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Gomez-Pena S, Rueda de Eusebio Á, Arrazola García J, Romero Fernández P, Moreno Casado MJ, Crespo Rodríguez AM. Update of cartilaginous tumours according to the WHO classification 2020. RADIOLOGIA 2024; 66:57-69. [PMID: 38365355 DOI: 10.1016/j.rxeng.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/11/2023] [Indexed: 02/18/2024]
Abstract
Cartilaginous tumours are a large and heterogeneous group of neoplasms characterised by the presence of a chondroid matrix, with lobular growth and arcuate, ring-like or popcorn-like calcification patterns. MRI shows hyperintensity in T2-weighted sequences and a lobulated or septal relief in postcontrast images. In the WHO 2020 classification, chondral tumours are classified as benign, intermediate or malignant. Despite technological advances, they continue to pose a challenge for both the radiologist and the pathologist, being the main difficulty the differentiation between benign and malignant tumours, which is why they require a multidisciplinary approach. This paper describes the main changes introduced in the 2020 update, describes the imaging characteristics of the main cartilaginous tumours and provides the radiological keys to differentiate between benign and malignant tumours.
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Affiliation(s)
- S Gomez-Pena
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain.
| | - Á Rueda de Eusebio
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain
| | - J Arrazola García
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain
| | - P Romero Fernández
- Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, Spain
| | - M J Moreno Casado
- Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, Spain
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Alsford S, Low S, Mistry A. Chondromyxoid fibroma of the iliac bone: a brief radiological review. BMJ Case Rep 2022; 15:15/11/e251363. [PMID: 36446478 PMCID: PMC9710343 DOI: 10.1136/bcr-2022-251363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Chondromyxoid fibroma (CMF) is a rare, benign bone tumour most commonly located within the metaphyseal region of the long bones surrounding the knee joint. Here, we present an interesting case of a young woman in her early 20s with CMF of the left iliac bone and include a literature review of comparable studies with an emphasis on radiological findings and important differential diagnoses to be aware of in this atypical location.
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Affiliation(s)
- Samuel Alsford
- Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Samantha Low
- Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Alpesh Mistry
- Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Yang Z, Cai J, Du Z, Song J. How I do it: Surgical Resection of a Recurrent Chondromyxoid Fibroma by Micro-Endoscopic Combination Technique. Acta Neurochir (Wien) 2022; 164:1961-1965. [PMID: 35312869 DOI: 10.1007/s00701-022-05185-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The surgical resection of the tumor spreading into the cavernous sinus (CS) is complicated and challenging. METHOD We report a left recurrent CS chondromyxoid fibroma occupying the clival-petrous apex-parasellar-suprasellar area, which was totally removed by the micro-endo combination technique via the middle cranial fossa extradural approach. CONCLUSION This case demonstrates the value of the micro-endoscopic combination technique for complicated skull base surgery.
