Elizabeth Schultz

Malignant fibrous histiocytoma at the site of a total hip replacement: review of the literature and case report

Abstract Tumors developing in association with metallic implants are being reported with increasing frequency in the orthopedic literature. The authors report the tenth case of malignant fibrous histiocytoma associated with a total hip replacement. The diagnosis was made during an evaluation for rapid radiographic osteolysis surrounding the femoral component detected less than 1 year after revision of a hemiarthroplasty to a total hip replacement. The short latency period and aggressiveness of this tumor mimicking rapid osteolysis prompted a review of the literature, etiology and significance of implant-associated malignant fibrous histiocytoma.

Case report 872

A case of an ancient schwannoma was presented. The rare occurrence of this tumor has resulted in only a few reported cases with descriptions of its features on imaging. Our patients tumor, like one previously reported case, demonstrated calcification on the plain film - a finding not associated with other histologic types of schwannomas. Angiography revealed the tumor to be hypervascular. Evaluation by MRI demonstrated a lobulated, encapsulated soft tissue mass containing several cystic areas that corresponded histologically to areas of necrosis. Hypertrophied blood vessels were seen in the periphery of the tumoral mass. Too few ancient schwannomas have been reported to conclude whether or not radiographic evidence of soft tissue calcification is characteristic of this histologically distinctive subtype of schwannoma. However, since calcification is seen histologically as part of the degenerating process, its presence on plain films could be a feature of this tumor. Furthermore, the presence of cystic areas on MRI is not surprising given the pathological changes that occur in this tumor. We suggest that a diagnosis of ancient schwannoma be considered when a patient presents with a hypervascular soft tissue mass containing amorphous calcification on plain films and cystic areas on MRI. Despite the nonspecificity of these imaging findings, this point is relevant because each of these features suggests the presence of a malignant mass. Awareness of the possibility of a benign ancient schwannoma could obviate unnecessary radical surgery.

Malignant lymphoma involving the patella

Abstract The majority of skeletal lesions affecting the patella are benign and include entities such as chondroblastoma, giant cell tumor, osteomyelitis, and gout. Malignant processes involving the patella are distinctly unusual. Isolated occurrences of plasmacytoma, osteosarcoma, hemangiosarcoma, and metastatic disease have been reported. Malignant lymphoma involving the patella is extremely uncommon, although lymphomatous infiltration of the skeletal system is not a rare event, especially with the histiocytic lymphoma. The most frequent radiologic manifestations of skeletal lymphoma include osteolytic lesions with ill-defined margins involving the metaphysis of the long bones of the lower extremities. Involvement of the short tubular and flat bones, as well as the axial skeleton, occurs less commonly. The prognosis for lymphoma involving the skeleton is poor.

Case report 380

A seven-year-old girl presented with a history of difficulty opening her mouth and swelling of the jaw on the left side. Increasing symptoms and swelling of the jaw had been noted over the past several weeks before presentation. Radiological studies demonstrated a well-defined, grossly expanding, lytic lesion involving the posterior third of the horizontal ramus of the left side of the mandible. All laboratory findings were within normal limits. The child was admitted for biopsy and curettage. It was believed that all tumor tissue had been removed.

Isolated injury of the cuboid bone

Abstract. The purpose of this study was to describe isolated injury of the cuboid bone as a potentially radiographically occult cause of foot pain. The imaging studies of 17 patients, 13 women and 4 men aged 17–79 years (average 45 years), who presented with pain over the lateral aspect of the midfoot were retrospectively reviewed. Frontal, lateral, and inversion-oblique radiographs were available for all patients. In addition, MR imaging was performed in eight patients, CT in two, conventional tomography in two, and bone scan in one. Conventional radiographs revealed cuboid fracture in seven patients. Of the remaining ten, eight underwent MR imaging which demonstrated four fractures, three bone bruises, and one stress reaction, and two had tomography, CT, and/or bone scan, all of which documented an isolated cuboid fracture. Isolated fracture of the cuboid may be radiographically occult. Other imaging modalities, particularly MR imaging, can document this injury as the source of pain.

Open reduction and internal fixation of a glenoid fossa fracture in a child : A case report and review of the literature

Scapular fractures in children are rare injuries. The indications for the surgical treatment of glenoid fossa fractures in children are not well defined. We report on an eight-year-old child with a displaced glenoid fossa fracture requiring open reduction and internal fixation. A review of the literature and indications for the operative management of glenoid fossa fractures in children are discussed.

Dislocation of the second through fifth carpometacarpal joints

We report a case of dislocation of the second through fifth carpometacarpal joints and review the mechanism of injury and radiographic findings in such injuries.