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Haseli S, Mansoori B, Shafiei M, Shomal Zadeh F, Chalian H, Khoshpouri P, Yousem D, Chalian M. A Review of Posteromedial Lesions of the Chest Wall: What Should a Chest Radiologist Know? Diagnostics (Basel) 2022; 12:diagnostics12020301. [PMID: 35204391 PMCID: PMC8871555 DOI: 10.3390/diagnostics12020301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 12/10/2022] Open
Abstract
A heterogeneous group of tumors can affect the posteromedial chest wall. They form diverse groups of benign and malignant (primary or secondary) pathologies that can arise from different chest wall structures, i.e., fat, muscular, vascular, osseous, or neurogenic tissues. Chest radiography is very nonspecific for the characterization of chest wall lesions. The modality of choice for the initial assessment of the chest wall lesions is computed tomography (CT). More advanced cross-sectional modalities such as magnetic resonance imaging (MRI) and positron emission tomography (PET) with fluorodeoxyglucose are usually used for further characterization, staging, treatment response, and assessment of recurrence. A systematic approach based on age, clinical history, and radiologic findings is required for correct diagnosis. It is essential for radiologists to be familiar with the spectrum of lesions that might affect the posteromedial chest wall and their characteristic imaging features. Although the imaging findings of these tumors can be nonspecific, cross-sectional imaging helps to limit the differential diagnosis and determine the further diagnostic investigation (e.g., image-guided biopsy). Specific imaging findings, e.g., location, mineralization, enhancement pattern, and local invasion, occasionally allow a particular diagnosis. This article reviews the posteromedial chest wall anatomy and different pathologies. We provide a combination of location and imaging features of each pathology. We will also explore the role of imaging and its strengths and limitations for diagnosing posteromedial chest wall lesions.
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Affiliation(s)
- Sara Haseli
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98105, USA; (S.H.); (M.S.); (F.S.Z.); (P.K.)
| | - Bahar Mansoori
- Department of Radiology, Division of Abdominal Imaging, University of Washington, Seattle, WA 98105, USA;
| | - Mehrzad Shafiei
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98105, USA; (S.H.); (M.S.); (F.S.Z.); (P.K.)
| | - Firoozeh Shomal Zadeh
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98105, USA; (S.H.); (M.S.); (F.S.Z.); (P.K.)
| | - Hamid Chalian
- Department of Radiology, Division of Cardiothoracic Imaging, University of Washington, Seattle, WA 98105, USA;
| | - Parisa Khoshpouri
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98105, USA; (S.H.); (M.S.); (F.S.Z.); (P.K.)
| | - David Yousem
- Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, MD 21287, USA;
| | - Majid Chalian
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98105, USA; (S.H.); (M.S.); (F.S.Z.); (P.K.)
- Correspondence: ; Tel.: +1+(206)-598-2405
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Lin T, Li XY, Zou CY, Liu WW, Lin JF, Zhang XX, Zhao SQ, Xie XB, Huang G, Yin JQ, Shen JN. Discontinuous polyostotic fibrous dysplasia with multiple systemic disorders and unique genetic mutations: A case report. World J Clin Cases 2020; 8:6197-6205. [PMID: 33344623 PMCID: PMC7723713 DOI: 10.12998/wjcc.v8.i23.6197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/27/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Polyostotic fibrous dysplasia (PFD) is an uncommon developmental bone disease in which normal bone and marrow are replaced by pseudotumoral tissue. The etiology of PFD is unclear, but it is generally thought to be caused by sporadic, post-zygotic mutations in the GNAS gene. Herein, we report the case of a young female with bone pain and lesions consistent with PFD, unique physical findings, and gene mutations.
CASE SUMMARY A 27-year-old female presented with unbearable bone pain in her left foot for 4 years. Multiple bone lesions were detected by radiographic examinations, and a diagnosis of PFD was made after a biopsy of her left calcaneus with symptoms including pre-axial polydactyly on her left hand and severe ophthalmological problems such as high myopia, vitreous opacity, and choroidal atrophy. Her serum cortisol level was high, consistent with Cushing syndrome. Due to consanguineous marriage of her grandparents, boosted whole exome screening was performed to identify gene mutations. The results revealed mutations in HSPG2 and RIMS1, which may be contributing factors to her unique findings.
CONCLUSION The unique findings in this patient with PFD may be related to mutations in the HSPG2 and RIMS1 genes.
