Premature epiphyseal fusion and degenerative arthritis in chronic recurrent multifocal osteomyelitis

A 9-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis affecting multiple sites. During an 8-year follow-up he developed premature closure of a distal radial epiphysis and degenerative changes in the adjacent radiocarpal joint. Received: 26 July 1999 Revision requested: 24 August 1999 Revision received: 27 September 1999 Accepted: 8 October 1999     

Erdheim-Chester disease with intramuscular lipogranuloma

We report on a rare manifestation of Erdheim-Chester disease with intramuscular lipogranuloma. The patient was a 66-year-old man who noted a soft tissue mass in the right quadriceps femoris muscle. Radiographs revealed symmetrical osteosclerosis in the diametaphysis of both femora and tibiae. An open biopsy revealed a proliferation of lipid-laden histiocytes in the femoral bone marrow and the quadriceps femoris muscle. To our knowledge, this is the second case of Erdheim-Chester disease involving muscle. Received: 4 October 1999 Revision requested: 18 November 1999 Revision received: 1 December 1999 Accepted: 2 December 1999     

Epithelioid sarcoma mimicking abscess: review of the MRI appearances

A case of epithelioid sarcoma involving the soft tissues of the ankle is presented. The tumor was a hemorrhagic, fluid-filled, multiloculated lesion with inflammatory changes in the surrounding planes. Tuberculous abscess was diagnosed on the basis of the clinical picture, ultrasound and MRI findings. Surgical exploration of the ankle mass was carried out because of lack of local healing while the patient’s general and pulmonary status improved on antituberculosis treatment. This was an unusual case of epithelioid sarcoma mimicking a multilocular abscess. Received: 11 October 1999 Revision requested: 2 November 1999 Revision received: 30 October 2000 Accepted: 3 November 2000     

Osteosarcoma of the metatarsal bone

A case of osteosarcoma arising from a metatarsal bone is reported, focusing on the radiological findings and differential diagnosis. Received: 16 November 1998 Revision requested: 17 December 1998 Revision received: 11 January 1999 Accepted: 14 January 1999     

MR appearances in a case of femoral ecchinococcosis

Magnetic resonance (MR) findings of a rare case of osseous echinococcosis with involvement of the femur are described. Attention is drawn to the typical MR appearances and therapeutic management. Received: 4 October 1999 Revision requested: 28 October 1999 Revision received: 20 November 1999 Accepted: 1 December 1999     

Metastatic bone tumor mimicking spontaneous osteonecrosis of the medial condyle of the femur: misleading appearance on MR imaging

We report a case of a metastatic bone tumor that mimicked spontaneous osteonecrosis of the medial condyle of the femur on magnetic resonance imaging. Received: 5 October 1999 Revision requested: 11 November 1999 Revision received: 10 January 2000 Accepted: 17 January 2000     

Elastofibroma of the neck

Elastofibromas are benign lesions of the chest wall. We describe the first reported case of elastofibroma in the neck. Imaging features as well as location of the lesion were atypical. On computed tomography and magnetic resonance imaging the lesion contained a marked preponderance of fat, because the lesion arose within fat. Received: 12 November 1998 Revision requested: 18 November 1998 Revision received: 16 August 1999 Accepted: 24 August 1999     

Post-Paget telangiectatic osteosarcoma of the skull

Sarcomatous transformation is the most dreaded complication of Paget’s disease. We report on a case of post-Paget telangiectatic osteosarcoma of the skull, a variant of osteogenic osteosarcoma, in a 79-year-old woman. We discuss the radiological pattern in relationship to the differential diagnosis. Received: 27 July 1998 Revision requested: 24 August 1998, 23 December 1998 Revision received: 25 November 1998, 12 April 1999 Accepted: 13 April 1999     

Oncogenic osteomalacia

The clinical, imaging, metabolic, histologic and biochemical aspects of oncogenic osteomalacia are reviewed. The bone and soft tissue tumor and tumor-like lesions associated with this paraneoplastic syndrome are discussed. The radiologist’s role in the diagnosis and evaluation of this entity is presented. Received: 11 November 1999 Revision requested: 30 December 1999 Revision received: 7 January 2000 Accepted: 10 January 2000     

Fracture of the lateral process of the talus: appearance at MR imaging and clinical significance

The case of a 59-year-old man with chronic lateral ankle pain following an inversion injury is presented. MR imaging performed to evaluate for soft tissue injury revealed an unsuspected fracture of the lateral process of the talus. The patient underwent surgical exploration of the fracture with debridement of adjacent loose bodies and is currently undergoing aggressive physical rehabilitation. Received: 23 November 1998 Revision requested: 18 December 1998 Revision received: 4 January 1999 Accepted: 4 January 1999     

Synovial desmoplastic fibroblastoma of hip joint with bone erosion

A 78-year-old woman presented with pain at the left hip. Initial radiographs showed minimal age-related changes. Over the next 2 years she developed large erosions in the left femoral neck and proceeded to hip replacement. Histological examination showed bland spindle cells in a loose and hyalinised collagenous stroma considered to represent a desmoplastic fibroblastoma (collagenous fibroma). This is the first reported case of synovial desmoplastic fibroblastoma. Received: 23 November 1998 Revision requested: 16 December 1998 Revision received: 10 February 1999 Accepted: 4 March 1999     

Fibroma of tendon sheath of the infrapatellar fat pad

We report on a 13-year-old boy who was found to have a fibroma of the tendon sheath associated with the patellar tendon and within Hoffa’s fat pad of the knee. This benign tumor has never been described in this location previously. The MRI characteristics are correlated with the histologic findings. Received: 20 November 1998 Revision requested: 17 December 1998 Revision received: 16 February 1999 Accepted: 19 February 1999     

