Myxoid liposarcoma: MRI features with histological correlation.

BACKGROUND AND AIMS: Myxoid liposarcoma is classified in the group of sarcomas with adipose differentiation, which is the second most common group of sarcomas. However, myxoid liposarcoma is not a homogeneous entity, because the behavior and clinical course of these tumours can vary widely. This study aimed to describe the magnetic resonance imaging (MRI) features of myxoid liposarcomas and to determine whether the MRI features are associated with the histologic grade and can differentiate between low-grade and high-grade tumours and thus help in clinical decision making. MATERIAL AND METHODS: We studied 36 patients with myxoid liposarcomas treated at our centre between 2010 and 2018. We analysed clinical variables (age, sex, and tumour site) and MRI features (size, depth, borders, fatty component, myxoid component, non-fatty/non-myxoid component, apparent diffusion coefficient (ADC), and type of enhancement after the administration of intravenous contrast material). We correlated the MRI features with the histologic grade and the percentage of round cells. RESULTS: In our series, patients with myxoid liposarcomas were mainly young adults (median age, 43 years). There were no differences between sexes; 97.2% were located in the lower limbs, 86.1% were deep, and 77.8% had well-defined borders. Of the 23 myxoid liposarcomas that contained no fat, 16 (69.6%) were high grade (p = 0.01). All the tumors with a myxoid component of less than 25% were high grade (p = 0.01); 83.3% of those with a non-fatty/non-myxoid component greater than 50% were high grade (p = 0.03) and 61.5% had more than 5% round cells (p = 0.01). Diffusion sequences were obtained in 14 of the 36 patients; ADC values were high (median, 2 × 10-3 mm2/s), although there were no significant associations between low-grade and high-grade tumours. Contrast-enhanced images were available for 30 (83.3%) patients; 83.3% of the tumours with heterogeneous enhancement were high grade (p = 0.01). CONCLUSIONS: MRI can be useful for differentiating between high- and low-grade myxoid liposarcomas and can help in clinical decision making.

[Dynamic magnetic resonance imaging in the diagnosis of tumors and pseudotumors of the musculoskeletal system]. / Resonancia magnética dinámica en el diagnóstico de las lesiones tumorales y seudotumorales del sistema musculoesquelético.

The greater temporal resolution provided in ultrafast dynamic contrast-enhanced magnetic resonance imaging sequences makes it possible to know the physiological phenomenon of the distribution of the contrast material through a time-signal intensity curve. Analyzing these curves enables us to deduce information relevant to the vascularization and perfusion of tissues, capillary permeability, and the interstitial space in the tumor. A steep curve with early washout in a space-occupying lesion greatly increases the possibility of histological malignancy, although this type of curve is not rare in benign lesions and relatively flat curves are not rare in malignant tumors. Nevertheless, dynamic studies of the uptake of contrast material provide important information for the characterization of neoplasms that, together with the usual signs, can help to differentiate between benign and malignant tumors of adipocyte, chondroid, or neural lineage, clearing up diagnostic uncertainty in certain benign lesions such as osteoid osteoma and ischemic musculoskeletal disease. Furthermore, it enables the accurate determination of the response to chemotherapy, detecting recurrence within the treated tumor early, delimiting more precisely the margins between the tumor and peritumoral edema, and helping in diagnostic planning by determining the most vascularized areas of the tumor, which are more likely to be malignant.

Myxoid liposarcoma: MRI features with histological correlation. / Liposarcoma mixoide: características por resonancia magnética con correlación histológica.

