Douglas G. Connell

Intramedullary chondroid tumors of bone: correlation of abnormal peritumoral marrow and soft-tissue MRI signal with tumor type

Abstract Objective. To determine whether enchondromas and chondrosarcomas can be differentiated on the basis of peritumoral MR signal abnormality. Design. STIR and T2-weighted MRI images were retrospectively assessed for the presence and extent of abnormal peritumoral marrow and soft-tissue signal. The cause of the peritumoral signal abnormality was determined by histologic correlation with resection specimens. The presence or absence of bone destruction was noted. Patients. Twenty-three patients were studied: ten with enchondromas (three men, seven women; ages 33–73 years) and 13 with chondrosarcomas (seven men, six women; ages 25–88 years). Results. Abnormal peritumoral marrow signal was present on STIR images around none of 10 enchondromas and all of 13 chondrosarcomas (P<0.0001). The marrow signal abnormality corresponded histologically to fine marrow fibrosis in all cases. Adjacent abnormal soft-tissue signal was present on STIR images around none of ten enchondromas and eight (62%) of 13 chondrosarcomas (P=0.0026). Abnormal soft-tissue signal was more common around high-grade than low-grade chondrosarcomas (100% vs 38%, P=0.028), and was more extensive (mean extent 28 mm vs 8 mm; P>0.04). In the subset of tumors without bone destruction, peritumoral marrow signal abnormality was present around none of ten enchondromas and all of five chondrosarcomas (P=0.0003); abnormal soft-tissue signal was present around none of ten enchondromas and two of five chondrosarcomas (P>0.05). Conclusion. Abnormal marrow or soft-tissue signal around a chondroid tumor is suggestive of chondrosarcoma, even in the absence of bone destruction. STIR images are necessary for adequate detection of peritumoral signal abnormalities.

Pictorial review: Giant cell tumours of bone

Giant cell tumour of bone is a relatively common neoplasm with limited potential for metastatic spread. These tumours usually occur at the ends of bones with their epicentre in the epiphysis. This essay will review the various common and some of the less frequently encountered manifestations of giant cell tumours at multiple different sites, as well as postoperative recurrence. Different imaging modalities including plain film, tomography, computed tomography and magnetic resonance imaging are shown.

Embolization of the left gastric artery in the absence of angiographic extravasation

Nine high-risk patients with endoscopic evidence of bleeding from the left gastric artery teritory without angiographic extravasation were embolized to prevent rebleeding. Three were embolized with Gelfoam particles, 1 with Gianturco coils, and 5 with Gelfoam plus coils. Three patients rebled; 2 were embolized with Gelfoam only, and the third with coils only. No rebleeding occurred in the 5 patients treated with Gelfoam plus coils. No ischemic complications occurred. We conclude that embolization of the left gastric artery, despite absence of extravasation, is effective in preventing rebleeding in high-risk patients and that both Gelfoam and coils be used.

Giant cell tumor of bone with selective metastases to mediastinal lymph nodes.

Abstract We report an unusual case of a recurrent giant cell tumor of the patella which presented with metastatic disease to the posterior mediastinal lymph nodes with no evidence of pulmonary metastases. The patient underwent chemotherapy with subsequent successful removal of the mediastinal mass. A review of the reported cases of mediastinal giant cell tumor metastases is provided.

Soft tissue osteosarcoma with telangiectatic features: MR imaging findings in two cases

Abstract Extraskeletal osteosarcomas are rare tumors, and the telangiectatic variety is the least common histological variety in this group. This report describes the clinical and MR imaging findings in two cases arising in the pretibial soft tissues. Both tumors demonstrated marked inhomogeneity with T2-weighted spin echo and STIR sequences. One of the tumors revealed numerous fluid levels within the lesion. A review of the MRI features of these tumors is provided. Osteosarcoma with telangiectatic features should be considered in the differential diagnosis of a soft tissue mass with fluid-fluid levels in patients 40 years of age or older.

Chondroid lipoma: MRI appearances with clinical and histologic correlation.

Abstract Chondroid lipoma is a recently described benign tumor of adipose origin which, pathologically, mimics myxoid liposarcoma and myxoid chondrosarcoma. This tumor typically presents as a well-defined mass in the superficial tissues of the extremities. In this report, we present the magnetic resonance imaging (MRI) appearances of a pathologically proven chondroid lipoma. To our knowledge, this is the first report of any imaging findings associated with this tumor.

Low-grade parosteal osteosaracoma of the ulna with dedifferentiation into high-grade osteosarcoma

Abstract This report describes a low-grade parosteal osteosarcoma of the ulna with dedifferentiation into high-grade osteosarcoma. The clinical, pathological, and imaging findings are described and discussed.

Case report 550

This 33-year-old woman presented with a ~l /2-year-history of right hip and groin pain. Her initial complaint was of intermittent stiffness following sitting. This progressed slowly for 18 months. At this time she developed painful snapping in the groin associated with the sensation of the hip giving way. At presentation, she was having pain at rest and at night and was falling at least once a day. Past history revealed that she had an osteotomy (type unknown) at age 15 months for correction of congenital dislocation of the right hip. Examination revealed tenderness over

Low-dose streptokinase thrombolysis of axillary-subclavian vein thrombosis

Nine patients with 10 episodes of acute axillary-subclavian vein thrombosis were treated with local low-dose streptokinase infusion. All patients except one were heparinized during the procedure with conversion to oral anticoagulation upon completion of the infusion. Recanalization was achieved in 7 patients (70%). Thrombosis recurred in 1, and in 2 patients the procedure was unsuccessful. No major complications were encountered. We concluded that local low-dose streptokinase infusion is a safe, simple, and effective method for treating acute axillary-subclavian vein thrombosis.

Case report 708

A patient is described who presented with a painful soft-tissue mass in the region of the right shoulder 10 months following nephrectomy for carcinoma. This mass proved to be a metastasis to skeletal muscle. A full metastatic work-up demonstrated no other detectable lesions. Metastases to skeletal muscle are rare, regardless of the site of origin, and their true incidence is difficult to determine since they rarely present clinically and are not routinely searched for, even on autopsy.