Muscle hernias of the lower leg: MRI findings

Muscle hernias of the lower leg involving the tibialis anterior, peroneus brevis, and lateral head of the gastrocnemius were found in three different patients. MRI findings allowed recognition of herniated muscle in all cases and identification of fascial defect in two of them. MR imaging findings and the value of dynamic MR imaging is emphasized. Received: 1 March 1999 Revision requested: 24 March 1999 Revision received: 19 April 1999 Accepted: 20 April 1999     

Hypertrophy and pseudohypertrophy of the lower leg following chronic radiculopathy and neuropathy: imaging findings in two patients

Enlargement of the ipsilateral muscle compartment is an exceptional finding in patients with chronic radiculopathy, peripheral nerve injury, anterior horn cell diseases, or acquired peripheral neuropathy. We report radiographic, ultrasonographic, CT and MRI findings in a patient with chronic S1 radiculopathy and another with chronic neuropathy of the common fibular nerve (L4-S2), both presenting with painless enlargement of the calf muscles. Received: 2 November 1998 Revision requested: 17 December 1998 Revision received: 11 January 1999 Accepted: 14 January 1999     

Subacromial-subdeltoid lipoma arborescens associated with a rotator cuff tear

A 44-year-old man presented with lipoma arborescens of the right shoulder, associated with a rotator cuff tear. MRI revealed villous proliferations with signal intensity of fat on all pulse sequences. At surgery, this bursa was found to contain moderately yellow cloudy fluid without fat globules. Histological examination of the lesion showed subsynovial accumulation of mature fat cells. Received: 13 October 1998 Revision requested: 10 November 1998 Revision received: 22 January 1999 Accepted: 31 January 1999     

Multifocal osteosarcoma as second tumor after childhood retinoblastoma

We present a case of multifocal osteosarcoma (MFOS) arising 11.5 years after successful treatment of bilateral retinoblastoma. The clinical, imaging and pathological findings at onset, after therapy, and during follow-up are described. Fluorescent in situ hybridization did not reveal a deletion of the RB-1 retinoblastoma gene, although the presence of an inactivating mutation invisible to this method cannot be ruled out. The MFOS may have been a second multifocal tumor associated with the original retinoblastoma or a post-irradiation sarcoma with extensive metastases. Received: 20 November 1998 Revision requested: 5 January 1999 Revision received: 8 March 1999 Accepted: 19 March 1999     

Mannosidosis: an unusual cause of a deforming arthropathy

We report on a case of a deforming arthropathy in a young man with a lysosomal storage disorder. A 31-year-old man with a known diagnosis of mannosidosis presented with a painful swollen right elbow. Radiographs of his right elbow showed a disorganised joint with multiple fragments resembling the appearances of a neuropathic joint. This case provides further evidence that a deforming arthropathy may occur as part of the spectrum of skeletal abnormalities seen in mannosidosis. Received: 17 November 1999 Revision requested: 13 December 1999 Revision received: 6 March 2000 Accepted: 9 March 2000     

Bilateral metachronous periosteal tibial amyloid tumors

Localized primary periosteal amyloid tumors are extremely rare. A case of bilateral tibial amyloid tumor is presented. A 62-year-old woman initially presented with a painful mass in the anterior aspect of the right leg. There was no evidence of underlying systemic disease, including chronic infection or malignancy. Based on the results of resistance with Congo red staining to treatment with potassium permanganate and positivity for kappa light chain, we classified this particular case as AL-type amyloidosis. The patient noticed a swelling in the opposite leg 2 years later. The second tumor was also an AL-type amyloidoma. Amyloid tumors are generally solitary. This is the first case of bilateral periosteal amyloid tumors of the AL-type occurring in the tibiae. Received: 10 November 1999 Revision requested: 15 November 1999 Revision received: 6 March 2000 Accepted: 9 March 2000     

Congenital transverse deficiency of the tibia and fibula: a report of two cases

We report two similar, but unrelated, patients with congenital bilateral partial deficiencies of the tibia and fibula associated with intact feet. In both patients, the tibia and fibula were absent on initial radiographs, while the femur and the tarsal bones were well developed and there was bilateral teratologic dislocation of the hips. Ultrasound and magnetic resonance imaging (MRI) studies suggested the presence of cartilaginous remnants of the tibia and fibula. There were multidirectional instabilities in the knees and ankles. The clinical and radiological features of these cases are distinct from those of congenital longitudinal deficiency of the tibia, in which the fibula is always preserved, and from longitudinal deficiency of the fibula, in which the tibia is present and the foot is usually involved. We suggest that the bilateral partial deficiencies of the tibia and fibula associated with the intact foot and teratologic dislocation of the hips is a single-entity disorder, possibly categorized as an intercalary transverse deficiency of the lower limb. Received: 5 October 1999 Revision requested: 10 November 1999 Revision received: 30 November 1999 Accepted: 1 December 1999     

Chondromyxoid fibroma of two thoracic vertebrae

We report on a case of chondromyxoid fibroma involving two adjacent thoracic vertebrae with features of aggressive behaviour on radiographs, CT and MRI. Histology revealed typical chondromyxoid fibroma with unusually coarse calcifications. Chondromyxoid fibroma of the spine is rare, and only 30 of these tumours have been reported so far. Involvement of two contiguous vertebral bodies by chondromyxoid fibroma, as reported here, appears exceptional. Received: 10 August 1998 Revision requested: 14 September 1998, 29 December 1998 Revision received: 22 December 1998, 19 January 1999 Accepted: 21 January 1999