Pair of glomus tumors in thigh – both periosteal and intramuscular: Rare tumor in atypical location

Glomus tumors are benign neoplasms that arise from neuromyoarterial glomus bodies accounting for <2% of soft-tissue tumors. Glomus tumors represent around 1–5% of all soft-tissue tumors and 1–5% of all hand tumors. About 75% of these tumors occur in hand with 75–90% of these occurring in characteristic subungual location. Extradigital location of glomus tumor is very rare. We report an exceptional case of extradigital glomus tumor causing thigh pain, where there were a pair of lesions both in periosteum and intramuscular location. A 47-year-old male with complaints of pain over medial aspect of the left lower thigh for 2 years on ultrasound revealed well-defined solid hypoechoic lesions within the left vastus medialis muscle and cortical-based lesion abutting the periosteum of distal diaphysis of the left femur on medial aspect. These lesions were hypointense on T1W, hyperintense on T2W and showed early homogenous enhancement on MRI. Histopathology revealed glomus tumors, which commonly occur in digits. Glomus tumors located in both periosteal and intramuscular locations in thigh were in very uncommon. Non-specific presentation with pain in such cases remains a diagnostic dilemma. Role of multimodality imaging and histopathology correlation is important in such situation.

SPECT/CT with 99mTc-sestamibi for the evaluation of skeletal muscle perfusion after electrical muscle stimulation in athletes

Objective: The purpose of this study was to evaluate the effects of electrical muscle stimulation (EMS) on muscles, using 99mTc-sestamibi SPECT/CT. Materials and Methods: We prospectively enrolled 20 consecutive male professional water polo players. The mean age was 25 years (range, 18-36 years). All athletes underwent 99mTc-sestamibi SPECT/CT of the thigh (rectus femoris and vastus medialis muscle groups) before and after EMS. Images were quantified to identify increases in perfusion after EMS. Results: Before EMS, there were no significant differences between the right and left thigh (rectus femoris and vastus medialis muscles) in terms of perfusion (p = 0.4). However, the comparison between the pre- and post-EMS analyses of the same muscle groups showed significant differences in radiotracer uptake (p < 0.001), with a mean increase in perfusion of 128% for the rectus femoris muscle group (95% CI: 0.86-1.61) and 118% for the vastus medialis muscle group (95% CI: 0.96-1.79). Conclusion: 99mTc-sestamibi SPECT/CT is an objective means of evaluating blood flow in muscles submitted to EMS, which appears to promote significant increases in such blood flow.

Reliability of quantitative point shear-wave ultrasound elastography on vastus medialis muscle and quadriceps and patellar tendons

Aim: The aim of this work was to evaluate the reliability of pSWE in assessing the stiffness of the vastus medialis muscle and of the quadriceps and patellar tendons.Material and methods: For this purpose, 18 subjects (9 males and 9 females of 57±22 years) in good clinical conditions were included in this study. pSWE examination was conducted by a unique expert operator with more than ten years of experience in musculoskeletal ultrasound. Two sets of five measurements for each muscle and tendon district were bilaterally performed at the same manner, at least fifteen minutes apart. The mean value of the measurements of each set was statistically compared with that of the other set.Results: No significant differences were found comparing the mean value of the measurements of the two sets of evaluation performed in muscle and tendon areas (vastus medialis muscle: p=0.285; quadriceps tendon: p=0.979; patellar tendon: p=0.187). The intraclass correlation coefficient was excellent for all areas (vastus medialis muscle: 0.969; quadriceps and patellar tendons: 0.995 and 0.989, respectively).Conclusion: The pSWE technique demonstrated that it was a reliable method for measuring stiffness in vastus medialis muscle and quadriceps and patellar tendon in subjects who had undergone orthopedic surgery. This opens the possibility of many applications in monitoring stiffness before and after surgery and during rehabilitation.