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Smorgick Y, Granek T, Mirovsky Y, Rabau O, Anekstein Y, Tal S. Routine sagittal whole-spine magnetic resonance imaging in finding incidental spine lesions. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2020; 34:421-426. [DOI: 10.1007/s10334-020-00882-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
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Tannenbaum M, Colucci PG, Baad M, Borczuk AC, Steigman SA, Kovanlikaya A. Chondroid lipoma: multimodality imaging in a 9-year-old female. Skeletal Radiol 2020; 49:161-169. [PMID: 31230114 DOI: 10.1007/s00256-019-03259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 02/02/2023]
Abstract
Chondroid lipomas are rare, benign lipomatous tumors that occur most frequently in adults during the fourth decade of life. While a female predominance was observed in the initial series of 20 cases described in 1993, the subsequent 49 reported cases do not support a strong gender predilection. We report a case of a chondroid lipoma presenting in a 9-year-old female as a painless, enlarging, left gluteal mass. This is the second case to be reported in the first decade of life and the fourth pediatric case reported in the literature (age < 21). We review the imaging and pathology findings as well as present a comprehensive review of the current literature.
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Affiliation(s)
- Melissa Tannenbaum
- Tufts University School of Medicine, 145 Harrison Ave, Boston, MA, 02111, USA
| | - Philip G Colucci
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Radiology, 525 East 68th Street, New York, NY, 10065, USA
| | - Michael Baad
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Radiology, 525 East 68th Street, New York, NY, 10065, USA
| | - Alain C Borczuk
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology, 525 East 68th Street, New York, NY, 10065, USA
| | - Shaun A Steigman
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Surgery, 525 East 68th Street, New York, NY, 10065, USA
| | - Arzu Kovanlikaya
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Radiology, 525 East 68th Street, New York, NY, 10065, USA.
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Abstract
RATIONALE Chondroid lipoma (CL) is a rare benign tumor. No relevant epidemiological reports have been published on CL, and there is a lack of uniform diagnostic and treatment criteria for the tumor. PATIENT CONCERNS Here, we report a case of CL with a mass on the left buttock for 2 weeks, and further illuminate its diagnosis and treatment. DIAGNOSIS The diagnosis of CL was rendered according to the pathological indices. INTERVENTIONS The tumor was resected completely under spinal anesthesia. OUTCOMES The patient was followed-up for 6 months and showed no tumor recurrence or metastasis and there was resolution of the patient's lower-limb numbness and pain. LESSONS The case study presented here provides evidence that CL could be effectively diagnosed by using ultrasound, puncture or biopsy, and/or magnetic resonance imaging. Furthermore, the patient recovered without any complications after completely resecting the tumor.
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Aggarwal P, Wadhwa D, Kundu R, Virk JS, Garg SK. Proximal thigh chondrolipoma in a young boy: a rare entity. ANZ J Surg 2018; 89:1655-1657. [PMID: 30198158 DOI: 10.1111/ans.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/12/2018] [Accepted: 06/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Purnima Aggarwal
- Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Deepak Wadhwa
- Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Reetu Kundu
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Jagandeep S Virk
- Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India
| | - Sudhir K Garg
- Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India
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Ishibashi T, Nishio J, Kobayashi S, Shiramizu K, Yamamoto T. Chondrolipoma of the Ankle in a Child: A Case Report. J Foot Ankle Surg 2018; 56:1284-1287. [PMID: 28606791 DOI: 10.1053/j.jfas.2017.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Indexed: 02/03/2023]
Abstract
Chondrolipoma is an extremely rare variant of lipoma with cartilaginous metaplasia. The presence of nonlipomatous components can lead to a variety of entities in the differential diagnosis from the radiologic findings. We describe an unusual case of a chondrolipoma occurring in the right ankle of a 9-year-old female. Physical examination showed a 3.5-cm, elastic-hard, poorly mobile, nontender mass adherent to the Achilles tendon. Plain radiographs revealed a faintly calcified soft tissue mass without bone involvement. Magnetic resonance imaging showed a well-defined mass with 2 components with heterogeneous signal intensity, suggesting the coexistence of a fatty area and another nonlipomatous component. Marginal excision of the tumor was performed. Histologically, the tumor was composed of mature adipose tissue studded with islands of mature hyaline cartilage. Based on these findings, the tumor was diagnosed as a chondrolipoma. The patient had no evidence of local recurrence within 9 months of follow-up. To the best of our knowledge, this is the first case of chondrolipoma originating from the ankle in a child.
