Soft Tissue Components Research Articles

THE COMPLICATIONS OF DIFFERENTIAL DIAGNOSTICS OF HODGKIN LYMPHOMA

In the article are presented the questions of classification, pathogenesis and clinical diagnostics of Hodgkin Lymphoma with soft-tissue paravetebral component. The difficulties of early diagnostics, expressed at the expanse by oncological process localization, not typical for this disease, are shown on clinical case. The symptoms, conditioned by the compression of organs by tumor masses depend on pathological process localization: intrahepatic and extrahepatic obstruction of bile duct is manifested by jaundice; obstruction of lymphatic ducts in groin zone or in zone of small pelvic – by legs edema; at tracheobronchial compression is observed the pant and hoarse breathing; pulmonary abscesses or caverns can take place as a result of infiltration of pulmonary parenchyma that can stimulate lobar consolidation or bronchopneumonia; paraplegia can be observed because of epidural invasion with spine cord compression; compression of sympathetic cervical recurrent guttural nerve by increased lymph nodes can cause Horner’s syndrome and laryngoparalysis; neuralgias can be the result of nerve-root incarceration. Differential diagnostics can take a long time that lowers the effectiveness of therapy and decreases chances for recovery because of special treatment delay. The setting of correct diagnosis and choice of adequate therapy raises the chances for recovery, even at spead stage of tumor process that is attained at Hodgkin lymphoma in most cases.

Tubercular spondylitis: A review of MRI findings in 80 cases

BackgroundTuberculosis of spine is known as tubercular spondylitis or Pott's spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Pott's spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases. MethodsIn this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine. ResultsOf the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21–40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases. ConclusionTubercular spondylitis or Pott's spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses.

Accuracy of Various MRI Sequences in Determining the Tumour Margin in Musculoskeletal Tumours.

SummaryBackgroundIt is imperative that bone tumour margin and extent of tumour involvement are accurately assessed pre-operatively in order for the surgeon to attain a safe surgical margin. In this study, we comprehensively assessed each of the findings that influence surgical planning, on various MRI sequences and compared them with the gold standard – pathology.Material/MethodsIn this prospective study including 21 patients with extremity bone tumours, margins as seen on various MRI sequences (T1, T2, STIR, DWI, post-gadolinium T1 FS) were measured and biopsies were obtained from each of these sites during the surgical resection. The resected tumour specimen and individual biopsy samples were studied to assess the true tumour margin. Margins on each of the MRI sequences were then compared with the gold standard – pathology. In addition to the intramedullary tumour margin, we also assessed the extent of soft tissue component, neurovascular bundle involvement, epiphyseal and joint involvement, and the presence or absence of skip lesions.ResultsT1-weighted imaging was the best sequence to measure tumour margin without resulting in clinically significant underestimation or overestimation of the tumour extent (mean difference of 0.8 mm; 95% confidence interval between −0.9 mm to 2.5 mm; inter-class correlation coefficient of 0.998). STIR and T1 FS post-gadolinium imaging grossly overestimated tumour extent by an average of 16.7 mm and 16.8 mm, respectively (P values <0.05). Post-gadolinium imaging was better to assess joint involvement while T1 and STIR were the best to assess epiphyseal involvement.ConclusionsT1-weighted imaging was the best sequence to assess longitudinal intramedullary tumour extent. We suggest that osteotomy plane 1.5 cm beyond the T1 tumour margin is safe and also limits unwarranted surgical bone loss. However, this needs to be prospectively proven with a larger sample size.

Relationship of bone erosion with the urate and soft tissue components of the tophus in gout: a dual energy computed tomography study.

