MRI biomarkers in osseous tumors.

Although radiography continues to play a critical role in osseous tumor assessment, there have been remarkable advances in cross-sectional imaging. MRI has taken a lead in this assessment due to high tissue contrast and spatial resolution, which are well suited for bone lesion assessment. More recently, although somewhat lagging other organ systems, quantitative parameters have shown promising potential as biomarkers for osseous tumors. Among these sequences are chemical shift imaging (CSI), apparent diffusion coefficient (ADC), and intravoxel incoherent motion (IVIM) from diffusion-weighted imaging (DWI), quantitative dynamic contrast enhanced (DCE)-MRI, and magnetic resonance spectroscopy (MRS). In this article, we review the background and recent roles of these quantitative MRI biomarkers for osseous tumors. Level of Evidence: 3 Technical Efficacy Stage: 3 J. MAGN. RESON. IMAGING 2019. J. Magn. Reson. Imaging 2019;50:702-718.

Osseous cavernous hemangioma of the superior orbital rim.

A 53-year-old male presented with a bony lesion over the superior orbital rim increasing in size over several months. CT imaging showed a circumscribed, osseous lesion involving the outer table of the right frontal bone and superior orbital rim with a honeycomb appearance. Anterior orbitotomy revealed an osseous lesion along the superior orbital rim with purple cavernous spaces. Histopathological examination demonstrated cavernous vascular channels with variably-sized lumens and variably-thickened vascular walls interspersed among bony trabeculae consistent with an osseous cavernous hemangioma.

Chondromyxoid Fibroma of the Distal Tibia: A Rare Case Report.

Chondromyxoid fibroma is one of the rarest bone tumours, occurring most frequently in adult men in their second and third decades. It generally affects the metaphysis of long bones, particularly the femur and tibia. Diagnosis can pose differential challenges with various tumor types, particularly chondrosarcoma, requiring separate management. We present a case of chondromyxoid fibroma of the distal tibia detected by soft tissue swelling. Clinical, epidemiological and radiological aspects will be discussed.

Epithelioid Hemangioendothelioma of the Foot.

We describe the case of an 18-year-old male Army reservist presenting with left lower extremity pain for which he was initially diagnosed with a stress injury. After failing conservative treatment, a radiograph was obtained showing a "lacelike" appearance of the medullary bone in the foot and ankle. Magnetic resonance imaging subsequently demonstrated widespread polyostotic marrow replacement with coarsened trabeculations. A biopsy was obtained which diagnosed the patient with polyostotic epithelioid hemangioendothelioma which is the most common malignant vascular tumor of bone. The patient ultimately underwent a below the knee amputation once computed tomography of the chest, abdomen, and pelvis excluded distant metastatic disease. It is important for radiologists to be aware of this diagnosis because osseous epithelioid hemangioendothelioma can present like a stress injury and be mistaken for a less serious diagnosis while potentially having visceral involvement.

Aggressive Ossifying Fibroma of the Maxilla.

The aggressive ossifying fibroma is an uncommon benign fibro-osseous lesion which has been described in the literature under a variety of terms. This tumor is distinguished from standard ossifying fibroma based on its more clinically aggressive biological behavior, occurrence in children and young adults, and tendency to occur in different anatomic sites. We report a case of a 45-year-old female who presented with a unilateral swelling of the right middle face for 5 months. Clinical examination showed a mass extended over the right maxilla. Orthopantomogram and computed tomography scan were performed. Biopsy suggests a fibro-osseous lesion. The complete surgical excision of tumor was performed under local anesthesia. The histopathological examination revealed the diagnosis of an aggressive ossifying fibroma-trabeculae type. No recurrence was noted. Because of its aggressive and compressive nature, aggressive ossifying fibroma requires an early complete surgical excision. A long-term clinical and radiological surveillance is necessary to prevent recurrence.

[An application of posterior cervical and transoral approaches to treating primary malignant osseous tumors in craniovertebral junction].