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Affiliation(s)
- Takuya Ishibashi
- Resident, Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Jun Nishio
- Assistant Professor, Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Shunsuke Kobayashi
- Resident, Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kei Shiramizu
- Orthopaedic Surgeon, Tsushima Orthopaedic Surgery, Nagasaki, Japan
| | - Takuaki Yamamoto
- Chair and Professor, Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Katsuyama Y, Shirai T, Terauchi R, Tsuchida S, Mizoshiri N, Mori Y, Kubo T. Chondroid lipoma of the neck: a case report. BMC Res Notes 2018; 11:415. [PMID: 29954455 PMCID: PMC6022339 DOI: 10.1186/s13104-018-3523-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/20/2018] [Indexed: 11/15/2022] Open
Abstract
Background Chondroid lipoma, first described in 1993 by Meis and Enzinger, is a very rare lipomatous tumor. Because it is a benign tumor, it does not require radiotherapy, chemotherapy, or extensive resection. However, histologically, it is often confused with a sarcoma. It is crucial to differentiate chondroid lipoma from sarcoma to avoid choosing an inappropriate treatment strategy. Although MRI, radiography, and ultrasound have been used to evaluate chondroid lipomas, imaging cannot accurately differentiate chondroid lipoma from sarcoma. Case presentation A 39-year-old man presented to a local clinic with a 1-month history of a painless mass in his left neck. Results of a needle biopsy suggested an atypical lipomatous tumor, and the patient was referred to our hospital. Physical examination revealed a hard and mobile mass in the left neck. Plain X-ray radiographs showed an absence of calcification in the soft tissue mass. MRI revealed a well-defined and lobulated mass, and on T1-weighted images, the lesion showed heterogeneity, with higher signal intensity than that of muscle. On T2-weighted images, the septum had low-signal intensity. On T2-weighted fat-suppressed images, the signal of the mass was completely suppressed. The SUVmax of the mass on FDG PET was 1.84. An additional needle biopsy was performed, and on the basis of the results, we arrived at a diagnosis of well-differentiated liposarcoma. The mass was resected marginally. Macroscopically, the mass was encapsulated and markedly harder than well-differentiated liposarcoma. Histologically, the tumor was composed of myxoid and cartilaginous matrix, and mature fat cells and lipoblast-like cells were present. The final diagnosis was chondroid lipoma, and no recurrence was observed 1 year after surgery. Conclusions Chondroid lipoma is an extremely rare benign soft tissue tumor that is often confused with sarcoma. It is very important to differentiate chondroid lipoma from sarcoma when the SUVmax value of the mass is low, even when biopsy results suggest that it is a sarcoma.
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Affiliation(s)
- Yusei Katsuyama
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiharu Shirai
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Ryu Terauchi
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Shinji Tsuchida
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naoki Mizoshiri
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuki Mori
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Gupta P, Potti TA, Wuertzer SD, Lenchik L, Pacholke DA. Spectrum of Fat-containing Soft-Tissue Masses at MR Imaging: The Common, the Uncommon, the Characteristic, and the Sometimes Confusing. Radiographics 2017; 36:753-66. [PMID: 27163592 DOI: 10.1148/rg.2016150133] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fat-containing tumors are the most common soft-tissue tumors encountered clinically. The vast majority of fat-containing soft-tissue masses are benign. Lipomas are the most common benign fat-containing masses and demonstrate a characteristic appearance at magnetic resonance (MR) imaging. Less common benign soft-tissue masses include lipoblastoma, angiolipoma, spindle cell lipoma/pleomorphic lipoma, myolipoma, chondroid lipoma, lipomatosis of nerve, lipomatosis, hibernoma, and fat necrosis. Well-differentiated liposarcomas (WDLPSs)/atypical lipomatous tumors (ALTs) are locally aggressive soft-tissue masses that do not metastasize. Biologically more aggressive liposarcomas include myxoid, pleomorphic, and dedifferentiated liposarcomas. At MR imaging, lipomas typically resemble subcutaneous fat but may contain a few thin septa. The presence of thick, irregular, enhancing septa and nonfatty soft-tissue mass components suggests liposarcoma rather than lipoma. However, benign lipomatous lesions and WDLPS/ALT often have overlapping MR imaging findings. Distinguishing WDLPS/ALT from a benign lipomatous lesion or from fat necrosis at imaging can be challenging and often requires histologic evaluation. We present the spectrum of fat-containing masses, using the World Health Organization classification of adipocytic tumors, with an emphasis on commonly encountered lesions, characteristic MR imaging findings associated with specific tumors, and overlapping MR imaging findings of certain tumors that may require histologic sampling. We also briefly discuss the role of molecular markers in proper characterization and classification of fat-containing soft-tissue masses. (©)RSNA, 2016.