Imaging and pathology studies have established a close relationship between tophus and bone erosion in gout. The tophus is an organized structure consisting of urate crystals and chronic inflammatory tissue. The aim of this work was to examine the relationship between bone erosion and each component of the tophus. Plain radiographs and dual energy CT scans of the feet were prospectively obtained from 92 people with tophaceous gout. The 10 MTP joints were scored for erosion score, tophus urate and soft tissue volume. Data were analysed using generalized estimating equations and mediation analysis. Tophus was visualized in 80.2% of all joints with radiographic (XR) erosion [odds ratio (OR) = 7.1 (95% CI: 4.8, 10.6)] and urate was visualized in 78.6% of all joints with XR erosion [OR = 6.6 (95% CI: 4.7, 9.3)]. In mediation analysis, tophus urate volume and soft tissue volume were directly associated with XR erosion score. About a third of the association of the tophus urate volume with XR erosion score was indirectly mediated through the strong association between tophus urate volume and tophus soft tissue volume. Urate and soft tissue components of the tophus are strongly and independently associated with bone erosion in gout.

COMPARISONS AMONG COMPUTED TOMOGRAPHIC FEATURES OF ADIPOSE MASSES IN DOGS AND CATS.

A better understanding of the CT features of different forms of canine and feline adipose tumors would be valuable for improving patient management and treatment. The purpose of this retrospective, cross-sectional study was to describe and compare the CT features of pathologically confirmed lipomas, infiltrative lipomas, and liposarcomas in a sample of canine and feline patients. A total of 50 animals (46 dogs, four cats) and a total of 60 lesions (23 lipomas, 20 infiltrative lipomas, and 17 liposarcomas) were included in the study. Lipomas appeared as round to oval-shaped (n = 21), well-marginated (n = 20) fat-attenuating lesions. Infiltrative lipomas appeared as homogeneous, fat-attenuating masses but, unlike lipomas, they were most commonly characterized by an irregular shape (75%; P < 0.001), and linear components, hyperattenuating relative to the surrounding fat (100%; P < 0.05). Liposarcomas were represented exclusively by heterogeneous lesions with soft tissue attenuating components with a multinodular appearance (76.5%; P < 0.05). Regional lymphadenopathy (n = 10) and amorphous mineralization (n = 4) were also observed in association with liposarcomas. Computed tomography can provide useful information regarding disease location, extent, and involvement of the adjacent structures. Tumor definition and shape were the most useful parameters to differentiate between lipomas and infiltrative lipomas. The presence of a heterogeneous mass, with a multinodular soft tissue component and associated regional lymphadenopathy and mineralization, were features favoring a diagnosis of liposarcoma.

Primary alveolar rhabdomyosarcoma of the bone: two cases and review of the literature

BackgroundRhabdomyosarcoma (RMS) is a malignant tumor of mesenchymal origin and comprises the largest category of soft-tissue sarcomas both in children and adolescents. From a pediatric oncology point of view, RMS has traditionally been classified into alveolar (ARMS) and embryonal (ERMS) subtypes. The anatomical localization of the tumor may vary, but commonly involve the head/neck regions, male and female urogenital tract or the trunk and extremities.Case presentationHere, we report two challenging cases involving 17- and 9-years-olds males where diffuse and multiplex bone lesions suggested either a hematological disease or a primary bone tumor (mesenchymal chondrosarcoma). Biopsies, proved a massive infiltration of the bone marrow cavity with rhabdomyosarcoma. In both cases, the ARMS subtype was confirmed using FOXO1 break-apart probes (FISH). Radiological examination could not identify primary soft tissue component in any localization at the time of diagnosis in either cases.ConclusionsPrimary alveolar rhabdomyosarcoma of the bone as a subtype of ARMS, seems to be a distinct clinico-pathological entity with challenging diagnostic difficulties and different, yet better, biological behavior in comparison to soft tissue ARMS. However, it is difficult to be characterized or predict its prognosis and long-term survival as only sporadic cases (four) were reported so far.

Maxillary Sinus Grafting With Biphasic Bone Ceramic or Autogenous Bone: Clinical, Histologic, and Histomorphometric Results From a Randomized Controlled Clinical Trial.

