Hemangioma of the Rib Mimicking Chondrosarcoma: A Report of Two Cases and Literature Review

Cases. Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone. Conclusion. We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.

Clinical and imaging features of tumors in the scapula

Background: Scapula is a small irregular-shaped flat bone, which may suffer from a variety of tumors or tumor-like lesions. Because the imaging manifestations are complex and changeable, correct imaging diagnosis is difficult. Introduction: At present, there are few related radiology literatures, and it is necessary to fully analyze the imaging signs of different types of benign and malignant tumors in scapula to guide clinical treatment. This study was to investigate clinical and imaging presentations of tumors and tumor-like lesions in the scapula so as to increase the diagnostic accuracy of diseases in the scapula. Methods: Patients with scapular tumors confirmed by pathology were enrolled. The imaging and clinical data were analyzed. Result: Among 108 patients, benign tumors were in 53 (49.1%) cases, intermediate in seven (6.5%), and malignant in 48 (44.4%) involving 16 diseases. Osteochondroma was the first benign tumors in 45 cases accounting for 84.9% of all benign scapular tumors followed by chondroma in four cases (7.5%). The intermediate tumors were mainly eosinophilic granuloma in four cases. Metastatic tumors were the commonest malignant tumor (27 cases or 56.2% of all malignant tumors), followed by chondrosarcoma (in 13 cases). Except for the one case of chondroblastoma in which the lesion involved the glenoid cavity, all the other cartilaginous tumors were located in the scapular body and processes. The type of lesions in the bony processes is the same as in the scapular body, the common lesions in the central area of body were malignant tumors, and the commonest lesions in the glenoid area were metastasis. Common imaging features of malignant scapular tumors were ill-defined margins, cortical destruction and soft tissue involvement. The imaging features of chondrosarcoma lack specificity except calcification. Benign lesions usually had clear boundary and marginal sclerosis. Conclusion : A wide variety of benign and malignant tumors may occur in the scapula with mostly cartilaginous and metastatic tumors, and the location and distribution of lesions are similar in the scapula to those in the long bones.

MRI differentiation of low-grade and high-grade chondrosarcoma of the shoulder girdle, chest wall and pelvis: a pictorial review based on 111 consecutive cases

Approximately 40% of conventional chondrosarcomas arise from the shoulder girdle, chest wall and pelvis. This pictorial review describes the MRI features which may aid in the differentiation of Grade one chondrosarcoma (G1-CS) from high-grade chondrosarcoma (HG-CS) and dedifferentiated chondrosarcoma (DD-CS) in these locations, based on literature review and assessment of 111 consecutive cases presenting to the senior authors institution over a 13 year period. Of the 111 patients reviewed (71 males and 40 females; mean age 54.3 years; range 17–92 years), 27 were Gd1-CS, 72 were HG-CS and 12 were DD-CS. Tumours arising from the scapula, acetabulum, pubis/ischium and sacrum were more likely to be HG-CS, as were intra medullary tumours. MRI features associated with HG-CS and DD-CS included cortical destruction, bone oedema, soft tissue oedema, tumour necrosis, intermediate T2W SI and joint invasion. The presence of a soft tissue mass became a significant differentiating feature for tumours arising within the medullary cavity, but this was location specific and did not differentiate between Gd1-CS and HG-CS/DD-CS arising from the sternum or clavicle.

MRI Features of Solitary Vertebral Masses in Dogs: 20 Cases (2010–2019)

The objective of the study was to describe the MRI features of cytologically or histologically diagnosed solitary vertebral masses in dogs and identify potential MRI features enabling differentiation between malignant and benign lesions. Patients were divided into malignant and benign groups according to the final diagnosis. Medical records and MRI studies were retrospectively reviewed, and specific imaging features were compared. The malignant group comprised 15 dogs, with 5 dogs included in the benign group. MRI features of the different histopathologic/cytologic types of masses are described. Involvement of the vertebral body, a hyperintense signal on T2-weighted, short tau inversion recovery, T1-weighted, and T1-weighted gradient echo sequences and evidence of cortical destruction were significantly associated with malignancy (P < .05). Hypointensity on T1-weighted gradient echo sequence was significantly associated with benign masses (P < .05). The presence of bone sclerosis was significantly associated with osteosarcomas compared with other malignant masses (P < .05). Fractures (5 cases) were only seen in the group of malignant masses. This pilot study identifies some MRI features that may help differentiate between malignant and benign solitary vertebral masses. Greater case numbers are needed in future studies.

Calcifying odontogenic cysts: A 20-year retrospective clinical and radiological review

Objective: Calcifying odontogenic cysts (COCs) exhibit diverse clinical behaviours and may be associated with other benign odontogenic tumours. In this study, the clinical and radiological features of COCs were analysed according to subtypes based on the classification by Praetorius et al. Emphasis was placed on cases exhibiting atypical or aggressive radiological appearances. This information may assist the clinician to better understand the radiological spectrum of COCs. Methods: Histologically confirmed cases of COCs were retrospectively reviewed in a 20-year period from three tertiary institutions. The following clinical information was reviewed: patient demographics, main complaint, clinical duration, anatomical site and detailed radiological features. Results: Twenty-seven cases of COCs were included in the study. Asymptomatic swelling was the main clinical presentation with infrequent reports of associated pain. COCs had an anterior mandibular predilection. Well-demarcated borders were seen in all cases with isolated cases showing focal areas with loss of demarcation. Unilocular lesions were more common than multilocular variants. Internal calcifications were frequent and six cases presented with associated odontomas. Maxillary COCs resulted in the displacement of the maxillary sinus and/or nasal cavity walls. Radiological signs of aggression, including cortical destruction, were noted in a few cases. Conclusion: Given the fact that COCs can present with a spectrum of clinical behaviours and radiological presentations, the academic debate regarding the cystic versus neoplastic nature of the entity is justifiable. The cases in the current sample presented with diverse presentations, ranging from indolent to lesions with significant growth and aggression.

Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center

Study Design: Retrospective study. Objectives: Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy. Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed. Results: Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid–fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%. Conclusions: Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.

The role of magnetic resonance imaging in the diagnosis of malignant bone neoplasms. Current state of an issue

The review article is about clinical experience in the use of modern tomographic methods (magnetic resonance imaging (MRI) and X-ray computed tomography (CT)) in the diagnosis and assessment of the progression of malignant bone neoplasms, summarizing the results of the largest studies demonstrating the comparative characteristics of the methods. Numerous data demonstrate high sensitivity of MRI and form the following diagnostic tasks that can be solved by this method: the involvement degree of soft tissues in the pathological process, damage to the neurovascular bundle, the articular surface, assessment of the extent of tumor in the bone marrow canal. At the same time, CT shows a higher sensitivity in assessing cortical destruction and the degree of matrix mineralization. The article discusses the variety of program sequences and modes of MRI scanning, the prospects of the method in assessing the prevalence, staging, and differential diagnosis of bone tumors.

Computed Tomographic and Histopathological Characteristics of 13 Equine and 10 Feline Oral and Sinonasal Squamous Cell Carcinomas

Squamous cell carcinoma (SCC) is the most common equine sinonasal and feline oral tumour. This study aimed to describe the computed tomographic and histopathological characteristics of equine and feline SCC. Thirteen horses and 10 cats that had been histopathologically diagnosed with oral or sinonasal SCC and had undergone computed tomography (CT) of the head were retrospectively included in the study. CT characteristics of the mass and involved structures were noted. Histological examinations were evaluated according to a human malignancy grading system for oral SCC, which considered four grades of increasing aggressiveness. In horses, the masses were at the levels of the paranasal sinuses (n = 8), mandible (n = 3), tongue (n = 1), and nasal cavity (n = 1). In cats, the masses were at the levels of the maxilla (n = 4), mandible (n = 3), tongue (n = 1), and buccal region (n = 1) and were diffusely distributed (facial and cranial bones; n = 1). Masses in the equine paranasal sinuses showed only mild, solid/laminar, periosteal reactions with variable cortical destruction. However, maxillary lesions in cats showed severe cortical destruction and irregular, amorphous/pumice stone-like, periosteal reactions. CT revealed different SCC phenotypes that were unrelated to the histological grade. For morphologic parameters of the tumour cell population, a variability for the degree of keratinization and number of mitotic cells was noted in horses and cats. Concerning the tumour-host relationship a marked, extensive and deep invasion into the bone in the majority of horses and cats was seen. Most cases in both the horses and cats were categorized as histological grade III (n = 8); four horses and one cat were categorized as grade IV, and one horse and one cat were categorized as grade II. In this study, we examined the diagnostic images and corresponding applied human histopathological grading of SCC to further elucidate the correlations between pathology and oral and sinonasal SCC imaging in horses and cats.

Successful Treatment of a Massive Desmoplastic Fibroma of the Ilium without Surgery: A Case Report with Long-Term Follow-Up

Desmoplastic fibroma of the bone (DFB) is a notably rare, lytic, locally aggressive but nonmetastatic, primary benign bone tumor in patients less than 30 years old. As the recommended primary treatment for DFB, wide resection is preferred to curettage from the perspective of recurrence but wide resection of DFB in the pelvis such as in the acetabulum could result in greater functional loss, suggesting the need for conservative treatments. However, there is no report on long-term follow-up following conservative treatment for DFB. The present case involved a 21-year-old woman with right hip pain. Radiological evaluation revealed a massive lesion throughout the right ilium and acetabulum with partial osteolysis, cortical destruction, marginal sclerosis, slight pseudotrabeculation, and bone expansion. Open biopsy from the ilium showed the proliferation of spindle cells in an abundant collagenous matrix without atypia and mitosis, suggesting a diagnosis of DFB. Conservative treatment was selected considering the risk of greater functional loss following wide ilium resection. An evaluation 10 years after follow-up showed a partially sclerotic lesion of the ilium and the absence of pain. The current case demonstrates that conservative therapy may be effective even in some cases of aggressive DFB.

Successful Reconstruction of Bone and Soft Tissue Defect Using Artificial Dermal Matrix after Hand Injury due to Dog Bite

Here we report a successful treatment of animal bite wound involving the bone. We used an artificial dermal matrix to reconstruct the cortical defect and prevent adhesion of the tendinous structures. A 48-year-old woman visited the emergency department for a painful hand swelling due to a dog bite 2 months earlier. A physical examination revealed a firmly palpable lesion with swelling and tenderness on the dorsal aspect of her hand. Magnetic resonance imaging found lytic changes of the second metacarpal bone with cortical destruction and fluid collection. After debridement of the necrotic tissue, a cortical bone defect with inflammatory changes of the medulla was noted. Following several days of irrigation, an artificial dermal matrix was applied with skin flap coverage to restore the soft tissue and bone defect. Three months later, the patient showed good motion of her hand without any restrictions. We believe artificial dermal matrix can be a good treatment strategy for restoring bone defect and preventing tendon adhesion simultaneously.