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Kamal AF, Wibowo RS. Cement arthrodesis of the knee using combined intramedullary nail, plate and screws after wide excision in huge chondromyxoid fibroma of proximal tibia, a case report. Int J Surg Case Rep 2022; 93:106940. [PMID: 35339814 PMCID: PMC8961187 DOI: 10.1016/j.ijscr.2022.106940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Chondromyxoid fibroma is a rare benign cartilaginous neoplasm, a mixture of benign cartilage and fibrous and myxoid tissue. It usually affects young people, commonly in the second and third decades of life with male being predominant. Differential diagnosess in chondromyxoid fibroma, are giant cell tumor, bone cyst, enchondroma, osteoblastoma, and low-grade chondrosarcoma. Case presentation We present a case of an 18-years-old male, with chief complaint of pain on the right knee since 3 year ago with an increasing size reaching diameter of 55 cm within three years. The radiograph and MRI revealed lytic blastic expansile multiloculated lesion, with wide transitional zone, and periosteal reaction on the epymetadiaphyseal part of right proximal tibia. The surgical procedure was performed consist of wide excision, reconstruction by cement knee arthrodesis using Kuntscher-nail, dynamic compression plate, bone cement and gastrocnemius flap. Clinical discussion After 3 months of surgery follow-up, there was no sign of recurrence, the patient walked partially weight bearing with a crutch. In 1 years post operative follow up, the Muscukoskeletal Tumor Society Scoring (MSTS) was 80%. There was no sign of recurrence. Conclusion In cases with large tumor size, wide excision with bone and soft tissue reconstructive surgery is required as mechanical and biological reconstruction. The cement arthrodesis provides a faster duration of surgery, lower risk of infection, and good functional outcome. Chondromyxoid fibroma is a rare benign cartilaginous neoplasm, mixture of benign cartilage and fibrous and myxoid tissue There are no specific recommendation in management of chondromyxoid fibroma due to limited published article with chondromyxoid fibroma. The mechanical and biological reconstruction are very important during reconstructive surgery.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Riko Satriyo Wibowo
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
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Nishath PV, Reddy P, Choukimath SM, Hosangadi AA. Cytological diagnosis of chondromyxoid fibroma. J Cytol 2022; 39:78-80. [PMID: 35814876 PMCID: PMC9262003 DOI: 10.4103/joc.joc_132_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/25/2021] [Accepted: 10/14/2021] [Indexed: 11/04/2022] Open
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Zeinoddini A, Bezold A, Ezzeldin O, AL Jadiry H. Radiological manifestations of chondromyxoid fibroma in the zygoma: A case report and literature review. BJR Case Rep 2021; 7:20210008. [PMID: 35047203 PMCID: PMC8749392 DOI: 10.1259/bjrcr.20210008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
Chondromyxoid fibroma (CMF) is a rare benign bone tumor of cartilaginous origin, with an extremely rare craniofacial occurrence. Considering its rarity, craniofacial CMF presents a diagnostic challenge for radiologists. To our knowledge, only seven cases of zygomatic CMF have been described in the literature, only one of which was in the paediatric age group. Furthermore, none of the currently reported cases include MRI findings of zygomatic CMF. Here, we present a paediatric case of CMF of the zygoma with a comprehensive literature review of the reported cases, focusing on their radiological features and its differential diagnosis.
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Affiliation(s)
- Atefeh Zeinoddini
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Amy Bezold
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Obadah Ezzeldin
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Huda AL Jadiry
- Neuroradiology Division, Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
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Engel H, Herget GW, Füllgraf H, Sutter R, Benndorf M, Bamberg F, Jungmann PM. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. ROFO-FORTSCHR RONTG 2020; 193:262-275. [PMID: 33152784 DOI: 10.1055/a-1288-1209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chondrogenic tumors are the most frequent primary bone tumors. Malignant chondrogenic tumors represent about one quarter of malignant bone tumors. Benign chondrogenic bone tumors are frequent incidental findings at imaging. Radiological parameters may be helpful for identification, characterization, and differential diagnosis. METHODS Systematic PubMed literature research. Identification and review of studies analyzing and describing imaging characteristics of chondrogenic bone tumors. RESULTS AND CONCLUSIONS The 2020 World Health Organization (WHO) classification system differentiates between benign, intermediate (locally aggressive or rarely metastasizing), and malignant chondrogenic tumors. On imaging, typical findings of differentiated chondrogenic tumors are lobulated patterns with a high signal on T2-weighted magnetic resonance imaging (MRI) and ring- and arc-like calcifications on conventional radiography and computed tomography (CT). Depending on the entity, the prevalence of this chondrogenic pattern differs. While high grade tumors may be identified due to aggressive imaging patterns, the differentiation between benign and intermediate grade chondrogenic tumors is challenging, even in an interdisciplinary approach. KEY POINTS · The WHO defines benign, intermediate, and malignant chondrogenic bone tumors. · Frequent benign tumors: osteochondroma and enchondroma; Frequent malignant tumor: conventional chondrosarcoma. · Differentiation between enchondroma versus low-grade chondrosarcoma is challenging for radiologists and pathologists. · Pain, deep scalloping, cortical destruction, bone expansion, soft tissue component: favor chondrosarcoma. · Potential malignant transformation of osteochondroma: progression after skeletal maturity, cartilage cap thickness (> 2 cm adult; > 3 cm child). · Potentially helpful advanced imaging methods: Dynamic MRI, texture analysis, FDG-PET/CT. CITATION FORMAT · Engel H, Herget GW, Füllgraf H et al. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. Fortschr Röntgenstr 2021; 193: 262 - 274.
