Bony Lesions Research Articles

Chronic Injury of Sagittal Band by Metacarpal Head Osteoma: A Case Report

Injury of the sagittal band, a crucial component of the extensor hood, can occur in various situations, including spontaneous events, trauma, and rheumatic diseases. This case presents a rupture of the sagittal band resulting from chronic irritation caused by a metacarpal head osteoma. A 22-year-old female presented with ulnar subluxation of the extensor tendon at the left third metacarpophalangeal joint, without any history of trauma or pain. Ultrasonography and computed tomography revealed a 1.7 mm-sized bony lesion on the radial side of the metacarpal head, accompanied by a partial tear of the radial sagittal band. Our hypothesis that chronic irritation of the sagittal band by the adjacent bony lesion led to the partial tear was confirmed by intraoperative findings. The lesion was excised, and the radial sagittal band was reconstructed. Histopathological examination confirmed a diagnosis of osteoma. To our knowledge, this is the first reported case of sagittal band rupture caused by an osteoma of the metacarpal head. This case underscores the importance of considering an underlying metacarpal head osteoma in patients with non-rheumatoid joints presenting, in the absence of a traumatic history, with a sagittal band rupture due to chronic irritation.

Anterior Rotator Interval Lesion (ARIL), its association with glenoid labrum pathology in patients with anterior shoulder pain and surgical outcome of Arthroscopic Rotator Interval Closure (ARIC)

BackgroundAnterior rotator interval lesions (ARIL) have been associated with shoulder instability. However, a paucity of data exists on its association with labrum pathology as a source for persistent anterior shoulder pain. This study primarily aims to describe pathoanatomy of ARIL and the parameters we used that aid in the diagnosis of ARIL. Secondly, the objective is to describe and report the prevalence of ARIL in combination with labrum injuries presenting as anterior shoulder pain with mild or no instability. Lastly, we intend to present a cohort of patients with combined labrum injury and ARIL and report on the clinical results after labrum repair with Arthroscopic Rotator Interval Closure (ARIC). MethodsConsecutive patients at a single center in United States treated for labrum tears were included by retrospective chart-review. Patients presenting with anterior shoulder pain with mild or no instability were included. Patients with recurrent dislocations, moderate to severe instability and those with bony lesions were excluded. Besides history and physical examination, Magnetic Resonance Arthrography (MRA) was used to aid the diagnosis. Labrum tears with ARIL were treated with an additional ARIC procedure along with arthroscopic labrum repair. ResultsOut of two hundred fourty patients with a labrum tear, 114 had associated ARIL. The prevalence of ARIL ranged from 71 % with reverse Bankart tears to 46 % with anterior Bankart and 36 % in Type II SLAP tears. The success rate after labrum tear repair with ARIC performed in patients with ARIL with labrum pathology was 94.7 % at a 2-year follow-up in terms of relief from anterior shoulder pain. ConclusionAlmost half (47.5 %) of our patients presented with anterior shoulder pain with labrum tears were associated with ARIL. We recommend keeping a high index of suspicion for ARIL in labrum injuries presenting mainly with anterior shoulder pain for better treatment planning. Level of evidenceLevel IV (Retrospective case series without a comparision group)

Tubercular Osteomyelitis of Skull: Case Report and Review of the literature

Skeletal tuberculosis constitutes about 1j of all cases. Usually, spine and limb bones are involved. Tubercular osteomyelitis of the skull is a rare entity; therefore, diagnosis is rarely suspected. We report one such rare case of an atypical calvaria skull osteomyelitis in a14 years old female who presented with swelling on the right frontoparietal region for 3 months. CT scan of brain and bony window revealed a lytic bony lesion at the right parietal bone with associated epidural soft tissue component at the right parietal top causing compression over adjacent parenchyma- possibly eosinophilic granuloma or chronic osteomyelitis. Patient was treated surgically by excision of the lesion with cranioplasty by synthetic bone cement. After surgical treatment, the specimen was sent for histopathology which showed granulomatous inflammation histologically consistent with tuberculosis. She was treated with antitubercular therapy. Our Case highlights all these aspects of skull tuberculosis with review of the available literature relevant to skull tubercular osteomyelitis. EWMCJ Vol. 12, No. 1&2, January-July 2024: 111-119

