RESUMO
OBJECTIVE: The purpose of this study was to define and correlate the appearance of the rotator cable on MRI with arthroscopy, band-saw cadaveric sections, and histology. MATERIALS AND METHODS: Two cadaveric shoulders underwent 3-T MRI, band-sawing, and histologic evaluation. Three readers evaluated the MRI for the presence of the cable, and the same readers and a pathologist reviewed the macroscopic and microscopic specimens for a structure that corresponded to the cable. Cadaver 1 underwent arthroscopic evaluation to evaluate for the presence of a cable. Seventy consecutive shoulders that underwent 1.5- or 3-T MRI were also reviewed for the presence of the cable and evaluation of its characteristics (location, thickness, and width). RESULTS: A linear band of hypointense signal intensity was found along the undersurface of the supraspinatus and infraspinatus tendons on both cadaveric MR images, which correlated to a linear band of tissue in the same location on macroscopic and microscopic evaluation and linear thickening along the cuff articular surface on arthroscopy consistent with the cable. The cable was seen in 74.3% of the MRI studies in both sagittal and coronal planes with a mean (± SD) distance of the cable from the medial margin of the enthesis of 1.33 ± 0.27 cm, a mean width of the cable of 1.24 ± 0.31 cm, and a mean thickness of 0.19 ± 0.05 cm. CONCLUSION: The rotator cable is a structure that can be consistently seen on gross anatomic and histologic analysis, arthroscopy, and MRI in the intact rotator cuff. Familiarity with the typical location and morphology of the cable may allow easier characterization of disease that can involve the cable, such as rotator cuff tears.
Assuntos
Imageamento por Ressonância Magnética/métodos , Manguito Rotador/anatomia & histologia , Cadáver , Feminino , Humanos , Pessoa de Meia-Idade , Estatística como AssuntoRESUMO
A 29-year-old female presented with pain and a palpable mass in the left wrist. Imaging demonstrated a multiloculated cystic mass adjacent to the radial aspect of the scaphoid, which was intimately associated with and appeared to arise from the wall of the radial artery and its dorsal branch. The mass was surgically resected. The histological analysis confirmed the presence of adventitial cystic disease (ACD) of the radial artery. In addition, within a year time span, a second 34-year-old male patient presented with a palpable mass in the right hand. Imaging demonstrated a cystic mass encasing the dorsal carpal branch of the radial artery and its terminal vessels to the thumb and index finger. The diagnosis of ACD was raised based on MR imaging. Histological analysis confirmed the presence of an adventitial cyst. ACD of the arteries is a rare disorder of unknown etiology, which usually involves the popliteal artery. Less common sites of involvement include the external iliac, common femoral, radial, and ulnar arteries. To our knowledge, there have only been six previous case reports of adventitial cystic disease involving the radial artery. The imaging features, histology, differential diagnosis, pathogenesis, and treatment are discussed.
Assuntos
Túnica Adventícia , Cistos , Artéria Radial , Doenças Vasculares , Adulto , Túnica Adventícia/diagnóstico por imagem , Túnica Adventícia/patologia , Túnica Adventícia/cirurgia , Cistos/diagnóstico , Cistos/etiologia , Cistos/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Artéria Radial/diagnóstico por imagem , Artéria Radial/patologia , Artéria Radial/cirurgia , Radiografia , Resultado do Tratamento , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/cirurgiaRESUMO
We retrospectively analyzed 97 total knee arthroplasty cases with medial osteoarthritis from seven participating surgeons in our teaching hospital to determine the percentage of patients who met the following eligibility criteria for unicompartmental knee arthroplasty (UKA): healthy cartilage in the lateral compartment based on (1) visual analysis, (2) histological analysis and (3) absence of UKA contraindications based on clinical analysis. The cases with healthy lateral cartilage, intact anterior cruciate ligament and posterior cruciate ligament, lack of patello-femoral arthritis, preoperative range of motion (ROM) greater than 90, and genu varum less than 10° represented 21% of the 97 cases studied. This percentage would likely have been higher had the cases been assessed earlier in the disease process. It was concluded that there is the potential to utilize UKA more frequently in the future.