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Affiliation(s)
- Hannes Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Georg W Herget
- Department of Orthopaedics and Traumatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Hannah Füllgraf
- Institute for Surgical Pathology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Switzerland
| | - Matthias Benndorf
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Pia M Jungmann
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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8
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Gutierrez LB, Link TM, Horvai AE, Joseph GB, O'Donnell RJ, Motamedi D. Secondary aneurysmal bone cysts and associated primary lesions: imaging features of 49 cases. Clin Imaging 2020; 62:23-32. [PMID: 32036238 DOI: 10.1016/j.clinimag.2020.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the imaging, anatomic, and clinical features of a series of secondary aneurysmal bone cysts (ABC) and to ascertain their most commonly associated primary bone lesions. METHODS Forty-nine cases of histopathologically proven secondary ABCs were retrospectively reviewed. Demographic data and clinical history were obtained. Radiographic, computed tomographic, magnetic resonance, and nuclear medicine imaging were analyzed. Lesion location, imaging characteristics, and associated primary lesions were documented. Linear regression analysis and Chi-squared testing was performed for statistical analysis. RESULTS Twenty-four males and 25 females were included, with an age range of 8-79 years (mean 29.7 + - 4.5 years). Eleven types of primary bone lesion were identified, with giant-cell tumor (n = 17, 35%), chondroblastoma (n = 11, 22%), fibrous dysplasia (n = 6, 12%), osteoblastoma (n = 4, 8%) and osteosarcoma (n = 4, 8%) being the most frequent. The lesions involved chiefly the long bone epiphyses (n = 25, 51%). Secondary ABC imaging findings and locations most closely approximated those of their primary counterparts, although fluid-fluid levels were seen at a higher frequency than previously reported in primary chondroblastoma (9/11, 82%), fibrous dysplasia (2/6, 33%), osteoblastoma (4/4, 100%), osteosarcoma (3/4, 75%), and chondromyxoid fibroma (1/2, 50%). CONCLUSION The most common primary lesions associated with secondary ABC were giant cell tumor and chondroblastoma, located in the long bone epiphyses. The majority of the secondary ABCs demonstrate predominant imaging characteristics typical of the primary bone lesions, but with a higher presence of fluid-fluid levels.
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Affiliation(s)
- Luis B Gutierrez
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America.
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Andrew E Horvai
- Department of Pathology, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Richard J O'Donnell
- Department of Orthopaedic Surgery, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, United States of America
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Sono T, Ware AD, McCarthy EF, James AW. Chondromyxoid Fibroma of the Pelvis: Institutional Case Series With a Focus on Distinctive Features. Int J Surg Pathol 2018; 27:352-359. [PMID: 30580642 DOI: 10.1177/1066896918820446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chondromyxoid fibroma (CMF) is a relatively uncommon benign bone tumor of cartilaginous differentiation. The primary pitfall in the histopathologic diagnosis of CMF is confusion with a high-grade chondrosarcoma, owing to the atypical stellate and spindled cells set within a chondromyxoid background. CMF is particularly challenging to diagnose within the pelvis, where clinical suspicion for chondrosarcoma is high and benign lesions may grow to a large size to occupy the pelvic bones. In our practice, we noted this difficulty in several consecutive cases, especially when older patients presented with CMF within the pelvis. This prompted an institutional retrospective case review of all CMF within the pelvis. In 10 cases, we found overall that CMF of pelvis occurred in an older age range (mean age = 48.6 years), was larger in size (mean size = 6.0 cm), and showed a higher rate of soft tissue extension (50%) as compared with prior reports of nonpelvic CMF. Typical histologic features of CMF were seen in all cases; however, a high frequency of dystrophic calcification (50%) and necrosis (30%) was observed. Of interest, these aggregate demographic, radiologic, and histologic findings are all consistent with a benign neoplasm that has grown undetected within the pelvis over a long period of time. Recognition of these differences between pelvic CMF and tumors involving other sites will aid in avoiding misdiagnosis of this uncommon entity.
