CT-guided percutaneous laser photocoagulation of osteoid osteomas of the hands and feet

Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet.     

Florid reactive periostitis of the hands

Reactive periostitis of the hand can be a confounding lesion on both radiological and histological grounds. An erroneous diagnosis of a malignant tumor, particularly an osteosarcoma, is a possibility. Two cases of florid reactive periostitis of the hand mistaken for osteosarcoma are reported here to illustrate this entity and caution against a diagnostic pitfall.     

Chondrosarcoma of the short tubular bones of the hands and feet

Objective. To report 12 cases of chondrosarcoma in a rare location, the short tubular bones of the hands and feet, as well as 12 cases of enchondroma in similar locations, emphasizing the radiologic and histopathologic features. Design and patients. All relevant cases that had both histologic slides and radiographs available were taken from the files of one orthopedic referral hospital and the personal files of one of the authors. A similar number of enchondroma cases was selected at random from the files. Results and conclusions. One malignancy arose in a background of enchondromatosis, with all the others being solitary lesions. A pathologic diagnosis of malignancy is often difficult in the absence of radiologic signs of malignancy (cortical destruction with or without soft tissue extension). However, three cases were unusual in that the initial radiograph demonstrated a benign appearance. Another group of three malignancies was surprisingly indolent biologically. The treatment of choice is ray resection (or more limited amputation in a lesion of the middle or distal phalanx).     

Chondroblastoma of the patella

This study reviews 16 cases of chondroblastoma of the patella which constitute nearly 6% of a large group of chondroblastomas scattered throughout the skeleton. Both radiologic and histologic appearances of chondroblastomas of the patella are indistinguishable from those of chondroblastomas arising in other sites. A reasonable differential diagnosis, including chondromalacia patella, is discussed together with important therapeutic considerations.     

Chondroblastoma of temporal bone

Summary The case of a 55-year-old female with chondroblastoma arising from the left temporal bone is presented. Although 10 cases of temporal chondroblastoma have been reported, this is the first in which plain radiography, pluridirectional tomography, computed tomography (CT) and angiography were performed. We discuss the clinical and radiological aspects of this rare tumor.     

Chondroblastoma arising in the triradiate cartilage

Chondroblastoma is a relatively rare benign bone tumor of cartilage origin. Roentgenologically it presents usually as a region of lytic destruction of bone with a thin sclerotic rim in the epiphysis of long tubular bone. Less than 9% occur in the pelvic bones but show a tendency to arise from the triradiate cartilage. We present two cases of chondroblastoma originating in the triradiate cartilage, each showing extensive lytic bony destruction and an intrapelvic soft tissue mass. A review of the literature suggests that chondroblastoma of the triradiate cartilage shows an aggressive radiological appearance.     

Diaphyseal chondroblastoma in a long bone: first report

Chondroblastoma is a rare benign bone tumor typically located in the epiphysis. We describe the first case of chondroblastoma arising in the diaphysis of a long bone. The patient was a 13-year-old girl who presented with pain over her right thigh. Radiographs showed a lytic lesion in the diaphysis of her right femur. A core biopsy and a subsequent surgical resection were performed.     

Chondroblastoma of the knee in a teenager

Chondroblastoma is an uncommon osseous neoplasm that accounts for less than 1% of all bone tumors. Characteristically it arises in the epiphysis or apophysis of long bones in young patients and may extend into the metaphysis. A sixteen-year-old male presents with a 1-year history of left knee pain associated with joint stiffness and interfering with performing daily activities. Radiographic and contrast enhanced magnetic resonance imaging favored the diagnosis of chondroblastoma. This was then confirmed histologically. The clinical signs and symptoms of Chondroblastoma are usually nonspecific, pain is most often moderate and can be revealed as a result of a trauma. The definitive diagnosis is mainly pathological due to the lack of specificity of radiological findings consistent with the presented case.     

