Thoracic meningioma with ossification: Case report

Background: The incidence of spinal meningiomas is 0.33/100000 population, and ossified spinal meningiomas are even less commonly encountered. Case Description: A 64-year-old male presented with a progressive T4-level thoracic myelopathy. MR imaging revealed an intradural extramedullary mass that significantly compressed the spinal cord. The accompanying CT demonstrated hyperdensities within the lesion consistent with punctate calcification vs. ossification (i.e. consistent with histological bone formations within tumor). The patient underwent complete resection of the tumor resulting in a full recovery of neurological function within 6 postoperative weeks. The pathological specimen showed findings consistent with an ossified spinal meningioma. Conclusion: Here, we identified a rare case of an ossified thoracic T4 meningioma occurring in a 64-year-old male.

Multiple bilateral pulmonary epithelioid hemangioendothelioma mimicking metastatic lung cancer: case report and literature review

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare tumor of low to intermediate malignancy, which originates from vascular endothelial cells. Most patients with PEH are asymptomatic and the tumor occurs most frequently in women. Typical radiologic images of patients with PEH are multiple irregular nodules with punctate calcification and pleural indentation. Here, we describe a 54-year-old woman who presented with multiple bilateral nodules of different sizes and well-defined borders, as well as lung markings, without punctate calcification or pleural indentation. These atypical computed tomography images resulted in misdiagnosis as metastatic lung cancer. Right upper lobe wedge resection was performed; intraoperative frozen pathologic examination suggested that the tumor was benign. However, immunohistochemical analysis revealed the presence of PEH. Subsequently, the patient chose watchful waiting, rather than chemotherapy. This rare case of PEH with atypical computed tomography findings, which was misdiagnosed as metastatic lung cancer, demonstrates that intraoperative frozen analysis is unreliable; thus, histopathological analysis is necessary.

Punctate Calcification Group

This chapter discusses punctate calcification group and related disorders and includes discussion on Greenberg dysplasia, chondrodysplasia punctata Conradi-Hünermann type, CHILD (congenital hemidysplasia with ichthyosiform erythroderma and limb defects) syndrome, chondrodysplasia punctata (rhizomelic type), chondrodysplasia punctata (brachytelephalangic type), chondrodysplasia punctata (autosomal dominant type), chondrodysplasia punctata (tibia-metacarpal type), and Keutel syndrome. Each discussion includes major radiographic features, major clinical findings, genetics, major differential diagnoses, and a bibliography.

Thyroid Hormones, Autoantibodies, Ultrasonography, and Clinical Parameters for Predicting Thyroid Cancer

Our objective was to evaluate thyroid nodule malignancy prediction using thyroid function tests, autoantibodies, ultrasonographic imaging, and clinical data. We conducted a retrospective cohort study in 1400 patients with nodular thyroid disease (NTD). The thyroid stimulating hormone (TSH) concentration was significantly higher in patients with differentiated thyroid cancer (DTC) versus benign thyroid nodular disease (BTND) (p=0.004). The receiver operating characteristic curve of TSH showed an AUC of 0.58 (95% CI 0.53–0.62,p=0.001), sensitivity of 74%, and specificity of 57% at a cut-off of 1.59 mIU/L. There was an incremental increase in TSH concentration along with the increasing tumor size (p<0.001). Thyroglobulin antibody (TgAb) concentration was associated with an increased risk of malignancy (p=0.029), but this association was lost when the effect of TSH was taken into account (p=0.11). Thyroid ultrasonographic characteristics, including fewer than three nodules, hypoechoic appearance, solid component, poorly defined margin, intranodular or peripheral-intranodular flow, and punctate calcification, can be used to predict the risk of thyroid cancer. In conclusion, our study suggests that preoperative serum TSH concentration, age, and ultrasonographic features can be used to predict the risk of malignancy in patients with NTD.

Chondrosarcoma of the Distal Phalanx of the Great Toe

Enchondromas are the most common benign cartilaginous bone tumors of the toe. In contrast, chondrosarcomas are very uncommon in the foot. We report an unusual case of a chondrosarcoma arising in the great toe. The patient was a 62-year-old woman whose chief complaint was swelling of her left great toe. Radiography showed subtle punctate calcification and mild sclerosis and irregularity of the distal phalanx in the great toe. Magnetic resonance imaging showed extraskeletal growth. The distal phalanx was amputated. Histologic examination demonstrated a grade 1 chondrosarcoma. Two years after surgery, the patient was free of recurrence and lung metastasis. (J Am Podiatr Med Assoc 97(2): 156–159, 2007)

The Contrasting Effects on Bone Histology of Vitamin D and of Calcium Carbonate in the Osteomalacia of Chronic Renal Failure

1. The histological appearances of cancellous bone from the ilium have been quantified in thirteen patients with osteomalacia due to chronic renal failure. 2. There was an excess of osteoid tissue and a reduction in the extent of the calcification front in that osteoid lamella lying next to calcified bone. 3. Administration of calcium compounds orally produced an increase of punctate calcification within the osteoid, but there was no change in the extent of the calcification front. 4. Administration of vitamin D produced a marked rise in the extent of the calcification front but no increase of punctate calcification within the osteoid. 5. This rise in the extent of the calcification front was not dependent on a rise in plasma calcium × plasma phosphorus product. 6. It is concluded that vitamin D has a direct action on the bone in patients with the osteomalacia of chronic renal failure.