The present, randomized, controlled clinical trial compared the histologic and histomorphometric results from maxillary sinus augmentation with either biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% β-tricalcium phosphate) or autogenous bone (AB) as bone-grafting materials. Ten patients received bilateral sinus elevation surgery with intraoral AB chips (control group) on one side and BCP (test group) on the contralateral side. After a healing period of 6 to 8 months, implant sites were created and trephine cores were harvested for histological and histomorphometric analysis of the grafted areas. The histological examination of biopsies showed BCP particles interconnected by bridges of a vital newly formed bone. Histomorphometry demonstrated that the amount of newly formed bone in the control group (36.8%) was significantly greater than that in the BCP (28.2%) group (P = 0.0032). BCP and AB cores revealed an average of residual graft particles of 32.9% and 4.8%, respectively. The average percentage of soft tissue components was 38.9% in the BCP cores and 58.4% in the AB cores. Based on our findings, the amount of vital bone formation was significantly higher for AB than that for BCP. However, BCP seemed to be a biocompatible and osteoconductive material that can be used with success as a bone substitute in maxillary sinus procedures.

Tissue Engineering and the Future of Facial Volumization.

Volume loss due to facial aging can be restored by facial volumization using a variety of materials. Volumization can be performed in isolation or concurrent with other facial rejuvenation procedures to obtain an optimal aesthetic result. There is a myriad of manufactured products available for volumization. The use of autologous fat as facial filler has been adopted more recently and possesses certain advantages; however, the ideal filler is still lacking. Tissue engineering may offer a solution. This technology would provide autologous soft-tissue components for use in facial volumization. The use of stem cells may enable customization of the engineered product for the specific needs of each patient.

Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study.

This study was undertaken to determine the correlation between the radiological changes in haemophilic arthropathy [X-ray, Ultrasound (US) and MRI] and clinical assessment as determined by the Hemophilia Joint Health Score (HJHS); and to document the US and MRI changes in joints that appear normal on plain X-ray and clinical evaluation. Of 55 study joints (22 knees and 33 ankles) in 51 patients with haemophilia/von Willebrand disease, with a median age of 15 years (range: 5-17) were assessed using X-rays (Pettersson score) and clinical examination (HJHS) at two centres (Toronto, Canada; Vellore, India). MRI and ultrasonographic scoring was done through a consensus assessment by imagers at both centres using the IPSG MRI and US scores. The HJHS had a good correlation with the Pettersson score (rs = 0.66). Though the HJHS had moderate correlation with the osteochondral component of the MRI and US scores (rs 0.51, 0.45 respectively), its correlation with the soft tissue component was poor (rs 0.19; 0.26 respectively). Of the 18 joints with a Pettersson score of zero, 88.9% had changes that were detected clinically by the HJHS. Osteochondral abnormalities were identified in 38.9% of these joints by the MRI, while US images of the same joints were deemed abnormal in 83.3% by the current criteria. US identified haemosiderin and other soft tissue changes in all of the joints, while the same changes were noted in 94.4% of these joints on MRI. There were four joints with a HJHS of zero, all of which had soft tissue changes on MRI (score 1-7) and US (score 2-7). Osteochondral changes were detected in three of these joints by US and in 2 by MRI. There were four joints with an MRI score of 0-1 that had significant US scores (3-5) and HJHS scores (0-6). US and MRI are able to identify pathological changes in joints with normal X-ray imaging and clinical examination. However, further studies are required to be able to differentiate early abnormalities from normal. Clinical (HJHS) and radiological assessment (US/MRI) provide complimentary information and should be considered conjointly in the assessment of early joint arthropathy.

Pre and Post Radiotherapy Imaging findings of Aggressive Vertebral Haemangioma of the Thoracic Spine

Vertebral hemangiomas (VH) are common unifocal or multifocal benign lesions in spine imaging with incidence of 10%-12%. Patients are usually asymptomatic and often vertebral hemangioma is incidental finding on imaging. An aggressive or atypical vertebral hemangiomas have associated imaging features like extra-osseous extension, compression fractures, vertebral ballooning & soft tissue components exist with incidence of 1% to 3%. Treatment protocols for aggressive VHs include combination of radiotherapy, vertebroplasty, alcohol injection, embolization, and surgery. We present a case of 24 year female patient having aggressive D12 vertebral hemangioma showing extra-osseous extension, ballooning and small intra-spinal soft tissue component not causing cord compression and follow up imaging after completion of radiotherapy.