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Affiliation(s)
- Pushpender Gupta
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - Tommy A Potti
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - Scott D Wuertzer
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - Leon Lenchik
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
| | - David A Pacholke
- From the Departments of Radiology of Kadlec Regional Medical Center, 888 Swift Blvd, Richland, WA 99352 (P.G.); Wake Forest School of Medicine, Winston-Salem, NC (T.A.P., S.D.W., L.L.); and W.G. (Bill) Hefner VA Medical Center, Salisbury, NC (D.A.P.)
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The impact of routine whole spine MRI screening in the evaluation of spinal degenerative diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:1993-1998. [DOI: 10.1007/s00586-017-4944-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
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Kanna RM, Gaike CV, Mahesh A, Shetty AP, Rajasekaran S. Multilevel non-contiguous spinal injuries: incidence and patterns based on whole spine MRI. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1163-9. [PMID: 26329650 DOI: 10.1007/s00586-015-4209-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 08/22/2015] [Accepted: 08/22/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Multi-level non-contiguous spinal injuries are not uncommon and their incidence varies from 1.6 to 77% depending on the type of imaging modality used. Delayed diagnosis and missed spinal injuries in non-contiguous spine fractures have been frequently described which can result in significant pain, deformity and neurological deficit. The efficacy of whole spine MRI in detecting asymptomatic significant vertebral fractures is not known. METHODOLOGY Consecutive spinal injury patients treated between 2011 and 2013 were retrospectively evaluated based on clinical and radiographic records. Patients' demographics, mode of injury, presence of associated injuries, clinical symptoms and the presence of neurological deficit were studied. Radiographs of the fractured region and whole spine MRI were evaluated for the presence of multi-level injuries. RESULTS Among 484 patients, 95 (19.62%) patients had multilevel injuries including 86 (17.76%) with non-contiguous injuries. Five common patterns of non-contiguous spinal injuries were observed. Pattern I: cervical and thoracic--29.1%, Pattern II: thoracolumbar and lumbosacral--22.1%, Pattern III: thoracic and thoracolumbar--12.8 %, Pattern IV: cervical and thoracolumbar--9.1% and Pattern V: lumbosacral and associated injuries--9.0 %. The incidence of intra-regional non-contiguous injuries was 17.4%. Whole spine MRI scan detected 24 (28.6%) missed secondary injuries of which 5 were unstable. CONCLUSION The incidence of multilevel non-contiguous spine injury using whole spine MRI imaging is 17.76%. Five different patterns of multi-level non-contiguous injuries were found with the most common pattern being the cervical and thoracic level injuries. The incidence of unstable injuries can be as high as 21% of missed secondary injuries.
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Affiliation(s)
- Rishi Mugesh Kanna
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - Chandrasekar V Gaike
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - Anupama Mahesh
- Department of Radiology, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - Ajoy Prasad Shetty
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India
| | - S Rajasekaran
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam road, Coimbatore, 641043, India.
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Yıldız AE, Aydıngöz Ü, Sökmensüer C, Karçaaltıncaba M. Intramuscular chondroid lipoma: magnetic resonance imaging diagnosis by 'fat ring sign'. Balkan Med J 2015; 32:107-10. [PMID: 25759781 DOI: 10.5152/balkanmedj.2014.14035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 08/12/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Chondroid lipoma is an extremely rare variant of benign lipomatous lesions that is composed of lipoblasts, mature fat, and chondroid matrix. Although benign lipomatous lesions are the most common soft tissue tumors and imaging findings are often pathognomonic, there have been few reports describing the imaging features of chondroid lipoma. CASE REPORT We present magnetic resonance imaging (MRI) findings of a pelvic intramuscular chondroid lipoma in a 59 year-old man and describe a "fat ring sign" that may be useful to diagnose this rare tumor radiologically. CONCLUSION Magnetic resonance imaging findings of a chondroid lipoma may be heterogenous according to the distribution of the fatty and chondroid tissue. However, in the presence of "fat ring sign," radiologists should consider a diagnosis of chondroid lipoma preoperatively.
