Intramedullary Well-Differentiated Osteosarcoma: Imaging and Pathologic Findings in 17 Patients

Background: Intramedullary well-differentiated osteosarcoma (IMWDOS) is rare and may easily be misdiagnosed. Objective: This study was to investigate the clinical, imaging and pathological features of IMWDOS for correct diagnosis. Results: There were 13 males and 4 females with an age range of 19-55 years (mean 32). The lesion was located at long bones in 16 patients and at the second region of acetabulum in one patient. Except for three patients with limited areas of lesions, all the other patients had wide areas of disease, and the lesion in long bones all involved the metaphysis area with possible extension towards the diaphysis. In imaging, the lesion usually had an unclear boundary with destruction of bone cortex, uneven thickness of the bone cortex, thick and coarse trabecula in the lesion, but few periosteal reaction and soft tissue masses. The lesion was histologically composed of spindle cells with slight atypia. Follow-up was performed 2-101 months (mean 37.7) in 14 cases, 10 years in one case and 26 years in the remaining two. At follow-up, 12 patients (12/17 or 70.6%) who had complete resection including amputation (n=2), wide excision (n=8) and endoprosthetic replacement (n=2) had no recurrence or metastasis. Among five patients with curettage, three (3/17 or 17.6%) were recurrent with two deaths, and the third one died during post-operation chemotherapy. Conclusion: Intramedullary well-differentiated osteosarcoma tends to occur at the metaphysis of long bones, especially at the distal femur. Histological, clinical and imaging findings lack characteristics and should be closely combined to reach a correct diagnosis. The prognosis of patients with complete lesion resection is good while incomplete lesion curettage or resection will lead to recurrence and transformation into a highly malignant tumor.

Prenatally Diagnosed Infantile Myofibroma of Sartorius Muscle—A Differential for Soft Tissue Masses in Early Infancy

Background: Infantile myofibromatosis (IM) is a soft tissue disease with solitary or multiple benign tumors, and an etiology still unknown. IM is a mesenchymal disorder of early infancy and is more frequent in males. IM may present as a solitary lesion of the skin, bone, muscle, subcutaneous tissue, located at the head, neck, and trunk, with good prognosis; or, as a multicentric form, with or without visceral involvement (heart, lung, gastrointestinal tract, kidney), with a poor prognosis. The definitive diagnosis of IM is confirmed by pathology. Treatment may be conservative, surgical, or chemotherapeutical. Case presentation: A two months old female patient, prenatally diagnosed at 30 weeks, presenting with a tumor on the antero-internal aspect of the left thigh. She was admitted due to rapid postnatal evolution, and the patient required surgery for tumor resection. Previously, clinically, biological and imaging investigations were performed, but the final diagnosis was histological and by immunostaining. The patient had a favorable postoperative outcome. Conclusions: Despite its low frequency, IM should be considered in the differential diagnosis of soft tissue masses at an early age. The clinical form (solitary or multicentric), location, and visceral involvement will dictate the treatment and prognosis.

Primary chest wall Burkitt lymphoma in a case of HIV infection with immune reconstitution

Burkitt lymphoma (BL) develops at an increased frequency in patients with HIV irrespective of the CD4 count. Lymph nodes and gastrointestinal tract are common sites of involvement by BL; however, primary chest wall BL is rare. A 52-year-old man on highly active antiretroviral therapy (HAART) for HIV with a CD4 count of 0.204 x 109 cells/L presented with a 3-month history of enlarging chest wall mass. PET-CT scan imaging showed a bulky mass involving the musculoskeletal planes of left chest wall with the involvement of underlying pleura. Biopsy with immunohistochemistry confirmed BL. Patient received EPOCH-R (infusional etoposide, vincristine, and doxorubicin with prednisone, cyclophosphamide and rituximab) regime for six cycles along with HAART, attained complete remission (CR) and remains free of BL at 5 years. BL should be considered in the differential diagnosis of soft tissue masses in HIV-infected patients irrespective of their CD4 count.

Lip Lumps Need not be mucocele

Lip lesions are the most common oral mucosal lesions. Mucocele is the second most common benign soft tissue masses of the lips only next to infectious etiology. Tumors of the minor salivary glands of the lip were a rare diagnosis made clinically. Excision and histopathological examination must be done for all the lip lumps as this remains the gold standard for the diagnosis. In this article, we discuss three lip lumps which were clinically suspected as mucocoele turned out to be an unexpected diagnosis which only became clear following excision and histological examination.

Usefulness of the Ultrasound in Hand Surgery: Part I

In the last years, ultrasonography (US) of the wrist and hand have increased in popularity. Technical advances led us to improve image quality and have the ability to see superficial soft-tissue structures with high resolution with the patient in our office.The advantages of US are the fact that it is noninvasive, its lack of ionising radiation, low cost, and portability. The dynamic real-time assessment in the office is an additional benefit.Ultrasound can be used in hand surgery for both diagnostic and therapeutic purposes. We can use US for injections with needle guidance, for the evaluation of soft-tissue masses, foreign bodies, tendon injuries, compressive neuropathies, and rheumatologic joint disease. It also helps us perform ultrasound-guided procedures: carpal tunnel syndrome, trigger finger, and intersection syndrome or compartimental syndrome.The aim of the present review is to describe different uses of US in hand surgery to show its important role of providing to the surgeon more information on the diseases of their patients.

Role of diffusion-weighted MRI in evaluation of pediatric musculoskeletal soft tissue masses

Background In pediatric patients, soft tissue masses encompass a wide heterogeneous group of benign and malignant lesions. MRI is a powerful diagnostic tool in the workup of soft tissue tumors in children, and it helps in characterization of lesion and evaluation of the extent of the lesion. However, conventional MRI techniques are not specific in differentiating benign from malignant lesions. So to improve characterization of tumors, DWI was added to MRI techniques as it increases sensitivity and specificity by detecting the micro-diffusion changes of water into intra- and extracellular spaces. The aim of this work was to highlight the diagnostic value of DWI in detection and characterization of different musculoskeletal soft tissue masses in pediatrics. Results There was a statistically significant difference regarding the mean ADC value of benign and malignant masses (P value = 0.001*). The mean ADC value for all benign masses (n = 41) was 1.495 ± 0.55 SD × 10–3 mm2/s, while the mean ADC value for all malignant masses (n = 21) was 0.449 ± 0.27 SD × 10–3 mm2/s. The cutoff ADC value between benign and malignant masses was 0.88 × 10–3 mm2/s. This cutoff ADC value has sensitivity of 100.0%, specificity of 92.3%, PPV of 66.7%, NPV of 100.0% and diagnostic accuracy of 93.3%. Conclusion In pediatric patients, DWI is an innovative valuable noninvasive imaging technique for characterization of musculoskeletal soft tissue masses and discrimination between benign and malignant masses.

Fibroadenoma in a suprapubic accessory breast

Ectopic breast tissue (EBT) is relatively common and can occur along the milk line or mammary ridge and often outside this line. We report a case of a female patient presenting with a suprapubic mass for 2 years, found later to be EBT containing a fibroadenoma. We believe this is a very rare finding. Moreover, we highlight the importance of considering EBT in the differential diagnoses of soft tissue masses.