Simple Bone Cyst with Mesenchymal Proliferation Involving Epiphysis of the Proximal Fibula: A Case Report

: Epiphyseal involvement of a simple bone cyst (SBC) is rare. Furthermore, its pathological variant is even more uncommon. Herein, we report a case of a 22-year-old woman with an SBC containing unusual mesenchymal tissue proliferation with epiphyseal involvement in the proximal fibula. Magnetic resonance imaging showed a cystic lesion that involved the entire epiphysis as well as some soft tissue components. Hence, our initial differential diagnosis did not include SBC. However, pathology confirmed a SBC. Thus, SBC should be considered in the diagnosis of cystic lesions despite the atypical imaging findings.

A Novel Semiautomated Fractional Limb Volume Tool for Rapid and Reproducible Fetal Soft Tissue Assessment.

The purpose of this study was to document the reproducibility and efficiency of a semiautomated image analysis tool that rapidly provides fetal fractional limb volume measurements. Fifty pregnant women underwent 3-dimensional sonographic examinations for fractional arm and thigh volumes at a mean menstrual age of 31.3 weeks. Manual and semiautomated fractional limb volume measurements were calculated, with the semiautomated measurements calculated by novel software (5D Limb Vol; Samsung Medison, Seoul, Korea). The software applies an image transformation method based on the major axis length, minor axis length, and limb center coordinates. A transformed image is used to perform a global optimization technique for determination of an optimal limb soft tissue boundary. Bland-Altman analysis defined bias with 95% limits of agreement (LOA) between methods, and timing differences between manual versus automated methods were compared by a paired t test. Bland-Altman analysis indicated an acceptable bias with 95% LOA between the manual and semiautomated methods: mean arm volume ± SD, 1.7% ± 4.6% (95% LOA, -7.3% to 10.7%); and mean thigh volume, 0.0% ± 3.8% (95% LOA, -7.5% to 7.5%). The computer-assisted software completed measurements about 5 times faster compared to manual tracings. In conclusion, semiautomated fractional limb volume measurements are significantly faster to calculate when compared to a manual procedure. These results are reproducible and are likely to reduce operator dependency. The addition of computer-assisted fractional limb volume to standard biometry may improve the precision of estimated fetal weight by adding a soft tissue component to the weight estimation process.

Imaging evaluation of bone tumors.

The radiographic approach to bone tumors consists in analyz-ing a certain lesion in an organized manner, paying attention tospecific radiographic features such as location, margins and tran-sition zones, periosteal reaction patterns, mineralization, lesionsize, and whether or not soft tissue components are present

Primary Intracranial Ewing's Sarcoma (Peripheral Primitive Neuroectodermal Tumour of Parietal Bone) with Spinal and Pelvic Metastasis in a Young Female Child: Rare Case Report and Review

Introduction The Peripheral Primitive Neuroectodermal Tumour (pPNET)/Ewing's sarcoma family tumor (ESFT) group is a recently redefined term which includes all small round cell tumors of bone, soft tissue, and nerve with a common neuroectodermal origin. These highly aggressive pediatric soft tissue tumors occur less frequently in the craniospinal axis. Primary cranial lesion associated with spinal and pelvic metastasis is a rare presentation. Clinical Presentation A 9-year old girl was hospitalized with features of progressive increase in intracranial pressure with quadriparesis. The patient had ⅘ quadriparesis with bilateral papilledema. Brain MRI showed a large, hetero intense, contrast enhancing right parietal bony lesion infiltrating the dura with mass effect over the brain. Brain CT showed bony expansion and multiple calvarial lytic lesions. MRI cervical spine revealed collapsed fourth cervical vertebral body with extensive paravertebral and paraspinal soft tissue components with cord compression. Metastatic workup revealed a lytic lesion in the left iliac bone and left lung. The patient underwent a surgically challenging C4 corpectomy with cage fixation followed by craniotomy and excision of parietal bony lesion with titanium mesh cranioplasty in the same sitting. Histopathology revealed pPNET and was confirmed by CD99 positivity. Conclusion This rare multiple site tumor presentation was carefully planned and effectively managed by a combined single-stage surgical approach involving total excision of primary parietal bone and metastatic cervical spine tumors with primary titanium mesh cranioplasty and cervical spine stabilization, followed with radiotherapy and chemotherapy, which resulted in good recovery and improved the overall prognosis for the patient.

Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing.

Fat-containing tumors are the most common soft-tissue tumors encountered clinically. The vast majority of fat-containing soft-tissue masses are benign. Lipomas are the most common benign fat-containing masses and demonstrate a characteristic appearance at magnetic resonance (MR) imaging. Less common benign soft-tissue masses include lipoblastoma, angiolipoma, spindle cell lipoma/pleomorphic lipoma, myolipoma, chondroid lipoma, lipomatosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas (WDLPSs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metastasize. Biologically more aggressive liposarcomas include myxoid, pleomorphic, and dedifferentiated liposarcomas. At MR imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septa. The presence of thick, irregular, enhancing septa and nonfatty soft-tissue mass components suggests liposarcoma rather than lipoma. However, benign lipomatous lesions and WDLPS/ALT often have overlapping MR imaging findings. Distinguishing WDLPS/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be challenging and often requires histologic evaluation. We present the spectrum of fat-containing masses, using the World Health Organization classification of adipocytic tumors, with an emphasis on commonly encountered lesions, characteristic MR imaging findings associated with specific tumors, and overlapping MR imaging findings of certain tumors that may require histologic sampling. We also briefly discuss the role of molecular markers in proper characterization and classification of fat-containing soft-tissue masses. (©)RSNA, 2016.

Finding the Nidus: Detection and Workup of Non-Central Nervous System Arteriovenous Malformations.

Vascular anomalies are a diverse group of pathologic conditions. They have different manifestations, natural histories, and treatments. Compared with other vascular malformations, arteriovenous malformations (AVMs) are considered the most symptomatic and difficult to manage. AVMs inherently progress and have a high rate of recurrence after treatment. Imaging helps provide an accurate and early diagnosis, which can then be used to direct appropriate management, with embolization evolving as the primary therapy. Thus, radiology plays a crucial role in the detection, workup, and management of AVMs. Ultrasonography (US) is a useful initial imaging modality, particularly when AVMs involve the extremities or a superficial or accessible location. Limitations include poor identification of soft-tissue and bone components, as well as suboptimal evaluation of deep or complex AVMs. Magnetic resonance (MR) angiography is the preferred imaging modality for AVMs and should be considered in any symptomatic patient or in the initial evaluation of vascular anomalies that are equivocal at US. Computed tomographic angiography should be reserved for those patients who are unable to undergo MR angiography or for evaluation of acute symptoms, such as bleeding or airway compromise. Conventional catheter-based angiography is useful for real-time depiction and evaluation of AVMs, particularly in the planning and execution of endovascular treatment and in the diagnosis of an AVM when findings from noninvasive imaging are equivocal for a high-flow component. As with the diagnostic workup, MR angiography is the preferred posttreatment modality. (©)RSNA, 2016.

