Michael J. Pitt

Osteosarcoma in a patient with McCune-Albright syndrome and Mazabraud's syndrome.

Abstract Sarcomas infrequently develop in osseous sites of fibrous dysplasia. We report a patient with Mazabraud’s syndrome (polyostotic fibrous dysplasia and soft tissue myxomas) complicated by the development of osteogenic sarcoma in a bone affected by fibrous dysplasia. This is the third case of osteosarcoma within the small population of reported patients with Mazabraud’s syndrome. There may be an increased incidence of malignant transformation in these individuals’ dysplastic bones above that associated with patients suffering from fibrous dysplasia alone.

Aggressive Osteoblastoma: A Case Report Involving a Unique Chromosomal Aberration

Osteoblastomas are rare bone-producing neoplasms that generally occur in the young and can be misdiagnosed as an osteosarcoma if correlation with clinical history, radiology, and histology is not carefully considered or if the several variants of osteoblastoma are not recognized. These variants lie on a morphologic spectrum between conventional osteoblastoma and osteosarcoma. Aggressive osteoblastoma is one such subtype. As the name implies, the histologic features of aggressive osteoblastoma may appear malignant, and its biologic behavior may separate it from conventional osteoblastoma. We report a case of aggressive osteoblastoma occurring in the femoral diaphysis of a 12-year-old girl; this osetoblastoma was dyssynchronous from the radiologic appearance and a diagnostic challenge. Cytogenetic evaluation of the neoplasm revealed a pseudodiploid clone with a balanced translocation involving chromosomes 4, 7, and 14. Using the premise that cytogenetics might be useful as a diagnostic tool for a more specific classification, we reviewed the literature in order to compare our findings with known chromosomal aberrations.

Magnetic resonance imaging in coccidioidal arthritis

Abstract Objective. The authors assessed the MRI findings of appendicular coccidioidal arthritis. Design. T1- and T2-weighted MR images of affected joints, both with and without intravenous gadopentetate dimeglumine, were performed in nine adult patients (ten studies) and evaluated by three masted readers, using a four-point certainty scale for: synovial abnormality, articular cartilage loss, subarticular bone loss, abnormal marrow signal, enhancement of osseous and articular structures, and assessment of disease activity. Findings were correlated with biopsy results or clinical course. Results. Eight patients had active and one had inactive arthritis, involving the knee (five patients), ankle (two patients), and elbow (one patient). Synovial complex was the most common finding in active arthritis (P<0.025). Cartilage and subarticular bone loss were seen 56% and 89% of patients with active disease, respectively. Abnormal marrow signal was uncommon (two patients). All cases showed synovial and/or osseus enhancement. Conclusions. MRI findings in coccidiodal arthritis are described. Enhancement of thickened synovium and erosions was seen after intravenous gadopentetate.

Molecular pathology of chondroid neoplasms: part 1, benign lesions

This two-part review presents an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. This first part presents a brief review of methods in molecular pathology along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images. Malignant chondroid neoplasms will be considered in the second part of this review.

Osteoblastoma: A Mimic of Osteosarcoma

Osteoblastoma, a bone-forming neoplasm without metastatic potential, can be mistaken histologically for various benign and malignant primary neoplasms of bone or mimic nonneoplastic conditions, including osteoid osteoma, giant cell tumor of bone, aneurysmal bone cyst, and chondroblastoma [1]. The most important diagnostic distinction is to distinguish osteoblastoma from osteosarcoma. Although both lesions usually have characteristic clinical, radiologic, and histologic findings, in certain cases the distinction between both can be difficult. This is complicated by lesions that morphologically and biologically appear to exist at the interface between the two. In this review, we describe the characteristics of osteoblastomas and review criteria that can prove helpful in the distinction among the various pathologic entities.

Association of the presence of bone bars on radiographs and low bone mineral density

ObjectiveBone bars (BB) are struts of normal trabecular bone that cross the medullary portions of the metaphysis and diaphysis at right angles to the long axis of the shaft. The purpose of this investigation was to determine whether the presence of bone bars (BB) identified on radiographs of the proximal femurs and tibia, predict lower bone mineral density (BMD) as evaluated with dual-energy x-ray absorptiometry (DXA) in the lumbar spine, total hip, or femoral neck.Materials and methodsA total of 134 sequential DXA patients underwent radiography of the pelvis, hips, and both knees. The radiographs were evaluated for the presence of BB by two musculoskeletal radiologists who were blinded to DXA results. A t test was used to evaluate the relationship of BB to BMD and a Chi-square test was used to determine if BB were equally distributed among the categories of normal BMD, low bone mass (osteopenia), and osteoporosis.ResultsBB were associated with lower BMD at all measured sites. BB at the intertrochanteric and proximal tibial sites were the most predictive of low BMD while supraacetabular and distal femur BB were less predictive. Osteoporosis or osteopenia is seen in 60–91% of those with BB depending on the side and reader. It is only seen in about 40% of those without BB.ConclusionsWe conclude that the presence of BB suggest decreased BMD and when correlated with other clinical information, might support further evaluation of BMD.