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10
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He K, Jiang S, Zhang X, Mao Y, Zhu W, Wang Y, Song J, Chen L. Preliminary Exploration of the Diagnosis and Treatment of Skull-Based Chondromyxoid Fibromas. Oper Neurosurg (Hagerstown) 2018; 15:270-277. [PMID: 29165705 DOI: 10.1093/ons/opx233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 10/10/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chondromyxoid fibromas (CMFs) are benign tumors that occur rarely in the skull base. OBJECTIVE To conduct a preliminary exploration of the diagnosis and treatment of cranial CMFs. METHODS A retrospective analysis of 19 cases of CMFs in the base of the skull between 2009 and 2014 in our hospital was conducted. The clinical manifestations, imaging characteristics, pathology, treatment strategies, and outcomes were examined. RESULTS The study cohort included 7 women (36.8%) and 12 men (63.2%), and symptom duration ranged from 1 mo to 5 yr. Of the 19 intracranial CMF cases examined, 15 (78.9%) conformed with the diagnostic criteria for extracranial CMF. Resection operations yielded subtotal removal of 13 tumors (68.4%) and partial removal of 6 tumors (31.6%). Postoperative pathological analysis demonstrated that the tumors were characterized by spindle-shaped or stellate cells arranged in a myxoid matrix without mitoses or permeation. Follow-up (range 2-7.3 yr; mean, 4.4 ± 1.7 yr) revealed that symptoms improved postoperatively in 15 cases (78.9%), were maintained in 2 cases (10.5%), and worsened in 2 cases (10.5%). Imaging follow-up revealed that residual tumors were stable in 18 cases (94.7%) and enlarged in 1 case (5.3%). CONCLUSION An accurate diagnosis should involve comprehensive consideration of clinical, radiological, and pathological features. The treatment strategy for CMFs consists of maximizing tumor removal while protecting adjacent key structures. Postoperative stereotactic radiotherapy is appropriate for residual tumors.
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Affiliation(s)
- Kangmin He
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Shize Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yin Wang
- Department of Pathology, Hua-shan Hospital, Fudan University, Shan-ghai, China
| | - Jianping Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Gholamrezanezhad A, Basques K, Kosmas C. Peering beneath the surface: Juxtacortical tumors of bone (part I). Clin Imaging 2018; 51:1-11. [PMID: 29414518 DOI: 10.1016/j.clinimag.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/06/2018] [Accepted: 01/16/2018] [Indexed: 12/18/2022]
Abstract
Juxtacortical or surface tumors of bone are neoplasms arising from or just outside the cortex, and are composed of different histologic types. Although the imaging appearances of these lesions have similarities to their intramedullary counterparts, their location alters their radiographic and MR characteristics, creating difficulties in diagnosis. Meanwhile, several non-neoplastic lesions, such as stress reaction/stress fracture and indolent infectious processes, compound the differential diagnosis. Neoplastic juxtacortical lesions of bone have been classified into five categories: cartilaginous, fibrous, lipomatous, osseous, and metastatic tumors. Our goal in part one of this review is to illustrate the characteristic radiographic, CT and MR imaging features of various juxtacortical neoplasms, including pathognomonic imaging findings that can aid in diagnosis, and to develop an appropriate differential diagnosis for surface lesions based on imaging characteristics, lesion location and patient age.
