Extraosseous Extension Research Articles

Synovial hyperemia in giant cell tumor of bone: angiographic pitfall.

Arteriography has been found useful in the clinical staging of giant cell tumors of bone in its capacity to demonstrate the presence and extent of soft tissue, extraosseous extension of the tumor. A potential source of error is the presence of hyperemic synovial tissue that may closely resemble tumor vascularity, and therefore be confused with tumor extraosseous extension. Of the 48 giant cell tumors in this series, 21 demonstrated extraosseous vascularity representing synovial hyperemia. Two patients were considered to have extraosseous tumor extent but only hypertrophic synovial tissue was found at surgery. The angiographic features of synovial hyperemia are outlined.

Angiographic features of osteosarcoma

Arteriography was carried out in 64 cases of pathologically confirmed osteosarcoma to evaluate the angiographic features of this lesion. This investigation proved that a variety of angioarchitectures exist in osteosarcomas, mainly related to the histologic type of tissue as well as the degree of differentiation of a tumor. Fibroblastic and chondroblastic osteosarcomas proved to be less vascular than the osteoblastic type, while the most differentiated tumor appeared to be the least vascular. This technique proved useful in choosing the proper site, or sites, for biopsy as well as for determining the intra- and extraosseous extension of the tumor. Instances were also encountered in which it was of assistance in differentiating osteosarcoma from pathologically similar bone lesions.

Symptomatic vertebral haemangiomas.

Eight cases of vertebral haemangioma causing spinal cord or nerve root compression are described, together with one other which was not causing organic signs or symptoms. The compression was due to extradural tumour in 5 cases, bony expansion encroaching on the neural canal in 2 cases, and a combination of bony expansion and extradural tumour in one case. When present the classical radiological appearance of accentuated vertical striation or honeycomb pattern is easily recognized, but atypical features, such as apparent pedicular erosion, paravertebral soft tissue mass and bony expansion, may occur, making diagnosis more diffcult. In 2 cases the correct diagnosis was not made before surgery. In one of these there were no plain film changes and in the other a metastasis was considered the more likely diagnosis. In the asymptomatic case the absence of extra-osseous extension was an important factor in excluding any possible clinical significance of the haemangioma. The great importance of pre-operative spinal angiography is stressed.

Management of critical valvular outflow obstruction in neonates.

OBJECTIVE: To present a case of metastatic esthesioneuroblastoma (ENB) involving the spine. BACKGROUND: Esthesioneuroblastoma (also known as olfactory neuroblastoma) is a rare malignancy of the olfactory epithelium. Although local invasion beyond the nasal cavity and adjacent sinuses is common, distant metastases are extraordinarily rare. To date, fewer than thirty documented cases involving the spine, spinal cord, or leptomeninges have been reported. DEISGN/METHODS: Case report. Review of clinical notes, pathology, and imaging studies. RESULTS: A 67 year-old woman presented with recurrent epistaxis. Computer tomography (CT) revealed an expansile right nasal mass causing remodeling of the nasal cavity and medial orbital wall. She underwent a gross total resection and was diagnosed with ENB - Kadish Stage C (extension beyond the nasal cavity and paranasal sinuses). Post-operatively, she was treated with 59.4 Gy of radiation delivered over 33 fractions. Post treatment surveillance consisted of frequent nasal endoscopies. Twenty months after diagnosis she presented with complaints of left shoulder pain as well as lower back pain affecting her ability to walk. Neurological examination was limited by discomfort but was notable for hyperreflexia at the knees and decreased rectal tone. X-ray revealed a pathological fracture of the left humerus. Magnetic resonance imaging (MRI) of the spine showed destructive lesions at T12 and L1 with prominent extraosseous extension into the epidural and paraspinal spaces resulting in severe spinal canal stenosis, neural foraminal effacement and cord compression. CT-guided biopsy provided the diagnosis of metastatic ENB. The patient underwent a multilevel posterior laminectomy and fusion to decompress the spine. She had a full neurological recovery. CONCLUSIONS: Distant metastases from ENB are rare, but can occur despite careful surveillance for local recurrence. Patients with ENB who present with back pain should be imaged early to investigate the possibility of drop metastases. <b>Disclosure:</b> Dr. Armand has nothing to disclose. Dr. Welch has nothing to disclose.