximal tibia, who was initially misdiagnosed as having a malignancy based on (18)F-FDG PET/CT. (18)F-FDG PET/CT showed a well-marginated osteolytic lesion with abnormal FDG uptake. The mass demonstrated low signal intensity on T(1) weighted MRI. On T(2) weighted images, the lesion appeared as a cluster of high signal intensity lobules and showed strong enhancement on contrast-enhanced T(1) weighted images. Surgical curettage was performed and histopathological examination of the excised tissue confirmed a cavernous haemangioma.     

Measurements of bone mineral density of the proximal femur by two commercially available dual energy X-ray absorptiometric systems.

Two dual energy X-ray absorptiometric (DXA) instruments have recently become commercially available for local bone densitometry: the QDR-1000 (Hologic Inc.) and the DPX (Lunar Radiation Corp.). We report the precision, influence of femoral rotation, correlation and agreement of bone mineral measurements of the proximal femur by these two instruments. In vitro (femur phantom) short-term precision was 1.1%-3.5%, and the long-term precision was 1.2%-3.8%. In vivo (groups of 10 premenopausal and 10 post-menopausal women) short-term precision of duplicate measurements was 1.6%-4.7%, and long-term precision was 1.9%-5.5%. Overall, the precision for Ward's triangle was over 3% and that for the femoral neck and trochanter, 2%-3%. Rotation of a femur phantom produced a statistically significant change in the bone mineral density (BMD) of the femoral neck. Within a clinically relevant range of femoral rotation (20 degrees inward rotation +/- 5 degrees) the coefficient of variation (CV%) increased by a mean factor of 1.1-1.4. Although the correlation (r less than 0.9) between BMD measurements of the proximal femur by the DPX and QDR-1000 in 30 postmenopausal women was high, there was lack of agreement between the two instruments. We found no statistically significant differences between the right and left femur in 30 postmenopausal women. A bilateral femur scan took a mean total time of about 22 min. We conclude that with the introduction of DXA instruments, the precision of bone mineral measurements of the proximal femur has improved. However, for comparability between commercially available DXA instruments, it might be advantageous if units were standardized.     

Metachronous haemorrhagic epithelioid and spindle cell haemangioma of bone

We present the case of a 7-year-old boy with a haemorrhagic and spindle cell haemangiomas of the ring finger. The lesions appeared in a metachronous fashion initially in the distal phalanx and 16 months later in the proximal phalanx. Radiography revealed expansile lytic lesions of the phalanges. Haemorrhagic epithelioid and spindle cell haemangioma is a benign condition which, due to its unusual morphology, can be confused with more aggressive or malignant endothelial neoplasms. This condition with its possible multifocal presentation should be considered when diagnosing vascular lesions of bone in order that appropriate treatment can be implemented.     

Lower limb ischaemia caused by fractured osteochondroma of the femur

Osteochondroma is the most common benign bone tumour and can arise in any bone. They frequently develop around the knee in the distal femur and the proximal tibia. These are usually asymptomatic, but can occasionally impinge on the surrounding vessels and cause various clinical manifestations. We have encountered a patient with multiple hereditary exostoses, in whom the osteochondroma located in the distal portion of the femur fractured as a result of an injury from a traffic accident. The migrated osteochondroma compressed the femoral artery and led to an acute onset of lower extremity ischaemia. Although trauma or vigorous exercise can cause vascular complications caused by osteochondroma, vascular insufficiency due to fracture of osteochondroma after a traumatic injury is extremely rare.     

Measurements of bone mineral density of the proximal femur by two commercially available dual energy X-ray absorptiometric systems

