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Primary bone tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Jennifer N Murphy, Steven L J James, Murali Sundaram, A Mark Davies
Ewing sarcoma typically demonstrates ill-defined bone destruction with a permeative, moth-eaten pattern and a wide zone of transition (Figure 22.3). Most lesions demonstrate a mixed sclerotic/lytic pattern (75%), with a purely lytic form also occurring (25%) (55). Long bones are most frequently involved in the meta-diaphyseal region though it may be purely diaphyseal. The femur and humerus are most commonly involved, but lesions involving the pelvic bones and ribs are not infrequent. A periosteal reaction is often present which typically has an interrupted, lamellated pattern. The classic ‘onion-skin’ or ‘sunburst’ pattern may also occur and the Codman angle is also commonly observed (Figure 22.3) (27%) (55). There is frequently a large soft tissue mass which may cause scalloping or saucerization of the cortex. Occasionally, Ewing sarcoma may have a predominantly sclerotic pattern; however, this is more common in the flat bones. MRI demonstrates an area of marrow infiltration of intermediate signal intensity on T1 and intermediate/high signal on T2/STIR sequences (Figure 22.6) (55). Skip metastasis may be identified (14%), so imaging of the whole bone is again vital (55). A circumferential soft tissue mass and multilaminated periosteal reaction is often identified. Saucerization of the cortex is well demonstrated, representing subperiosteal tumour spread. Very rarely, a periosteal Ewing sarcoma occurs, most often in adolescent males. The imaging features are of a soft tissue mass arising from the surface of bone without extension into the medullary cavity.
Extended matching item (EMI)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
Match the clinical questions below to the above list options. What is the most likely diagnosis given the imaging findings and the patient’s age?What is the type of periosteal reaction described?What is the best initial investigation for assessment of the lesion?List two most appropriate imaging examinations for staging.
Case 14
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
The x-ray (Figure 14c) shows sequestrum formation within the humerus. There is periosteal reaction. This suggests osteomyelitis. Blood culture revealed a bacteraemia with Escherichia coli, and the same organism was isolated from the right humerus. Patients with sickle cell anaemia have an increased risk of osteomyelitis, as organisms may enter the bloodstream from areas of mucosal damage (e.g. in the urinary and gastrointestinal tracts) subjects are hyposplenic, and areas of infarcted marrow can be readily colonised by organisms. Salmonella osteomyelitis is particularly common, as hyposplenism predisposes to this organism, and bile from haemolysis within the marrow provides an enriched culture medium.
Cat at home? Cat scratch disease with atypical presentations and aggressive radiological findings mimicking sarcoma, a potential diagnostic pitfall
Published in Acta Orthopaedica, 2021
Florian Amerstorfer, Jasminka Igrec, Thomas Valentin, Andreas Leithner, Lukas Leitner, Mathias Glehr, Jörg Friesenbichler, Iva Brcic, Marko Bergovec
An atypical manifestation of CSD, such as knee soft tissue mass and osteomyelitis, as in our cohort, is rare and mainly affects children (Carithers 1985, Robson et al. 1999, Donà et al. 2018). Osteomyelitis associated with B. henselae frequently occurs along with regional lymphadenopathy due to hematogenous or lymphatic spread after the inoculation of the microorganisms (Florin et al. 2008, Erdem et al. 2018). In atypical CSD, MRI is the imaging technique of choice in characterization of inflammatory soft tissue mass with adjacent soft tissue edema and in evaluation of bone lesions (Mazur-Melewska et al. 2015, Erdem et al. 2018). For bone lesions, radiography or CT are complementary imaging methods to MRI, useful in evaluating the bone destruction pattern and periosteal reaction. A permeative destruction pattern with cortical destruction and extraosseous soft tissue extension can mimic primary malignant bone processes, as seen in one of our patients (Figure 4, case number 5).
Intra-osseous tophaceous gout of a bipartite patella mimicking aggressive bone tumour
Published in Modern Rheumatology Case Reports, 2021
Fidelis Marie Corpus-Zuñiga, Keiichi Muramatsu, Ma. Felma Rayel, Yasuhiro Tani, Tetsuya Seto
A 31 year-old male nurse came to the orthopaedic clinic, initially because of a direct fall on his left knee. Past medical history showed that he already had an injury on his left knee 10 years prior and was diagnosed with a bipartite patella classified as Saupe type III. His initial radiographs revealed cystic lesion connected to the separation site of the patella (Figure 1). Gradual resolution of pain was noted, however, after a month the pain recurred and he came back to the clinic. His primary physician then requested for a computed tomography (CT) scan which showed intraosseous lesion of the patella and the osteosclerotic changes surrounding the intrapatellar lesion. Periosteal reaction, suggesting malignant bone tumour was not observed (Figure 2). Although his pain improved again after a month, there was recurrence of the anterior knee pain. A repeat CT scan revealed enlargement of the bone lesion, suspected aggressive bone tumour. Magnetic resonance imaging (MRI) showed heterogeneous low and high signal intensity masses on T1- and T2-weighted images and enhancement of the lesion by gadolinium contrast (Figures 3, 4). The border between the patella and intrapatellar lesion was clear. He was referred to Nagato general hospital for surgical management.
Can MRI differentiate between atypical cartilaginous tumors and high-grade chondrosarcoma? A systematic review
Published in Acta Orthopaedica, 2020
Claudia Deckers, Maarten J Steyvers, Gerjon Hannink, H W Bart Schreuder, Jacky W J de Rooy, Ingrid C M Van Der Geest
In cartilaginous tumors production of chondroid matrix results in the typical lobulated growth pattern and the so-called ring and arc appearance (Logie et al. 2013). In HGCS these typical chondroid features become lost due to poor differentiation of cells. Chondrosarcoma cells actively infiltrate between individual fat cells, compressing and eventually replacing them (Brien et al. 1997). Absence of areas of entrapped fat is therefore highly indicative of HGCS. In addition, invasion of Haversian systems leads to periosteal reaction. Eventually there is destruction of the cortex and invasion of soft tissue (Brien et al. 1997). Yoo et al. (2009) found that on gross pathological evaluation, a central non-enhancing region corresponded to an area of hemorrhagic cyst, necrosis, and/or yellow-brown soft tissue mass reflecting a myxoid change, all characteristics of malignant tumors.