Intra-articular fibroma of tendon sheath of the shoulder joint: synovial fibroma.

The case of a 30-year-old woman with multiple loose bodies in the shoulder joint is presented. The patient complained of discomfort of her right shoulder. Conventional radiographs failed to reveal any abnormality of the shoulder. On MRI numerous loose bodies were detected that resembled synovial chondromatosis. Histologically, the loose bodies were composed of a benign fibroblastic lesion with diagnostic features of fibroma of tendon sheath, each surfaced by synoviocytes. The clinicopathologic features of intra-articular fibroma of tendon sheath are reviewed. We propose using the term "synovial fibroma" for tumors with histopathologic features of fibroma of tendon sheath arising in the synovium of joints.

Intracortical osteosarcoma; two-year delay in diagnosis.

Intracortical osteosarcoma is the rarest type of osteosarcoma. In most instances the tumor arises in the cortex of the femur, less commonly, in the tibia. We describe an 11-year-old patient with intracortical osteosarcoma of the tibia in whom the tumor was present for 2 years and became painful 3 months prior to presentation.

Partial transient osteoporosis of the hand.

OBJECTIVE: To describe the radiographic and scintigraphic findings of partial transient osteoporosis (PTO) of the hand. To discuss the relationship of PTO and other localized demineralizing diseases. DESIGN AND PATIENTS: Three patients with PTO that affected two or three digits of the hand are reported. Two patients were middle-aged women and the third was a young man. All presented with a history of trauma to the hand. All patients experienced localized burning pain, swelling and vasomotor changes including redness of the skin, hyperhidrosis and signs of vasomotor instability of the involved fingers. Plain radiography and bone scanning were used in the diagnosis and follow-up of these cases. RESULTS: All patients had a radial distribution of the osteoporosis that involved adjacent rays. In all patients two rays were involved. The radiographic changes manifested as minimal patchy osteoporosis involving the cortical, cancellous, subarticular and subperiosteal bone with no articular involvement. The increased uptake on scintigraphy coincided with the radial distribution of the osteoporosis. All patients improved on physical therapy and were symptom-free approximately 6 months after the initial injury. These patients were followed up for more than 2 years. CONCLUSION: PTO of the hand is an uncommon disease with typical clinical and radiographic findings. Bone scintigraphy confirms the partial involvement of the hand.

High-frequency ultrasound examination of the wrist and hand.

High-frequency ultrasound (US) is an efficient, rapid and inexpensive altenative to magnetic resonance imaging (MRI) for investigation of diseases in the soft tissues of the wrist and hand. US allows detection of foreign bodies and the reliable identification of a variety of traumatic lesions affecting tendons, annular pulleys, ligaments, vessels and nerves. Inflammatory diseases of tendons, including acute and chronic tenosynovitis and some degenerative conditions in the wrist and hand, can also be diagnosed. In entrapment neuropathies, US is able to identify nerve shape changes and possible extrinsic space-occupying lesions that may cause nerve compression within the tunnels. In patients with localized swelling of the hand or wrist, US is able to assess the presence of an expansile lesion and to characterize its nature in most cases. The objective of this article is to review the main findings and the primary indications of US in the investigation of disorders of the hand and wrist.

Primary non-Hodgkin lymphoma of bone: unusual manifestation of lymphoproliferative disease following liver transplantation.

We present the case of a 66-year-old man with primary non-Hodgkin lymphoma of the right femur that developed following orthotopic liver transplant, while on immunosuppressive therapy. The diagnosis was suggested on the basis of the MRI findings and confirmed by open biopsy. He was treated successfully with local radiotherapy and has remained disease free for 14 months after the onset of the disease.

Osteoid osteoma of a cervical vertebral body.

An osteoid osteoma in the anterior part of the body of the fourth cervical vertebra occurred in a 22-year-old female. The patient's main complaint was neck pain and occasional numbness of the extremities. The pain was relieved by analgesics. Plain radiography and a 99Tcm MDP bone scan showed a non-specific abnormality. CT suggested the pathological diagnosis with reasonable certainty. The unusual location of the lesion and the role of various diagnostic modalities are discussed and the literature reviewed.

Angiosarcomas associated with bone infarcts.

