Malignant chondroblastoma presenting as a recurrent pelvic tumor with DNA aneuploidy and p53 mutation as supportive evidence of malignancy

We report a rare case of malignant chondroblastoma, which presented in a 47-year-old man as a recurrent tumor, 18 years following wide excision of a typical pelvic chondroblastoma. Radiologic studies of the recurrent tumor showed a large, lytic, destructive lesion of the right pelvic bones and femur, with a pathologic fracture of the latter, a large pelvic soft tissue mass, and multiple pulmonary metastases. Biopsy tissue showed typical features of chondroblastoma, but also increased nuclear atypia, hyperchromasia, and pleomorphism, compared to the original tumor, and, most significantly, abnormal mitotic figures. Immunohistochemical studies of the recurrent tumor revealed p53 mutation and extensive proliferative activity, and flow cytometric studies showed DNA aneuploidy, none of which was present in the original tumor. The patient received chemotherapy and radiation, but died of disease eight months after presentation. We also review chondroblastoma in general, to assign this unusual lesion to a tumor subtype. Received: 29 March 1999 Revision requested: 27 April 1999 Revision received: 23 June 1999 Accepted: 29 June 1999     

Computed tomography of desmoid tumors of bone: desmoplastic fibroma

Desmoplastic fibroma of bone is a rare benign tumor, first described by Jaffe in 1958 [6]. Since then approximately 80 cases have been reported in the long bones, although the tumor also involves the jaw bones, particularly the mandible. The plain film features consist of a lytic, expansile lesion, usually in the metaphysis of bone, sometimes extending into the soft tissues. We present two cases involving the long bones in which the correct diagnosis was suggested by computed tomography (CT). The CT appearance of the lesions is described.     

颌骨肿瘤性病变的CT诊断

目的:探讨颌骨肿瘤性病变的CT诊断价值。方法:搜集28例经手术病理证实的颌骨肿瘤患者的临床及CT资料,回顾性分析各种病变的影像学特点。结果:28例中含牙囊肿10例,造釉细胞瘤8例,骨纤维异常增殖症5例,骨肉瘤3例,鳞癌2例。良性病变主要CT表现为颌骨膨胀性改变,病灶密度不均,边缘光整,类圆形或分叶状;恶性者常有骨质破坏改变及邻近软组织肿胀。结论:CT能够明确颌骨肿瘤的范围、骨质改变,对病变的诊断及鉴别诊断有一定价值。     

Intraosseous schwannoma of the metacarpal

Intraosseous schwannoma (neurilemmoma) is an extremely rare, benign neoplasm, constituting less than 0.2% of primary bone tumors. It infrequently involves the bones of the hand. We present a case of intraosseous neurilemmoma of the metacarpal. Received: 26 July 1999 Revision requested: 16 August 1999 Revision received: 16 September 1999 Accepted: 4 October 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     

Cystic fibrous dysplasia mimicking giant cell tumor: MRI appearance

We report the case of a 43-year-old man who presented with an osteolytic and expansive lesion in the left distal femur mimicking a giant cell tumor. Magnetic resonance imaging (MRI) showed that most of the lesion was cystic, and histological examination revealed fibrous dysplasia with marked cystic degeneration. Radiographic findings of cystic fibrous dysplasia in the end of a long bone may be similar to those of a giant cell tumor, and a biopsy is essential for the final diagnosis. Received: 4 June 1999 Revision requested: 10 August 1999 Revision received: 13 September 1999 Accepted: 15 September 1999     

The magnetic resonance imaging of musculoskeletal hemorrhage

Hematomas in the extremities can present clinically as a soft tissue mass. Hematomas can usually be distinguished from neoplasia on MR by the signal patterns of hemoglobin breakdown products, which are dependent on the chemical bonding and oxidation state of hemoglobin iron. Beginning with a discussion of relevant atomic electronic structure, this review will examine how oxyhemoglobin, deoxyhemoglobin, methemoglobin, and hemosiderin, the principal iron compounds occurring in the various stages of a hematoma, affect its appearance on MRI. Received: 26 August 1999 Revision requested: 6 October 1999 Revision received: 27 October 1999 Accepted: 27 October 1999     