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Affiliation(s)
- Tiao Lin
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Xin-Yu Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Chang-Ye Zou
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Wei-Wei Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Jun-Fan Lin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Xin-Xin Zhang
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Si-Qi Zhao
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Xian-Biao Xie
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Gang Huang
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Jun-Qiang Yin
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Jing-Nan Shen
- Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
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Lin T, Li XY, Zou CY, Liu WW, Lin JF, Zhang XX, Zhao SQ, Xie XB, Huang G, Yin JQ, Shen JN. Discontinuous polyostotic fibrous dysplasia with multiple systemic disorders and unique genetic mutations: A case report. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Liu X, Ye J, Zhang Y, Liu Q, Bai R, Yuan W, Cai D, Zheng X, Bian Y, Zhou S, Lv J, Ding Y, Xie F, Lu H, Xie B. Ocular Biodistribution of 89Zr-Bevacizumab in New Zealand Rabbits Determined Using PET/MRI: A Feasibility Study. Iran J Radiol 2019; In Press. [DOI: 10.5812/iranjradiol.68697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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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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Abstract
Whole-body fluorine 18 fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) is performed primarily for oncologic indications; however, FDG uptake is not specific for malignancy. Herein we focus on causes of increased FDG uptake in and around joints, as lesions in these locations are commonly benign. A combination of primary intra-articular processes and osseous processes that may occur near the joint space will be discussed. Causes of intra-articular and periarticular increased FDG activity can be broadly divided into infectious, inflammatory, degenerative, and benign neoplastic categories. A familiarity with the full range of these processes is important to avoid misinterpretation, in turn decreasing unnecessary follow-up studies, procedures, and treatments. Differentiation from malignancy is often possible on the basis of a different level of FDG activity, divergent response to therapy, or differing changes over time, in comparison with a patient's known primary cancer. Recognizing an intra-articular lesion location can also be critical, as intra-articular metastases are rare. In some cases, benign FDG-avid articular and periarticular entities have a specific appearance at FDG PET/CT and a correct diagnosis may be made without any additional workup. In most other cases, comparison with prior studies and/or additional imaging can afford an accurate diagnosis. This review is meant to introduce the reader to a spectrum of benign FDG-avid articular and periarticular processes that may be encountered at oncologic FDG PET/CT to increase confidence and diagnostic accuracy. (©)RSNA, 2016.
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Affiliation(s)
- Mariah L White
- From the Departments of Radiology (M.L.W., G.B.J., B.M.H, P.J.P, S.M.B.) and Immunology (G.B.J.), Mayo Clinic, 200 First Street SW, Mayo 2E, Rochester, MN 55905
| | - Geoffrey B Johnson
- From the Departments of Radiology (M.L.W., G.B.J., B.M.H, P.J.P, S.M.B.) and Immunology (G.B.J.), Mayo Clinic, 200 First Street SW, Mayo 2E, Rochester, MN 55905
| | - Benjamin Matthew Howe
- From the Departments of Radiology (M.L.W., G.B.J., B.M.H, P.J.P, S.M.B.) and Immunology (G.B.J.), Mayo Clinic, 200 First Street SW, Mayo 2E, Rochester, MN 55905
| | - Patrick J Peller
- From the Departments of Radiology (M.L.W., G.B.J., B.M.H, P.J.P, S.M.B.) and Immunology (G.B.J.), Mayo Clinic, 200 First Street SW, Mayo 2E, Rochester, MN 55905
| | - Stephen M Broski
- From the Departments of Radiology (M.L.W., G.B.J., B.M.H, P.J.P, S.M.B.) and Immunology (G.B.J.), Mayo Clinic, 200 First Street SW, Mayo 2E, Rochester, MN 55905
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Kamaleshwaran KK, Joseph J, Kalarikal R, Shinto AS. Image Findings of Polyostotic Fibrous Dysplasia Mimicking Metastasis in F-18 FDG Positron Emission Tomography/Computed Tomography. Indian J Nucl Med 2017; 32:137-139. [PMID: 28533645 PMCID: PMC5439207 DOI: 10.4103/0972-3919.202237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fibrous dysplasia (FD) of the bone is characterized by the medullary cavity of bones becoming filled with fibrous tissue, and its etiology remains unknown. It is usually asymptomatic and found incidentally on imaging studies that are performed for other purposes. FD may closely mimic the appearance of bony metastatic disease on radiological examinations. We report the case of a 45-year-old female patient, which appeared to have multiple bone lesions on initial workup images. Subsequently, the bone lesions that showed increased FDG uptake on PET/CT in right femur and tibia were identified as FD. The present case is a useful addition to the current body of literature of false positive F-18 FDG PET/CT due to a benign skeletal pathology and underscores the importance of high index of suspicion and careful correlation, whenever one comes across such an unusual PET/CT finding.
