Generalized intramuscular granulocytic sarcoma mimicking polymyositis

We report a case of granulocytic sarcoma exclusively manifesting as diffuse intramuscular infiltration of the proximal upper and lower limb girdle and the torso muscles in a patient with previous history of acute myelogenous leukemia 5a. Whole-body CT showed widespread distribution of ill-defined intramuscular, homogeneously enhancing lesions. On whole-body MRI, lesions were homogeneously hyperintense on fat saturated T2-weighted images, isointense on T1-weighted images and strongly enhancing after intravenous gadolinium contrast administration. Histopathology revealed muscular infiltration of blast cells with identical immunochemistry to the initial manifestation of leukemia, diagnostic for an extramedullary relapse manifesting as granulocytic sarcoma. CT and MRI characteristics of this previously undocumented manifestation of granulocytic sarcoma should assist in the identification of such cases.     

MRI of perineural extramedullary granulocytic sarcoma

Granulocytic sarcoma is an extramedullary solid tumour consisting of myelogenous leukaemic blast cells, usually seen in acute myeloid leukaemia and less commonly in patients with chronic myeloid leukaemia or myeloproliferative disorders. Blast cells have a predilection for periosteal and perineural regions and rarely precede evidence of systemic disease. We present two patients, aleukaemic on peripheral blood counts, both at presentation and during subsequent treatment. We present the MRI features of this rare but important condition. Received: 16 November 1999 Accepted: 5 October 2000     

Intraarticular epithelioid sarcoma

A case of an intraarticular epithelioid sarcoma is presented. The patient was a 35 year old man who presented with a 10 months history of a chronic monoarthritis. The MRI showed a diffuse lesion involving the synovial membrane of the knee. There was a marked increased signal on T2 weighted images. Most epithelioid sarcomas involve the subcutaneous tissues of the hands or feet. This presentation is unusual and this entity should be considered in the differential diagnosis of an intraarticular proliferative process.     

Skeletal manifestations of granulocytic sarcoma (chloroma)

Skeletal manifestations of chloroma were reviewed in five patients. In four cases, a chloroma was the initial manifestation of a systemic disease. In the fifth, an elderly patient developed a bone lesion during a blastic crisis while under treatment for chronic myelogenous leukemia. Two patients presented with lytic lesions of the ribs, two with lytic lesions of the femur, and one with a predominantly sclerotic lesion of the scapula. The laboratory findings in two patients were within normal limits. All lesions were confirmed by bone biopsy.     

Primary pulmonary osteogenic sarcoma

A 56-year-old man initially presented to his family physician with tingling in the fingertips of his left hand. A chest radiograph revealed a left upper lobe mass. Local resection found a soft tissue osteogenic sarcoma. This is a report of a rare case of primary pulmonary osteogenic sarcoma. Received: 12 May 1999 Revision requested: 28 June 1999 Revision received: 11 January 2000 Accepted: 12 January 2000     

Intraneural synovial sarcoma

This report describes and discusses the clinical, MRI, and pathologic findings in a case of synovial sarcoma arising within a peripheral nerve. Intraneural origin of synovial sarcoma is very unusual, and the MR imaging appearance of this condition has not been previously reported. MR imaging was valuable, as it showed the intraneural location and extent of the tumor, but it did not allow a specific histologic diagnosis.     

Extensively calcified synovial sarcoma

 Synovial sarcoma is an uncommon fibroblastic soft tissue neoplasm, commonly arising near, but not necessarily from, the synovium of joint capsules, bursae or tendon sheaths. The radiological diagnosis is difficult. We present a case of synovial sarcoma studied with plain film radiography, CT, and pathology that had an unusual extensive calcification, which complicated its radiological diagnosis.     

Alveolar soft part sarcoma

 We present a rare case of alveolar soft-tissue sarcoma, with extensive bone invasion. The differential diagnosis with bone metastasis and primary bone tumors is dicscussed.     

Intra-articular calcifying synovial sarcoma mimicking synovial chondromatosis

 A case of intra-articular calcifying synovial sarcoma of the right knee joint in a 27-year-old man is reported. Prior to admission the patient had been suffering pain in the right knee for 5 years. Plain radiographs showed multiple calcified densities in the anterior aspect of the right knee closely mimicking synovial chondromatosis. Histological examination revealed that the lesion was a synovial sarcoma with extensive calcification subjacent to the synovial surface. Although intra-articular calcifying synovial sarcoma is very rare, it is important to be aware of the fact that synovial sarcoma, as well as synovial chondromatosis, can be present as a calcified lesion in the joint cavity.     

Synovial sarcoma of the hand

We report on a 23-year-old woman with a poorly differentiated synovial sarcoma on the palm of her hand which presented as a painless nodule. The MRI findings are presented along with the clinical and pathologic features. Becaue of similar morphological features, these tumors can be confused with benign lesions such as aggressive fibromatosis or ganglion cysts, especially when very small. The possibility of a synovial sarcoma mimicking a benign lesion needs to be considered when the mass does not have an unequivocal benign diagnosis on MR imaging. Following wide resection and reconstruction, our patient has been disease free with good function for 28 months.     

