Peter Brys

Correlation between clinicopathological features and karyotype in 100 cartilaginous and chordoid tumours. A report from the Chromosomes and Morphology (CHAMP) Collaborative Study Group

The evaluation of chondroid lesions requires full integration of clinical, radiographic, and pathological data; tumour typing is often a challenge for the diagnostic pathologist. Although a variety of chromosomal abnormalities have been documented in chondroid lesions, the potential usefulness of cytogenetic analysis remains unclear. This study has critically reviewed and analysed 117 karyotyped samples from 100 patients with cartilaginous and chordoid tumours. Cases were selected based on successful chromosomal analysis and adequacy of clinical, radiographic, and pathological information. To ensure objective evaluation, the cytogenetic results were correlated in a double‐blind setting with consensus diagnoses independently determined on each case, after complete review of the histological, radiographic, and clinical findings. Karyotypic aberrations were identified in 41/92 cartilaginous tumours (5/11 osteochondromas, 2/3 chondromyxoid fibromas, 0/4 chondroblastomas, 11/29 chondromas, 0/3 chondroid tumours of undetermined malignant potential, 22/40 chondrosarcomas and 1/2 miscellaneous cartilaginous lesions) and 5/8 chordomas. Complex karyotypic changes were a feature of malignant tumours (chondrosarcoma and chordoma) and of chondrosarcoma among cartilaginous tumours, where they correlated with high tumour grade. Among primary well‐differentiated cartilaginous lesions of bone, the finding of an abnormal karyotype was consistently associated with a grade 1 chondrosarcoma diagnosis. Among karyotypically abnormal cartilaginous tumours, loss of distal 8q was associated with osteochondroma, +5 with synovial chondroma/chondromatosis and parosteal or soft tissue chondroma, alterations of chromosome arm 6q with chondromyxoid fibroma, +7 with bone chondrosarcoma, and 17p1 alterations with grade 3 chondrosarcoma. Alterations involving 12q13 characterized synovial chondroma/chondromatosis in the chondroma group and myxoid chondrosarcoma of bone in the chondrosarcoma group. In conclusion, cytogenetic abnormalities in chondroid lesions are common and are not randomly distributed. They are associated with malignancy/tumour grade as well as with specific diagnoses in many cases, and can therefore be of potential value for tumour typing. Copyright

Inflammatory myofibroblastic tumor of bone: report of two cases with evidence of clonal chromosomal changes.

Inflammatory myofibroblastic tumor (inflammatory pseudotumor) is a pseudosarcomatous lesion that is recognized with increasing frequency in various anatomic locations. However, this lesion has not been previously reported in bone. We report on two cases of inflammatory myofibroblastic tumor occurring in bone in young adults. Both tumors presented as slightly painful, osteolytic, and well-delineated lesions of the distal femur, with a hyperintense signal on T2-weighted magnetic resonance imaging. The patients had an uneventful recovery after curettage. The follow-up time was 11 months for both patients, and no recurrence was noted. On histologic examination, the lesions were characterized by collagen-rich and generally poorly cellular tissue containing spindled to plump (myo)fibroblast-like cells and a variable admixture of inflammatory cells. Focal calcifications and reactive bone formation were present. Clonal, albeit different, chromosomal changes were found in both cases (47,XY,-9,-12,add(21)(q21),+der(?)t(?;9)(?;q11), +mar,+r and 47, XY, +r/47, idem, add(12)(p13)). The present and other reported cytogenetic findings suggest that inflammatory myofibroblastic tumors could well be neoplastic.

Anteromedial tibial tubercle transfer in patients with chronic anterior knee pain and a subluxation-type patellar malalignment

We performed a prospective analysis of 29 Fulkerson anteromedial tibial tubercle transfers in patients with chronic anterior knee pain. The average followup was 32 months (range, 25 to 44). Fourteen patients (Group 1) had subluxation-type malalignment (congruence an gle >20°, tilt angle >8°) and were treated with an isolated anteromedial tibial tubercle transfer. Fifteen patients (Group 2) had combined subluxation and tilt malalignment (congruence angle >20°, tilt angle <8°) and underwent anteromedial tibial tubercle transfer combined with a lateral release. Pre- and postopera tive evaluations included clinical and radiographic ex aminations, Lysholm and Kujala patellofemoral scores, and standing-alignment computed tomography scans in 15° of flexion taken transversely at the midpatellar. In all but one patient a dramatic improvement in Lysh olm and Kujala scores was noted. The congruence angle improved in all patients except one, with an average improvement of 16° in Group 1 and of 14° in Group 2. The tilt angle remained relatively unchanged (change, -0.5°) in Group 1, but it improved by 11 ° in Group 2. We conclude that an isolated anteromedial tibial tubercle transfer can consistently improve patellar subluxation and, when combined with a lateral release, can improve patellar subluxation and tilt, resulting in improved functional scores for patients with chronic anterior knee pain.

Cross-sectional outcome analysis of athletes with chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy.