BACKGROUND AND AIMS: Myxoid liposarcoma is classified in the group of sarcomas with adipose differentiation, which is the second most common group of sarcomas. However, myxoid liposarcoma is not a homogeneous entity, because the behavior and clinical course of these tumors can vary widely. This study aimed to describe the magnetic resonance imaging (MRI) features of myxoid liposarcomas and to determine whether the MRI features are associated with the histologic grade and can differentiate between low-grade and high-grade tumors and thus help in clinical decision making. MATERIAL AND METHODS: We studied 36 patients with myxoid liposarcomas treated at our center between 2010 and 2018. We analyzed clinical variables (age, sex, and tumor site) and MRI features (size, depth, borders, fatty component, myxoid component, non-fatty / non-myxoid component, apparent diffusion coefficient (ADC), and type of enhancement after the administration of intravenous contrast material). We correlated the MRI features with the histologic grade and the percentage of round cells. RESULTS: In our series, patients with myxoid liposarcomas were mainly young adults (median age, 43 years). There were no differences between sexes; 97.2% were located in the lower limbs, 86.1% were deep, and 77.8% had well-defined borders. Of the 23 myxoid liposarcomas that contained no fat, 16 (69.6%) were high grade (p=0.01). All the tumors with a myxoid component of less than 25% were high grade (p=0.01); 83.3% of those with a non-fatty / non-myxoid component greater than 50% were high grade (p=0.03) and 61.5% had more than 5% round cells (p=0.01). Diffusion sequences were obtained in 14 of the 36 patients; ADC values were high (median, 2 x 10-3 mm2/s), although there were no significant associations between low-grade and high-grade tumors. Contrast-enhanced images were available for 30 (83.3%) patients; 83.3% of the tumors with heterogeneous enhancement were high grade (p=0.01). CONCLUSIONS: MRI can be useful for differentiating between high- and low-grade myxoid liposarcomas and can help in clinical decision making.

[Family picnodisostosis, report of a case after 10 years of follow-up]. / Picnodisostosis familiar, reporte de un caso tras 10 años de seguimiento.

INTRODUCTION: Pycnodysostosis is a rare disease secondary to a mutation in gen 1q21 that codifies the cathepsin K, proteolitic enzyme implicated in the metabolism of osteonectin, osteopontin and type I colagen. Its global incidence is around 1-1.7 cases per million, without genre prevalences, it is clinically caracterized by short stature, craneal deformities, «birds face¼ and bone fragility with pathological fractures tendency predominantly affecting long bones and occasionally vertebral pedicles. Radiologically is characterized by sclerous bones with permeable medular cannel. Despite there are numerous clinical reports on medical literature, just a litlle describe families with more than one afected member and its followship is usually short-term. OBJECTIVE: To analize clinical evolution of these afected patients. MATERIAL AND METHODS: A retrospective, descriptive, observational study was reelized in three patients with diagnosis of pycnodisostosis, between July 2006 and March 2016. RESULTS: different affection forms of pycnodisostosis where observed, some of them, atipical, as for example spondilolisis and a escapule fracture in one patien. CONCLUSIONS: The present study could be the longest longitudinal report ever registered. By knowing the presented variety of manifestations and complications, the reader could select the best treatment method for each case.

INTRODUCCIÓN: La picnodisostosis es una rara enfermedad secundaria en una mutación en el gen 1q21 que codifica la catepsina K, enzima implicada en el metabolismo de osteonectina, osteopontina y colágeno I. La incidencia mundial es de 1-1.7 casos por millón, sin prevalencia por género, se caracteriza clínicamente por talla baja, deformidades craneales, «cara de pájaro¼ y fragilidad ósea con tendencia a fracturas patológicas, que afectan predominantemente los huesos largos y ocasionalmente en los pedículos vertebrales. Radiológicamente es característica la presencia de osteoesclerosis con canales medulares permeables. Aunque existen numerosos reportes de casos clínicos en la literatura, pocos son los que describen familias con más de un individuo afectado y el seguimiento suele ser a corto plazo. OBJETIVO: Analizar la evolución clínica de los pacientes afectados. MATERIAL Y MÉTODOS: Se realizó estudio retrospectivo, descriptivo, observacional de tres pacientes con diagnóstico de picnodisostosis, en el período de Julio 2006 a Marzo de 2016. RESULTADOS: Se observaron diferentes formas de afectación de la picnodisostosis, algunas de ellas atípicas como la espondilólisis y una fractura de escápula en una paciente. CONCLUSIONES: El presente estudio podría ser el análisis longitudinal más extenso del que se tenga registro. Conocer la variedad de manifestaciones y complicaciones presentadas permitirá al lector seleccionar el mejor método de tratamiento para cada caso.

[Clinical course of decompressive surgery for the treatment of lumbar stenosis]. / Evolución clínica de la cirugía descompresiva en el tratamiento del canal lumbar estrecho degenerativo.

