Robert S. Sherman

Aneurysmal Bone Cyst: Its Roentgen Diagnosis

During the past few decades a rather striking lesion of bone has been described in the literature under many seemingly unrelated designations: ossifying hematoma (4, 8, 28), subperiosteal giant-cell tumor (6, 13, 16, 24, 25, 27), atypical giant-cell tumor (7), aneurysmal giant-cell tumor (11), “hemorrhagic” bone cyst (2), expansile hemangioma (15), and aneurysmal bone cyst (1, 9, 10, 17, 18, 20, 21, 22). In recent years the term “aneurysmal” bone cyst has been most widely accepted. While the pathogenesis remains unsettled, there seems to be general agreement that the lesion is a distinct clinical and pathological entity, a fact established through the work of Jaffe and Lichtenstein (17, 18, 20, 21). The roentgenographic picture has been described as showing a diaphyseal and eccentric location and a characteristically expanding, “ballooned-out” shape having multiloculations (1, 17, 20, 27). While the occurrence of these cardinal roentgen features is evident, certainly there exists a need for fuller x-ray e...

The Roentgen Appearance of Ossifying Fibroma of Bone

According to Eden (2), the disease generally known as ossifying fibroma was first described in 1872 by Menzel, who considered it to be a form of osteoma. At least two early textbooks on the jaw, that of Heath in 1894 (5) and of Scudder in 1912 (12), contain accounts of tumors consistent with the lesion under discussion here. Montgomery (8) in 1927 probably introduced the term ossifying fibroma. At this time he described 3 cases and in a review of the literature was able to uncover 14 similar ones. Geschickters paper (4) on jaw tumors in 1935 contained a section on ossifying fibroma. Two years later Phemister and Grimson (9) in a significant study presented 13 cases, reviewed 2 of Montgomerys, and noted 30 more from the literature. These authors, employing the term fibrous osteoma for ossifying fibroma, suggested that this process bore a relationship to membranous bone similar to that which osteochondroma bears to cartilaginous bone. In 1939 Eden presented a study of 5 cases primarily from the pathologic...

The roentgen appearance of benign osteoblastoma.

This paper records an attempt to determine the roentgenologic features of benign osteoblastoma through a review of the literature and personal experience with 4 new cases of this uncommon and interesting bone tumor. Two writers (1, 3) state that this neoplasm has no characteristic roentgen appearance, while another (6) holds an opposite opinion. There has been no review of a representative volume of cases in an attempt to resolve these differences. Histologically, benign osteoblastoma is characterized by the presence of well vascularized osteoid and bone-forming tissue which bears a certain similarity to osteoid osteoma (3). However, benign osteoblastoma differs significantly both clinically and roentgenographically from the classical osteoid osteoma (3, 6). To date there have appeared in theliterature about 30 cases of benign osteoblastoma (1–6). Lichtenstein (6) carefully analyzed the material reported by Dahlin and Johnson (1) under their designation “giant osteoid osteoma.” It was his opinion that mos...

Ewing's Sarcoma: Its Roentgen Classification and Diagnosis

In 1921, James Ewing identified a form of primary malignant bone tumor which he designated “diffuse endothelioma” or “endothelial myeloma” (7). This lesion is commonly known today as Ewings sarcoma or Ewings tumor. While the clinical and pathological aspects have been amply stressed in a number of reports covering large series of cases (4, 5, 14, 15, 21), the literature on roentgen diagnosis (1, 10, 11, 13, 16, 18, 20) is relatively incomplete; there is no study based on a sufficient volume of dependably proved material with x-ray diagnosis as the primary object. Much of the writing pertaining to the roentgen aspects has been done by those not fully oriented in this specialty. Furthermore, since the pathological identification of this lesion may be extremely difficult, some of the cases upon which discussion of x-ray diagnosis has been based are open to question. Material After careful scrutiny, 111 cases of Ewings sarcoma from the files of Memorial Center (New York) were considered satisfactory for th...

Radiological identification of fibrous dysplasia of the jaws.

Fibrous dysplasia of the jaws has been noted in a number of reports, but a clear and complete picture of its roentgen appearance in the mandible and maxilla has not emerged. This is because the number of cases studied has usually been small or because the jaw involvement was but a part of the general disease and therefore was not presented in detail. This study of 17 histologically proved cases of fibrous dysplasia of the jaw is undertaken, therefore, to formulate a basis for the roentgen identification of that disease. In about 50 per cent of all the patients with fibrous dysplasia referred to us for x-ray consultation, jaw involvement has been the presenting or only manifestation of the disease. In addition to the relative frequency with which the jawbones may be the main site of the process, there are other reasons for considering the roentgen diagnosis of fibrous dysplasia of the jaw in a separate category. The differential diagnosis of jaw lesions, because of the presence of dental elements, is more ...