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Affiliation(s)
- Ali Gholamrezanezhad
- Departments of Emergency Radiology and Musculoskeletal Imaging, Keck School of Medicine, University of Southern California (USC), 1520 San Pablo St, Los Angeles, CA 90033, USA.
| | - Kyle Basques
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Christos Kosmas
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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An intracortical chondromyxoid fibroma in the diaphysis of the metatarsal. Skeletal Radiol 2017; 46:1757-1762. [PMID: 28808739 DOI: 10.1007/s00256-017-2743-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
Chondromyxoid fibromas (CMFs) are rare, benign, primary tumors of bones, and occur in the metaphyses of the medullary canals of the long bones. The occurrence of intracortical CMFs is extremely rare. Very few cases of intracortical CMFs located in the long tubular bones have been reported to date. Moreover, even though the feet are the second most common site for CMF (after the knees), intracortical metatarsal CMF has not been reported previously, to our knowledge. We report an intracortical CMF occurring in the diaphysis of the metatarsal in a 17-year-old man. It showed the same imaging findings as usual intramedullary CMFs, except for its cortical location. The development and serial increase in this tumor over time are also demonstrated in this report. Additionally, we present a review of current literature on intracortical CMFs.
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Kwee TC, de Klerk JMH, Nix M, Heggelman BGF, Dubois SV, Adams HJA. Benign Bone Conditions That May Be FDG-avid and Mimic Malignancy. Semin Nucl Med 2017; 47:322-351. [PMID: 28583274 DOI: 10.1053/j.semnuclmed.2017.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Positron emission tomography with the radiotracer 18F-fluoro-2-deoxy-d-glucose (FDG) plays an important role in the evaluation of bone pathology. However, FDG is not a cancer-specific agent, and knowledge of the differential diagnosis of benign FDG-avid bone alterations that may resemble malignancy is important for correct patient management, including the avoidance of unnecessary additional invasive tests such as bone biopsy. This review summarizes and illustrates the spectrum of benign bone conditions that may be FDG-avid and mimic malignancy, including osteomyelitis, bone lesions due to benign systemic diseases (Brown tumor, Erdheim-Chester disease, Gaucher disease, gout and other types of arthritis, Langerhans cell histiocytosis, and sarcoidosis), benign primary bone lesions (bone cysts, chondroblastoma, chondromyxoid fibroma, desmoplastic fibroma, enchondroma, giant cell tumor and granuloma, hemangioma, nonossifying fibroma, and osteoid osteoma and osteoblastoma), and a group of miscellaneous benign bone conditions (post bone marrow biopsy or harvest status, bone marrow hyperplasia, fibrous dysplasia, fractures, osteonecrosis, Paget disease of bone, particle disease, and Schmorl nodes). Several ancillary clinical and imaging findings may be helpful in discriminating benign from malignant FDG-avid bone lesions. However, this distinction is sometimes difficult or even impossible, and tissue acquisition will be required to establish the final diagnosis.
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Affiliation(s)
- Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | - John M H de Klerk
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Maarten Nix
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ben G F Heggelman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Stefan V Dubois
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Hugo J A Adams
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Deventer, The Netherlands
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14
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Ladd LM, Roth TD. Computed Tomography and Magnetic Resonance Imaging of Bone Tumors. Semin Roentgenol 2017; 52:209-226. [PMID: 28965542 DOI: 10.1053/j.ro.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Lauren M Ladd
- Department of Radiology and Imaging Sciences, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN.