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Affiliation(s)
- Adalet Elçin Yıldız
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Üstün Aydıngöz
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cenk Sökmensüer
- Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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JAVID M, CALLEJA M, SHETTY S. Picture quiz: Musculoskeletal imaging. IMAGING 2013. [DOI: 10.1259/imaging.20110023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Setiawati R, Dimpudus FJ, Sun Z. Chondroid lipoma of the right thigh: Correlation of imaging findings and histopathology of an unusual benign lesion. Australas Med J 2012; 5:355-8. [PMID: 22905062 DOI: 10.4066/amj.2012.1260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chondroid lipoma is a rare and unusual benign soft tissue lesion. Although there have been several reports of the imaging findings of chondroid lipoma, very few described the radiographic calcification or ossification in a chondroid lipoma. We present a case of chondroid lipoma with adipose tissue and ossified components on plain radiography and MRI images. Correlation of imaging findings and pathological examination is provided to confirm the diagnosis.
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Affiliation(s)
- Rosy Setiawati
- Musculoskeletal Division, Department of Radiodiagnostic, Faculty of Medicine Airlangga University, Indonesia
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To determine the incidence and clinical characteristics of noncontiguous spinal injuries (NCSI) in a pediatric population. The secondary objective is to identify high-risk patients requiring further imaging to rule out NCSI. SUMMARY OF BACKGROUND DATA NCSI can add significant complexity to the diagnosis, management, and outcome of children. There is very little in the pediatric literature examining the nature, associated risk factors, management, and outcomes of NCSI. METHODS All children up to 18 years of age with a spinal injury, as defined by International Classification of Diseases, Ninth Revision codes, at one pediatric trauma hospital were included (n = 211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurological injury and recovery, associated injuries, medical complications, treatment, and outcome were recorded. RESULTS Twenty-five (11.8%) of 211 patients had NCSI, with a median age of 13.0 years (interquartile range = 8-15). The most common pattern of injury was a double thoracic noncontiguous injury. Sixteen percent of the cases of NCSI were initially missed, with no clinical deterioration due to missed diagnosis. Associated injuries occurred in 44% of patients with NCSI. Twenty-four percent of patients with multiple NCSI had a neurological injury compared with 9.7% in patients with single-level or contiguous injuries (P = 0.046). CONCLUSION There is a high incidence of children with multiple NCSI who are more likely to experience neurological injuries compared with patients with single-level or contiguous spinal injuries. Patients with a single-level spinal injury on existing imaging with an associated neurological injury should undergo at least plain films of the entire spine to exclude noncontiguous injuries. In patients without neurological injury and a single spinal fracture, radiography showing at least 4 levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded.
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Chandra J, Sheerin F, Lopez de Heredia L, Meagher T, King D, Belci M, Hughes RJ. MRI in acute and subacute post-traumatic spinal cord injury: pictorial review. Spinal Cord 2011; 50:2-7. [PMID: 22064660 DOI: 10.1038/sc.2011.107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Pictorial review. OBJECTIVES To illustrate MRI signs of acute and subacute injury with emphasis on evidence-based links to clinical outcome and implications for treatment. METHODS Description of important aspects of MRI techniques and illustration of critical MRI signs important in the assessment of spinal cord injury following trauma, in the acute and subacute stages. CONCLUSIONS Familiarity with cord MRI appearances has an important impact on planning the management of the acutely spinal cord injured patient and also identifying complications in the subacute phase particularly in the presence of neurological deterioration.
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Affiliation(s)
- J Chandra
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
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Park SE, Lee JU, Ji JH. Intraneural chondroid lipoma on the common peroneal nerve. Knee Surg Sports Traumatol Arthrosc 2011; 19:832-4. [PMID: 21153537 DOI: 10.1007/s00167-010-1343-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 11/15/2010] [Indexed: 11/29/2022]
Abstract
Both intraneural lipoma and chondroid lipoma have been reported in the previous literature as a separate disease entity on rare occasions. But intraneural chondroid lipoma has not been ever reported till now. So we present such a patient with an intraneural chondroid lipoma localized to common peroneal nerve.
