Hyperfunctioning parathyroid carcinoma.

Primary hyperparathyroidism is rarely caused by carcinoma. We report a patient who manifested many of the clinical and radiographic features of the disease. When encountering symptomatic hypercalcemia with or without a palpable neck mass, carcinoma should be considered in the differential diagnosis. Patient survival depends on an aggressive surgical approach to the primary lesion and recurrent disease.

Occult malignancy presenting as metastatic disease to the hand and wrist.

Osseous metastases to the hand and wrist are uncommon. Most cases represent the manifestation of known malignancy with disseminated disease. Less commonly, acrometastases are the initial presentation of malignancy. In both instances, diagnosis of malignancy is frequently not considered either clinically or radiographically. This results in a delay in diagnosis and in inappropriate therapy. Three cases of occult malignancy presenting as acrometastases are reported. The author stresses the importance of considering this diagnosis when faced with any aggressive lytic or blastic lesion of the hand and wrist in a patient in the fifth decade of life or older.

Primary osseous malignant fibrous histiocytoma involving a rib.

A case is presented of an 86-year-old man who developed progressive chest wall pain over a 16-month period. Radiologic studies demonstrated lytic destruction of the right fourth rib anterolaterally. A limited thoracotomy led to the diagnosis of malignant fibrous histiocytoma. This represents an unusual primary bone lesion in the rib. A concise discussion of primary MFH of bone including its radiographic appearance, differential diagnosis, and pathology was presented.

Nondisplaced shearing-type talar body fractures.

The majority of talar body fractures represent avulsive injuries or are associated with obvious displacement or dislocation. Minimally displaced, nonavulsive fractures of the talar body are rare and can be difficult to recognize. Delay in diagnosis and therapy may be associated with an increased risk of osteonecrosis, malunion, secondary osteoarthritis, and other complications. We present two cases of nondisplaced talar body fractures with delay in diagnosis and stress the importance of recognizing these fractures, given the appropriate mechanism of injury.

Radiographic analysis of an investigational hydroxyapatite-coated total hip replacement.

RATIONALE AND OBJECTIVES: The impetus to discover cementless techniques for fixing implants to bone is the result of the high failure rates of cemented arthroplasty in young, active patients. The application of hydroxyapatite (HA) to implants represents an alternative. The purpose of this investigation is to define the early radiographic pattern of an HA femoral stem and compare this definition with an identical stem without the HA treatment. METHODS: Radiographic analysis was performed on 98 hips: 63 HA stems and 35 non-HA stems, with a 1-year follow-up. Radiographic parameters analyzed included: 1) radiolucent line formation; 2) endosteal bone formation; 3) calcar response; 4) periosteal bone formation; 5) heterotopic bone formation; 6) stem subsidence; and 7) quality of fit. RESULTS: The HA stem demonstrated greater proximal endosteal sclerosis and distal radiolucency (P < .001). The non-HA (control) stem demonstrated greater proximal and distal radiolucency (P < .02) and distal endosteal sclerosis (P < .001). CONCLUSION: The HA pattern suggests proximal load transference and bony fixation. The control pattern suggests distal loading and fixation, in addition to motion between the stem and native femur. These patterns indicate an advantage of the HA fixation over traditional implants.

The hallux sesamoids revisited.

The hallux sesamoids are vulnerable to significant injury and weight-bearing stress in both the athlete and the nonathlete. Unfortunately, they are often dismissed as inconsequential accessory bones. The historical significance, embryology, anatomy, and physiology of the sesamoids and the salient features of both traumatic and nontraumatic pathologic conditions affecting these structures are presented. Because the sesamoids can be responsible for prolonged disabling foot pain and discomfort, it is important for both clinician and radiologist to pay attention to these bones and recognize the early signs of abnormality.

Epithelioid hemangioendothelioma of bone. A report of two cases and review of the literature.

Epithelioid hemangioendothelioma is the prototype of a group of vascular tumors characterized by epithelioid or histiocytoid endothelial cells. Epithelioid hemangioendothelioma of bone is a rare lesion that constitutes fewer than 1% of primary malignant skeletal neoplasms. We describe two cases that illustrate the spectrum of radiographic features seen with this neoplasm, and also present its appearance on magnetic resonance imaging.

Case report 632. Parosteal osteochondromatous hamartoma associated with Trevor's disease (dysplasia epiphysealis hemimelica).

The current case represents a patient with classic plain film findings of Trevor's disease (DEH) seen in the foot and ankle, who presented with a large, eccentric metaphyseal lesion in the ipsilateral distal femur. The radiographic and pathologic characteristics of this large metaphyseal lesion were considered atypical for a simple osteochondroma; therefore, we propose the term "parosteal osteochondromatous hamartoma" as a descriptive term that best fits its unique characteristics.

Concentric joint space narrowing of the hip associated with hemosiderotic synovitis (HS) including pigmented villonodular synovitis (PVNS).

Concentric joint space narrowing of the hip is an expected radiographic finding in cases of inflammatory arthritis such as rheumatoid arthritis or sepsis. However, similar joint space narrowing is associated with chronic hemorrhagic conditions that produce hemosiderotic synovitis. Hemosiderotic synovitis results from chronic intra-articular bleeding such as occurs in pigmented villonodular synovitis, generalized bleeding diathesis, synovial hemangioma, and chronic trauma. Five hips in five patients with concentric joint space narrowing not associated with inflammatory arthritis or with hemophilia were reviewed clinically, radiographically, and pathologically. All patients had a hemosiderotic synovitis. The definitive diagnosis of pigmented villonodular synovitis was made pathologically in two cases that demonstrated nodular areas of giant cell proliferation, collagen production, and lipid-laden histiocytes on histologic samples.