OBJECTIVE: To investigate the surgical method for primary malignant osseous tumors in the craniovertebral junction (CVJ) and its effectiveness. METHODS: The clinical data of 7 patients with primary malignant osseous spinal tumors in CVJ, which collected between September 2010 and April 2019, were retrospectively analyzed. There were 5 males and 2 females, aged 23 to 75 years (median, 56 years). All patients were diagnosed as chordoma in 4 cases, plasmacytoma in 2 cases, and fibrosarcoma in 1 case. The disease duration ranged from 0.7 to 36.0 months, with an average of 12.2 months. Lesion location: 1 case of C 0, 1, 3 cases of C 2, 1 case of C 1, 2, 1 case of C 2, 3, and 1 case of C 0-2. Preoperative visual analogue scale (VAS) score was 6.7±2.1, the Japanese Orthopaedic Association (JOA) score was 15.6±2.4. According to American Society of Spinal Cord Injury (ASIA) grading system, there was 1 case of grade C, 1 case of grade D, and 5 cases of grade E. According to Enneking stage of spinal malignant tumor, there was 1 case of stage ⅠB, 2 cases of stage ⅡB, and 4 cases of stage Ⅲ. According to Weinstein-Boriani-Biagini (WBB) stage, there was 1 case of 5-8/A-D, 1 case of 4-9/A-D, 1 case of 6-7/B-D, 1 case of 6-7/A-D, 2 cases of 1-12/A-D, and 1 case of 3-10/A-D. All these patients were treated with tumor extended resection, bone graft fusion, and internal fixation via posterior cervical approach, as well as tumor (stage Ⅰ or stage Ⅱ) boundary resection via transoral or submandibular approach. Meanwhile, anterior reconstructive fusion was procedured with bone grafting Cage needed to place the internal fixation. RESULTS: The operation time was 307-695 minutes (mean, 489.57 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 1 107.14 mL). There was no intraoperative injury in vertebral artery and spinal cord or any related postoperative complications, including incision infection, intracranial infection, and pulmonary infection. All the patients were followed up 3-57 months (mean, 21 months). Postoperative X-ray film and CT showed that the internal fixation screw was firm and in a satisfactory position, and the bone graft was fused at 3-6 months after operation. Symptoms such as neck pain, limb numbness, and fatigue relieved to different degrees after operation. At 3 months after operation, the VAS score improved to 1.7±0.8 ( t=7.638, P=0.000); while the JOA score improved to 16.1±1.5, but no significant difference was found when compared with preoperative score ( t=1.549, P=0.172). According to ASIA grading system, 1 patient with grade C had upgraded to grade D after operation, while the remaining patients had no change. There were 4 cases of recurrence after operation, in which those patients were with high malignancy of tumors before the first surgery. Their tumors also affected a wide range of slope or surrounding soft tissues and could not be completely removed. Among the 4 cases, 1 patient underwent transoral tumor removal operation again, while the other 3 cases gave up further treatment. There was no recurrence among the remaining 3 cases. CONCLUSION: Primary malignant osseous tumors in the CVJ can be completely exercised via means of trabsoral or submandibular approach. Meanwhile the anterior reconstruction can be achieved by placing special Cage specimen. These two methods together with postoperative adjuvant treatments such as radiotherapy and chemotherapy can improve the survival time of patients and reduce tumor recurrence.

Endoscopic Optic Nerve Decompression for Optic Neuropathy in Sinonasal Fibro-Osseous Tumors.

BACKGROUND: Sinonasal fibro-osseous tumors involving the skull base sometimes result in the encasement of the optic canal and can cause the compressive optic neuropathy. This study aimed to elucidate the optimal timing of endoscopic optic nerve decompression (OND) in cases with optic neuropathy caused by fibro-osseous tumors. METHODS: Medical records were reviewed retrospectively from July 2008 through November 2016. Subjects who underwent surgery with endoscopic OND for optic neuropathy caused by fibro-osseous lesions were enrolled. Pre- and postoperative ophthalmologic evaluation were analyzed, including best-corrected visual acuity, visual field testing, and color vision. RESULTS: A total of 9 patients underwent OND. Seven patients had fibrous dysplasia and 2 patients had juvenile ossifying fibroma. Patients included 6 boys and 3 girls. The average age was 15 years with a range of 8-17 years. Symptom duration ranged from 2 months to 4 years. The mean follow-up period was 28 months (range, 0.8-76.4 months). There was no immediate deteriorated vision after OND. Eight eyes (88.9%) were improved and 1 eye (11.1%) had only visual field improvement. However, patients whose visual impairment was in the range of finger count and hand motion were not recovered beyond the quantitatively measurable level even after OND. CONCLUSIONS: Endoscopic OND in patients with optic neuropathy caused by a fibro-osseous tumor in the sinonasal region is safe and worth trying to improve visual outcomes. Early therapeutic OND is recommended before the patient's visual function is decreased below quantitatively measurable vision.