BACKGROUND: Several authors and publications have focused on comparing the clinical course of nerve root decompressive surgery, with or without fusion, to treat degenerative lumbar stenosis. However, there are not many reports analyzing the clinical course after decompressive surgery of a single nerve root (the most symptomatic one) comparing it with decompression of all the roots in a segment. This study intends to compare the clinical course after decompressing the most symptomatic lumbar nerve root with the release of multiple lumbar nerve roots to relieve neuropathic pain resulting from degenerative lumbar stenosis. MATERIAL AND METHODS: A prospective, observational, descriptive longitudinal study was performed. A total of 38 patients were divided into two groups that included each 19 cases. Patients underwent recalibration of either a single nerve root or multiple nerve roots of a segment. Percentages were calculated as well as the Student t test and the Pearson correlation. RESULTS: In group A, a decrease of 46.63 points was seen in the Oswestry scale, representing a 66.73% improvement in pain. In group B, in turn, a mean decrease of 34.54 points was seen in the Oswestry scale, equivalent to a 47.23% improvement in pain, with a Student t in which p = 0.11 and a Pearson correlation coefficient of 0.08. CONCLUSIONS: No statistically significant differences were found between both study groups.

Diversos autores y publicaciones se han enfocado en comparar la evolución clínica de la cirugía descompresiva de las raíces, ya sea con o sin fusión, para el tratamiento del canal lumbar estrecho degenerativo. Sin embargo, no existen muchos reportes que analicen la evolución clínica tras la cirugía descompresiva de una sola raíz nerviosa (la más sintomática) contra la descompresión de todas las raíces de un segmento. El presente estudio pretende comparar la evolución clínica de la liberación radicular lumbar de la raíz más sintomática con respecto a la liberación de múltiples raíces lumbares para el alivio del dolor neuropático en el canal lumbar estrecho degenerativo.

Collateral biliary circulation in portal hypertension syndrome.

OBJECTIVE: to describe collateral circulation in the gallbladder wall in relation with portal hypertension syndrome, and to determine whether this syndrome is frequently associated portal vein thrombosis. METHODS: images were retrospectively reviewed for 9 patients with previously diagnosed portal hypertension syndrome, in whom ultrasound results suggested the presence of varices of the cystic vein. RESULTS: four patients showed signs suggesting portal vein thrombosis. The gallbladder wall showed diffuse hypoechoic thickening in all patients, 7 of whom had intramural dilation of tubular, tortuous appearance. Ultrasound findings, however, were not very specific, and differential diagnosis with a large number of other entities is required to rule out other possible causes of focal and diffuse thickening of the gallbladder wall. The use of Doppler sonographic techniques made it possible to determine the cause of the varices, and to confirm suspicions of portal thrombosis. This method was found to be just as sensitive as ultrasound imaging, and much more specific. Angiograms obtained in 3 patients for different reasons confirmed the ultrasonographic findings in all cases. CONCLUSIONS: this study confirms the association between thromboses and varices, and analyzes the physiopathological hypotheses invoked to explain this association. We emphasize the need for correct diagnosis, given the frequency of surgical iatrogenic bleeding or misdiagnosis resulting from confusion with other possible causes of gallbladder wall thickening. Doppler ultrasound is considered the ideal diagnostic method as it is harmless, sensitive and specific.

[Prosthetic radial head for type III Masson fractures]. / Prótesis de cabeza de radio en fracturas Mason tipo III.

INTRODUCTION: The treatment of type III Masson radius head fractures is variable; there is not a clear solution. MATERIAL AND METHODS: This study addresses the course of patients treated with radius head replacement for type III Masson fractures at ISSEMYM Medical Center, Ecatepec, Mexico. RESULTS: Four male patients were included; mean age was 34.5 years (range 28-41). The mechanism of injury was direct contusion; 3 of the elbows were left (75%) and one was right (25%). A bipolar uncemented prosthesis was used. According to Broberg and Morrey functional assessment criteria, patients had an excellent course. The mean time elapsed after surgery is 13 months. CONCLUSION: We concluded that the radius head prosthesis for type III Masson fractures is a good alternative. Patients may start rehabilitation right away, unlike what occurs with other surgical techniques.

CD4+ and CD8+ T lymphocyte regeneration after anti-retroviral therapy in HIV-1-infected children and adult patients.