| | - Trenton D Roth
- Department of Radiology and Imaging Sciences, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN
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Copelan A, Chehab M, Dixit P, Cappell MS. Safety and efficacy of angiographic occlusion of duodenal varices as an alternative to TIPS: review of 32 cases. Br J Radiol 2016; 89:20160088. [PMID: 25864218 DOI: 10.1259/bjr.20160088] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED BACKGROUND/RATIONALE OF STUDY: Analyze safety and efficacy of angiographic-occlusion-with-sclerotherapy/embolotherapy-without-transjugular-intrahepatic-portosystemic-shunt (TIPS) for duodenal varices. Although TIPS is considered the best intermediate-to-long term therapy after failed endoscopic therapy for bleeding varices, the options are not well-defined when TIPS is relatively contraindicated, with scant data on alternative therapies due to relative rarity of duodenal varices. Prior cases were identified by computerized literature search, supplemented by one illustrative case. Favorable clinical outcome after angiography defined as no rebleeding during follow-up, without major procedural complications. RESULTS Thirty-two cases of duodenal varices treated by angiographic-occlusion-with-sclerotherapy/embolotherapy- without-TIPS were analyzed. Patients averaged 59.5 ± 12.2 years old (female = 59%). Patients presented with melena-16, hematemesis & melena-5, large varices-5, growing varices-2, ruptured varices-1, and other- 3. Twenty-nine patients had cirrhosis; etiologies included: alcoholism-11, hepatitis C-11, primary biliary cirrhosis- 3, hepatitis B-2, Budd-Chiari-1, and idiopathic-1. Three patients did not have cirrhosis, including hepatic metastases from rectal cancer-1, Wilson's disease-1, and chronic liver dysfunction-1. Thirty-one patients underwent esophagogastroduodenoscopy before therapeutic angiography, including fifteen undergoing endoscopic variceal therapy. Therapeutic angiographic techniques included balloon-occluded retrograde-transvenous-obliteration (BRTO) with sclerotherapy and/or embolization-21, DBOE (double-balloon-occluded-embolotherapy)-5, and other-6. Twenty-eight patients (87.5%; 95%-confidence interval: 69-100%) had favorable clinical outcomes after therapeutic angiography. Three patients were therapeutic failures: rebleeding at 0, 5, or 10 days after therapy. One major complication (Enterobacter sepsis) and one minor complication occurred. CONCLUSIONS This work suggests that angiographic-occlusion-with sclerotherapy/ embolotherapy-without-TIPS is relatively effective (~90% hemostasis-rate), and relatively safe (3% major-complication-rate). This therapy may be a useful treatment option for duodenal varices when endoscopic therapy fails and TIPS is relatively contraindicated.
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Affiliation(s)
- Alexander Copelan
- Department of Radiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Monzer Chehab
- Department of Radiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Purushottam Dixit
- Department of Radiology, William Beaumont Hospital, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Mitchell S Cappell
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA; Division of Gastroenterology & Hepatology, William Beaumont Hospital, Royal Oak, MI, USA
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Taghipour Zahir S, Sefidrokh Sharahjin N, Sadlu Parizi F, Rahmani K. Chondromyxoid Fibroma of Two Cervical Vertebrae with Involvement of Surrounding Soft Tissue: Radiologic Diagnostic Dilemma. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e19273. [PMID: 26587204 PMCID: PMC4647118 DOI: 10.5812/iranjradiol.19273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/07/2014] [Accepted: 08/13/2014] [Indexed: 12/12/2022]
Abstract
Chondromyxoid fibroma is a rare benign cartilaginous neoplasm that mostly affects the metaphyseal region of the long bones. The tibia, small tubular bones of the foot, the distal femur and pelvis are common locations, but involvement of the vertebral bones, especially the cervical vertebra, is very rare. Radiographic features show typical characteristics and this tumor often presents as a lobulated, eccentric radiolucent lesion with no periosteal reaction. In addition, geographic bone destruction is seen in all cases. We present an adult female with a one-year history of neck pain, and ultrasound findings that suggest a right paravertebral muscular lesion due to inflammatory or neoplastic origins. The histopathological studies confirmed that the biopsied specimen was a chondromyxoid fibroma of the cervical vertebrae laminae and spinous processes (C3 and C4) with abutting soft tissue. Despite the unusual location and soft tissue presentation, a chondromyxoid fibroma should be considered in the differential diagnosis of a cervical bone lesion.
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Affiliation(s)
- Shokouh Taghipour Zahir
- Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Corresponding author: Shokouh Taghipour Zahir, Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Tel: +98-3518113615, Fax: +98-3518114100, E-mail:
| | | | - Farzad Sadlu Parizi
- Department of Neurosurgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Koorosh Rahmani
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Tyler PA, Mohaghegh P, Foley J, Isaac A, Zavareh A, Thorning C, Kirwadi A, Pressney I, Amary F, Rajeswaran G. Tibial cortical lesions: a multimodality pictorial review. Eur J Radiol 2014; 84:123-141. [PMID: 25445894 DOI: 10.1016/j.ejrad.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/01/2014] [Accepted: 09/09/2014] [Indexed: 11/29/2022]
Abstract
Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.