Benign vascular lesions of bone: radiologic and pathologic features

 The benign vascular tumors of bone represent a diverse group of tumors that can present with a broad spectrum of clinical signs and symptoms. They can also present a significant diagnostic challenge due to their widely variable radiographic imaging and histologic features. Some of the tumors manifest as clearly benign lesions with tissue-specific diagnostic imaging features, while others have non-specific imaging features that may simulate malignant neoplasm. This article will provide a review of the nomenclature and the characteristic radiographic and pathologic features of the benign vascular lesions of bone. The information will aid in improving our diagnostic accuracy and enhance our understanding of the biologic potential of this diverse group of osseous lesions. Received: 14 May 1999 Revision requested: 17 June 1999, 6 October 1999 Revision received: 27 October 1999 Accepted: 27 October 1999     

Hyperfunctioning parathyroid carcinoma

Primary hyperparathyroidism is rarely caused by carcinoma. We report a patient who manifested many of the clinical and radiographic features of the disease. When encountering symptomatic hypercalcemia with or without a palpable neck mass, carcinoma should be considered in the differential diagnosis. Patient survival depends on an aggressive surgical approach to the primary lesion and recurrent disease. Received: 27 May 1999 Revision requested: 28 June 1999 Revision received: 22 September 1999 Accepted: 27 September 1999     

Jansen type of spondylometaphyseal dysplasia

Metaphyseal dysplasia, type Jansen (JMD), is a rare skeletal dysplasia with characteristic radiographic abnormalities. Of the various types of metaphyseal dysplasia, JMD shows the most severe alteration in metaphyseal architecture. All of the long tubular bones, including those of the hands and feet, show metaphyseal irregularity with a fragmented appearance and slight widening. The adjacent physes are abnormally widened, while the epiphyses tend to be slightly enlarged, rounded but otherwise normal. The spine in infancy and childhood usually appears normal. This report describes a young girl with metaphyseal changes typical of JMD except for the hands and feet, which appeared normal. She also showed very unusual abnormalities of the spine. This appears, therefore, to represent a unique osteochondrodysplasia for which we propose the term spondylometaphyseal dysplasia, type Jansen. Received: 4 April 1999 Revision requested: 6 April 1999 Revision received: 29 November 1999 Accepted: 1 December 1999     

Extraosseous calcified plasmacytoma causing thoracic myelopathy

We report on a rare, calcified, plasma cell tumor of the spine causing progressive myelopathy. Other unusual features were the lack of an osseous lesion at the site of the mass, considerable calcified amyloid within the mass but no identifiable amyloid elsewhere, and normal serum immunoelectrophoresis. Received: 12 February 1999 Revision requested: 18 March 1999 Revision received: 19 April 1999 Accepted: 20 April 1999     

Hemangioma of bone arising in the ulna: imaging findings with emphasis on MR

An 18-year-old woman presented with left elbow joint pain. Radiographs and computed tomographic scan showed a well-defined osteolytic lesion of the left ulna associated with a honeycomb appearance on the radiographs. Magnetic resonance images showed intermediate signal intensity on T1-weighted images and mixed intermediate and high signal intensities on T2-weighted images. Only the periphery of the lesion enhanced with intravenously injected gadolinium-diethylenetriamine pentaacetic acid. The lesion was curetted to avoid pathologic fracture, and a histologic diagnosis of cavernous hemangioma of bone was made. Hemangioma involving the ulna is rare, but should be included in the differential diagnosis of a radiographic osteolytic lesion with a honeycomb appearance. Received: 17 September 1999 Revision requested: 31 October 1999 Revision received: 10 December 1999 Accepted: 13 December 1999     

扁骨、不规则骨的螺旋CT三维重建技术分析

评价螺旋ＣＴ三维成像技术在扁骨和不规则骨中的诊断作用。方法：对３１例扁骨,不规则骨进行快速螺旋ＣＴ扫描和三维重建,使用ＧＥＰｒｏｓｐｅｅｄＳＸａｄｖａｎｔａｇｅ螺旋ＣＴ三维成像装置为ＳＮＵ ＡＷ３．１。结果螺旋ＣＴ三维成像能清晰显示扁骨,不规则骨的正常和异常表现。     