ObjectiveTo compare the outcome of chronic patellar tendinopathy treated surgically and by extracorporeal shock wave therapy. DesignCross-sectional outcome analysis. SettingUniversity Hospital Pellenberg, Leuven, Belgium. Patients and InterventionsOf a total of 27 patients (28 knees) with chronic patellar tendinopathy, 13 were treated surgically, and 14 (15 knees) received extracorporeal shock wave therapy. Main Outcome MeasurementsFunctional outcome questionnaire: Victorian Institute of Sport Assessment score, Visual Analog Scale, and Roles and Maudsley classification. ResultsAt an average of 6 months of follow-up, the mean Victorian Institute of Sport Assessment and Visual Analog Scale scores for the extracorporeal shock wave therapy group were 78.8 ± 28.7 and 9 ± 2, respectively, which improved to 83.9 ± 28.6 and 9 ± 2, respectively, at 22.1 months. The surgery group scored 70.7 ± 22.2 points on the Victorian Institute of Sport Assessment at an average of 26.3 months of follow-up (p = 0.41 and p = 0.18) and 8 ± 3 on the Visual Analog Scale (p = 0.14). In the extracorporeal shock wave therapy group, 5 (33%) patients rated their pain status at 22.1 months as excellent, 5 (33%) as good, 2 (13%) as fair, and 2 (13%) as poor. In the surgery group, 4 (33%) evaluated the result as excellent, 3 (25%) as good, 3 (25%) as fair, and 2 as poor (17%). ConclusionsExtracorporeal shock wave therapy shows a comparable functional outcome to surgery in a cross-sectional analysis of patients with chronic proximal patellar tendinopathy resistant to conservative treatment.

Fibrolipomatous hamartoma in the foot: atypical MR imaging findings

Lipomatosis of a nerve is a well-known but uncommon entity mostly seen in the median nerve. Magnetic resonance imaging (MRI) has been shown to provide pathognomonic features, obviating the need for diagnostic biopsy. We present a case of lipomatosis of a branch of the medial plantar nerve with an atypical appearance on magnetic resonance imaging.

Fracture of the Proximal Tibia after Fulkerson Anteromedial Tibial Tubercle Transfer

Since Fulkerson first described anteromedial transfer of the tibial tubercle as a treatment for patients with chronic anterior knee pain and certain types of patellofemoral malalignment, this procedure has gained popularity because of its favorable results and acceptable complication rates compared with other surgical techniques in the treatment of anterior knee pain, such as the Maquet procedure. In this paper we present four cases of proximal tibial fracture shortly after a Fulkerson procedure.

Spontaneous resolution of a solitary osteochondroma

Abstract Spontaneous regression or resolution of a solitary osteochondroma is infrequent. A case of a surprisingly fast and complete resolution of an osteochondroma of the distal ulna in a 7-year-old boy is presented, with a review of previously reported cases.

Rotator cuff healing after needling of a calcific deposit using platelet-rich plasma augmentation: a randomized, prospective clinical trial

BACKGROUND Arthroscopic needling of a rotator cuff calcification is a highly reliable operation in terms of pain relief and return of function. However, during the needling process, a cuff defect is created. Little is known about the evolution of this defect. METHODS We conducted a prospective, randomized controlled clinical trial to investigate the evolution of the aforementioned defect and the role of platelet-rich plasma (PRP) augmentation in this healing process. Patients were randomized to either group 1 (PRP, n = 20) or group 2 (no PRP [control group], n = 20). Patients in group 1 received a perioperative PRP infiltration at the rotator cuff defect, whereas the control group did not. Patients were assessed clinically preoperatively and postoperatively at 6 weeks, 3 and 6 months, and 1 year. The Constant score, Simple Shoulder Test, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) were used as outcome measures. The evolution of the cuff defect was evaluated on sonography at 3 and 6 months and with magnetic resonance imaging after 1 year. RESULTS All patients improved significantly after surgery (P < .05). There was no difference in clinical outcome or rotator cuff healing between groups. We observed a high rate of persistent rotator cuff defects after 1 year in both groups. The presence of residual cuff defects did not influence the clinical outcome. CONCLUSION Arthroscopic needling is an operation with a predictive, good clinical outcome. We found a high rate of persistent rotator cuff defects after 1 year. This study could not identify any beneficial effect of the addition of PRP on rotator cuff healing. LEVEL OF EVIDENCE Level II; Randomized Controlled Trial; Treatment Study.

Giant schwannoma of the lower leg

Abstract Schwannomas are relatively common, benign, peripheral nerve sheath tumours. They usually range in size from 2 to 20 cm, but when localised in the lower legs the maximum length is less than 10 cm. The case reported here was a giant fusiform schwannoma of the left fibular nerve with a length of 25.5 cm. In contrast to the usual findings of giant schwannomas, no cystic, haemorrhagic or necrotic changes could be found by ultrasonography, computed tomography or magnetic resonance imaging. The combination of tumour size, location and radiological presentation is very unusual and, to our knowledge, has never been reported before in the literature.

Ultrasound in acute trauma of the ankle and hindfoot

Abstract. Ultrasound is a rapid, widely available and inexpensive imaging modality for the evaluation of the ankle and hindfoot. Ultrasonography can be performed in acute, semiacute and chronic conditions. Ankle injuries can be evaluated with ultrasound combined with X-rays. In the emergency room, acute trauma of ankle and hindfoot is an important indication for ultrasound.