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Affiliation(s)
| | - Jephy Joseph
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | - Radhakrishnan Kalarikal
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
| | - Ajit Sugunan Shinto
- Department of Nuclear Medicine and PET/CT, Comprehensive Cancer Care Center, Kovai Medical Center and Hospital Limited, Coimbatore, India
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Park SB, Choi JY, Kim HJ, Kim HJ, Lee KH, Kim BT. Incidental focal 18F-FDG uptake in the frontal process of the maxilla on PET/CT: prevalence and clinical significance. Ann Nucl Med 2016; 30:619-623. [DOI: 10.1007/s12149-016-1103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/21/2016] [Indexed: 11/30/2022]
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Rehak Z, Bencsikova B, Zambo I, Kazda T. Fibrous Dysplasia Presenting as a Cold Spot in 18F-FLT PET/CT Imaging. Clin Nucl Med 2016; 41:510-1. [DOI: 10.1097/rlu.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Guler I, Nayman A, Gedik GK, Koplay M, Sari O. Fibrous dysplasia mimicking vertebral bone metastasis on 18F-FDG PET/computed tomography in a patient with tongue cancer. Spine J 2015; 15:1501-2. [PMID: 25801387 DOI: 10.1016/j.spinee.2015.03.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/16/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Ibrahim Guler
- Department of Radiology, Selcuk University, 42075, Konya, Turkey
| | - Alaaddin Nayman
- Department of Radiology, Selcuk University, 42075, Konya, Turkey
| | - Gonca Kara Gedik
- Department of Nuclear Medicine, Selcuk University, 42075, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, Selcuk University, 42075, Konya, Turkey
| | - Oktay Sari
- Department of Nuclear Medicine, Selcuk University, 42075, Konya, Turkey
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Ahmadinejad N, Movahedinia S, Movahedinia S, Holakouie Naieni K, Nedjat S. Distribution of breast density in Iranian women and its association with breast cancer risk factors. Iran Red Crescent Med J 2013; 15:e16615. [PMID: 24693398 PMCID: PMC3955513 DOI: 10.5812/ircmj.16615] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/25/2013] [Accepted: 08/27/2013] [Indexed: 12/25/2022]
Abstract
Background: Breast cancer is one of the most common cancers and the first-leading cause of cancer deaths among women in the world. Indeed, breast cancer is ranked as the first malignancy among Iranian women. Breast density, defined as the percentage of fibro glandular breast tissue in mammographic images, is one of the known risk factors for breast cancer. According to American college of radiology-Breast Imaging Reporting and Data System (ACR-BIRADS), mammographic density is divided into four categories. Studies have shown that increased breast density is associated with significant increase in breast cancer risk. Therefore, it is assumed that breast density should be associated with other breast cancer risk factors. Objectives: The aim of this study was to assess the epidemiologic distribution of breast density of the patients in a referral center in Iran, and to evaluate the association of high breast density and breast cancer risk factors and other factors that may possibly affect the mammographic density according to previous studies. Patients and Methods: In an analytical cross-sectional study, 728 of those who had referred to Imam Khomeini Imaging Center either for diagnostic or screening purposes, participated in the study, after filling out the informed consent form, the survey questionnaire based survey assessing breast cancer risk factors affecting the breast density and related demographic features, was conducted. SPSS 11.5 software and chi-square, t-test and logistic regression tests were used to analyze the data. Results: Most of patients (75%) in categories 2 and 3 of mammographic density had a breast density of 51.9%, however, this amount was less (49.2%) in screening mammograms, while in diagnosing group it was more (51.6%). The Findings showed an increase in age, body mass index (BMI), duration of breast feeding, and also to be menopause e, unemployed and married, younger than 29 years old at first delivery, having children up to 8 and smoking are associated with less breast density. Diagnostic mammograms and symptomatic patients showed denser breasts. But density had no association with oral contraceptives pill (OCP) consumption or hormone replacement therapy or calcium and/or vitamin D consumption, age at menarche and menopause, menstruation cycle phase and family history of breast cancer. Age at the first delivery, menopausal status and parity were independently associated with breast density. Conclusions: Density distribution and risk factors prevalence is different among symptomatic patients and the diagnostic mammograms of the screened persons, hence such information should be considered in the patient managements. In order to consider the effect of marriage and parity on decreasing the breast density, basic consultations should be performed. Smokers and obese women may falsely show low breast density while they may be in high-risk group. In this study no specific phase of menstrual cycle is suggested for mammographic examinations.
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Affiliation(s)
- Nasrin Ahmadinejad
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Sajjadeh Movahedinia
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
- Corresponding Author: Sajjadeh Movahedinia, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences (TUMS), Imam Khomeini Hospital, Tehran, IR Iran. Tel: +98-2166581577 , E-mail:
| | - Samaneh Movahedinia
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Kourosh Holakouie Naieni
- Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
| | - Saharnaz Nedjat
- Epidemiology and Biostatistics Department, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, IR Iran
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