Pellegrini–Stieda ossification can also involve the posterior attachment of the MPFL

PURPOSE To evaluate for development of Pellegrini-Stieda (PS)-type ossification following injury to the posterior attachment of the medial patellofemoral ligament (MPFL). MATERIALS AND METHODS This retrospective study evaluated 27 patients with acute knee injury with initial radiographs, magnetic resonance imaging within 1 week of injury, and follow-up radiographs assessing for development of PS. RESULTS Of the 27 patients who developed PS ossification, 7 patients (25.9%) had isolated MPFL injury with the ossification slightly more proximal than the traditional PS. CONCLUSION Isolated injury to the posterior MPFL also leads to PS ossification, which is slightly superior in location to the traditional PS.

Molecular pathology of chondroid neoplasms: part 2, malignant lesions

This is the second part of a two-part review presenting an overview of the molecular findings associated with both benign and malignant chondroid neoplasms. The first part presented a brief review of modern methods in molecular pathology, along with a review of the cytogenetic and molecular genetic findings in benign chondroid neoplasms. This second part reviews the cytogenetic and molecular genetic findings in malignant chondroid neoplasms. Clinical aspects of the various lesions are briefly discussed, and each tumor is illustrated with representative radiographic and pathologic images.

Parturition pit: the bony imprint of vaginal birth.

PurposeTo retrospectively evaluate for pits along the dorsum of the pubic body in females and compare the presence/absence of these pits to vaginal birth data.Materials and methodsWe retrospectively reviewed females with vaginal birth data who underwent pelvic CT. The presence of pits along the dorsum of the pubic body, pit grade (0 = not present; 1 = faintly imperceptible; 2 = present; 3 = prominent), and the presence of osteitis condensans ilii, preauricular sulcus, and sacroiliac joint vacuum phenomenon were assessed on imaging. Musculoskeletal radiologists who were blinded to the birth data evaluated the CTs. 48 males were also evaluated for the presence of pits.Results482 female patients underwent CT pelvis and 171 were excluded due to lack of vaginal birth data. Of the 311 study patients, 262 had prior vaginal birth(s) and 194 had pits on CT. Only 7 of the 49 patients without prior vaginal birth had pits. There was a statistically significant association between vaginal birth and presence of pits (p < 0.0001). Patients with more prominent pits (grades 2/3) had a greater number of vaginal births. As vaginal deliveries increased, the odds of having parturition pits greatly increased, adjusting for age and race at CT (p < 0.0001). No males had pits.ConclusionOur study indicates that parturition pits are associated with prior vaginal birth and should be considered a characteristic of the female pelvis. The lytic appearance of prominent pits on imaging can simulate disease and create a diagnostic dilemma for interpreting radiologists.

Jack Edeiken, 1923–2002

M.J. Pitt Department of Radiology, University of Alabama, Birmingham, Alabama, USA Jack Edeiken, M.D., a leader in skeletal radiology, passed away on April 30, 2002 in Houston, Texas after a long and courageous battle with lung cancer. He was born into a medical family. Both his parents were physicians, his father a diagnostic radiologist of considerable repute. In addition, his uncle, brother, and brother-in-law were in the medical field. Jack was born May 25, 1923 in Philadelphia, Pennsylvania and attended high school, college, and medical school in Philadelphia. He graduated from Villanova College in 1943 and played on its basketball team. He graduated from the University of Pennsylvania Medical School in 1947 and interned at Mount Sinai Hospital in Philadelphia, where his father, Louis Edeiken, was Chairman of the Radiology Department. Following internship, Jack did a residency in radiology at the University of Pennsylvania under Eugene Pendergrass, M.D. After two years of military service, he joined the staff of the University of Pennsylvania as an instructor in radiology. In 1958, Dr. Edeiken joined the Radiology Department at Thomas Jefferson University Hospital where his mentor, Phillip J. Hodes, M.D. had recently been appointed Chairman. Dr. Edeiken succeeded Dr. Hodes as Chairman of the Radiology Department at Thomas Jefferson University Hospital in 1971 and served in that capacity until 1986. During his time at Jefferson, Dr. Edeiken developed a close friendship with his colleague, Gerald Dodd, M.D. When Dr. Edeiken stepped down as Chairman at Thomas Jefferson University Hospital, he went to the MD Anderson Cancer Center in Houston, Texas, and worked in Dr. Dodd’s department as Chief of Musculoskeletal Radiology. Dr. Edeiken’s career was long and dignified. He was one of the three founders of the International Skeletal Society (ISS) and his image is engraved on the coveted Founders Medal of the Society. He served as ISS Secretary-Treasurer, and President and was instrumental in developing the ISS endowment fund, serving as Chairman of the Board of Trustees. He was Editor-in-Chief of the Societys journal, Skeletal Radiology. Other activities in radiology included Chairman of the Commission of Education in Diagnostic Radiology for the American College of Radiology, Chancellor and board member of the American College of Radiology, and member of the Skeletal Radiol (2002) 31:738–739 DOI 10.1007/s00256-002-0581-1 O B I T U A RY