A Case Report of a Rare Presentation of Semimembranosus Tibial Plateau Avulsion: The Bony Ramp Lesion

Background: Tibial plateau posteromedial rim avulsions by semimembranosus tendon are a rare entity that have been reported in a few studies so far with controversial mechanisms. They are reported to accompany anterior cruciate ligament (ACL) or meniscal injuries. Their main fracture planes are usually placed in the coronal plane. Case Report: The patient was a 52-year-old man with a hyperextension-valgus tibial plateau fracture. The imaging studies revealed a compression fracture of the lateral and an avulsion fracture of the posteromedial plateau. However, no soft-tissue injuries were detected. The fragment was avulsed in the axial plane and covered by the medial meniscal posterior horn, creating the pattern of a longitudinal tear in the meniscal ramp lesion, but actually without any soft-tissue injuries. It was fixated using the tension band wiring technique with two Kirschner wires (K-wires) and one cancellous screw. Radiological and functional outcomes were excellent at 12-month follow-up. Conclusion: This fracture pattern merits special attention due to its unusual presentation, causing the meniscal posterior horn to separate from the articular surface. “Bony ramp lesion” best describes the simultaneous separation of the posterior horn of the medial meniscus (PHMM) and its underlying bony fragment without the meniscal tear that takes place in an actual medial meniscal ramp lesion.

Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report.

Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient's feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.

Uncommon Presentation of Multiple Myeloma: Pleural Effusion and Extensive Extramedullary Involvement

A 60-year-old female presented with abdominal pain, weight loss, and fatigue. Imaging revealed a pancreatic mass, bilateral pleural effusion, ascites, and lytic bony lesions. Investigations confirmed multiple myeloma with lambda light chain disease. Positron emission tomography-computed tomography (PET-CT) scan demonstrated extensive metabolically active soft tissue masses involving the pancreatic region, retroperitoneum, mediastinum, paravertebral regions, and multiple skeletal lesions with extraosseous soft tissue involvement, along with bilateral pleural effusions with metabolically active pleural and extrapleural deposits. The patient was initiated on a bortezomib, cyclophosphamide, and dexamethasone chemotherapy regimen with therapeutic thoracentesis for pleural effusion management. After two cycles, the patient showed remarkable clinical improvement. A repeat PET-CT scan revealed significant interval regression of soft tissue masses, metabolic activity resolution, and regression of pleural and extrapleural deposits. The extensive skeletal lytic lesions showed morphological stability but regression of associated metabolic activity and extraosseous soft tissue. This case highlights the potential of novel agent-based regimens in achieving exceptional responses in multiple myeloma patients with extensive extramedullary disease (EMD), including uncommon manifestations like pleural effusion. Early recognition and prompt initiation of appropriate therapy are crucial for improving outcomes in such cases.

Trypanosoma cruzi infection in American black bears (Ursus americanus): A case report in a cub from California and serologic survey for exposure in wild black bears from several states

Trypanosoma cruzi is an important cause of disease and death in humans and dogs, and although wildlife infections are common, less is known about disease manifestations. A 12-week-old male American black bear (Ursus americanus) cub with mild lethargy and anorexia presented to a wildlife rehabilitation center in Lake Tahoe, California. The cub continued to become increasingly weak and showed decreasing interest in play and other activities. The cub was anemic and had increased γ-glutamyltransferase (GGT) liver enzymes. A large number of trypanosomes were noted on a thin blood smear. Trypanosoma cruzi was isolated in culture from a subsequent blood collection. Proliferative bony lesions were noted on radiographs, but this finding was considered unrelated to the T. cruzi infection. The number of parasites observed in thin blood smears dramatically dropped over time, but it remained PCR positive until at least nine months. The cub continued to gain weight and became increasingly active. Serum samples from the cub were positive with three different serologic assays (IFA, ELISA, and ICT). The bear was not treated because of the decreasing parasitemia and the improvement in activity and appetite. Although the bear could not be released due to issues unrelated to T. cruzi, it remains healthy in a captive facility. Sequence analysis of the DHFR-TS and COII-ND1 gene sequences confirmed the bear was infected with DTC TcIV. Following the detection of this clinical case, a serologic survey was conducted to determine the prevalence of T. cruzi exposure of black bears in California, North Carolina, and Pennsylvania. Because no serologic assay has been validated for use in bears, three different assays were used. Marked differences in apparent seroprevalence range from 1% (requiring all three assays to be positive) to ∼20.7% (requiring only one assay to be positive). Black bears are naturally exposed to T. cruzi across the United States. Future studies using PCR testing of tissues or blood would be needed to better understand the prevalence of T. cruzi in wild black bears, lineages most commonly associated with infection, and if T. cruzi represents a health threat to bears.