Synovial sarcoma arising in association with a popliteal cyst

Synovial sarcoma is a relatively common soft tissue sarcoma particularly in the adolescent and young adult. We report an unusual case of a synovial sarcoma arising within a popliteal cyst in a 13-year-old female presenting with bilateral popliteal cysts. MR imaging demonstrated the cyst with evidence of subacute haemorrhage and a discrete nodule of tumour. Received: 20 July 2000 Revision requested: 10 August 2000 Revision received: 24 August 2000 Accepted: 28 August 2000     

Pelvic instability after bone graft harvesting from posterior iliac crest: report of nine patients

Objective. To report the imaging findings in nine patients who developed pelvic instability after bone graft harvest from the posterior aspect of the iliac crest. Design and patients. A retrospective study was performed of the imaging studies of nine patients who developed pelvic pain after autologous bone graft was harvested from the posterior aspect of the ilium for spinal arthrodesis. Plain films, bone scans, and CT and MR examinations of the pelvis were reviewed. Pertinent aspects of the clinical history of these patients were noted, including age, gender and clinical symptoms. Results. The age of the patients ranged from 52 to 77 years (average 69 years) and all were women. The bone graft had been derived from the posterior aspect of the iliac crest about the sacroiliac joint. All patients subsequently developed subluxation of the pubic symphysis. Eight patients had additional insufficiency fractures of the iliac crest adjacent to the bone graft donor site, and five patients also revealed subluxation of the sacroiliac joint. Two had insufficiency fractures of the sacrum and one had an additional fracture of the pubic ramus. Conclusions. Pelvic instability is a potential complication of bone graft harvesting from the posterior aspect of the iliac crest. The pelvic instability is manifested by insufficiency fractures of the ilium and subluxation of the sacroiliac joints and pubic symphysis. Received: 25 January 2000 Revision requested: 22 May 2000 Revision received: 15 September 2000 Accepted: 4 January 2001     

Radiation-induced tibial sarcoma in a treated case of hind foot angiomatosis

Hemangiomatosis with osteolysis, osteosclerosis and loss of bony definition is an uncommon disease entity. Many forms of treatment have been used, varying almost from case to case. The use of radiation therapy has proved successful in the control of the disease process in reported cases. The current case of hind foot hemangiomatosis went on to develop sarcoma 17 years later in the uninvolved tibia at the margin of the radiation field, which proved to be fatal to the patient. Treatment by radiotherapy had permitted normal function for 15 years. This case highlights the difficulties of management of skeletal angiomatosis based on anatomic location and emphasizes the need for judicious planning and selection of the mode of delivery of radiotherapy.     

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     

Ewing’s sarcoma of the thumb

 The case of a 51-year-old man with Ewing’s sarcoma of the thumb is presented. The tumor involved the distal phalanx of the right thumb, associated with an impressive extraskeletal mass. Histology revealed a round cell sarcoma with a positive immunoreactivity with monoclonal antibody O13. Five years after disarticulation at the metacarpophalangeal joint, the patient is alive without recurrence or metastasis.     

Ewing’s sarcoma presenting as a solitary bone cyst

This report describes a rare case of Ewing’s sarcoma presenting as a cystic lesion in the proximal humeral metaphysis. The clinical, pathological and radiological findings are described and discussed, with emphasis on the radiological appearances.     

Granulocytic sarcoma (chloroma) of the sacrum: initial manifestation of leukemia

We present an unusual case of a granulocytic sarcoma (chloroma) of the sacrum which predated the initial clinical manifestation of acute myelogenous leukemia. Although granulocytic sarcomas occur in up to 9.1% of cases of acute myelogenous leukemia they usually present concurrently with the leukemic presentation. Although granulocytic sarcomas can involve several different organ systems, bone is the most common site.     

Magnetic resonance imaging features of chloroma of the shoulder

 A patient with a history of essential thrombocytosis presented with diffuse skeletal pain and restricted motion of the left shoulder. Magnetic resonance imaging (MRI) of the left glenohumeral joint showed a soft tissue mass that displaced the rotator cuff. Biopsy of the mass revealed chloroma. MRI is the method that best characterizes this lesion.     

Dedifferentiated parosteal osteosarcoma with high-grade osteoclast-rich osteogenic sarcoma at presentation

We report a case of a 32-year-old woman who presented with parosteal osteosarcoma of the distal femur with simultaneous dedifferentiation to a high-grade osteoclast-rich osteogenic sarcoma. This pattern of dedifferentiation is rare, particularly at the time of presentation. We are aware of three other somewhat comparable cases in the literature; however, none is quite similar to our case.