Kissing periosteal chondroma and osteochondroma

We present an unusual case of two synchronous chondroid matrix lesions in the proximal femur of a 16-year-old male. They were incidental findings, which subsequently underwent surgical excision and confirmed the imaging findings of a "kissing" osteochondroma and a periosteal/juxtacortical chondroma. We could not find another report of these findings in the English literature.

[Pierre-Marie-Bamberger syndrome - a paraneoplastic syndrome of lung cancer - a case report]

The Pierre-Marie-Bamberger syndrome is a rare paraneoplastic syndrome caused by bronchial carcinoma. Typical signs are symmetric periostoses on the diaphyses of the long tubular bones, clubbed fingers and toes with eye-glass shape of the nails, neuro-vegetative disturbances and dysproteinemia. We report a 37-year-old patient with long-term nicotine abusus, who attracted attention by symptoms of a Pierre-Marie-Bamberger syndrome. Further diagnostics revealed a tumor in the apex of the left lung. After lobectomy of the upper lobe of the left lung the symptoms are completly disappeared.

[Parosteal rib lipoma: description of a case]

Parosteal lipoma is a usually indolent, rare benign tumor, characterized by clinicopathological findings similar to those of the commonly occurring subcutaneous lipoma, except for its intimate relationship with the connective tissue of the subjacent periosteal region. Parosteal lipoma commonly affects the diaphysis of long bones of the upper and lower limbs. We report an exceedingly rare case of parosteal lipoma of the rib, which presented in a 59-year-old man experiencing previous multiple traumas in this site.

Ultrasonography for the evaluation of forearm interosseous membrane disruption in a cadaver model

Recognition of interosseous membrane disruption associated with radial head injury and Essex-Lopresti injury is important, especially if radial head excision is contemplated. Because a widely accepted method to diagnose interosseous membrane disruption does not exist, we evaluated the accuracy of ultrasonography to diagnose this injury in a cadaver model. Nine pairs of cadaver forearms were randomized into 2 groups. The central third of the interosseous membrane of forearms of group 1 was cut, whereas it was visualized but not cut in group 2. A dynamic ultrasound examination was performed to determine interosseous membrane integrity, and static images were made. The static images were evaluated by 2 other radiologists and interpretations were recorded. One radiologist incorrectly interpreted 1 pair of forearms; the other 2 radiologists were 100% accurate. The accuracy of ultrasonography in detecting interosseous injuries was 96% with our methods.

Radiographic evaluation of malignant fibrous histiocytoma affecting maxillary alveolar bone: a report of 2 cases

OBJECTIVE

The purpose of this study was to evaluate the radiographic findings of malignant fibrous histiocytoma (MFH) and to discuss the contribution of these findings to a differentiation of MFH from other malignant tumors of the head and neck.

STUDY DESIGN

Two cases of MFH of the maxillary sinus affecting the alveolar bone were evaluated radiographically and scintigraphically.

RESULTS

We reported the following findings, which have only seldom been described: the presence of fairly well-demarcated bone destruction in the intraoral radiograph; the relatively smooth surface, uniform density, or no necrotic area of the tumor; in computed tomograph images showing the clear separation of the tumor from surrounding soft tissues; bone scintigraphs reflecting the periosteal reaction to tumor invasion; and lymphoscintigraphy of the metastatic lymph nodes.

CONCLUSION

We evaluated the radiographic findings from 2 cases of MFH and describe findings that may aid in the differentiation of MFH. These radiographic features may help dentists differentiate MFH from other malignant tumors in the head and neck, although MFH is a rare disease and there are no radiographic findings that would indicate a specific diagnosis of MFH.

Pott's puffy tumour: still not an eradicated entity

Pott's puffy tumour is an infrequent entity characterised by one or more subperiosteal abscesses associated with frontal bone osteomyelitis. Although cases in patients of all ages have been reported, teenagers are the most frequently affected. Early diagnosis and aggressive treatment are essential because of the high risk of severe neurological complications, such as epidural abscess, subdural empyema, and secondary septic thrombosis of the dural sinuses. This paper describes the case of a patient with a subperiosteal abscess resulting from sinusitis, with orbital and intracranial extension, and subsequent neurological complications. Despite modern methods of diagnosis and treatment, 13 new cases have been published in the last 5 years; in at least 3 (23%) of these cases there were serious neurological complications. Upper respiratory infections and sinusitis are leading causes of visits to the emergency department in the paediatric age group; however, no risk factors for poor outcome have so far been identified in any of these patients.

Radiological features of 24 periosteal chondrosarcomas

OBJECTIVE

To report the imaging findings of 24 periosteal chondrosarcomas diagnosed, staged, treated and followed in a single institution, to analyze and define their pattern, and discuss their practical consequences.

DESIGN AND PATIENTS

Plain films, 16 CT examinations and four MRI examinations were reviewed, and compared with the histological evaluation.