Imaging features of primary spinal osseous tumors and their value in clinical diagnosis.

This study explored the method of imaging diagnosis of primary spinal osseous tumors and the application value of imaging in clinical diagnosis. Sixty-nine patients with primary spinal osseous tumors who received treatment in Nankai Hospital from July 2016 to June 2017 were selected. All of them received X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) examinations to analyze the imaging features of the three examination methods. Sensitivity (Sen), specificity (Spe), positive predictive value (PV+), negative predictive value (PV-) and accuracy (Acc) were compared. The consistency of the three examination methods in diagnosing primary spinal osseous tumors was analyzed. Sen, Acc and PV- of the three examination methods in diagnosing spinal osseous tumors had obvious differences. MRI showed the highest Sen (P<0.05). MRI had relatively high consistency with CT scan in diagnosing primary spinal osseous tumors, and κ-value was 0.72. CT scan and X-ray had obvious difference in diagnosing primary spinal osseous tumors (P<0.05). The consistency between CT scan and X-ray in diagnosing primary spinal osseous tumors was relatively low, and κ-value was 0.47. MRI and X-ray had obvious difference in diagnosing primary spinal osseous tumors (P<0.05). The consistency between MRI and X-ray in diagnosing primary spinal osseous tumors was relatively low, and κ-value was 0.41. X-ray examination is easy to operate with high resolution. CT scan has obvious advantages in displaying lesions with complex structure, many of which locate in overlapping sites. MRI has more advantages and higher accuracy in judging the scope of the tumor. CT and MRI examinations have obviously higher efficacy than X-ray in diagnosing primary spinal osseous tumors. They are conducive in improving the accuracy of diagnosing primary spinal osseous tumors.

Giant Cells Osseous Tumor in the Tarsal Canal after Lateral Ankle Sprain.

Ankle sprain can cause injuries to the anatomic structures surrounding the tibiotarsal joint. A possible extra-articular pathology is to be hypothesized and diagnosed as early as possible. The subtalar joint, for anatomical and functional reasons, is one of the most damaged joints following an ankle sprain. In spite of this, its involvement is often underestimated. The clinical case presented in the present article is referred to a giant cells osseous tumor in the tarsal canal that was diagnosed 2 months after an inversion ankle sprain.

Benign mesenchymoma of bone: A rare case report.

Benign mesenchymomas, exceptionally rare tumors, composed of two or more nonepithelial mesenchymal elements are not usually found together in a tumor. We report herein a rare case of benign mesenchymoma in the lower end of tibia in a 36-year-old female showing fibrous, fatty, and osseous elements.

Fibroma osificante juvenil, presentación de un caso clínico y revisión de la literatura / Juvenil ossifying fibroma, case report and review of the literature

Se presenta el caso de una paciente de seis años, de sexo femenino sin antecedentes mórbidos ni familiares de importancia, quien consulta por proptosis izquierda en abril de 2011. Se realiza resonancia magnética de cerebro evidenciándose un tumor de seno etmoidal con compromiso de órbita izquierda que ocasiona exoftalmo. La biopsia endoscópica nasal fue compatible con fibroma osificante juvenil. Posteriormente se realiza antrostomía con etmoidectomía en dos tiempos, con resultados satisfactorios para la paciente. Aunque el fibroma osificante juvenil es un tipo de lesión benigna poco frecuente, puede llegar a ser muy agresiva y con una alta tasa de recidiva en ciertas ocasiones, por lo que se debe tener en cuenta para realizar un diagnóstico y tratamiento precoz, con un seguimiento programado a largo plazo.

This paper presents the case of a patient of six years old female without background or important morbidly in her family, who consults for left-sided proptosis in April of 2011. It performs brain magnetic resonancebeing demonstrated a tumor of theethmoid sinus with commitment to the left orbit that causes exophthalmus. Nasal endoscopic biopsy was compatible with juvenile ossifying fibroma. It was subsequently performed ananthrostomy whitethmoidectomy in two times, with satisfactory results for the patient. Although the Juvenile ossifying fibroma is a rare type of benign lesion, can be very aggressive and have a high recurrence rate in certain occasions, by what should be taken into account to make an early diagnosis and treatment, with a scheduled follow up in the long term.