Methodology and development of a machine learning probability calculator: Data heterogeneity limits ability to predict recurrence after arthroscopic Bankart repair.

The aim of this study was to develop and train a machine learning (ML) algorithm to create a clinical decision support tool (i.e., ML-driven probability calculator) to be used in clinical practice to estimate recurrence rates following an arthroscopic Bankart repair (ABR). Data from 14 previously published studies were collected. Inclusion criteria were (1) patients treated with ABR without remplissage for traumatic anterior shoulder instability and (2) a minimum of 2 years follow-up. Risk factors associated with recurrence were identified using bivariate logistic regression analysis. Subsequently, four ML algorithms were developed and internally validated. The predictive performance was assessed using discrimination, calibration and the Brier score. In total, 5591 patients underwent ABR with a recurrence rate of 15.4% (n = 862). Age <35 years, participation in contact and collision sports, bony Bankart lesions and full-thickness rotator cuff tears increased the risk of recurrence (all p < 0.05). A single shoulder dislocation (compared to multiple dislocations) lowered the risk of recurrence (p < 0.05). Due to the unavailability of certain variables in some patients, a portion of the patient data had to be excluded before pooling the data set to create the algorithm. A total of 797 patients were included providing information on risk factors associated with recurrence. The discrimination (area under the receiver operating curve) ranged between 0.54 and 0.57 for prediction of recurrence. ML was not able to predict the recurrence following ABR with the current available predictors. Despite a global coordinated effort, the heterogeneity of clinical data limited the predictive capabilities of the algorithm, emphasizing the need for standardized data collection methods in future studies. Level IV, retrospective cohort study.

High Rate of Return to Sport in Contact and Collision Athletes After Arthroscopic Latarjet With Cortical Button Fixation

Background: Contact and collision athletes face a higher risk of recurrent anterior shoulder instability after surgical stabilization. The Latarjet procedure is often preferred given the high incidence of bony lesions. However, this stabilizing procedure, performed either open or arthroscopically, is met with concerns regarding complications and revision surgery rates. Purpose: To evaluate the return to sport (RTS) and assess complication and instability recurrence rates in contact/collision athletes undergoing the arthroscopic Latarjet procedure using a guided technique with suture buttons for coracoid fixations. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was conducted on contact/collision athletes who underwent the arthroscopic Latarjet procedure for recurrent anterior shoulder instability between January 2011 and March 2018. All patients were operated on arthroscopically using glenoid and coracoid guides and suture button fixation of the transferred coracoid. RTS was defined as the patient being able to participate in his or her activity without any restriction postoperatively. Two independent observers assessed patients using postoperative computed tomography (CT) scans to evaluate coracoid positioning and healing. A multivariate analysis was performed to identify predictive factors associated with persistent apprehension. A group comparison was performed to assess RTS failure risk factors. Results: In 136 contact/collision athletes (mean age, 25 ± 7 years), 93% were satisfied, and 98% achieved shoulder stability at a mean follow-up of 60 months (range, 24-117 months). No suture button–related complications or neurovascular issues were reported. Overall, 82% (112/136) returned to contact/collision sports. The mean time to RTS was 5.3 ± 1.2 months (range, 3-7.3 months). In a CT study performed 2 weeks after surgery, 87% (118/136) of bone grafts were positioned below the equator and 93% (126/136) were flush to the glenoid surface. At the 6-month postoperative CT examination, complete bone block healing was achieved in 84% (114/136). On clinical examination at the latest follow-up, 36 patients (26%) reported some anterior apprehension on testing. On multivariate analysis, patients with severe humeral bone defects (medium to large Hill-Sachs lesions, Calandra grade 2 or 3) had a higher risk of postoperative persistent apprehension. On group comparison, a visual analog scale score >3 and persistent anterior apprehension were found to be associated with failure of RTS. Conclusion: The arthroscopic Latarjet procedure with suture button fixation allowed 82% of athletes with recurrent anterior shoulder instability to return to contact or collision sports. Patients with severe humeral bone defects have a higher risk of persistent anterior apprehension and decreased RTS. The arthroscopic-guided procedure with suture button fixation is safe; accurate, with a high rate of anatomic graft positioning and healing; and reliable, with a low recurrence rate.