Assuntos
Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Ligamento Cruzado Anterior/patologia , Ligamento Cruzado Anterior/cirurgia , Definição da Elegibilidade , Feminino , Fêmur/patologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Ligamento Cruzado Posterior/patologia , Ligamento Cruzado Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We present a case of intraarticular myositis ossificans in the right knee of a child. Myositis ossificans (MO), though relatively rare in childhood and even more uncommon within a joint, should be included in the differential diagnosis of an intra-articular mass when indicated by the typical clinical, radiographic, and histologic findings. An 11-year-old male presented with a history of trauma to his right knee. Four weeks after the initial injury, an MRI demonstrated evidence of an ACL rupture with a "cystic mass" within the intercondylar notch along the anterior surface of the torn ligament. At subsequent arthroscopy, the mass noted on MRI was removed. The histology was consistent with MO. The authors believe this to be the first case of MO in the intercondylar notch detected by MRI, treated by arthroscopy, and confirmed by histology.
Assuntos
Artroscopia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Miosite Ossificante/patologia , Miosite Ossificante/cirurgia , Criança , Humanos , MasculinoAssuntos
Adenocarcinoma Papilar/secundário , Neoplasias Ovarianas/patologia , Neoplasias Torácicas/secundário , Parede Torácica , Adenocarcinoma Papilar/diagnóstico , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fotomicrografia , Neoplasias Torácicas/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Tendão do Calcâneo/patologia , Procedimentos de Cirurgia Plástica , Ligamento Cruzado Posterior/patologia , Tendão do Calcâneo/transplante , Tendão do Calcâneo/ultraestrutura , Artroplastia do Joelho , Colágeno/ultraestrutura , Feminino , Humanos , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Dor/cirurgia , Ligamento Cruzado Posterior/cirurgia , Ligamento Cruzado Posterior/ultraestrutura , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/efeitos adversosAssuntos
Neoplasias Ósseas/patologia , Condroblastoma/patologia , Fibroma/patologia , Tíbia/patologia , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Condroblastoma/diagnóstico por imagem , Condroblastoma/cirurgia , Diagnóstico Diferencial , Feminino , Fibroma/diagnóstico por imagem , Fibroma/cirurgia , Humanos , Dor/diagnóstico por imagem , Dor/patologia , Cintilografia , Tíbia/diagnóstico por imagemAssuntos
Articulação do Tornozelo/patologia , Artralgia/etiologia , Neoplasias Ósseas/diagnóstico , Edema/etiologia , Plasmocitoma/diagnóstico , Ossos do Tarso/patologia , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Artralgia/patologia , Artralgia/radioterapia , Artralgia/cirurgia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Curetagem , Edema/patologia , Edema/radioterapia , Edema/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Plasmocitoma/complicações , Plasmocitoma/radioterapia , Plasmocitoma/cirurgia , Radioterapia Adjuvante , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Articulação do Cotovelo/patologia , Hemangioma/diagnóstico , Neoplasias de Tecidos Moles/diagnóstico , Membrana Sinovial/patologia , Artrite Infecciosa/diagnóstico , Biópsia , Braquetes , Criança , Condromatose Sinovial/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Intervalo Livre de Doença , Feminino , Hemangioma/cirurgia , Humanos , Infecções por Mycobacterium/diagnóstico , Sarcoma Sinovial/diagnóstico , Neoplasias de Tecidos Moles/cirurgia , Sinovite Pigmentada Vilonodular/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report the findings from an aspiration biopsy and resection of a chordoma-like tumorous mass in the wall of the thorax of a 36-yr-old man with immunohistochemical, ultrastructural, and cytogenetic studies. The 4-cm oval tumor was an incidental finding on physical examination, and no other lesions were identified after comprehensive radiologic studies. The aspirate was composed of sheets and nests of cells with distinct borders in a myxoid and fibrillary extracellular matrix. The neoplastic cells were uniform and round or polygonal with abundant pale blue vacuolated cytoplasm and small round, central or eccentric nuclei. On electron microscopy, mitochondrial rough endoplasmic reticulum complexes were seen in neoplastic cells. These features were similar to those of a conventional chordoma. However, the cytogenetic pattern, 43, XY ,-1, -2, der (5)t(1p;5q), -6, add(8p) ,add(10q), was not typical. In addition, the neoplastic cells were positive for vimentin, S-100, AE1/AE3, CAM 5.2, and CK 19; were focally positive for EMA and smooth muscle actin; and were negative for cytokeratin 1 and 10 (34 beta E12), CK 7, CK 8 (35H 11B), CK 17, and CK 20. The cytogenetic and immunohistochemical patterns were different from conventional chordoma and its peripheral counterpart, chordoma periphericum, suggesting the diagnosis of parachordoma. To the best of our knowledge, this is the first report of fine-needle aspiration of this newly defined and rare entity.