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Affiliation(s)
- P A Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - P Mohaghegh
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - J Foley
- Department of Radiology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ES, UK.
| | - A Isaac
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - A Zavareh
- Department of Radiology, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE, UK.
| | - C Thorning
- Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH, UK.
| | - A Kirwadi
- Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
| | - I Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - F Amary
- Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, UK.
| | - G Rajeswaran
- Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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Bhamra JS, Al-Khateeb H, Dhinsa BS, Gikas PD, Tirabosco R, Pollock RC, Skinner JA, Aston WJ, Saifuddin A, Briggs TW. Chondromyxoid fibroma management: a single institution experience of 22 cases. World J Surg Oncol 2014; 12:283. [PMID: 25217119 PMCID: PMC4247711 DOI: 10.1186/1477-7819-12-283] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
Background Several different strategies have been reported for the treatment of chondromyxoid fibromas, all with variable outcomes and high recurrence rates. Methods We report on 22 consecutive cases of chondromyxoid fibromas treated by intralesional curettage, four of which had adjuvant cementation at our institution between 2003 and 2010. We assessed the functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system. Results Nine males and 16 females with a mean age of 36.5 years (range 11 to 73) and a mean follow-up of 60.7 months were included in the study. Local recurrence occurred in two patients (9%) within the first 2 years following the index procedure. This was treated by re-curettage only of the residual defect. Two postoperative complications occurred: a superficial wound infection in one patient and a transient deep peroneal nerve neurapraxia in the other. The mean postoperative MSTS score was 96.7%. Conclusions Intralesional curettage and cementation is as an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate. Careful case selection with stringent clinical and radiographic follow-up is recommended.
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Affiliation(s)
- Jagmeet S Bhamra
- Bone Tumour Unit, The Royal National Orthopaedic Hospital, Stanmore, Middlesex HA7 4LP, UK.
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Fukawa T, Akatsu Y, Sasho T. Intra-articular angioleiomyoma of the knee with an atypical finding on gadolinium-enhanced magnetic resonance imaging: a case report. J Med Case Rep 2014; 8:238. [PMID: 24985748 PMCID: PMC4088310 DOI: 10.1186/1752-1947-8-238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/19/2014] [Indexed: 11/12/2022] Open
Abstract
Introduction Angioleiomyoma is a benign smooth muscle tumor. It originates in the tunica media of veins. In general, it arises from the dermis, subcutaneous fat and fascia of lower extremities in middle-aged women. The case of intra-articular occurrence is very rare. Case presentation This case report describes a 30-year-old Asian man with a 6-month history of recurrent pain localized in the lateral side of his left knee. Magnetic resonance imaging revealed an isolated intra-articular lesion. We performed a surgical excision of this lesion. On histological examination, the diagnosis of angioleiomyoma was confirmed. After the surgery, he recovered completely. Furthermore, no sign of recurrence was observed 1 year after surgery. Conclusions In this study, we report a rare case of intra-articular angioleiomyoma of the knee. The mass showed atypical findings on magnetic resonance imaging including gadolinium-enhanced imaging in comparison to previously reported intra-articular lesions. This intra-articular tumor is difficult to diagnose prior to surgery due to paucity of information.
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Affiliation(s)
| | | | - Takahisa Sasho
- Department of Orthopaedic Surgery, Graduated School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
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Abstract
Myxomas of bone in the head and neck are rare tumors. We present a 68 year old female with pain and epistaxis who was found to have the first reported case of a myxoma arising within the vomer bone. Some atypical magnetic resonance imaging features are described, however, myxoma imaging features are often non-specific and typically evoke a benign differential diagnosis. Surgical excision is the treatment of choice.
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Affiliation(s)
- David Besachio
- Department of Radiology, Neuroradiology Division, 30 N 1900 E, Salt Lake City, UT 84132, USA.
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