OBJECTIVE: A bone infarct may occasionally dedifferentiate to osteogenic sarcoma, fibrosarcoma or malignant fibrous histiocytoma. However, the association of an angiosarcoma with a bone infarct is extremely rare. Such an association is presented in three patients. Their clinical course is compared with that of patients with bone infarcts associated with other sarcomas. DESIGN AND PATIENTS: The three patients were men with a mean age of 43 years. Cases 1 and 3 presented with a pathological fracture at the site of the angiosarcoma. Plain radiography was done in the three patients, computed tomography (CT) was performed in cases 1 and 3 and magnetic resonance imaging (MRI) in case 3. The femur was the site of the three tumors: midshaft in cases 1 and 3 and distal shaft in case 2. On the basis of the radiographic findings, and clinical examination, an open biopsy was performed for the three men, which confirmed the diagnosis of a high-grade angiosarcoma associated with a bone infarct. RESULTS: Case 1 was treated with high-above knee amputation and is still alive after 18 months from the time of operation. Segmental resection of the distal femur with adjuvant chemotherapy and local irradiation was the treatment for case 2, who is still alive with no tumor recurrence on metastatic disease 3 years from the operation. Intramedullary rodding was done for case 3 who died 6 months later. CONCLUSION: The association of an angiosarcoma with a bone infarct has been established in only five cases. Although the number of such associations is small, it seems that such an association may be prognostically more or less the same as in those cases in which a bone infarct is associated with either osteosarcoma, fibrosarcoma or malignant fibrous histiocytoma, where the survival rate is unfavorable. A cause-and-effect relationship may exist between a bone infarct and subsequent development of a bone sarcoma.

Malignant fibrous histiocytoma associated with a bone infarct in a patient with hereditary bone dysplasia.

Hereditary bone dysplasia (HBD) is an extremely rare clinicopathological entity manifested by diaphyseal medullary stenosis and cortical bone thickening associated with a propensity for fractures affecting the long tubular bone. Malignant transformation has been reported to occur at an alarming frequency. The hereditary pattern appears to be autosomal dominant. In this paper we present the case of a 19-year-old man with hereditary bone dysplasia who was unaware of his underlying condition until he presented with malignant transformation arising in an area of bone infarct of the left tibia.

Tuberculous gluteal abscess without bone involvement.

A cold abscess secondary to tuberculous spondylitis or osteomyelitis is a well-recognized entity. However, a soft tissue tuberculous abscess without bone involvement is rare. We present such a case.

Sonographic evaluation of tears of the gastrocnemius medial head ("tennis leg")

Rupture of the medial head of the gastrocnemius muscle, or tennis leg, is a common lesion affecting middle-aged persons. An imaging examination may be needed to rule out other diseases and assess the severity of the tear. We reviewed the sonographic images of 65 patients with clinically suspected tennis leg. Fifty-one partial and 14 complete tears were diagnosed. Twenty-five patients had follow-up examinations (15 days to 24 months; mean, 45 days). The torn muscle fibers, hematoma, and the reparative process were appreciated by ultrasonography. Ultrasonography may be a useful noninvasive, low-cost modality for diagnosis and follow-up of tennis leg.

Elastofibroma dorsi: sonographic findings.

OBJECTIVE: Elastofibroma dorsi is a rare, slow-growing reactive pseudotumor of connective tissue typically located in the subscapular region. We report the sonographic characteristics of three cases of elastofibroma dorsi. CONCLUSION: The sonographic appearance of elastofibroma dorsi consists of arrays of interspersed linear or curvilinear hypoechoic stands against an echogenic background. These findings reflect the alternating pattern of fibroelastic streaks and fat that is also detected with other imaging techniques and found on pathologic specimens. In the proper clinical setting, a prospective sonographic diagnosis can obviate the need for further imaging assessment and biopsy.

Synovial chondrosarcoma arising in synovial chondromatosis of the right hip.

The case of a 55-year-old man with chondrosarcoma to the cervical spine is described. Two years previously the patient had undergone a right hip replacement for synovial chondromatosis. Re-evaluation of the biopsy specimen from the right hip taken at the time of the initial operation showed areas of chondrosarcoma arising in the background of synovial chondromatosis. The unusual presentation of this rare entity is discussed.

Dedifferentiated parosteal osteosarcoma of the radius.

A 35-year-old woman presented with a painful swelling in the left distal radius that had been present for 1 year. Radiography and computerized tomography revealed a sclerotic surface lesion that had grown over the year and eroded the cortex. Histological examination demonstrated two distinct components: a cartilaginous low- to moderate-grade osteosarcoma on the surface and a high-grade osteosarcoma in the intramedullary component. This case is uncommon in two aspects: the radius is a rare site for such a tumor and the dedifferentiation was revealed at the time of the first surgery and was not secondary to recurrence.

Vertebral arch or posterior spinal tuberculosis.

Posterior spinal tuberculosis or arch tuberculosis is a form of skeletal tuberculosis that selectively involves the vertebral arch. It may mimic skeletal neoplasm clinically and radiographically. Although posterior spinal tuberculosis has been reported in developing countries it has rarely been found in the United States. As a result, there is limited information about this entity in the US literature. We are presenting our experience in a patient born in the United States.