Mesenchymal Chondrosarcoma: A Rare Aggressive Variant of Chondrosarcoma

A 15-year-old boy reported a 2-month history of severe left thigh pain Physical examination revealed left thigh swelling measuring 6x5 cm. X-ray of the region showed mixed lytic and sclerotic lesion involving the femoral head and neck. A Computed Tomography scan showed mixed lytic and sclerotic lesion involving the femoral head and neck with cortical irregularity and mild periosteal reaction with associated soft tissue in the anterior aspect. Magnetic resonance imaging demonstrated heterogeneous signal intensity lesion with areas of sclerosis involving the femoral head and neck. The large associated soft tissue in the anterior aspect appears predominantly hyperintense on T2W images. On post-contrast axial and sagittal images, heterogeneous enhancement with areas of necrosis involving soft tissue was seen. A presumptive radiological differential diagnosis of Ewing Sarcoma and Osteosarcoma was made. However, on histopathology, it was a case of mesenchymal chondrosarcoma.

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ESTIMATION OF SOFT TISSUE INTERPOSITION AFTER FEMORAL HEAD AND NECK EXCISION IN DOGS USING VENTRODORSAL PELVIC RADIOGRAPHY

Veterinary Radiology & Ultrasound ◽

10.1111/j.1740-8261.1993.tb01567.x ◽

1993 ◽

Vol 34 (4) ◽

pp. 230-234 ◽

Cited By ~ 1

Author(s):

F.A. Mann ◽

J.T. Hathcock ◽

C. Wagner-Mann

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Head And Neck ◽

Pelvic Radiography

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The effect of calcar femoral neck plating on vascularity of the femoral head and neck

Bone & Joint Open ◽

10.1302/2633-1462.28.bjo-2021-0099.r1 ◽

2021 ◽

Vol 2 (8) ◽

pp. 611-617

Author(s):

Jeremy F. Kubik ◽

Troy D. Bornes ◽

Craig E. Klinger ◽

Jonathan P. Dyke ◽

David L. Helfet

Keyword(s):

Femoral Head ◽

Femoral Neck ◽

Head And Neck ◽

Femoral Neck Fractures ◽

Quantitative Mri ◽

Qualitative Assessment ◽

Quadrant Analysis ◽

Open Approach ◽

Post Contrast ◽

Neck Fracture

Aims Surgical treatment of young femoral neck fractures often requires an open approach to achieve an anatomical reduction. The application of a calcar plate has recently been described to aid in femoral neck fracture reduction and to augment fixation. However, application of a plate may potentially compromise the regional vascularity of the femoral head and neck. The purpose of this study was to investigate the effect of calcar femoral neck plating on the vascularity of the femoral head and neck. Methods A Hueter approach and capsulotomy were performed bilaterally in six cadaveric hips. In the experimental group, a one-third tubular plate was secured to the inferomedial femoral neck at 6:00 on the clockface. The contralateral hip served as a control with surgical approach and capsulotomy without fixation. Pre- and post-contrast MRI was then performed to quantify signal intensity in the femoral head and neck. Qualitative assessment of the terminal arterial branches to the femoral head, specifically the inferior retinacular artery (IRA), was also performed. Results Quantitative MRI revealed a mean reduction of 1.8% (SD 3.1%) of arterial contribution in the femoral head and a mean reduction of 7.1% (SD 10.6%) in the femoral neck in the plating group compared to non-plated controls. Based on femoral head quadrant analysis, the largest mean decrease in arterial contribution was in the inferomedial quadrant (4.0%, SD 6.6%). No significant differences were found between control and experimental hips for any femoral neck or femoral head regions. The inferior retinaculum of Weitbrecht (containing the IRA) was directly visualized in six of 12 specimens. Qualitative MRI assessment confirmed IRA integrity in all specimens. Conclusion Calcar femoral neck plating at the 6:00 position on the clockface resulted in minimal decrease in femoral head and neck vascularity, and therefore it may be considered as an adjunct to laterally-based fixation for reduction and fixation of femoral neck fractures, especially in younger patients. Cite this article: Bone Jt Open 2021;2(8):611–617.

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Soft Tissue Sarcoma of the Head and Neck pN1 TNM Finding v8

10.32388/033ws7 ◽

2020 ◽

Author(s):

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Head And Neck

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Head and neck osteosarcoma: CT and MR imaging features

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20190202 ◽

2020 ◽

Vol 49 (2) ◽

pp. 20190202

Author(s):

Zhendong Luo ◽

Weiguo Chen ◽

Xinping Shen ◽

Genggeng Qin ◽

Jianxiang Yuan ◽

...

Keyword(s):

Soft Tissue ◽

Head And Neck ◽

Giant Cell ◽

High Signal ◽

Imaging Features ◽

Matrix Mineralization ◽

Imaging Characteristics ◽

Mri Features ◽

Signal Intensities ◽

Ct And Mri

Objective: This study aims to assess the CT and MRI features of head and neck osteosarcoma (HNO). Methods: 37 HNOs were identiﬁed, and the following imaging characteristics were reviewed on CT and MRI. Results: A total of 37 patients(age 41.5 ± 15.0 years old; 16 males, 21 females) were included in the study. Tumours occurred in the maxilla (16, 43.2%), mandible (8, 21.6%), skull base (6, 16.2%), calvarium (5, 13.5%), paranasal sinuses (1, 2.7%) and cervical soft tissue (1, 2.7%). 16 patients received radiotherapy for nasopharyngeal carcinoma. Three patients (8.1%) developed osteosarcomas related to a primary bone disease. 16 of the (43.2%) tumours demonstrated lytic density on CT scans, followed by 13 (35.1%) showing mixed density and 7 (18.9%) with sclerotic density. Matrix mineralization was present in 32 (86.5%). 3 out of 24 (12.5%) tumours showed lamellar periosteal reactions, 21 out of 24 (87.5%) showed spiculated periosteal reactions. 12 tumours showed low signal intensities on T1WI, with 16 having heterogeneous signal intensities. 10 tumours showed high signal intensities on T2WI, and 18 showed heterogeneous signal intensities. With contrast-enhanced images, 3 tumours showed homogeneous enhancement (2 osteoblastic and 1 giant cell-rich), 18 tumours showed heterogeneous enhancement (13 osteoblastic, 4 fibroblastic and 1 giant cell-rich), and 7 tumours showed peripheral enhancement (6 chondroblastic and 1 osteoblastic). These tumours were characterized by soft tissue masses with a diameter of 5.6 ± 1.8 cm. Conclusions: HNO is a rare condition and is commonly associated with previous radiation exposure. This study provides age, sex distribution, location, CT and MRI features of HNO.

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SOFT TISSUE CAM IMPINGEMENT IN ADOLESCENTS: MRI REVEALS IMPINGEMENT LESIONS UNDERAPPRECIATED ON X-RAY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00063 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0006

Author(s):

Benjamin L. Johnson ◽

Hamza Alizai ◽

Montanez Ben ◽

K. John Wagner ◽

Tyler Youngman ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Plain Radiograph ◽

Alpha Angle ◽

Duration Of Symptoms ◽

X Ray ◽

Insidious Onset ◽

Adolescent Patients ◽

Cam Impingement ◽

Soft Impingement

Background: The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. Hypthesis/Purpose: The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI. Methods: A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test. Results: Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<0.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome. Conclusion: In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.

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