Skull base “intrinsic” bony mass lesions: conventional, diffusion and perfusion imaging with a proposed imaging approach

Background and purposeImaging with conventional MRI plays a pivotal role in characterization of skull base bone-intrinsic lesions, yet some lesions are very challenging. The purpose of this study is to evaluate the role of diffusion and perfusion by T2* dynamic susceptibility contrast (DSC) in characterization of such lesions.ResultsLesions showed mostly correlated with approach: Chordomas had low perfusion and intermediate to high perfusion, while chondrosarcoma had ADC value > 1.6 × 10–3/cm2 and more perfused. Metastases had variable ADC values usually intermediate with high perfusion. Plasmacytomas had similar features yet with characteristic conventional morphology and single number. Lymphoma (primary bony) had high perfusion and lowest diffusion ADC (= 04–0.7 × 10–3/cm2). Giant cell tumors and hemangiopericytomas had lowest perfusion.ConclusionThe proposed imaging approach showed very good results and high accuracy in differentiation of skull base bony lesions.

Comparing the Efficacy of the Knotless Suture Anchor Technique in Bony and Soft Tissue Bankart Lesions: A Cohort Study on Shoulder Instability Patients

Comparing the Efficacy of the Knotless Suture Anchor Technique in Bony and Soft Tissue Bankart Lesions: A Cohort Study on Shoulder Instability Patients

Repeat Exchange Autologous Cranioplasty for Recurrent Benign Osteoma: Meta-analysis and Literature Review.

Osteomas are benign bony lesions that can occur throughout the craniofacial skeleton. Surgical excision can be an effective treatment, as recurrence is relatively uncommon. Outside of incomplete resection, causes of recurrence are poorly documented, especially in the pediatric population. Exchange cranioplasty is an autologous reconstructive surgical option for patients of all ages, and it can be effective in the treatment of large calvarial osteomas. Recurrent lesions of the cranioplasty site have not been well described in the literature, with only 3 documented reports. In this study, we present a unique case of a recurrent osteoma at the site of a prior exchange cranioplasty. The authors also provide a systematic review of the literature for recurrent osteomas and highlight causes and conclusions for these lesions. Utilizing the PRISMA guidelines, a systematic review of articles published across databases was performed to identify accounts of recurrent osteomas at prior cranioplasty sites. Our systematic review illustrates that recurrent osteomas overlying different cranioplasty biomaterials is a rare entity and is due to incomplete resection of the galea and periosteum during the index procedure. Biomaterial selection for the pediatric population requires careful consideration before reconstruction. Though limited by 3 articles previously published and without a direct link to recurrence, long-term studies are needed to further guide biomaterial selection in the pediatric population to evaluate potential recurrences.

Comparison of the Latarjet Procedure and Iliac Crest Bone Graft Transfer in Bone Bankart Lesions in Recurrent Anterior Shoulder Dislocations.

There are various treatment modalities for bony Bankart lesions following glenohumeral joint dislocations. In this research, we aimed to compare the radiological and clinical results of patients who underwent the Latarjet procedure and iliac crest bone graft transfer. Clinical and radiological data of 15 patients were retrospectively evaluated. Inclusion criteria were a history of at least two dislocations, being between 18-65 years of age and having at least 10% glenoid bone loss. The exclusion criteria were defined as follows: patients who underwent only soft tissue procedures, patients who did not attend the follow-up, patients with other pathology in the upper extremity (fracture, cuff tear, etc.), and patients with a follow-up period of less than 12 months time. Nine patients underwent the Latarjet procedure and six underwent iliac crest bone graft transfer. Clinical evaluation, age, gender, body mass index, range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, Constant score, and Visual Analogue Scale (VAS) score were evaluated. Radiographic evaluation was performed with preoperative and postoperative direct radiographs and computed tomography. Mann-Whitney U test, t-test, and Fisher exact tests were used for group comparisons. The mean age of the patients was 32.6 years and the mean follow-up period was 24.9 months. When the two groups were compared, no statistical difference was found in terms of age, gender, body mass index, range of motion, Constant score, VAS score, glenoid cartilage stepping, and bone defect (p>0.05). The operation time was longer in the iliac crest bone graft transfer group compared to the Latarjet group (p<0.05). Latarjet and iliac crest bone graft transfer can be used successfully in the treatment of bony Bankart in recurrent anterior shoulder dislocations. The operation time is longer in iliac crest bone graft transfer compared to the Latarjet procedure.

