Henry H. Jones

Tertiary Hyperparathyroidism and Apparent Cure of Vitamin-D-Resistant Rickets after Removal of an Ossifying Mesenchymal Tumor of the Pharynx

Abstract In a 40-year-old man with bone pain, hypophosphatemia, normocalcemia, elevated serum alkaline phosphatase and increased renal phosphate clearance, and radiologic evidence of osteomalacia, acquired vitamin-D-resistant rickets (VDRR) was diagnosed. The patient responded to vitamin D and oral phosphate until a pharyngeal tumor was removed in 1965. After surgery, his serum phosphate rose, and hypercalcemia supervened. Therapy was stopped, but these changes have persisted. He remains free of bone pain, with normal serum phosphate and alkaline phosphatase, but with elevated levels of serum calcium and parathyroid hormone. The temporal relation between tumor removal and apparent cure of VDRR suggests that the tumor was secreting a vitamin D antagonist. The histologic findings suggested a similar cell type in this case and three similar ones. These cases should be referred to as ossifying mesenchymal tumors associated with VDRR.

MR imaging of clear cell sarcoma (malignant melanoma of the soft parts): A multicenter correlative MRI-pathology study of 21 cases and literature review

Abstract Objective. To evaluate MR imaging and pathology findings in order to define the characteristic features of clear cell sarcoma of the soft tissues (malignant melanoma of the soft parts). Design and patients. MR examinations of 21 patients with histologically proven clear cell sarcoma of the musculoskeletal system were retrospectively reviewed and assessed for shape, homogeneity, delineation, signal intensities on T1- and T2-weighted images, contrast enhancement, relationship with adjacent fascia or tendon, secondary bone involvement, and intratumoral necrosis. In 19 cases the pathology findings were available for review and for a comparative MR-pathology study. Results. On T1-weighted images, lesions were isointense (n=3), hypointense (n=7) or slightly hyperintense to muscle (n=11). Immunohistochemical examination was performed in 17 patients. All 17 specimens showed positivity for HMB-45 antibody. In nine of 11 lesions with slightly increased signal intensity on T1-weighted images, a correlative MR imaging-pathology study was possible. All nine were positive to HMB-45 antibody. Conclusions. Clear cell sarcoma of the musculoskeletal system often has a benign-looking appearance on MR images. In up to 52% of patients, this lesion with melanocytic differentiation has slightly increased signal intensity on T1-weighted images compared with muscle. As the presence of this relative higher signal intensity on T1-weighted images is rather specific for tumors displaying melanocytic differentiation, radiologists should familiarize themselves with this rare entity and include it in their differential diagnosis when confronted with a well-defined, homogeneous, strongly enhancing mass with slightly higher signal intensity compared with muscle on native T1-weighted images.

Running, osteoarthritis, and bone density: Initial 2-year longitudinal study

PURPOSE The purpose of this study was to present the 2-year follow-up results examining associations of repetitive long-term physical impact (running) with osteoarthritis and osteoporosis in 34 members of a running club now aged 52 to 74 years and 34 matched control subjects. PATIENTS AND METHODS Roentgenograms of the hands, lateral lumbar spine, and knees were assessed in pairs (1984 and 1986) without knowledge of running status. Computerized scans of the first lumbar vertebrae were obtained to quantify bone mineral. RESULTS A decrease in bone density over the 2-year period was statistically significant for nearly all subjects, especially for runners who decreased their running habits. At the 2-year follow-up, runners maintained greater bone density. Progression of the roentgenographic scores for osteoarthritis demonstrated a statistically significant increase in almost all groups in this normative population over the 2-year period. Female runners had more spur formation in the weight-bearing knee roentgenograms than did control subjects. CONCLUSION With the possible exception of spur formation in women, running did not appear to influence the development of radiologic osteoarthritis in the populations studied.

