Elaine MacDuff

Imaging in osteofibrous dysplasia, osteofibrous dysplasia-like adamantinoma, and classic adamantinoma

Fibro-osseous lesions of the bone are well-recognized primary bone tumours. However, given the degree of overlap of imaging findings and variation in management of various sub-types, it is a widely accepted practice to perform a biopsy to obtain histopathological confirmation of the diagnosis. The following is a summary of the epidemiology, clinicopathological features, and review of the imaging features of fibro-osseous lesions, including osteofibrous dysplasia, osteofibrous dysplasia-like adamantinoma, adamantinoma, and lesions that closely mimic them. The illustrated examples are histologically proven cases that were presented to a tertiary referral teaching hospital and national bone and soft-tissue tumours unit. It is important that all radiologists are aware of the nature and imaging characteristics of these tumour sub-types, so that suspected lesions are recognized and appropriately referred to specialist bone tumour services for work-up and management.

Primary Osseous Tumors of the Hindfoot: Why the Delay in Diagnosis and Should We Be Concerned?

BackgroundBony tumors of the foot account for approximately 3% of all osseous tumors. Diagnosis is frequently delayed as a result of lack of clinician familiarity and as a result of their rarity. The reasons for the delays, however, are unclear.Questions/purposesWe therefore determined (1) how hindfoot tumors present and the specific reasons for delay in diagnosis; (2) whether the spectrum of disease varies between the talus and calcaneus; and (3) how these patients were treated.MethodsWe retrospectively reviewed the medical notes and imaging for all patients with 34 calcaneal and 23 talar tumors recorded in the Scottish Bone Tumour Registry. Demographics, presentation, investigation, histology, management, recurrence, and mortality were recorded.ResultsHindfoot tumors present with pain and often swelling around the heel (calcaneus) or ankle (talus), most often misdiagnosed as soft tissue injury. Calcaneal lesions were more likely to be malignant than talar lesions: 13 of 34 versus three of 23.ConclusionsClinicians should be aware that hindfoot tumors can be initially misdiagnosed as soft tissue injuries and suspicion of a tumor should be raised in the absence of trauma or persistent symptoms. Lesions affecting the calcaneus are more likely to be malignant. Early diagnosis and adjuvant therapy are important.Level of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Dahlin's Bone Tumors, Sixth Edition

Edited by K K Unni, and C Y Inwards, Published by Wolters Kluwer, Lippincott Williams & Wilkins, Philadelphia, 2010, pp 402. ISBN 978-0-7817-6242-7. The sixth edition of Dahlins classic text on bone tumours is a welcome addition to the bookshelves. This has been a standard work for over 40 years, and an interval of 14 years has elapsed since the fifth edition. Drs Unni and Inwards are to be congratulated on this revision, which has brought the text into the style to be expected of a bench book in 2010. The new edition continues the traditional format of clinical features and invaluable epidemiological data, the …

Tophaceous gout of the patella: a report of two cases.

Introduction. Tophaceous gout of the patella is rare and may masquerade as a tumour or tumour-like condition. Cases. We report two patients with gout involving the patella, one complicated by a pathological fracture and the other occurring in a bipartite patella in a young adult. Discussion. Typical imaging appearances and measurement of serum urate will usually confirm the diagnosis but, occasionally, the serum urate level may be normal in active gout and in such cases, a biopsy will be required. Conclusion. Gout of the patella may masquerade as a tumour or tumour-like condition and it is important to consider gout in the differential diagnosis.

Osteoblastoma: a rare cause of stiff elbow

Osteoblastoma is a benign, osseous tumour that is usually found in the femur, tibia, foot and posterior elements of the vertebrae but rarely around the elbow. Elbow stiffness is common after trauma, infection (in particular tuberculosis), synovitis and arthritis, but is rarely caused by a tumour. In this case, an osteoblastoma in the distal humerus was excised through an Outerbridge—Kashiwagi approach, which successfully addressed the patients main complaint of elbow stiffness and restricted function. However, the lesion recurred a few months later and was treated successfully by computed tomography-guided thermoablation.