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Affiliation(s)
- Sang-Eun Park
- Department of Orthopedic Surgery, College of Medicine, Daejon St. Mary's Hospital, The Catholic University of Korea, 520-2, Deahung-dong, Joong-ku, Daejon, 302-803, Korea
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Delineation of chondroid lipoma: an immunohistochemical and molecular biological analysis. Sarcoma 2011; 2011:638403. [PMID: 21559269 PMCID: PMC3087950 DOI: 10.1155/2011/638403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Accepted: 02/22/2011] [Indexed: 02/03/2023] Open
Abstract
Aims. Chondroid lipoma (CL) is a benign tumor that mimics a variety of soft tissue tumors and is characterized by translocation t(11;16). Here, we analyze CL and its histological mimics. Methods. CL (n = 4) was compared to a variety of histological mimics (n = 83) for morphological aspects and immunohistochemical features including cyclinD1(CCND1). Using FISH analysis, CCND1 and FUS were investigated as potential translocation partners. Results. All CLs were strongly positive for CCND1. One of 4 myoepitheliomas, CCND1, was positive. In well-differentiated lipomatous tumors and in chondrosarcomas, CCND1 was frequently expressed, but all myxoid liposarcomas were negative. FISH analysis did not give support for direct involvement of CCND1 and FUS as translocation partners. Conclusions. Chondroid lipoma is extremely rare and has several and more prevalent histological mimics. The differential diagnosis of chondroid lipomas can be unraveled using immunohistochemical and molecular support.
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Han IH, Suh SH, Kuh SU, Chin DK, Kim KS. Types and prevalence of coexisting spine lesions on whole spine sagittal MR images in surgical degenerative spinal diseases. Yonsei Med J 2010; 51:414-20. [PMID: 20376895 PMCID: PMC2852798 DOI: 10.3349/ymj.2010.51.3.414] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases. MATERIALS AND METHODS Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed. RESULTS MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age >or= 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis. CONCLUSION Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.
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Affiliation(s)
- In-Ho Han
- Department of Neurosurgery, Pusan National University School of Medicine, Busan, Korea
| | - Sang-Hyun Suh
- Department of Radilogy, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Uk Kuh
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Su Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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The role of the plain radiograph in the characterisation of soft tissue tumours. Skeletal Radiol 2009; 38:549-58. [PMID: 18566812 DOI: 10.1007/s00256-008-0513-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 04/21/2008] [Indexed: 02/02/2023]
Abstract
A radiograph is often the first investigation to be requested when a patient presents with limb pain or a mass. Whilst we do not advocate that this is the only investigation to be employed in the evaluation of such patients, a working knowledge of the variety of abnormal findings that can present in the soft tissues on radiographs remains useful. We reviewed the radiographic findings of soft tissue masses from a prospectively compiled database of all such lesions presenting to a specialist orthopaedic oncology service over the past 8 years. Of the cohort of 1,058 individuals with a proven soft tissue tumour, 454 had had a radiograph taken of the affected area. Of these, 281 (62%) patients had a positive radiographic finding. The most common findings were a visible soft tissue mass (n = 141), the presence of calcification (n = 76), fat (n = 32) and evidence of bone involvement (n = 62). More than one finding was sometimes present in the same patient. These findings were present in both benign and malignant tumours. This review article describes the incidence and diagnostic relevance of these plain film findings for suspected soft tissue tumours.
