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.

Microcomputed tomography of the holotype of the early tetrapod Ichthyerpeton bradleyae (Huxley in Wright and Huxley, 1866) from the Pennsylvanian of Ireland

Ichthyerpeton bradleyae (Huxley in Wright and Huxley, 1866) is one of the seven tetrapods originally described by Huxley from the Jarrow Assemblage (Pennsylvanian, Langsettian Regional Substage equated with the Bashkirian International Stage) in south-eastern Ireland. The holotype, one of only two specimens considered to represent the taxon, consists of the postcranial skeleton, which has been highly compressed and has undergone extensive replacement of bone by carbonaceous material. The holotype is studied using microcomputed tomography, which reveals that the vertebral column has at least 25 diplospondylous vertebrae with cylindrical centra. Neural arches and a haemal arch are described for the first time. Neural arches in the caudal region are paired and neural spines only contact one another dorsally. The hemal arch is fused and wraps around the ventral margin of the centrum. A stout femur and tibia are described. The morphology of the femur is unique for early tetrapods, with fibular and tibial condyles of similar length and lacking an adductor crest. The morphology of the femur, and its length relative to the tibia, suggests that the holotype of I. bradleyae preserves an immature individual. The tibia is a flat bone characteristic of stem tetrapods. Phalanges from the right and left pes are present. Because the phalanges are disarticulated, a phalangeal count cannot be determined. Despite the new anatomical information, the systematic position of I. bradleyae is still difficult to establish; however, it does not belong within the colosteids, temnospondyls, or embolomeres, to which it has previously been assigned.

Osteoid Osteoma of the Scapular Neck: A Cause of Long-lasting Unexplained Pain

Introduction: Osteoid osteoma (OO) is a common tumor of the diaphysis of long bone, where the reported incidence is up 10% of all benign bone tumors. Its presence in flat bone is seldom mentioned in literature and can be misleading when the bone involved is in proximity to a zone of wide variety of possible pathology. We report a case of a young patient with OO in a very rare location of the body –the scapular neck – that was misdiagnosed for a long period of time before receiving adequate therapy. Case Report: A 20-year-old female patient presented to the clinic with chronic left shoulder pain. During the past 2 years, she received medical and physical therapy, to deal with different diagnosis such as cervical spine pathology, muscular spasm, and rotator cuff disease. However, she did not improve. At time of presentation to our clinic, radiographs of the shoulder were done and turned to be inconclusively normal. After negative magnetic resonance imaging of the cervical spine, a computed tomography scan of the shoulder was done and showed a round well-defined lesion localized in the scapular neck with a focal lucent nidus within surrounding sclerotic reactive bone measuring 8.5 mm in largest diameter, compatible with OO. Bone scan showed increased uptake. The patient was given aspirin in an intention to test and treat. The patient had dramatic pain relieve at first, which confirmed the diagnosis of OO. But then, pain became unremitting, so a decision was made for radiofrequency ablation of the lesion which gave excellent results. Conclusion: OO is a common benign neoplasm with high variable clinical picture and anatomic localization. Despite being more common in long bone, flat bone OO localization should be always kept in mind. Careful history and physical examination should be done for each patient presenting with unexplained pain; night pain should always raise suspicion of this condition. Radiographs are not always conclusive, and the patient with high suspicion

Upper Gastrointestinal Foreign Body, our Experience in Faridpur Medical College Hospital

Accidental ingestion and impaction of food or non-food foreign body in upper GIT is not uncommon. This retrospective study was undertaken at Gastroenterology department of Faridpur Medical College Hospital, Bangladesh. Data were collected from endoscopy software by computer search among patients with foreign bodies in upper GIT from January 2012 to December 2018. Total 41 patients with endoscopically proved ingested with or without impacted foreign body in the upper GIT were studied. Of them, 28 were male and 13 were female with age ranges from 15 to 85 years with a mean age of 52.66 ± 19.7 years. Meat bolus was the commonest type (12; 29.3%), followed by dental prosthesis (9; 22%). Most of them (24; 58%) were impacted between 20 to 30 cm from incisor teeth. We could successfully remove 38 cases with a success rate of 92.7% with the help of dormia basket, polypectomy snare & rat tooth foreign body grasper. We found few erosions and superficial ulcerations at the impacted site among patients with dental prosthesis, pill with strip and chicken bone. One patient with sharp flat bone of hilsa fish was impacted at esophagus like sharp cutting blade and produced incised looking wound at both esophageal walls. In 19 cases (46.34%) we found definite anatomic abnormalities and 19 cases (46.34%) no abnormalities was found. Rest 3 cases, who were referred to surgeon we failed to know the underlying pathology. Sharp foreign bodies impacted at upper esophagus were difficult to remove endoscopically. Faridpur Med. Coll. J. Jul 2019;14(2): 74-78

Microscopic and macroscopic comparisons of 0.223 soft point and full metal jacket ammunition with bos taurus scapulae as a proxy to human flat bones

BackgroundThe prevalence of civilian 0.223 ammunition is widespread. Due to low costs and the same dimensions as a 5.56×45 mm North Atlantic Treaty Organization, this round is exceptionally popular. However, recent mass shootings have employed soft point (SP) expanding ammunition to cause grievous wounds compared with military full metal jacket (FMJ) rounds that do not rapidly expand on impact.MethodsThe aim of this given study is to compare FMJ and SP rounds to determine if there are diagnostic differences between the bullet types in the wounds inflicted to flat bones. Bos taurus scapulae were used for 25 m simulated cranial gunshot injuries. Scanning electron microscopy was employed to assess the difference in wound morphology and elemental analysis between SP and FMJ rounds.ResultsEntrance and exit wound morphology change significantly between the two different types of ammunition as seen with circumferential delamination which is indicative of FMJ rounds and is not seen with the softer SP hunting rounds. Lead staining of the entrance wound is visible on only the SP rounds.ConclusionGunshot flat bone wound morphology is distinctively different between SP and FMJ rounds. Circumferential delamination is only seen with FMJ due to the hardness of the round. Lead staining is only seen with SP rounds due to bullet composition.

Viability of Bos taurus scapulae as a flat bone proxy for ballistic testing

BackgroundHandguns and rifles are often involved in violent deaths such as homicide and suicide. Consequently, forensic investigations are important to clarify the nature of ballistic trauma.MethodsThis study investigated the differences in entrance and exit wound morphology with Bos taurus (bovine) scapulae that have two cortical layers surrounding a central cancellous bone section which are comparable with human flat bones, with a series of experiments using six different calibres (0.22 Long Rifle, 9×19 mm North Atlantic Treaty Organization, 0.40 Smith & Wesson, 0.45 Automatic Colt Pistol, 5.56×45 mm and 7.62×51 mm). B. taurus (bovine) scapulae were used for closed range 30 cm simulated executions.ResultsThe ballistic experiments presented similarities in entrance wound morphology and exit wound bevelling with that of recognised forensic cases. As muzzle velocity increased, bevelling increased. Circumferential delamination is clearly visible with full metal jacket rounds, yielding similar bone damage morphology as human crania.ConclusionBovine scapulae seem appropriate for ballistic simulations of flat bone injuries on the macroscopic level, if the correct portion of the scapulae is deployed. More research is needed to further substantiate these interpretations.