Epileptic patients with anterior shoulder instability: are there specific bone lesions? A case control study

Chronic epilepsy may cause important bipolar bony lesions. We aim to compare the specific pathoanatomic metrics of the bony lesions in chronic shoulder anterior instability that occur in patients with epilepsy vs. patients without epilepsy. From 2006 to 2020, we included epileptic and nonepileptic patients with anterior recurrent shoulder instability. We randomly adjusted the patients of the 2 groups according to the sex, age, and type of management. We included 50 patients. For each included patient, we performed an in-depth analysis and comparison of the glenoid bone loss based on the computed tomography scan: PICO method (patient/population, intervention, comparison and outcomes) using the best-fit circle; and the Hill-Sachs lesion: the depth and width were given as a percentage of the humeral head diameter on an axial view. We also evaluated the engaging character of the involved lesion using the on-track vs. off-track analysis. Those characteristics were compared between the 2 groups. We found a glenoid bone loss in 32 patients. Glenoid bone loss was not significantly greater in patients with epilepsy (P=.052). A Hill-Sachs lesion was found in 42 patients (22 in the group with epilepsy and 20 in the group without epilepsy). Hill-Sachs lesions were significantly deeper and larger in the group with epilepsy (depth: 22% vs. 9%, P<.001; width: 43% vs. 28%, P=.003). In the group with epilepsy, 90% of the bone lesions were off-track vs. 30% in the group without epilepsy. Thus, the patients with epilepsy presented more engaging bony lesions than patients without epilepsy (P=.001) (OR=23). In a population of patients with epilepsy who had shoulder instability, Hill-Sachs lesions are larger and deeper than in normal patients with shoulder instability. By contrast, there is no significant difference regarding the characteristics of the glenoid bone loss if present. This implies that bone lesions in instable shoulders of patients with epilepsy need at least a bony stabilization procedure on the humeral side in the majority of cases.

Which type of supra-syndesmal fractures Weber C or Equivalent Weber C have the best reduction of the distal tibio-fibular syndesmosis? A prospective CT-scan investigation on 60 ankles

IntroductionThe reduction of the distal tibiofibular syndesmosis (SyTFd) is a crucial factor in the functional prognosis following a suprasyndesmotic ankle fracture. Few studies have compared, using computed tomography (CT), the quality of SyTFd reduction in Weber C ankle fractures (WebC) and Equivalent Weber C (EqWebC) fractures, where there is a medial ligament injury instead of a bony malleolar lesion. This CT-based study aimed to answer the following questions: (1) Do Weber C fractures allow for better reduction of the distal tibiofibular syndesmosis compared to Equivalent Weber C fractures? (2) Are the functional outcomes one year postoperatively better for Weber C fractures compared to Equivalent Weber C fractures? HypothesisThe hypothesis was that WebC fractures would present better reduction of the SyTFd than EqWebC fractures due to the restoration of bone anatomy, considering the bony nature of the medial ligament involvement. Materials and methodsSince December 2021, all patients presenting with an ankle fracture were included in a database. Suprasyndesmotic fractures were extracted, and between December 2021 and February 2022, 60 patients underwent surgery for a suprasyndesmotic fracture (28 WebC – 32 EqWebC). All patients were operated on using the same technique and underwent a postoperative bilateral CT scan in axial slices with both ankles in a neutral position (foot at 90 ° to the leg). An analysis of 8 measurements was performed under the same conditions. Each fractured ankle was compared to the healthy contralateral ankle, and a delta was obtained for each measurement. The follow-up was standardized. At one year, an AOFAS Score and a Maryland Foot Score (MFS) were recorded. Statistical differences between the two groups were measured using the Student's t-test and Chi-square test. ResultsThere was a significant difference between the WebC and EqWebC groups for clinical scores at one year postoperatively: AOFAS: 92.0 ± 6.3 [78–100] vs. 80.1 ± 5.4 [62–100], p < 0.05; MFS: 90.9 ± 6.4 [78–100] vs. 81.6 ± 5.2 [64–100], p < 0.05. CT scan analysis of the SyTFd reduction found significantly better reduction in the WebC group. DiscussionWebC fractures showed better clinical scores associated with better SyTFd reduction on postoperative CT scans. The anatomical reduction related to the bone reduction criteria during surgery could explain our findings. Level of evidenceIII; Case-Control Comparative Study.

