Julius Smith

Malignancy in chronic ulcers and scars of the leg (Marjolin’s ulcer): a study of 21 patients

Abstract Objective. To study the imaging features of patients with chronic ulcers of the leg that were associated with malignancy. Design and patients. All patients who on biopsy were proven to have malignancy – the majority of which were squamous cell carcinoma – were included in a prospective study. Ulcers limited to the foot were excluded but ulcers of the leg which extended into the foot were included. Amputation was performed in all but two patients, due to pain, bleeding or tissue necrosis. Results. The etiology was multifactorial. The mean duration of the ulcers was 36 years including venous ulcers, extensive scarring of the leg secondary to infection, injury or burns. One ulcer was secondary to a snake bite. The remainder, usually in the upper part of the leg, had repeated episodes of blunt trauma or knife wounds, which were also complicated by infections which failed to heal or, if they healed, regularly recurred. Although arterial insufficiency was not primary in any patient, most were of advanced age and it may have been an element in some patients. Despite infection, osteomyelitis was present in only one patient. The essential features were bone destruction, soft tissue mass and periosteal reaction. The bone destruction was visible on the radiographs in all but one case. The soft tissue masses varied in size but in general were very large. The periosteal reaction varied in type but most commonly was lamellated. The classic undulating solid periosteal reaction of venous stasis was only occasionally present. The periosteal reaction was nonspecific in the majority of cases and did not aid in the diagnosis or etiology. MRI and CT studies were performed in six patients. These were helpful in defining the extent of bone destruction and periosteal reaction but were not essential in management. Conclusion. Chronic ulcer present for decades that then undergoes malignant change is a disease of developing countries where patients only consult physicians when they have developed complications such as pain, bleeding or tissue necrosis. Chronic ulcers may require to be biopsied at regular intervals as malignant change in these ulcers is directly related to their duration.

Polyostotic fibrous dysplasia associated with intramuscular myxomas: Mazabraud’s syndrome

Abstract Mazabraud’s syndrome, though uncommon, is reported increasingly frequently. It represents an entity readily recognisable radiologically on MR imaging. Awareness of the syndrome, particularly when the myxoma is solitary, can prevent misdiagnosis of intramuscular myxomas (especially when large) as malignant mesenchymal tumors containing myxoid tissue. We review the 34 cases previously reported in the literature and include a recent case from our center.

Hodgkin's Disease complicated by radiation sarcoma in bone

Seven patients after treatment of Hodgkins Disease who developed bone sarcomas in the radiation field were seen at this centre over the past eight years. Radiation-induced sarcoma in bone in patients with Hodgkins Disease is poorly documented. The large number of cases appeared to be an important new development and led to our review of all the patients with radiation-induced sarcomas (RIS) seen at this centre over the past 40 years. Thirty-seven patients with RIS in previously normal bone were found, and of these, only one patient with underlying Hodgkins Disease, who was seen here 27 years earlier. Hodgkins Disease and breast cancer were the most common primary underlying conditions and, as a result, the bones of the shoulder girdle were the commonest site of radiation-induced sarcoma. The clinical histories and radiographic findings of the eight patients with underlying Hodgkins Disease are discussed in detail.

Hyperparathyroidism associated with sarcoma of bone.

Abstract The objective of this paper is to report the uncommon association of hyperparathyroidism (one case resulting from an adenoma and the other from chief cell hyperplasia) and sarcoma of bone. The radiographic appearances of both cases were thought to be a little unusual and are discussed in detail. The possible relationship of the sarcomas to brown tumors is discussed.

Chondromyxoid fibroma of the lumbar spine

Abstract A bulky tumor of the first lumbar vertebra is described. The case is the 21st to be reported. The tumor resembled an aneurysmal bone cyst radiologically. It was resected without incident. The previously reported cases are reviewed and the literature discussed

Chronic ulceration of the leg following extensive scarring due to a snake bite complicated by squamous cell carcinoma

Abstract Chronic ulcers of the leg are common in Brazil, perhaps more common than in the developed world. We report a case of a chronic ulcer of the leg following extensive scarring due to a bite by a venomous snake, which eventually led to a squamous cell carcinoma.

Bursa formation in secondary chondrosarcoma with intrabursal chondrosarcomatosis.

Osteocartilaginous exostoses (osteochondromata) are rather common bone tumors. Although most are straightforward lesions, one may occasionally encounter one of a number of well-recognized complications. In the current case, secondary malignant transformation and bursal sac formation were present. Additionally, numerous malignant chondroid nodules were shed into the attached bursa, giving rise to a large soft tissue mass, a situation which we feel is both remarkable and, to our knowledge, unique.

Osteoblastic metastases in renal cell carcinoma

Renal cell carcinoma (hypernephroma, renal adenocarcinoma) metastasizes to the skeleton in approximately 10% of cases and characteristically produces expansile lytic lesions (Forbes et al., 1977). Although sclerotic changes may be seen following radiotherapy, osteosclerotic metastases in this condition prior to therapy are virtually unknown (Forbes et al., 1977; Sherman and Pearson, 1948). We report here well-documented case of renal cell carcinoma which produced osteoblastic metastases and was confirmed by autopsy examination.

Synchronous Paget’s sarcoma of tibiae in which Paget’s disease was limited to these bones

Abstract A 51-year-old native of Rio de Janeiro presented with bilateral synchronous Paget’s sarcomas in the tibiae, which developed in the upper right tibia and in the distal third of the left tibia. There were no other areas of Paget’s disease. The largest tumor spread to the right inguinal nodes and also soft tissue. The tumor in the left tibia spread dramatically in the soft tissues up the leg and only involved the medullary cavity in its inferior portion. The patient died, but there was no autopsy. Comments are made about the prevalence of Paget’s disease in Rio de Janeiro.

A photopenic lesion in osteosarcoma

Primary and secondary bone tumours usually result in areas of increased tracer uptake on bone scans because of osteoblastic reaction of the bone surrounding the tumour (Kirchner, 1980). Rarely, tumours may result in areas of reduced tracer uptake (Georgen et al, 1974; Sy et al, 1975; Goris et al, 1980; Kado et al, 1980; Bushnell et al, 1983; Makhija, 1983; Weingrad et al, 1984). In this report, a case of osteosarcoma with prominent fibroblastic reaction is presented as it resulted in the unusual finding of a “cold” lesion on bone scintigraphy.