The Roentgen Findings in Neuroblastoma

A little over ten years ago Wyatt and Farber (1), of Childrens Hospital, Boston, published an excellent work dealing with neuroblastoma sympatheticum. The roentgenologic appearances encountered in this tumor were considered in detail, along with its treatment. The writers based their conclusions concerning roentgen diagnosis upon a study of 34 proved cases. No like number of personally observed cases had been presented previously from this point of view nor has any appeared subsequently so far as we know. With the volume of material available at Memorial Center it seemed to us worth while to check their conclusions by an investigation of x-ray diagnosis alone, including the problems of differential diagnosis. The present effort has been limited to a total of 50 cases selected from a somewhat larger number. Of course, not all patients have had a complete x-ray survey of all areas of possible involvement, but the roentgen studies were felt to be generally adequate. Fourteen of the tumors became available a...

The Roentgen Appearance of Gastric Argentaffinoma

The purpose of the study to be reported here was to determine the roentgenologic appearance of argentaffinoma of the stomach and to report 4 cases of this rare tumor, 3 primary in the stomach and 1 with metastases involving that organ. Bensaid (3) states that gastric argentaffinomas represent only 1 per cent of all carcinoids. Lattes and Grossi (24) found records of only 5 carcinoids of the stomach in the Presbyterian Hospital files from 1910 to 1955. During that time 1,236 carcinomas of the stomach were encountered. To our knowledge there are now 59 published cases of gastric argentaffinoma (5, 6, 8, 12, 16, 20, 24, 29). Argentaffinomas originate from the Kulschitzky cells of the crypts of Lieberkuhn, as demonstrated by Gosset and Masson (19) and Masson (33), who considered these tumors to be of endocrine origin because of the resemblance to the chromaffin cells of the paraganglia. Carcinoids appear almost exclusively below the esophagus in the gastrointestinal tract, particularly in the region of the ap...

A Roentgen Study of Muscle Tumors Primary in the Lung1

There are certain tumors of the lung which, although uncommon, are becoming increasingly important because of the use of roentgen surveys of the chest and because of advances in thoracic surgery. Muscle tumors primary in the lung belong in this group. While reports of these tumors have usually been confined to single cases, the present study is concerned with a group of 7 from the files of Memorial Hospital. Because we were unable to recognize these roentgenologically, and because they seemed to present a general similarity in appearance, it seemed worth while to study them from the standpoint of roentgen diagnosis. Very little has been written about muscle tumors of lung origin. Ewing (2) stated that well identified cases of primary sarcoma of the lung are very rare. He pointed out that failure to recognize such primary tumors had probably accounted for a number of erroneous reports. In his classification of primary sarcomas of the lung he included a peribronchial sarcoma, the origin of which was thought...

Radiographic Diagnosis of Ureteral Involvement by Metastatic Breast Cancer

Our purpose is to describe rather characteristic radiographic findings in 24 women with breast cancer in whom periureteral metastases developed. The detailed clinical courses of these patients, including factors relative to the management of ureteral obstruction, have been described elsewhere (2). Clinical Material These cases are unselected. A review of the records of all patients with metastatic breast cancer has not been made, nor have routine excretory urograms been obtained in all patients with mammary carcinoma. The metastases in these patients were suspected clinically on the basis of signs and symptoms suggestive or diagnostic of disease in the urinary tract. There were two types of ureteral involvement in these 24 patients. In 12, metastases were confined to ureteral or periureteral sites (“isolated”), while in the others ureteral disease was a part of more extensive pelvic and abdominal involvement, arbitrarily termed “bulk” metastases. The radiographic appearance was almost the same in both gro...

Roentgen Characteristics of Osteogenic Sarcoma of the Jaw

Sarcomas of the jaw, like sarcomas in other portions of the skeleton, may offer a difficult diagnostic task for the roentgenologist. The problem of adequately demonstrating lesions affecting the jaws and the need to differentiate between the tumor and diseases peculiar to the dental structures are more or less serious additional factors to be considered. Furthermore, the jaws are especially prone to invasion by malignant growths arising in neighboring organs and tissues. Most workers dealing with bone sarcoma classify their material upon a histologic rather than a radiologic basis. At Memorial Hospital all services adhere fairly closely to Ewings classification (5), which subdivides osteogenic sarcoma as follows: medullary, telangiectatic, sclerosing, medullary fibrosarcoma, and periosteal fibrosarcoma. The chondroma series is represented on the malignant side solely by chondrosarcoma. Pancoast et at. (7) reported three sarcomas of the jaws, each of which showed both sclerosing and osteolytic manifestati...