Two dual energy X-ray absorptiometric (DXA) instruments have recently become commercially available for local bone densitometry: the QDR-1000 (Hologic Inc.) and the DPX (Lunar Radiation Corp.). We report the precision, influence of femoral rotation, correlation and agreement of bone mineral measurements of the proximal femur by these two instruments. In vitro (femur phantom) short-term precision was 1.1%–3.5%, and the long-term precision was 1.2%–3.8%. In vivo (groups of 10 premenopausal and 10 postmenopausal women) short-term precision of duplicate measurements was 1.6%–4.7%, and long-term precision was 1.9%–5.5%. Overall, the precision for Ward's triangle was over 3% and that for the femoral neck and trochanter, 2%–3%. Rotation of a femur phantom produced a statistically significant change in the bone mineral density (BMD) of the femoral neck. Within a clinically relevant range of femoral rotation (20° inward rotation ±5°) the coefficient of variation (CV%) increased by a mean factor of 1.1–1.4. Although the correlation (r < 0.9) between BMD measurements of the proximal femur by the DPX and QDR-1000 in 30 postmenopausal women was high, there was lack of agreement between the two instruments. We found no statistically significant differences between the right and left femur in 30 postmenopausal women. A bilateral femur scan took a mean total time of about 22 min. We conclude that with the introduction of DXA instruments, the precision of bone mineral measurements of the proximal femur has improved. However, for comparability between commercially available DXA instruments, it might be advantageous if units were standardized. Offprint requests to: O.L. Svendsen     

Comparison of dual energy X-ray absorptiometry of the proximal femur with morphologic data.

Measurements of bone mineral density (BMD) of the proximal femur (including femoral neck, Ward's triangle and trochanteric region) were compared with the Singh index grading in 40 normal subjects (20 male, 20 female) and in 116 patients (18 male, 98 female) referred for assessment of possible osteoporosis. Additionally, the BMD and the Singh index of 12 cadaver specimens (6 male, 6 female) of the proximal femur were compared with each other and with the histomorphology of the femoral necks of the specimens. Although there was a good correlation of Singh index with BMD in the group of male patients with suspected osteoporosis and in the series of bone specimens, there was a poor correlation in the group of female patients as well as in the normal controls and in the patient population as a whole. There was also poor correlation of Singh index values with histomorphologic data, whereas the BMD measurements correlated well with the amount of calcified bone found histologically in the femoral necks of the bone specimens. We conclude that the Singh index cannot be used to predict BMD of the proximal femur accurately.     

Estimation of parameters affecting the uptake of 99mTc-methylenediphosphonate in rat femur with model simulation

The uptake of ^99mTc-methylenediphosphonate (MDP) in different parts of rat femur was simulated using a local three-space model for tracer transfer. The model consisted of bone blood, bone ECF-space and space for tracer deposition. The measured ^99mTc-MDP concentration in the systemic blood and the local bone blood flow measured by ¹³¹I-macroaggregated albumin microspheres were used as input parameters. The measured blood flow values were 6.3, 3.1 and 15.3 ml/100 g/min for proximal, middle and distal femur, respectively. The model parameters that gave the best fit to measured ^99mTc-MDP uptake curves in computer simulation showed that bone blood flow, volume of ECF-space, permeability surface area product and accretion constant from ECF-space to space for tracer deposition were highest in distal and lowest in middle femur. The values corresponded to peak extraction fractions of 0.38, 0.62, and 0.31 for proximal, middle and distal femur, respectively. We conclude that the simulation gives acceptable model parameters, and indicates applicability of a similar model into clinical quantitative bone scintigraphy.     

局部植入BMP对去势大鼠股骨近端生物力学强度及髓腔面积变化的影响

目的探讨去势大鼠股骨近段植入牛骨形成蛋白(bone morphorgeneic protein,BMP)后其骨生物力学强度及髓腔面积的变化。方法随机选取6月龄wistar雌性大鼠22只,摘除卵巢制作绝经后骨质疏松模型成功后,同一只动物双侧肢体对照,试验侧股骨颈植入牛骨形成蛋白及纤维蛋白(FS)复合物,对照侧植入纤维蛋白,术后4周、8周处死取材,测量股骨近端生物力学强度及髓腔面积和截面面积。结果4周后,试验侧与对照侧股骨近端骨生物力学强度和髓腔面积无明显差异;8周后,试验侧股骨近端生物力学强度较对照侧增高;髓腔面积较对照侧有较明显的减小(P<0.05)。结论股骨近端局部植入BMP可提高去势大鼠股骨近端局部的生物力学强度和减小近端髓腔面积和截面积,其可能减少骨质疏松性髋部骨折置换后假体的松动,成为骨质疏松性骨折假体置换中新的辅助治疗方法。