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     

Acetabular pneumatocyst containing air–fluid level

The presence of intraosseous gas most commonly occurs in osteomyelitis, vacuum phenomenon, and postsurgery or posttraumatic states. Several cases of subchondral gas-filled lesions, called pneumatocysts, have also been described in the sacroiliac joint and clavicle, none of them with intralesional air–fluid level. These pneumatocysts are innocuous lesions of uncertain origin. We describe one case of acetabular pneumatocyst containing air–fluid level in a 62-year-old man with long-standing ankylosing spondylitis involving hip joint. To our knowledge, this is the first reported case of a pneumatocyst in an acetabular location containing air–fluid level. Received: 15 June 1998; Revision received: 4 November 1998; Accepted: 11 December 1998     

Arthritis and hidradenitis suppurativa diagnosed in a 48-year-old man

We report the case of a 48-year-old man who presented with an erosive, seronegative, HLA-B27-negative, peripheral polyarthritis, associated with hidradenitis suppurativa of axillae and buttocks. The pertinent literature is reviewed. This paper is the second devoted to this topic in a radiological journal and the first to document erosion of the posterior aspect of the calcaneus. Received: 15 September 1998 Revision requested: 28 October 1998 Revision received: 22 February 1999 Accepted: 22 February 1999     

De novo malignant transformation of giant cell tumor of bone

Two cases of malignant lesions are reported, both of which arose secondary to an originally benign giant cell tumor (GCT) of bone. The first case was a typical benign GCT, which occurred in the left proximal tibia of a 31-year-old woman. The tumor was treated by curettage and bone grafting. However, it recurred twice during 15 years of follow-up. The second recurrence showed that the lesion histologically had turned into malignant fibrous histiocytoma. The second case also started as an initially benign GCT that arose in the left distal femur of a 41-year-old man. The patient underwent curettage and bone grafting. The lesion recurred 13 years postoperatively. The histological appearance of the recurrent tumor showed it to be an osteogenic sarcoma. In both patients, radiation had never been given. Malignant transformation has rarely been reported in patients with GCT of bone who have not received radiation treatment. Received: 12 June 2000 Revision requested: 17 August 2000 Revision received: 13 October 2000 Accepted: 18 October 2000     

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     

Parosteal osteosarcoma of a metatarsal with intramedullary invasion

A 70-year-old man presented with increasing swelling of 2 years’ duration, on the dorsal aspect of the forefoot. Imaging studies revealed a heavily calcified surface lesion of bone with early invasion of the underlying second metatarsal. Both imaging findings and the subsequent resection histology were consistent with a parosteal osteosarcoma, which is particularly rare at this site and at this age. The differential diagnosis of a mineralizing surface lesion of bone arising in the foot is discussed. Received: 2 June 1998 Revision requested: 8 August 1998 Revision received: 16 November 1998 Accepted: 17 November 1998     

Digital enlargement in tuberous sclerosis

A 23-year-old woman with a medical history significant for tuberous sclerosis presented with symptoms of postpartum endometritis. Focal gigantism of the third digit of her right hand was incidentally noted and is reported to be a rare manifestation of tuberous sclerosis. Received: 19 October 1998 Revision requested: 3 November 1998 Revision received: 16 November 1998 Accepted: 17 November 1998     

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     

Primary non-Hodgkin lymphoma of bone: unusual manifestation of lymphoproliferative disease following liver transplantation

We present the case of a 66-year-old man with primary non-Hodgkin lymphoma of the right femur that developed following orthotopic liver transplant, while on immunosuppressive therapy. The diagnosis was suggested on the basis of the MRI findings and confirmed by open biopsy. He was treated successfully with local radiotherapy and has remained disease free for 14 months after the onset of the disease. Received: 26 August 1998 Revision requested: 12 November 1998 Revision received: 23 November 1998 Accepted: 24 November 1998     

Intra-articular regional migratory osteoporosis of the knee

We report a case of lntra-articular regional migratory osteoporosis of the knee in a 53-year-old man. The case demonstrates an unusual pattern of migration of the marrow edema within the knee joint. This phenomenon has received scant attention in the radiological literature. Received: 9 July 1999 Revision requested: 24 August 1999 Revision received: 6 October 1999 Accepted: 8 October 1999     

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     

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     

Immunoglobulin D myeloma presenting as an extraosseous soft tissue tumor

We report a 69-year-old man who suffered an extraosseous tumor of immunoglobulin D myeloma (lambda type) in the shoulder girdle, mimicking a primary soft tissue sarcoma. The tumor was isointense with adjacent muscle on T1-weighted MR images, and hyperintense on T2-weighted images. No continuity with the neighboring bone was noted. After administration of gadolinium, the central part of the tumor showed marked contrast enhancement. Although the tumor showed a complete response to the initial chemotherapy, the patient died of the disease 31 months after its initial manifestation. Several bone marrow aspirations and biopsies of the ilium and sternum had shown no increase in plasma cells (range 0.6–1.2%) until the disease became advanced 19 months after its initial manifestation. Received: 1 September 2000 Revision requested: 9 October 2000 Revision received: 11 November 2000 Accepted: 15 November 2000     