Assuntos
Neoplasias Ósseas/patologia , Cordoma/patologia , Adulto , Biomarcadores Tumorais/análise , Biópsia por Agulha Fina , Neoplasias Ósseas/química , Neoplasias Ósseas/cirurgia , Cordoma/química , Cordoma/cirurgia , Aberrações Cromossômicas , Citogenética , Retículo Endoplasmático Rugoso/ultraestrutura , Humanos , Masculino , Mitocôndrias/ultraestrutura , Costelas/patologia , Costelas/cirurgia , Tórax , Resultado do TratamentoRESUMO
OBJECTIVE: To report, in 4 patients, the occurrence of 2 different primary tumours in proximity in the same bone. Three patients had osteosarcomas, and 1 had a giant cell tumour; all had coincident metaphyseal fibrous defect. METHODS: Four patients (2 women, 1 man and 1 boy; 18, 25, 24 and 10 years of age, respectively) presented with progressive pain in the knee and distal thigh. All were studied by radiography, magnetic resonance imaging was done in 3 patients, and diagnostic open biopsy was performed for all. RESULTS: Radiologic studies demonstrated tumours in the distal end of the femur in all 4 patients. Biopsy tissue showed a metaphyseal fibrous defect in all, with coexistence of an associated giant cell tumour in 1 patient and an osteosarcoma in each of the others. In all cases, the metaphyseal fibrous defect was penetrated by the adjacent tumour. CONCLUSIONS: Despite the relative prevalence of metaphyseal fibrous defect, giant cell tumour and osteosarcomas in the distal end of the femur and their occurrence in approximately the same age group, their association has rarely been reported. As both giant cell tumours and osteosarcomas are usually diagnosed late in their clinical course, they may outgrow and destroy any evidence of pre-existing metaphyseal fibrous defect. The rate of destruction is also influenced by the distance between the 2 lesions--the shorter the distance, the earlier the destruction.
Assuntos
Neoplasias Femorais/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Adolescente , Adulto , Criança , Feminino , Neoplasias Femorais/diagnóstico por imagem , Fibroma/diagnóstico , Fibroma/diagnóstico por imagem , Tumor de Células Gigantes do Osso/diagnóstico , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Osteossarcoma/diagnóstico , Osteossarcoma/diagnóstico por imagem , RadiografiaRESUMO
BACKGROUND: Recently, intra-articular viscosupplementation with hyaluronate-derived products has gained popularity as a palliative modality for the treatment of osteoarthritis of the knee. Mild pain or swelling at the site of injection may occur in up to 20% of patients, although severe local inflammation, warmth, and joint effusion are rare. We present a series of six cases in which granulomatous inflammation of the synovium was observed after hyaluronate viscosupplementation of the knee. METHODS: Six knees (five patients) treated with intra-articular Hylan G-F 20 viscosupplementation underwent a surgical procedure because of persistent symptoms. Routine histopathological evaluation, supplemented by alcian-blue staining and hyaluronidase digestion, was performed in each case. RESULTS: Chronically inflamed synovium with areas of histiocytic and foreign-body giant-cell reaction was observed surrounding acellular, amorphous material. The material stained with alcian blue, a stain for hyaluronate, which disappeared after hyaluronidase digestion. CONCLUSIONS: We believe that the injected hyaluronate (Hylan G-F 20) may have been responsible for the synovitis in our patients and thus may be a pathological cause of recalcitrant symptoms after such injection. It is not known whether the responsible pathological agent was the hyaluronate derivative, a contaminant of the purification process, or a component of the carrier substance. Importantly, it appears that the findings in these patients most likely represent a previously unreported pathological response to a viscosupplementation product. This report should raise clinical awareness about this potential complication.