Osteoma compacto central de mandíbula: relato de caso clínico / An central compact osteoma of the mandible: report of clinical case

O osteoma é considerado um tumor ósseo benigno de crescimento lento, contínuo, indolor e de etiologia controversa. Geralmente é diagnosticado em pacientes jovens no período da puberdade,VG nos exames radiográficos de rotina ou quando assume um grande tamanho levando à assimetria facial. Os osteomas são classificados quanto à localização radiográfica em três grupos: central, periféricoe extraósseo. No exame histológico, são classificados em dois tipos: compacto e medular. Noprimeiro, predomina osso lamelar denso e escasso tecido medular. No segundo, predomina osso dotipo trabecular com abundante medula fibro gordurosa. Neste caso clínico apresentado de Osteoma Compacto Central de Mandíbula, o tratamento proposto foi O DO controle clínico-radiográfico periódico, por ser de pequeno tamanho, assintomático, e, ainda, não comprometer o nervo alveolar inferior e não haver relatos de malignização.

Osteoma has been considerated a benign bone tumor. It presents slow, continuous and painless growth. It has a controversial etiology. Usually it is diagnosed on young patients at puberty periodduring routine radiographic exams or when it assumes a huge size causing facial asymmetry. Osteoma is classificated in three groups according radiographic localization: central, peripheral and extraskeletal. And it is classificated in two groups according histologic exam: compact and medullar. Thefirst type predominate dense lamella bone and scarce medullar tissue. And the second one predominate bone with spaces and abundant medulla with fibrofatty. The aim of this article is to describea clinical case of Central Compact Osteoma of the Mandible that was decided just to follow up with periodic radiographic control because it was no commited to inferior alveolar nerve and there is not reports of the malignity.

Cisto ósseo aneurismático: relato de caso e revisão da literatura / Aneurysmatic osseous cyst: a case report and literature review

O nome cisto ósseo aneurismático traz confusões, pois a lesão não é um aneurisma nem tampouco um cisto verdadeiro. Segundo a OMS, esta doença define-se como lesão osteolítica expansiva, constituída de espaços cheios de sangue, podendo ocorrer em qualquer segmento do esqueleto, sendo mais freqüente nas hastes dos ossos longos ou na coluna vertebral. Nos maxilares, esta afecção é rara, sendo a mandíbula mais acometida que a maxila. Sua sintomatologia escassa é rapidamente exacerbada com o crescimento da lesão, que geralmente é rápido, podendo causar compressão de estruturas nervosas, levando ao surgimento de sintomas, como dor local. Achados radiográficos podem ser inespecíficos, sendo que os achados tomográficos costumam ser sugestivos. O tratamento do cisto ósseo aneurismático continua controverso, apresentando uma tendência à ressecção cirúrgica, visando à remoção completa da lesão, reduzindo, assim, o índice de recidiva. O presente artigo tem por finalidade relatar um caso raro de cisto ósseo aneurismático na mandíbula, evoluído de displasia óssea bem como discutir os aspectos clínicos, imaginológicos, histológicos, diagnóstico diferencial e tratamento dessa patologia.

The term aneurysmatic osseous cyst is confusing because the lesion is neither an aneurysm nor a true cyst. According to WHO, this affection is an expansive osteolytic lesion consisting of spaces filled with blood in any segment of the skeleton, being most frequently encountered in the diaphysis of the long bones or spinal cord. The maxillae arerarely affected and its predilection is for the mandible. Its scanty symptomatology is rapidly exacerbated with the growth of the lesion, which is usually rapid and may cause compression of nervous structures leading to the emergence of symptoms such as local pain. Radiological findings may be nonspecific, while the tomography findings are generally suggestive. The management of an aneurysmatic osseous cyst is controversial, the preferred treatment being surgical resection for the complete removal of the lesion, there by reducing the rate of recurrence. This paper reports a case of aneurysmatic osseous cyst in the mandible originating in a previous osseous dysplasia and discusses the clinical, radiological and histopathological features, differential diagnosis and management of this pathosis.