Impact of size and fragmentation of the anteroinferior glenoid rim on clinical and functional outcomes of non-operatively treated Bony Bankart lesions in middle-aged population

IntroductionThe optimal treatment approach for Bony Bankart remains a subject of considerable debate among shoulder surgeons. Existing literature highlights low recurrence rates and high patient satisfaction with nonoperative treatment, particularly in the middle-aged population. This study aimed to evaluate the recurrence rate of dislocation, as well as the clinical and functional outcomes in middle-aged individuals treated nonoperatively following an acute bony Bankart fracture. Additionally, the impact of glenoid rim size and fragmentation on the treatment outcome was investigated.Material and methodsA prospective analysis was conducted on 20 patients aged over 50 with nonoperatively treated bony Bankart fractures, ensuring a minimum follow-up of 24 months. The study population was categorized based on fragment size (small and medium) according to Kim classification and glenoid rim fragmentation (type 1b and 1c) according to Scheibel classification. Data including UCLA score, Rowe score, recurrence rate, clinical instability, and range of motion (ROM) were collected and analyzed.ResultsThe average UCLA and Rowe scores were 32.15 ± 2.85 and 93.85 ± 2.19, respectively, with no instances of dislocation recurrence. The affected shoulder exhibited no significant reductions in ROM compared to the contralateral side, except for a loss of external rotation (ER) (13.08° ± 7.51; p = 0.005). No differences were observed based on fragment size, although patients with multifragmented glenoid rims showed a greater loss of ER compared to those with a solitary fragment, albeit not reaching statistical significance.ConclusionNonoperative treatment appears to be a viable and effective option for middle-aged individuals with bony Bankart fractures, resulting in favorable functional outcomes and a low risk of recurrence. Additionally, a notable loss of external rotation was observed in fractures with glenoid rim fragmentation.Level of evidenceIV.

PLCG2 variants in cherubism

BackgroundCherubism is most commonly caused by rare heterozygous gain-of-function (GOF) missense variants in SH3BP2, which appear to signal through Phospholipase C Gamma 2 (PLCG2) to cause excessive osteoclast activity leading to expansile lesions in facial bones in childhood. GOF variants in PLCG2 lead to autoinflammatory PLCG2-associated antibody deficiency and immune dysregulation (autoinflammatory PLAID, or PLAID-GOF), characterized by variably penetrant autoinflammatory, autoimmune, infectious, and atopic manifestations. Cherubism has not been reported in PLAID to date. ObjectiveTo determine whether GOF PLCG2 variants may be associated with cherubism. MethodsClinical, laboratory, and genomic data from two patients with cherubism and other clinical symptoms observed in patients with PLCG2 variants were reviewed. Primary B-cell receptor (BCR)-induced calcium flux was assessed by flow cytometry. ResultsTwo patients with lesions consistent with cherubism but no SH3BP2 variants were found to have rare PLCG2 variants previously shown to be GOF in vitro, leading to increased BCR-induced calcium flux in one patient’s B cells. Variable humoral defects, autoinflammatory rash, and other clinical and laboratory findings consistent with PLAID were observed as well. ConclusionGOF PLCG2 variants likely represent a novel genetic driver of cherubism and should be assessed in SH3BP2-negative cases. Expansile bony lesions expand the phenotypic landscape of autoinflammatory PLAID, and bone imaging should be considered in PLAID patients.