RESULTS

There were 20 men and four women, aged from 17 to 65 years. Twelve lesions involved the distal femoral metaphyses (8 posteriorly), five the proximal humerus, two the proximal metaphyses of the femur and two of the tibia, two the humeral shafts and one the iliac wing. Size varied from 4 to 11 cm. The cortex was always involved (thick, 15; thin, 13). Typical cartilaginous calcifications and cartilaginous lobules were very frequent. Radial thick periosteal bone formations (n = 6) indicated calcifications between the lobules of cartilage. Medullary involvement was rare (n = 2). All patients are alive and free of disease.

CONCLUSIONS

Recognizing periosteal chondrosarcoma is of paramount importance because the prognosis is excellent after adequate local surgery alone. The patterns of other surface tumors of bone are usually different.

Child abuse fracture through physiologic periosteal reaction

Because infants from 1 to 6 months of age often normally show symmetric diaphyseal periosteal reaction, careful analysis of the reaction at a midshaft fracture site is needed to date the fracture, especially in a child-abuse evaluation. We present a case of an acute fracture through such physiologic reaction.

Sonography of acute osteomyelitis in rabbits with pathologic correlation

RATIONALE AND OBJECTIVES

Ultrasonography (US) has a potential role in the diagnosis of osteomyelitis. The purpose of this study was to determine the characteristic sonographic features of acute osteomyelitis and correlate them with pathologic findings.

MATERIALS AND METHODS

An experimental model of acute osteomyelitis was produced in the tibiae of 20 rabbits. Daily US and plain radiography were performed for 2 weeks. The authors evaluated periosteal reaction, subperiosteal fluid collection, and soft-tissue changes seen with US. A hypoechoic band and a hyperechoic line lying along the cortex were considered positive signs of subperiosteal fluid collection and periosteal reaction, respectively. The findings of periosteal reaction were compared for US and radiography, and pathologic findings were also correlated.

RESULTS

The most common sonographic finding was a hypoechoic band along the cortex (21 [75%] of 28 tibiae), usually associated with a linear periosteal reaction (20 [71%] of 28). This juxtacortical abnormal echogenicity corresponded to periosteal elevation with loose fibrovascular connective tissue and granulation, associated with subperiosteal abscess formation. The periosteal reactions were detected with US before they were seen on radiographs. The periosteum showed gradual thickening during the disease process. In 50% of infected tibiae, inflammation or abscess formation was observed in the surrounding soft tissue.

CONCLUSION

US readily demonstrates juxtacortical abnormal echogenicity and soft-tissue infection related to acute osteomyelitis. The abnormal echogenicity correlated well with the pathologic findings of periosteal reaction and subperiosteal abscess.

Periosteal osteosarcoma of the cranium

We report a case of periosteal osteosarcoma arising from the occiput in a 29-year-old woman. To the best of our knowledge, this is the first documented case of periosteal osteosarcoma involving the cranium.

[Bone metastasis revealing a primary prostate cancer]

Spiculated reactive periosteal bone is usually found in cases of primary malignant bone tumors; rarely in secondary bone lesions. The authors report a case of bone tumor of the clavicle in a 62 year-old patient with "sunburst " periosteal reaction on radiographs. The metastatic nature of this lesion from an unknown prostate carcinoma was confirmed by immunohistochemical studies of the clavicle biopsy. Tumorectomy was performed and the patient's status is stable with a follow-up of 10 months.

Physiologic periosteal changes in infancy

Surface modulation is part of normal bone growth. However, the radiologic appearance of physiologically growing bone in infancy may resemble changes secondary to trauma. This case report reviews bone remodeling in the postnatal infant and describes its unique radiologic and pathologic characteristics, allowing normal to be differentiated from healing and repair.

Primary osteosarcoma of the sphenoid bone with extensive periosteal extension--case report

A 28-year-old male presented with a primary osteosarcoma of the sphenoid bone with extensive periosteal extension manifesting as severe headache and right exophthalmos. Computed tomography (CT) and magnetic resonance imaging revealed an anterior middle cranial fossa tumor extending into both the orbit and the extracranial space. However, roentgenography and CT with bone windows showed no marked osteolytic changes of the sphenoid bone. Total removal of the tumor was performed via the orbitozygomatic approach. Surgery revealed that the tumor had extended periosteally without macroscopic bone destruction, but no obvious abnormalities of the skull. The histological diagnosis was osteosarcoma. The patient was treated with chemotherapy and radiation therapy, but died of tumor recurrence 10 months after the surgery.

[Subperiosteal abscess as a complication of osteomyelitis: usefulness of bone scintigraphy]

We present the case of an unweaned baby girl with acute femoral osteomyelitis. The bone scintigraphy showed diffuse photopenia of the femoral diaphysis. The final diagnosis revealed diaphyseal osteomyelitis complicated by the presence of a subperiostic abscess.

[Periostal interposition in epiphysiolysis, diagnosed by ultrasound]

Musculoskeletal ultrasound is a rapidly expanding diagnostic field. High frequency transducers with high spacial resolution make it possible to demonstrate superficial soft tissue structures such as tendons, muscles, ligaments and even, under certain circumstances, fractures and periosteum. A case is presented where ultrasound clearly visualised periostal interposition in a distal tibial epiphysiolysis in an eight year-old boy, and some aspects of ultrasound in musculo-skeletal imaging are discussed.