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21
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Value of immediate preprocedure magnetic resonance imaging in patients scheduled to undergo vertebroplasty or kyphoplasty. Spine (Phila Pa 1976) 2009; 34:609-12. [PMID: 19282740 DOI: 10.1097/brs.0b013e31819740bb] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To determine the incidence of additional vertebral compression fractures diagnosed with repeat MRI immediately before vertebroplasty or kyphoplasty. SUMMARY OF BACKGROUND DATA Vertebral compression fractures, which occur frequently in the elderly, are more likely in patients with prior vertebral compression fracture. When patients are evaluated for vertebroplasty, it is important to identify all unhealed fractures for effective treatment planning. METHODS In a retrospective study, we reviewed the records of all patients (n = 194) treated with vertebroplasty or kyphoplasty over a 6-year period at our institution, and identified all patients who had undergone a repeat MRI within 7 days of vertebroplasty or kyphoplasty. These studies were obtained as part of a clinical protocol prescribing a repeat MRI for any patient whose MRI had been obtained more than 3 months before the evaluation, or who had a change in their pain between referral and evaluation. RESULTS Twenty patients met inclusion criteria for the immediate preprocedure MRI protocol. A total of 14 new fractures in 11 patients were discovered on the immediate preprocedure MRI. Of these 14, 6 had less than 15% loss of height, making them potentially occult on radiographs; 3 fractures developed in 2 patients who had no change in back pain. CONCLUSION In select candidates for vertebroplasty or kyphoplasty, a repeat preprocedure MRI obtained within 1 week can help ensure that all painful fractures are treated. There is demonstrable value in this protocol for patients with an imaging evaluation over 3 months old or who have had any change in symptoms since the initial imaging workup.
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22
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Hoch B, Hermann G, Klein MJ, Abdelwahab IF. Ossifying chondroid lipoma. Skeletal Radiol 2008; 37:475-80. [PMID: 18259746 DOI: 10.1007/s00256-007-0444-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 12/05/2007] [Accepted: 12/08/2007] [Indexed: 02/02/2023]
Abstract
Chondroid lipoma is a rare variant of lipoma that pathologically can mimic liposarcoma or possibly other sarcomas. Variants of lipoma, including chondroid lipoma, may demonstrate radiological evidence of fat within the tumor, but often display heterogeneous features on imaging studies, making a clinical diagnosis difficult. A large collective experience with the imaging characteristics of chondroid lipoma is lacking due to the rarity of this tumor. We present a case of chondroid lipoma of the upper thigh in a 37-year-old woman who had regions of metaplastic bone formation within the tumor. Radiologically, the tumor presented as a large soft tissue mass with calcification and ossification. Although metaplastic bone formation in conventional lipoma is well described, it has been rarely reported to occur in chondroid lipoma and has not been pathologically documented or illustrated. The imaging findings and histopathology of this unusual tumor are presented, along with a review of the literature.
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Affiliation(s)
- Benjamin Hoch
- Department of Pathology, Mount Sinai Medical Center, P.O. Box 1194, One Gastave L. Levy Place, New York, NY 07422, USA.
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23
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Abstract
The value of medical imaging in detection, staging, grading, and tissue-specific diagnosis has been substantially increased, especially after the introduction of magnetic resonance imaging, the combined use of cytogenetic and molecular techniques and the refinement of biopsy techniques. In this paper, we will focus on the combination of parameters including clinical information, prevalence, age, location, and findings on medical imaging, yielding the highest diagnostic sensitivity and specificity. An imaging prototype of a malignant soft tissue tumor will be proposed. In a second part, we will present an overview of most common soft tissue tumors, especially focusing on these tumors having more characteristic imaging features that allow to make a more detailed tissue-specific diagnosis. Finally, we will give the radiologist a short list of important things to take home.
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Abstract
Whole body magnetic resonance imaging (MRI) opens new opportunities in diagnostic radiology as systemic disease entities can be examined with high sensitivity. This can lead to a change of paradigm, so that not only organ-related but rather disease-specific MRI examination protocols can be applied which focus on the underlying pathophysiology of the disease. Whole body MRI has already been successfully used for several oncological and non-oncological indications. In addition, whole body MRI has broadened the discussion regarding its use for secondary prevention. Compared to computed tomography, MRI does not use radiation. Although whole body MRI is still in an early stage, the enormous medical and economical potential can be envisioned.
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Affiliation(s)
- M Goyen
- Arztliche Direktion, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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25
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Hyzy MD, Hogendoorn PCW, Bloem JL, De Schepper AM. Chondroid lipoma: findings on radiography and MRI (2006:7b). Eur Radiol 2006; 16:2373-6. [PMID: 16924441 DOI: 10.1007/s00330-006-0243-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2005] [Revised: 02/19/2006] [Accepted: 03/07/2006] [Indexed: 10/24/2022]
Abstract
We present a case of chondroid lipoma with various tumor components on MRI and ossified components on radiography. Information from both imaging modalities is required to make the correct diagnosis, and the role of radiography as a first choice imaging modality is highlighted.