Utility of zero echo time (ZTE) sequence for assessing bony lesions of skull base and calvarium

The emergence of zero echo time (ZTE) imaging has transformed bone imaging, overcoming historical limitations in capturing detailed bone structures. By minimizing the time gap between radiofrequency excitation and data acquisition, ZTE generates CT-like images. While ZTE has shown promise in various applications, its potential in assessing skull base and calvarium lesions remains unexplored. Hence we aim to introduce a novel perspective by investigating the utility of inverted ZTE images (iZTE) and pseudoCT (pCT) images for studying lesions in the skull base and calvarium. A total of 35 eligible patients, with an average age of 42 years and a male/female ratio of 1:4, underwent ZTE MRI and images are processed to generate iZTE and pCT images were generated through a series of steps including intensity equalization, thresholding, and deep learning-based pCT generation. These images were then compared to CT scans using a rating scale; inter-rater kappa coefficient evaluated observer consensus while statistical metrics like sensitivity and specificity assessed their performance in capturing bone-related characteristics. The study revealed excellent interobserver agreement for lesion assessment using both pCT and iZTE imaging modalities, with kappa coefficient of 0.91 (P < 0.0001) and 0.92 respectively (P < 0.0001). Also, pCT and iZTE accurately predicted various lesion characteristics with sensitivity ranging from 84.3% to 95.1% and 82.6%-94.2% (95% CI) with a diagnostic accuracy of 95.56% and 94.44% respectively. Although both of them encountered challenges with ground glassing, hyperostosis, and intralesional bony fragments, they showed good performance in other bony lesion assessments. The pilot study suggests strong potential for integrating the ZTE imaging into standard care for skull base and calvarial bony lesions assessment. Additionally, larger-scale studies are needed for comprehensive assessment of its efficacy.

Epithelioid Hemangioma of the Spine: A Case Series and Treatment Flow Chart-Experience from a Single Centre.

Epithelioid hemangioma is recognized by the World Health Organization as a distinct benign neoplasm; however, it is characterized by locally aggressive and rarely metastasizing behavior. Epithelioid vascular tumors are rare bony vascular lesions with varying degrees of malignant potential that remain controversial because of their rarity, unusual morphological features, and unpredictable biological behavior. The application of new molecular tools, such as massive parallel sequencing technologies, have provided new diagnostic markers and an opportunity to further refine the classification of bone vascular neoplasms. Very few cases of EH of the spine have been reported in the literature; therefore, it is difficult to make evidence-based therapeutic decisions for these patients. We report herein our experience with eleven patients suffering from EH of the spine. The study population included three males and eight females treated in our center from 2016 to the present; the average age was 44.8 years (range 14-75 years). The surgical, clinical, and radiographic data were retrospectively analyzed. The mean follow-up was 34.8 months. All patients presented lytic vertebral body lesions, six of them with pathological fracture. The majority of patients (80%) presented myelo-radicular compression. All patients were surgically treated, and preoperative embolization was performed in all cases. In light of the literature review and the clinical experience of our center, we can consider EH a locally aggressive tumor that requires surgical treatment in case of symptoms. Here, we propose a treatment algorithm that could be useful in the management of patients with this rare disease.

Pink and Blue of Bones- A Histopathological Analysis of Bony Neoplasm in a Tertiary Hospital of Bihar

Background: Bone lesions have low incidence with diverse presentation and due to the presence of their limited studies it has become a challenging task to reach an accurate diagnosis. Aim and Objective: This study aims in studying variety of bony lesions observed clinically and histopathologically. Further categorizing into non neoplastic, tumour-like, benign tumour or malignant tumour and determining its correlation with the age and gender predisposition of these lesions. Materials and Methods: An ambispective study was executed in Pathology department , PMCH, Patna from May 2020 to April 2024 in which a total of 102 cases were collected. The necessary information for the retrospective analysis, such as the patient's age, sex, lesion location, and diagnosis, was obtained from the requisition form and the histopathology data kept in the department of pathology from May 2020 to May 2022. And for prospective study all the radiological proven bony lesions which were excised during period of May 2022 to April 2024 and were sent for histopathological examination were examined. Results: Non-neoplastic lesions were more common than neoplastic lesions among the 102 specimens that underwent histological examination (53 versus 49). With 21.5% of cases, tuberculous osteomyelitis was the most prevalent non-neoplastic lesion. The most common benign neoplastic lesion detected was a giant cell tumor of the bone (11.76%), while the most common malignant lesion found was osteosarcoma (2.94%). Conclusion: To improve patient management and diagnosis accuracy, it is advised to utilize clinical, radiological, and histological findings in an integrated manner.