Clavicular Lesion Research Articles

Benign clavicular lesions that may mimic malignancy

Nontraumatic lesions of the clavicle are infrequent. Of these, malignant tumors are more common than benign lesions. From January 1988 to January 1990, we examined 17 patients with benign lesions of the clavicle; in 8, the morphologic appearance of the lesion raised the possibility of malignancy in the differential diagnosis. The radiologic findings in these patients are presented. We propose that the unique shape and embryologic development of the clavicle may contribute to the atypical, aggressive presentation of some benign lesions in that bone.

LYTIC BONE LESIONS AND POLYARTHRITIS ASSOCIATED WITH ACNE FULMINANS

We describe a case of a male teenager, affected by acne fulminans. He had lytic bone lesions in both clavicles and arthritis of the right sacroiliac joint and spine. A bone scan showed increased uptake in these areas. Infection or a neoplastic disease was suspected but the cytological examination and the bacterial cultures of the material collected with a fine needle biopsy from the clavicular lesion were negative. The patient was treated with diclofenac and promptly recovered. Our report emphasizes that, although unusual, acne fulminans can be complicated by an erosive systemic arthritis and bone lesions. An immunological mechanism seems to be involved in this association.

Pustulosis palmoplantaris and its relation to chronic recurrent multifocal osteomyelitis.

In previous study we found that clavicular lesions in chronic recurrent multifocal osteomyelitis (CRMO) in young patients was associated with palmoplantar pustulosis (PPP). In this work the relationship between sternoclavicular lesions and PPP was studied in a group of adult patients. The sternoclavicular region of 52 patients with PPP and 25 control persons was examined by tomography. Among the PPP patients there were inflammatory lesions in the sternal synchondroses in 3 patients. There were no such lesions in the controls. In this unselected population of adult patients there was thus no definite association between PPP and sterno-clavicular lesions. In young patients on the other hand, CRMO with clavicular lesions may be another, probably noninfectious, cause of PPP.

Osteolysis of the Acromial End of the Clavicle in Rheumatoid Arthritis

Destructive changes in the acromial end of the clavicles have been reported in 11 patients with advanced rheumatoid arthritis by Alpert (1961).We wish to report a similar case which has recently come to our notice.The patient was a 37-year-old male with a three year history of rheumatoid arhtritis. The main radiographic findings were tapering of the acromial end of right clavicle and widening of the acromioclavicular joint space. Two remnants of non-osteolysed bone were seen between the acromion and the end of clavicle. The shoulder joint was not affected. Roentgen examination of another joints were within normal limits.This clavicular lesion must be distinguished from bone destruction caused by hyperparathyroidism, post-traumatic osteolysis, tuberculosis and acro-osteolysis.

A BIOPSY CASE OF PLEOMORPHIC HEMANGIOBLASTIC SARCOMA OF THE THORACIC WALL

A 14-year-old girl, was operated in October, 1957, with hemorrhagic tumor of the left clavicular lesion of the chest. Histologically, this tumor showed various patterns as in the following : Hemangioendotheliomatous, gemmangiomatous, fibrosarcomatous, xanthomatous and giant cell-like or pseudoalveolar ones. The outstanding neoplastic cells showing giant cell-like or pseudoalveolar arrangement were characterized by large nuclei, intensely basophilic cytoplasm and the potentialities to differentiate into endothelial cells, fibrocytes, pericytes and foam cells. This tumor, therefore, may be regarded as an undifferentiated mesenchymal mesoblastic sarcoma (hemangioblastic sarcoma) of the thoracic wall.

Skeletal Cryptococcosis (Torulosis)

The prognosis for patients in whom skeletal cryptococcosis is associated with "generalized" or meningeal involvement is poor, and there have been no recorded survivals of such patients in spite of therapy. In contrast to the fatal results in this group, however, the results in patients with localized bone disease have been good; these patients have all been well at the time their cases were reported. Table II lists these cases, describing the bones involved and the therapy employed. It is interesting to note that in all but two of these cases surgical extirpation of the disease locally was performed with apparently good results. In the case presented by Leopold cryptococcal infection of the talus and carpus was further complicated by the presence of pulmonary moniliasis. The patient in this case received vaccine therapy, but local excision of the diseased bone was not performed. The bone lesions apparently healed, but no change occurred in the pulmonary lesions. In the authors' case the clavicular lesion was treated by local curettement while the radial lesion was left untouched. Both lesions healed satisfactorily, but an analysis of the cause of this satisfactory outcome was clouded by the fact that several antibiotic and chemotherapeutic agents had been used. After reviewing this small series of cases, the authors feel that the prognosis for patients with localized bone lesions is good regardless of the therapy employed. They also feel, however, that surgical removal of the diseased bone will enhanced healing and will lessen the possibility of dissemination of the disease.