Unusual presentation of Erdheim-Chester disease in a child with acute lymphoblastic leukemia

Erdheim-Chester disease (ECD) is an uncommon, non-familial, non-Langerhans cell histiocytosis, which involves skeletal system and soft tissue usually in middle aged and elderly patients. The characteristic radiologic features include bilateral, symmetric cortical osteosclerosis of the diaphyseal and metaphyseal parts of the long bones, or bilateral symmetrically abnormal intense ^99mTechnetium labelling of the metaphyseal-diaphyseal region of the long bones, and computed tomography scan findings of “coated aorta” or “hairy kidneys”. ECD in childhood with osteolytic lesion is extremely rare. We describe an unusual case with an expansile lytic bone lesion at presentation in a case of acute lymphoblastic leukemia.     

Benign bone-forming lesions: osteoma,osteoid osteoma,and osteoblastoma

The benign bone lesions — osteoma, osteoid osteoma, and osteoblastoma — are characterized as bone-forming because tumor cells produce osteoid or mature bone. Osteoma is a slow-growing lesion most commonly seen in the paranasal sinuses and in the calvaria. When it occurs in the long bones, it is invariably juxtacortical and may need to be differentiated from, among others, parosteal osteosarcoma, sessile osteochondroma, and a matured juxtacortical focus of myositis ossificans. Osteoid osteoma and osteoblastoma appear histologically very similar. Their clinical presentations and distribution in the skeleton, however, are distinct: osteoid osteoma is usually accompanied by nocturnal pain promptly relieved by salicylates; osteoblastoma arises predominantly in the axial skeleton, spinal lesions constituting one-third of reported cases. This review focuses on the application of the various imaging modalities in the diagnosis, differential diagnosis, and evaluation of these lesions. Their histopathology also is discussed, and their treatment briefly outlined.     

Vertebral intra-osseous chordoma or giant notochordal rest?

Chordomas of the lumbar vertebral bodies are rare. We report an unusual case of an entirely intra-osseous chordoma of the fifth lumbar vertebra treated by vertebrectomy. Conventional radiographs and scintigraphy were normal. The lesion was well visualised by MR imaging, but showed only slight sclerosis on CT. We give our reasons for making a diagnosis of chordoma rather than giant notochordal rest and discuss the problems of management resulting from this diagnostic dilemma. Received: 25 February 1999 Revision requested: 2 March 1999 Revision received: 15 March 1999 Accepted: 18 March 1999     

Primary osteosarcoma of a metatarsal bone

Although osteosarcoma is the most common primary bone malignancy of childhood and adolescence that is not related to marrow cells, involvement of the short tubular bones is uncommon. In contrast to more conventional sites, where the tumor is usually high grade and found in adolescents, osteosarcoma of the small bones is more likely to be low grade, and is often seen in older individuals. We present a case of low-grade primary osteosarcoma of a metatarsal bone in a 25-year-old woman. Received: 22 December 1998 Revision requested: 3 February 1999 Revision received: 24 April 2000 Accepted: 26 April 2000     

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     

Desmoplastic fibroma of bone: MRI features

Desmoplastic fibroma of bone is a very rare benign tumor, which may be locally aggressive. In contrast to the well-documented radiological appearance, the literature on MR imaging features of this tumor is scarce. The MR imaging characteristics in our case are compared to those previously reported. Although there is a considerable overlap in the MR imaging features with other bone tumors, an interesting MR feature of desmoplastic fibroma is the presence of low to intermediate signal intensity foci on T2-weighted images, which radiographically does not correspond to calcifications. This feature may help narrow the differential diagnosis. Received: 24 May 1999 Revision requested: 30 June 1999 Revision received: 8 October 1999 Accepted: 14 October 1999     

Giant distal humeral geode

We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. Received: 8 July 1999 Revision requested: 24 August 1999 Revision received: 25 October 1999 Accepted: 26 October 1999