软骨母细胞瘤的X线诊断

本文对20例软骨母细胞瘤之典型,非典型以及复发、恶变、继发感染、特殊部位病变的X线表现进行了分析。着重讨论了本病的诊断,鉴别诊断,体层摄影、CT扫描的应用价值诸问题。旨在加强对本病的认识,提高诊断正确率。     

软骨母细胞瘤的X线诊断和鉴别诊断

笔者报告２８例经病理证实的软骨母细胞瘤，着重分析Ｘ线表现和Ｘ线诊断要点。并以９例有囊变的成人股骨头无菌坏死为对照组，探讨了鉴别诊断。     

Giant cell reparative granuloma and other giant cell lesions of the bones of the hands and feet

The present paper is a clinico-pathologic study of 52 osteolytic lesions containing giant cells, affecting the hands and feet and comprising 11 giant cell reparative granulomas, nine giant cell tumors, six chondroblastomas, and 26 aneurysmal bone cysts. The nature of osteolytic lesions of hands and feet must be carefully established in order to plan appropriate treatment without damaging the surrounding structures. Giant cell reparative granuloma has to be distinguished from other lesions containing giant cells. Clinical and radiologic findings proved of limited diagnostic value; the definitive diagnosis can be established only by histologic examination. Surgical treatment is discussed.     

成软骨细胞瘤影像学诊断

目的 探讨成软骨细胞瘤影像学表现特点。资料与方法 分析22例经手术病理或穿刺活检证实的成软骨细胞瘤资料,总结其X线平片、CT和MRI表现。结果 胫骨上端18例,股骨下端2例,肱骨上端2例。表现为骨骺区分叶状骨质破坏区,内见钙化和更低密度区;MR T1WI以低信号为主,T2WI上信号混杂,扩散加权成像（DWI）上呈等高信号。硬化边厚薄不一。病灶周围在X线和CT上见高密度骨质硬化区,MRI表现为骨髓水肿。骨膜反应常不与病灶相邻,MRI上为长T1、短T2信号,与皮质间见条状高信号。邻近软组织肿胀,部分患者见关节积液。MRI上病灶可呈环状或较均匀强化,骨髓水肿、骨膜反应和软组织肿胀均强化。结论 成软骨细胞瘤影像学表现较有特征性,结合X线平片、CT和MRI能做出正确诊断。     

Chondroblastoma: A clinical and radiological study of 104 cases

The clinical and radiographic findings in 104 patients with chondroblastoma are presented. Pain was an almost constant presenting complaint, often accompanied in the case of para-articular lesions by impaired function of an adjacent joint. The majority (80%) were in long bones with a mean age of presentation of 16 years. The characteristic radiological image of these lesions was an eccentric radiolucency, having a sharply defined sclerotic margin and containing areas of calcification in approximately a third of cases. They were always related to a growth plate. Nearly half were confined to the affected epiphysis or apophysis itself, but most of the remainder had traversed the growth plate to involve also the adjacent metaphysis. The bones around the knee and the proximal ends of the humerus and femur were the sites of predilection. A minority (20%) affected flat bones and short tubular bones of the hand and foot, with a peculiar affinity for the calcaneus and talus. The mean age of presentation of these was 28 years. The radiological pattern was similar, except for a greater tendency to expand the affected bone. Complications included the formation of a secondary aneurysmal bone cyst in 16 cases (10 of them in long bones), one malignant chondroblastoma, and one fibrosarcoma developing after radiation of the original chondroblastoma.     

Chondroblastoma of the patella with a secondary aneurysmal bone cyst

A case of chondroblastoma of the patella combined with an aneurysmal bone cyst is presented. Chondroblastoma of the patella is an uncommon, benign neoplasm. On the other hand, secondary aneurysmal bone cyst is frequently associated with giant cell tumour of chondroblastoma. Received 15 July 1997; Revision received 6 November 1997; Accepted 13 November 1997     

成软骨细胞瘤的X线诊断(附19例报告)

目的：探讨Ｘ线平片在成软骨细胞瘤诊断中的临床价值。方法：分析１９例成软骨细胞瘤的临床和Ｘ线表现。结果：Ｘ线表现囊状破坏伴骨皮质膨胀１２例，单纯囊状破坏７例，无不规则或溶骨性破坏。病变呈云絮状密度增高８例，砂粒状和斑点状骨化或条片状钙化４例。结论：Ｘ线平片对成软骨细胞瘤的诊断具有重要意义     