Effect of changes in weight-bearing exercise on lumbar bone mass after age fifty

This two year longitudinal study of 40 healthy subjects over age fifty (27 exercisers, 13 non-exercisers) was designed to evaluate the impact of weight-bearing exercise on lumbar bone mineral density as assessed by quantitative computed tomography. In both males and females exercising at moderate levels, a high correlation was found between changes in exercise and changes in bone density (r = 0.78 and 0.91, respectively P less than 0.002). For extreme levels of exercise (greater than 300 min/week in females over age fifty, and greater than 200 min/week in males over age seventy) bone density was low, confirming earlier cross-sectional results. Subjects without change in their exercise levels and non-exercisers lost similar amounts of bone. Increasing body mass index was identified as a protective factor with regard to lumbar bone loss. We conclude that in exercisers continuation of weight-bearing exercise is mandatory to prevent excessive bone loss. Extreme levels of exercise may be detrimental to bone density in subjects over age fifty years.

Osteophytosis of the knee: Association with changes in weight-bearing exercise

SummaryOsteoarthritis has been held to result from wear and tear. We addressed this hypothesis by analysis of anteroposterior radiographs of the knees of 51 subjects with mean age of 60 years who regularly practiced weight-bearing exercise. Radiographs were assessed for longitudinal changes in spur formation over a two-year period. The results showed a negative association between changes in weight-bearing exercise and changes in the rate of spur development in both males and females. The findings suggest that increasing repetitive impulse loading in the form of regular painless weight-bearing activity does not promote osteophytosis (or herhaps degenerative disease) in knee joints.

Hypertrophic osteoarthropathy of chronic inflammatory bowel disease

The case of a 14-year-old girl with painful periostitis and ulcerative colitis is reported. The association of chronic inflammatory bowel disease with osteoarthropathy is rare and has previously been reported in eight patients. The periosteal reaction found in association with inflammatory bowel disease is apparently related to a chronic disease course and may cause extreme localized pain.

Case report 663

We have presented an unusual case of chondroblastoma mimicking a malignant tumor. Retrospective review of radiographs obtained 19 years before the diagnosis gave us a unique opportunity to follow the natural history of this atypical lesion.

Case report 343

Fig. 1. A An anteroposterior roentgenogram of the upper lumbar spine demonstrates narrowing of the L1-L2 intervertebral disk space, with associated fragmentation and destruction of the adjacent endplates of the bodies of L1 and L2. Some loss of height of the body of L2 is present. B One year prior to the time that Fig. 1 A was obtained, the involved area appeared normal aside from degenerative changes and generalized osteopenia. Note loss of height in the vertebral body of L2 in Fig. 1A in comparison with the film one year earlier (Fig. 1 B). C A lateral roentgenogram obtained during Pantopaque myelography demonstrates narrowing of the L1-L2 interspace, adjacent destruction of the L2 and L2 vertebral bodies and a gibbus deformity. Encroachment upon the opacified subarachnoid space results in a high-grade, incomplete extradural block. D Computed tomography demonstrates fragmentation and destruction of the vertebral body of L2 with both intraspinal and paraspinal extension of osseous and soft tissue debris

Open quiz solution: Case report 617

This healthy, well-developed black girl, is the second child of an 18-year-old mother. A small lump behind her right ear was noted at 3 weeks of age, but may have been present since birth. At 4 weeks of age, the mass measured 11/2 x 11/2 cm. The mass grew and radiographs were obtained at age 8 weeks (Fig. 1). The patient was referred to us 4 weeks later when the mass was 4 x 4 cm in size. It was firm nontender, and

Open quiz: Case report 617

This healthy, well-developed black girl, is the second child of an 18-year-old mother. A small lump behind her right ear was noted at 3 weeks of age, but may have been present since birth. At 4 weeks of age, the mass measured 11/2 • 11/2 cm. The mass grew and radiographs were obtained at age 8 weeks (Fig_ 1). The patient was referred to us 4 weeks later when the mass was 4 x 4 cm in size. It was firm nontender, and