Previous studies have shown a slow recovery of naive CD4+ T cell counts after anti-retroviral therapy in HIV-1-infected adults, which is in accordance with thymus atrophy after puberty. Here we investigate whether or not different patterns of naive CD4+ and CD8+ T cell repopulation are present in adult and child patients undergoing anti-retroviral treatment. Thus, 25 adults under highly active anti-retroviral therapy and 10 children under combined anti-retroviral therapy were retrospectively analysed for T cell subpopulations at baseline (T0) and around week 12 (T1) and week 24 (T2) of anti-retroviral treatment. Mean serum HIV-1 RNA levels dropped in both groups. Recovery of T cells in adults was characterized by a heterogeneous response between patients, with only 44% of them increasing their naive CD4+ and CD8+ T cell counts at T1, and changes in mean total CD4+ T cells were mainly shaped by memory cells. Otherwise, children were characterized by an early increase in naive T cells. Thus, at T1, all children analysed had a strong rise in CD4+ (from 389 +/- 116 to 569 +/- 121 cells/microl; P < 0.01), and nine out of 10 also in naive CD8+ T cells (from 244 +/- 58 to 473 +/- 85 cells/microl; P < 0.05). However, no significant correlation between age and naive repopulation was observed (P = 0. 22) in children. Thus, children had the earlier and greater increases in naive T cell subsets than adults, probably due to a more active thymus, with the potential for immune reconstitution when HIV-1 replication is controlled.

Resonancia magnética dinámica en el diagnóstico de las lesiones tumorales y seudotumorales del sistema musculoesquelético / Dynamic magnetic resonance imaging in the diagnosis of tumors and pseudotumors of the musculoskeletal system

La mayor resolución temporal que ofrece la secuencia de imágenes ultrarrápidas de la resonancia magnética contrastada dinámica (RMD), permite conocer el fenómeno fisiológico de la distribución del contraste mediante una curva de intensidad de señal-tiempo (TIC), de cuyo análisis puede deducirse información relevante sobre la vascularización y perfusión tisular, la permeabilidad capilar y el espacio intersticial del tumor. El hallazgo de una curva de pendiente elevada con lavado precoz de contraste en una lesión ocupante de espacio aumenta sensiblemente la posibilidad de malignidad histológica, aunque no es raro el hallazgo de curvas de este tipo en lesiones histológicamente benignas y de curvas de perfil relativamente plano en tumores de reconocida malignidad. A pesar de todo, los estudios dinámicos de captación pueden aportar información de gran interés en el proceso de caracterización de las lesiones neoformativas, ayudando a los restantes datos semiológicos habituales a diferenciar las formas malignas de las benignas en las tumoraciones de estirpe adipocítica, condroide o neural, confirmando dudas diagnósticas en determinadas lesiones benignas como el osteoma osteoide y la patología isquémica osteomuscular, permitiendo determinar con precisión el grado de respuesta a la quimioterapia, detectando con precocidad la recidiva en el seno del tumor tratado, delimitando con mayor exactitud los márgenes del tumor frente al edema peritumoral y ayudando a la planificación diagnóstica al determinar las áreas más vascularizadas y, por tanto, más probablemente malignas del tumor (AU)

The greater temporal resolution provided in ultrafast dynamic contrast-enhanced magnetic resonance imaging sequences makes it possible to know the physiological phenomenon of the distribution of the contrast material through a time-signal intensity curve. Analyzing these curves enables us to deduce information relevant to the vascularization and perfusion of tissues, capillary permeability, and the interstitial space in the tumor. A steep curve with early washout in a space-occupying lesion greatly increases the possibility of histological malignancy, although this type of curve is not rare in benign lesions and relatively flat curves are not rare in malignant tumors. Nevertheless, dynamic studies of the uptake of contrast material provide important information for the characterization of neoplasms that, together with the usual signs, can help to differentiate between benign and malignant tumors of adipocyte, chondroid, or neural lineage, clearing up diagnostic uncertainty in certain benign lesions such as osteoid osteoma and ischemic musculoskeletal disease. Furthermore, it enables the accurate determination of the response to chemotherapy, detecting recurrence within the treated tumor early, delimiting more precisely the margins between the tumor and peritumoral edema, and helping in diagnostic planning by determining the most vascularized areas of the tumor, which are more likely to be malignant (AU)