Osteogenic sarcoma with skeletal muscle metastases

Two cases of osteogenic sarcoma with skeletal muscle metastases are described. A 40-year-old woman presented with progressive swelling of both calves and a soft tissue back lump. She had been diagnosed with mandibular chondroblastic osteogenic sarcoma 6 years earlier. Radiographs showed calcified masses. MRI scans and bone scintigraphy revealed multiple soft tissue masses in both calves. Bone scintigraphy also showed uptake in the back lump, right thigh and left lung base. Biopsy confirmed metastatic chondroblastic osteogenic sarcoma, which initially responded well to chemotherapy. However, the metastatic disease subsequently progressed rapidly and she died 21 months after presentation. The second case concerns a 20-year-old man who presented with a pathologic fracture of the humerus, which was found to be due to osteoblastic osteogenic sarcoma. He developed cerebral metastases 17 months later, followed by metastases at other sites. Calcified masses were subsequently seen on radiographs of the abdomen and chest. CT scans confirmed the presence of densely calcified muscle metastases in the abdominal wall, erector spinae and gluteal muscles. The patient’s disease progressed rapidly and he died 30 months after presentation. Received: 16 November 1998 Revision requested: 28 December 1998 Revision received: 18 January 1999 Accepted: 18 January 1999     

Dysplasia epiphysealis hemimelica of the scaphoid bone

We report a rare case of dysplasia epiphysealis hemimelica (DEH) in the wrist of a 7-year-old boy. Clinical, radiological and histopathological manifestations are discussed. The correct diagnosis of DEH, however, was made by the confrontation of the radiological and pathological data. The radiologist should inform the pathologist correctly about the imaging findings in order to avoid misdiagnosis of the lesion as osteochondroma. Received: 17 March 1998; Revision received: 30 June 1998; Accepted: 20 August 1998     

Colosalpingeal fistula: a rare complication of colonic diverticular disease

Diverticular disease is a common condition in Western countries. The formation of inflammatory fistulae, usually from sigmoid colon to bladder or vagina, can be a feature of complicated cases of the disorder and is normally an indication for surgical intervention. We present a case of colosalpingeal fistulation occurring secondary to diverticulitis, a complication which, to our knowledge, has not been previously reported in the radiological literature. As in this instance, the initial clinical presentation of this problem can often be non-specific, with localising symptoms occurring later. In our case, barium enema examination allowed good demonstration of the fistulous communication before the more specific symptoms were clinically apparent. Received: 29 July 1998; Revision received: 29 October 1998; Accepted: 4 November 1998     

Cotton-induced pseudotumor of the femur

Twenty-five years prior to presentation a 41-year-old man had a femoral fracture stabilized with a 4.5 mm AO/ASIF steel plate. The femur healed uneventfully and the patient was asymptomatic for the following 20 years. He then noticed a slow-growing swelling of the left thigh associated with a degree of weakness. Radiographs of the femur 25 years after fracture stabilization showed a massive expansive osteolytic process surrounded by a rim of bone. Magnetic resonance imaging (MRI) confirmed the presence of a large tumor. Since malignancy could not be excluded the patient underwent incisional biopsy. The histologic findings were nonspecific. Because of persistent symptoms the lesion was marginally excised. Intraoperatively a folded cotton sponge was found adjacent to the femur. Histopathologic investigation confirmed a foreign body reaction probably related to the retained cotton sponge. Reactive, foreign-body-induced change may mimic bone and or soft tissue malignancies. Received: 25 October 2000 Revision requested: 20 November 2000 Revision received: 19 February 2001 Accepted: 20 February 2001     

Proximal tibiofibular joint synovial cyst—one pathology with three different presentations

Synovial cysts of the proximal tibiofibular joint are less common than synovial cysts of the knee joint but may present in a similar fashion and may be difficult to diagnose clinically. We report three cases of such synovial cysts: (1) the synovial cyst presented as an asymptomatic lump distal to lateral joint line of the knee; (2) the synovial cyst presented as a mass fluctuating in size with intermittent symptoms; (3) a man with a large mass in proximal anterior leg and drop foot. The patients were operated. The first and the third patients were treated successfully without recurrence, and complete recovery of the proneal nerve in third case ensued. The synovial cyst recurred in the second case; however, the patient refused a second operation. Age distribution and clinical manifestation of extraneural proximal tibiofibular joint synovial cyst is discussed in the light of relevant literature.     

Perimortem fixation of the gastric and duodenal mucosa: a diagnostic indication for oral poisoning

Two cases of fatal oral poisoning are presented. In the first case, a 40-year-old man died due to a lethal dose of mercury (blood concentration 113.8 μg/ml) and in the second, a 34-year-old man died of chloralhydrate overdose with a lethal blood concentration of trichloroethanol (52 μg/ml), the active metabolite of chloralhydrate. In both cases gross examination and histology showed an unusually well preserved gastrointestinal mucosa in addition to unspecific signs of intoxication. The two cases demonstrate that the phenomenon of perimortal fixation is a useful indication for the forensic pathologist and should direct the suspicion to oral poisoning. The detection of fixation facilitates toxicology screening by indicating that the relevant substance must have the capability to precipitate proteins. Received: 24 November 1998 / Received in revised form: 18 February 1999