The histological spectrum of subperiosteal fibrocartilaginous pseudotumor of long bone (focal fibrocartilaginous dysplasia)

Clinicopathological features in six cases of focal fibrocartilaginous dysplasia (FFCD) which involved either the tibia (n = 4) or the femur (n = 2) were reviewed. All cases presented clinical and radiological characteristic features, and histopathological findings were analyzed in five of the six cases. The subject group comprised three boys and three girls, ages ranged from 12 to 18 months. Histologically, the individual lesions showed regional variation in cellularity, amount of fibrous and cartilaginous components. Paucicellular areas were mainly composed of dense fibrous tissue while more cellular areas contained foci of fibrocartilaginous element. The chondrocytes and stellate cells around cartilaginous area were positive for S-100 protein. One case contained both hyaline and fibrocartilage, and architecturally mimicked normal tendinous insertion. One case, which involved proximal tibia, was purely composed of fibrous tissue without fibrocartilage. All cases formed undulating and irregular borders against underlying cortical bone. Histopathologically variable spectrum suggests a strong possibility of undergoing transition from initial cellular and cartilagnous to late paucicellular, fibrous phase. Although any evidence that can explain basic pathogenesis or prognostic histological parameter is lacking, we believe that the term FFCD is not relevant because the presence of fibrocartilage is not an essential feature, and it can cause confusion with other pathological processes. We propose the term 'subperiosteal fibrocartilaginous pseudotumor of long bone' for this unique clinicopathological entity with which heterologous cartilaginous element can be associated.

Cortical revascularization after reamed and unreamed intramedullary nailing in the rabbit femur: a microangiographic histometric analysis

BACKGROUND

Intramedullary nailing leads to a reduction in cortical bone blood flow. The relative effect of reamed versus unreamed nailing on the degree of avascularity and on revascularization of the cortex remains controversial. We compared the effects of reamed versus unreamed intramedullary nailing on cortical revascularization and the time course for its recovery in the unfractured rabbit femur.

METHODS

A total of 56 New Zealand white rabbits were used as experimental animals. Reamed nailings with Kirschner wire (diameter, 3 mm) were performed in the right femora (group R, n = 49), and unreamed nailings with Kirschner wire (diameter, 2 mm) were performed in the left femora (group UR, n = 49) of the same animals after a standard surgical procedure. Microangiography that used Indian ink was performed for each killed animal at one of seven postoperative time periods: 2 hours, 3 days, and 1, 2, 3, 4, and 5 weeks after surgery. The right femora and the left femora of seven rabbits were used as the postoperative day 0 controls of group R and those of group UR, respectively. We evaluated the vascularization ratio (VR) in cross-sections according to the following formula: VR = the number of enhanced vessels with Indian ink/total cortical vessels. Each cross-section was divided into an inner and outer half, which were in turn divided into quarters, so that the entire cross-sectional are is represented by eight regions. The VR was calculated for each regions and then comparison was made between group R and group UR at various time periods and areas.

RESULTS

No statistically significant differences were observed in VR at any time period between group R and group UR in total cortical area and total periosteal side. However, on the total medullary side, the VR of group UR was significantly higher than that of group R at postoperative day 3 (p = 0.04). Statistically significant differences were observed between the VR on the periosteal side and that on the medullary side in both groups at all time periods aside from the 5-week period (p < 0.05). Revascularization of the cortex occurred 4 weeks after intramedullary nailing in both group R and group UR.

CONCLUSION

The periosteal circulation was maintained better than the medullary circulation, irrespective of whether the canal was reamed or not. The present study failed to detect any statistically significant differences in cortical revascularization between reamed nailing and unreamed nailing. Thus, we concluded that reamed and unreamed nailing are not differentially advantageous in the unfractured rabbit femur, in terms of impairment of cortical blood supply.

[Periosteal reaction]

The periosteal membrane covers the cortical bone except for the articular surface. The deep layer of the periosteum contains bone-forming mesenchymal cells, capillaries, and nerves. This layer is more active in infants than in adults. Prostaglandin osteopathy, infantile cortical hyperostosis, hypervitaminosis A, and congenital syphilis are examples of periostitis in infants. Incidental asymptomatic periosteal reactions are usually either physiological changes or cortical bone irregularities simulating periostitis. On the other hand, symptomatic periosteal reactions of single bone, such as bone tumor, tumor-like lesion, infection, and trauma, are always pathologic. Careful radiological analysis of periosteal reactions is needed to evaluate the activity and aggressiveness of the lesions. Periosteal reactions of multiple bones usually show solid smooth or undulating patterns. They include pachydermoperiostosis, secondary hypertrophic osteoarthropathy, vascular insufficiency, renal osteodystrophy, and thyroid acropachy. These are usually skeletal manifestations of systemic disorders.