A review of paediatric soft tissues masses referred to a tertiary musculoskeletal sarcoma centre

Rare blood neoplasm masking as a concerning soft tissue tumour: blastic plasmacytoid dendritic cell neoplasm

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive malignancy with fewer than 100 paediatric cases reported. This report details a boy who presented in young childhood with a skin lesion on his left buttock that clinically resembled a sarcomatous lesion. Histopathological work-up including flow cytometry, immunophenotyping and phenotypic correlation were consistent with the diagnosis of BPDCN. The diagnosis of BPDCN radically altered this patient's treatment pathway. The case highlights the importance of multidisciplinary team evaluation in soft tissue masses and careful consideration of alternative diagnoses. For this child, the diagnosis of BPDCN prevented an extensive local resection.

Are Imaging Evaluations of Soft-Tissue Masses Before Referral to a Specialized Center Being Performed Properly? A Systematic Review

BACKGROUND/OBJECTIVES

Since the initial approach towards the clinical presentation of soft-tissue masses is challenging for frontline physicians, some countries use clinical practice guidelines. Proper imaging work-up is crucial to differentiate between soft-tissue tumors. Recently, ultrasonography and magnetic resonance imaging (MRI) have been widely used. But there is some controversy about whether pre-referral evaluations are being conducted properly. Thus, this study aims to assess whether the ultrasonography investigation of soft-tissue masses prior to referral to the musculoskeletal tumor center is being performed adequately in terms of indications, diagnostic accuracy, and referral interval, and to evaluate whether the pre-referral MRI for soft-tissue masses is being conducted reasonably concerning indications, imaging protocol, reporting, diagnostic accuracy, and cost-effectiveness.

METHODS

The study protocol was registered. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We performed a database search of the MEDLINE, Embase, and Cochrane Library. Then, two authors reviewed the studies, and the third author resolved any disagreement between them. A total of nine studies were included. The Risk Of Bias In Non-Randomized Studies-of Interventions was applied. Relevant data were extracted by two authors.

RESULTS

This review showed that the way that the imaging investigations are performed in non-specialized centers before referral was generally considered inappropriate.

CONCLUSIONS

Frontline physicians should regard the alarm symptom as an indication for advanced imaging evaluation. Education and certification may be required for ultrasonography. MRI should be performed and interpreted in a specialized center or by a specialist with relevant expertise. Guidance may help reduce inappropriate imaging.

Ischial Tuberosity Avulsion Fracture Mimicking Calcified Mass on Plain Films: A Case Report

Ischial tuberosity avulsion fractures are overall uncommon but are known injuries in the adolescent population. They are the result of sudden, forceful contraction of the hamstring muscle groups. The characteristic radiographic appearance of an ischial tuberosity avulsion fracture is of an irregular ischial margin and a nearby avulsed bone fragment. Callous formation may ensue and appears as a calcific density in the region of injury. Awareness of the spectrum of radiographic presentations can help ensure correct diagnosis and minimize concern for alternative underlying diagnoses. This case report describes a 14-year-old boy with a chronic ischial tuberosity avulsion fracture which demonstrated an unusual presentation on radiographs and required MRI to confirm the diagnosis and rule out other potentially ominous pathology.