Synovial chondromatosis of the foot presenting with Lisfranc dislocation

Primary synovial chondromatosis is rare in the foot. We report a case of synovial chondromatosis affecting multiple sites of the foot and causing bone erosions in a 44-year-old woman. Radiographs demonstrated erosions of multiple metatarsals including the tarsometatarsal joints, resulting in Lisfranc tarsometatarsal dislocation. Magnetic resonance imaging showed the widespread synovial proliferation and soft tissue masses affecting the foot and helped in arriving at a differential diagnosis and plan for needle biopsy. Diagnosis was made initially by needle biopsy under computed tomography guidance and was subsequently confirmed by histopathological assessment of the surgically excised synovial masses. To our knowledge, multifocal synovial chondromatosis causing Lisfranc dislocation in the foot has not been reported previously.     

成软骨细胞瘤的影像学特征及鉴别诊断

目的:分析成软骨细胞瘤的影像学特征,提高对该病的影像学诊断和鉴别诊断水平。方法:回顾性分析经临床病理证实的12例成软骨细胞瘤的平片、CT和MRI表现。结果:12例中肿瘤位于胫骨近端4例,股骨头3例,股骨远端1例,肱骨头3例.胸椎(Th_3)附件1例。11例长骨病变者发生于骨骺和干骺端8例。骨端3例。主要X线表现为圆形或椭圆形骨质破坏区,边界清晰,8例可见硬化边,3例可见病灶内有点状钙化。7例行CT扫描,显示骨质破坏区边界锐利、硬化,病灶内斑点状或云絮状钙化6例。4例行MRI扫描,病灶于T_1WI上表现为等或稍低信号。T_2WI均呈低信号,其内可见点状高信号,STIR上呈均匀高信号;硬化边呈线样低信号,2例病灶周围骨质内有水肿.3例可见相邻关节囊积液。结论:成软骨细胞瘤的影像学表现具有一定特征性,多数可做出正确诊断。     

Cortical chondroblastoma: report of a case and literature review of this lesion reported in unusual locations

Chondroblastoma is a rare benign tumor occurring in adolescence and young adulthood, almost always involving the epiphysis of long bones. A 24-year-old man presented with a discrete soft-tissue lesion penetrating the cortex of the right distal femoral metadiaphyseal region. Biopsy revealed a chondroblastoma, and the patient subsequently underwent a total curettage of the lesion with cancellous bone graft from the iliac crest.     

软骨母细胞瘤的影像学对比分析

目的 探讨软骨母细胞瘤的X线、CT、MRI影像学特征及其诊断价值.方法 回顾性分析经手术病理证实的22例软骨母细胞瘤的3种检查方法的影像学征象及差异性.结果 22例中17例行X线检查,15例行CT检查,11例行MRI扫描;X线、CT和MRI对钙化的检出率分别为47％、66.7％和54.5％;对硬化边的检出率分别为82.3％、80％、90％;骨膜反应检出率分别为17.6％、13.3％和18.2％;MRI骨髓水肿的检出率为72.7％.结论 软骨母细胞瘤的影像学表现有一定的特征性,联合运用不同的检查手段能更全面地显示软骨母细胞瘤的影像学特点,有助于正确诊断.     

非典型部位成软骨细胞瘤的影像表现

目的 探讨非典型部位成软骨细胞瘤的影像表现.资料与方法 回顾分析经病理证实的11例非典型部位的成软骨细胞瘤的影像表现.结果 髌骨6例,肩胛骨2例,腓骨小头、肋骨、头状骨各1例.影像学表现主要为类圆形囊状低密度区,周围可见轻微硬化边;以膨胀性骨质破坏为主,其内有或无分隔,见骨嵴,偶尔见斑点及片状钙化.MRI表现为稍不均匀的长T1、长T2信号.结论 非典型部位的成软骨细胞瘤影像表现具有一定特点.