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Takenoshita S, Asano N, Kasahara T, Hirozane T, Yamaguchi S, Mori T, Ohkita H, Nakayama R, Nakamura M, Matsumoto M. Secondary peripheral chondrosarcoma arising from solitary osteochondroma of the clavicle: A case report. J Orthop Sci 2023; 28:1592-1596. [PMID: 34924250 DOI: 10.1016/j.jos.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shinichi Takenoshita
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Naofumi Asano
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan.
| | - Tomoki Kasahara
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Toru Hirozane
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Sayaka Yamaguchi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Tomoaki Mori
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Hajime Ohkita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, 160-8582, Japan
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Saifuddin A, Tyler P, Rajakulasingam R. Imaging of bone marrow pitfalls with emphasis on MRI. Br J Radiol 2023; 96:20220063. [PMID: 35522786 PMCID: PMC9975530 DOI: 10.1259/bjr.20220063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.
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Affiliation(s)
- Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Philippa Tyler
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Fung R, Fasen M, Warda F, Natter P, Nedrud S, Fernandes R, Alkhasawneh A, Gandhi GY. Clavicular Metastasis as an Initial Presentation of Papillary Thyroid Cancer. Case Rep Endocrinol 2021; 2021:6662071. [PMID: 34484842 PMCID: PMC8413079 DOI: 10.1155/2021/6662071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We present the case of a 44-year-old man with a large neck mass to highlight the unique presentation of papillary thyroid carcinoma (PTC) metastatic to the clavicle. METHODS We reviewed the medical record for a detailed history and physical examination findings. Our radiology colleagues examined the diagnostic imaging studies performed. The pathology team reviewed the neck mass biopsy and the confirmatory surgical pathology after total resection of the mass. RESULTS A 44-year-old man presented with an enlarging neck mass. Initial X-rays revealed a large soft tissue density mass that extended to the midline of the right clavicle. A neck ultrasound established a 5.4 × 3.6 cm mass with increased vascularity and calcification extending from the thyroid. A CT scan noted the extension of the mass into the adjacent sternoclavicular junction with osteolysis of the middle third of the clavicle and the superior aspect of the sternal body. Fine-needle aspiration revealed a thyroid neoplasm with follicular features and positive immunostaining consistent with thyroid carcinoma. The patient underwent a composite resection of the tumor, including a segmental osteotomy of approximately two-thirds of the medial clavicle. The pathology report confirmed PTC with extrathyroidal extension and clavicle involvement (staged pT4a pN0), with further genomic findings showing positive KRAS mutation. CONCLUSION Clavicular metastasis from differentiated thyroid cancer is rare. While the prognosis is generally favorable, various factors, including age greater than 45 years, poor differentiation, follicular thyroid carcinoma, Hurthle cell variant, and extrapulmonary metastasis, have typically been associated with poorer cancer-specific survival.
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Affiliation(s)
- Russell Fung
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Madeline Fasen
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Firas Warda
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patrick Natter
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Stacey Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Ahmad Alkhasawneh
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Gunjan Y. Gandhi
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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Schiettecatte E, Jans L, Jaremko JL, Chen M, Vande Walle C, Herregods N. MR Imaging of Rheumatic Diseases Affecting the Pediatric Population. Semin Musculoskelet Radiol 2021; 25:82-93. [PMID: 34020470 DOI: 10.1055/s-0041-1726435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article reviews the application of magnetic resonance imaging (MRI) to pediatric rheumatic diseases. MRI can detect early manifestations of arthritis, evaluate the extent of disease, and monitor disease activity and response to treatment.Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disorder, representing a diverse group of related diseases that share a definition of joint inflammation of unknown origin with onset before 16 years of age and lasting > 6 weeks. JIA may lead to significant functional impairment and is increasingly imaged with MRI to assess for active inflammation as a target for therapy. This is particularly true for juvenile spondyloarthritis that includes multiple subgroups of JIA and primarily involves the spine and sacroiliac joints.Other less common pediatric rheumatic diseases considered here are chronic recurrent multifocal osteomyelitis and collagen vascular diseases including polymyositis, dermatomyositis, scleroderma, and juvenile systemic lupus erythematosus.
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Affiliation(s)
- Eva Schiettecatte
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Jacob Lester Jaremko
- Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Min Chen
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Caroline Vande Walle
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
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Wu K, Huang YH. A rare case report: an inextricable shoulder pain as the exclusive presentation of lung adenocarcinoma with metastasis over contralateral clavicle. Eur J Med Res 2021; 26:23. [PMID: 33640029 PMCID: PMC7912515 DOI: 10.1186/s40001-021-00493-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Lung cancer is the fourth most common form of the tumor spreading to the bone. Among all patients of lung carcinoma, the most common sites of bone metastasis are vertebrae, ribs, and pelvis. By comparison, the clavicle is an extremely rare site of metastases not only in the population of lung cancers but among all types of tumors. Enlightened by this existing fact, we would like to share our experience of management of an uncommon clavicular metastasis and illuminate the obscure mechanism of its scarcity. Case presentation A 56-year-old female without any preknown systemic disease had suffered from a sole intermittent right shoulder pain without any other discomfort for 3 months. Physical examination performed at our orthopedic department showed tenderness over the right distal third of the clavicle with limited range-of-motion of the right shoulder. EGFR-mutated lung adenocarcinoma with metastasis over the right clavicle resulting in a pathological fracture was diagnosed according to the result of the incisional biopsy. Concurrent chemoradiation therapy accompanied with target therapy was performed. Eighteen months postoperatively, the clavicle pain was found to be subsided with stationary bony lesion under appropriate medication and palliative radiotherapy during the subsequent follow-up. Conclusions The clavicle is an exceedingly unusual site with 2% of metastatic involvement of all type of tumors and only 1% among the population of carcinoma of lung due to its scanty red marrow and sparse vascular supply. Despite the unpleasant prognosis of clavicular metastasis from primary lung adenocarcinoma, promising quality of life is achievable under multidisciplinary management.