Challenges and pitfalls in diagnosis of Parosteal Osteosarcoma: A clinicopathologic study of 23 cases

Objective: Parosteal Osteosarcoma (PO) is an uncommon variant of osteosarcoma. Diagnosing PO is important due to itsmalignant nature but the diversity of histologic features makes it challenging by adding a number of soft tissue, bony andcartilaginous lesions into the list of differential diagnosis. Our aim was to study the clinicopathologic and histological features ofPO with emphasis on features helpful in its discrimination from other mimicking lesions. Methods: We reviewed 23 cases of PO diagnosed in our institution between January 2001 and August 2015. Results: Femur was the most commonly involved bone (68.2%) along with other long bones and rib in a single case. Soft tissuecomponent was graded as Grade1 in 9(39%), Grade2 in 8(34.7%) and Grade3 in 4(17.3%) cases. Bony component was seeneither in combination of or exclusively as parallel streams and interconnected trabeculae (mosaic-pattern). Out of 9 cases withcartilage component, 3 showed a cartilage cap. 2(8.6%) cases showed dedifferentiation into osteosarcoma. Conclusion: PO should always be considered in the differential diagnosis of every lesion arising from the bone surface.Knowledge of the variations in histologic features helps to reach the correct diagnosis which should never be made withoutradiological correlation.

Back pain due to spinal metastatic leiomyosarcoma

A 25-year-old female patient presented with severe back pain. Contrast-enhanced thoracic magnetic resonance imaging revealed a large mass lesion at the body of the T11 vertebra and adjacent paravertebral soft tissues including the retroaortic area. The lesion was hypointense on T1-weighted images and hyperintense on T2-weighted images (Fig. 1A–C, E, and F). After intravenous contrast medium administration, the lesion showed diffuse and significant contrast enhancement (Fig. 1D and G). Computed tomography-guided percutaneous core needle biopsy was performed for the definitive diagnosis (Fig. 2, Left). The histopathologic diagnosis of the lesion was reported as metastatic leiomyosarcoma. The patient was given a neoadjuvant chemotherapy as the first step of treatment. The soft tissue component of the lesion demonstrated a marked decrease in size on her control contrast-enhanced thoracic MRI performed at the end of this chemotherapy protocol (Fig. 2, Middle and Right). After this initial treatment, T11 corpectomy operation was performed so as to resect the bony part of the lesion.

An unusual thoracic spinal pathology presenting as a dorsally exophytic intramedullary lesion

A 45-year-old woman presented with progressive spastic weakness of her lower limbs of 5 years' duration. She had previously undergone laminectomy and decompression of a thoracic lesion elsewhere. Magnetic resonance imaging of her spine (Fig. 1) demonstrated a well-defined intramedullary lesion from the T3 to T6 levels that was hyperintense on T1- and T2-weighted sequences. It had a broad, dorsally located exophytic component. Patchy areas of heterogeneously enhancing T2 isointense soft tissue components were seen in the superior aspect of the lesion (Fig. 2). There was no infiltration of the lesion into surrounding structures. The diagnosis was consistent with that of a recurrent intramedullary lipoma with a dorsally exophytic component. She underwent re-exploratory surgery and decompression of the lesion. Histopathology confirmed the lesion to be a lipoma. Fig. 2Gadolinium-enhanced T1 magnetic resonance imaging (MRI): (Left) midsagittal section showing patchy enhancement in the superior aspect of the lesion; (Right) axial section demonstrating the enhancing area extending into the exophytic component. View Large Image Figure Viewer Download Hi-res image

Acute Compartment Syndrome Following Fulkerson Surgical Technique in Patellofemoral Instability

Patellofemoral instability affects mostly young and active people. Patients present with Episodes of mechanical instability of the patella and anterior knee pain. Surgery can address both bony and soft-tissue components; however, no gold standard exists in the literature for surgical treatment. Fulkerson osteotomy technique for surgical repair was employed in this case, which resulted in immediate acute compartment syndrome for this patient. Acute compartment syndrome is an emergent condition requiring immediate surgical attention. This article assesses a case of acute compartment syndrome following Fulkerson osteotomy for anteromedial tibial tubercle transfer surgery in Patellofemoral syndrome involving a 19-year-old female. Resultant compartment syndrome following a Fulkerson technique surgery is rare in literature. This is a case of protracted pain, paresthesia, and paralysis through multiple surgical interventions and rehabilitation designed to preserve her lower limb due to the resultant acute compartment syndrome. This patient’s history is significantly unique in the literature and is reported here for study regarding occurrence and in preventing future potential surgical complications in similar patients.