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Affiliation(s)
- M D Hyzy
- Department of Radiology, Flinders Medical Centre, Bedford Park SA, 5042, Adelaide, Australia
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26
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Abstract
STUDY DESIGN Review article. OBJECTIVE To outline current concepts regarding the assessment and treatment of odontoid fractures. SUMMARY OF BACKGROUND DATA Odontoid fractures account for 9% to 15% of adult, cervical spine fractures. These injuries usually result from hyperflexion or hyperextension of the cervical spine during low-energy impacts in the elderly or high-energy impacts in the young and middle aged. Neurologic injury associated with these fractures is rare. METHODS A review of pertinent literature was conducted. The information gleaned from this review was summarized. RESULTS Odontoid fractures should be evaluated with appropriate imaging to assess the fracture itself as well as exclude other contiguous or noncontiguous fractures. The Anderson and D'Alonzo classification system is most commonly used. True type I and III odontoid fractures are generally thought to be relatively stable and are often treated nonoperatively with immobilization. Type II fractures at the base of the odontoid are less stable, and there are differing opinions regarding the precise definition and optimal treatment of these injuries. Nonoperative treatment options for odontoid fractures include external immobilization with a collar or halo. Operative treatment options for odontoid fractures include one of several posterior C1-C2 fusion constructs or anterior odontoid fixation if the fracture pattern is amenable. CONCLUSIONS Despite the frequency of odontoid fractures, there is still much debate regarding the optimal treatment of these fractures, especially the type II fractures. This fact may be because of the absence of an ideal solution for this clinical problem. Certainly, prospective controlled clinical studies are needed.
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Affiliation(s)
- Travis G Maak
- Department of Orthopaedics and Rehabilitation, New Haven, CT 06520-8071, USA
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27
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Leidel BA, Kanz KG, Mutschler W. [Evidence based diagnostic procedures for the determination of suspected blunt cervical spine injuries. Development of an algorithm]. Unfallchirurg 2006; 108:905-6, 908-19. [PMID: 15999250 DOI: 10.1007/s00113-005-0968-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to present existing publications, describing various diagnostic procedures as well as considering the evidence supporting them, to develop a recommendation for diagnosis. MATERIAL AND METHODS We reviewed relevant publications between 1966 and 2004 by a systemic literature search in MEDLINE, EMBASE, National Guideline Clearinghouse, Cochrane Library as well as a manual reference search. Keywords were cervical spine, cervical vertebrae, spinal, spinal cord, injury, trauma, fracture, dislocation, imaging, radiography, flexion, extension, fluoroscopy, computed tomography, computed scanning, and magnetic resonance imaging. The selected search results were then classified into levels of evidence. RESULTS From among a total of 10,000 publications, 137 relevant publications were stringently reviewed. The level of evidence is on the whole limited due to deficit data; therefore, only class II-III recommendations are possible. We developed an algorithm for the diagnostic approach to suspected trauma of the cervical spine. This clinical algorithm displays the complex diagnosis of cervical spine injury in a clear and logically structured process. CONCLUSIONS The diagnostic algorithm for cervical spine injury meets the presently required standards and maximizes care for the newly injured. The development, which can be followed using evidence-based medicine, is transparent and therefore aids the decision process when choosing an adequate diagnostic procedure.
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Affiliation(s)
- B A Leidel
- Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität München.
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Vilanova JC, Woertler K, Narváez JA, Barceló J, Martínez SJ, Villalón M, Miró J. Soft-tissue tumors update: MR imaging features according to the WHO classification. Eur Radiol 2006; 17:125-38. [PMID: 16489439 DOI: 10.1007/s00330-005-0130-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Revised: 11/21/2005] [Accepted: 12/13/2005] [Indexed: 02/07/2023]
Abstract
Soft-tissue tumors are a large and heterogeneous group of neoplasms. Hence, classification is often difficult. The most effective management decisions are made when a working group participates in the same diagnostic standard criteria in the evaluation of soft-tissue tumors. The purpose of this pictorial review is to highlight the new and the less well-known features on magnetic resonance (MR) imaging of soft-tissue tumors according to the World Health Organization (WHO) classification established in 2002. The article depicts the major changes of the WHO classification since it was established in 2002 and the most significant findings on MR imaging, thereby providing an update.
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Affiliation(s)
- Joan C Vilanova
- Department of Magnetic Resonance, Clínica Girona, Lorenzana, 36, 17002 Girona, Spain.
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