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Affiliation(s)
- Karl Wu
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC. .,Department of Materials and Textiles, Oriental Institute of Technology, New Taipei City, Taiwan, ROC.
| | - Yu-Hao Huang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
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Jamshidi K, Heidari M, Bagherifard A, Mirzaei A. Favorable outcome of extended curettage for the treatment of unifocal chronic sclerosing osteomyelitis of clavicle: a case series. J Shoulder Elbow Surg 2020; 29:954-960. [PMID: 31672493 DOI: 10.1016/j.jse.2019.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/15/2019] [Accepted: 08/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic sclerosing osteomyelitis (CSO) of the clavicle, especially its unifocal subset, is scarcely reported, and little is known about its characteristic features and treatment. We aim to describe the characteristic features and outcome of treatment in a series of patients with unifocal CSO of the clavicle. MATERIALS AND METHODS In a retrospective study, we identified 6 patients with a diagnosis of unifocal CSO of the clavicle. All patients underwent a core needle biopsy, and histologic examination confirmed the diagnosis. Laboratory investigations included the white blood cell count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and bacteriologic culture. We used plain radiographs, computed tomography scanning, and magnetic resonance imaging for the radiologic evaluation. RESULTS The median age of the patients was 16.5 years (range, 10-29 years). The ESR and CRP level were elevated in 5 cases. The bacterial culture results were negative in all cases. Sclerosis was the main radiologic symptom. Other radiologic features such as bone expansion, cystic change, periosteal reaction, cortex destruction, and soft-tissue edema could accompany sclerosis. Anti-inflammatory medications temporarily and slightly reduced the symptoms. Four patients underwent extended curettage, in whom the clinical, radiologic, and laboratory symptoms considerably subsided. In the 2 patients who did not agree to undergo surgical intervention, the clinical and radiologic symptoms fluctuated at the follow-up visits. CONCLUSION Unifocal CSO of the clavicle is associated with negative bacterial culture results, but the ESR and CRP level are frequently elevated. The symptoms fluctuate if not adequately treated. Extended curettage could be regarded as the treatment of choice.
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Affiliation(s)
- Khodamorad Jamshidi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Heidari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Bagherifard
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Liu Y, Huang XY, Feng WY, Luo XT, Wei CW, Liu JH, Lai YJ, Xiao ZM, Zhang X, Zhan XL. Analysis of the clinical efficacy of tumor resection methods used in 20 patients with clavicular tumor. World J Surg Oncol 2019; 17:106. [PMID: 31208415 PMCID: PMC6580492 DOI: 10.1186/s12957-019-1642-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background To retrospectively analyze the tumor resection method used in 20 patients with clavicular tumors and evaluate its clinical efficacy. Methods A total of 9 patients with clavicular benign tumors underwent intracapsular resection, and 11 patients with clavicular malignant tumors underwent tumor resection from May 2012 to May 2017. Of the 11 patients, 5 underwent clavicular reconstruction using the plate-cement complex. Surgical efficacy was assessed using the Musculoskeletal Tumor Society, Constant-Murley, and American Shoulder and Elbow Surgeons shoulder outcome scores preoperatively until 12 months postoperatively. Results The average duration of follow-up care was 33.7 (12–71) months. Of the 20 patients, 3 patients died, 3 survived with tumor recurrence or metastasis, and 14 survived with no tumor recurrence. Among the 5 patients who underwent resection of malignant clavicular tumors and reconstruction, 2 underwent a re-operation because of a loose screw and plate displacement. In the functional assessment of the shoulder joint, patients with benign and malignant clavicular tumors showed significantly higher scores postoperatively compared with preoperative scores. For malignant clavicular tumors, no significant improvement was observed when comparing the non-reconstruction and reconstruction groups. Conclusions Surgery is an optimal treatment for clavicular tumors. In patients with benign clavicular tumors, simple intracapsular resection can achieve a satisfactory prognosis. Reconstruction of a clavicular defect after resection of a clavicular malignant tumor is not recommended.
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Affiliation(s)
- Yun Liu
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xian-Ying Huang
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wen-Yu Feng
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Ting Luo
- Department of Pharmacy, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chang-Wu Wei
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | | | - Yin-Juan Lai
- Guangxi Medical University, Nanning, Guangxi, China
| | - Zeng-Ming Xiao
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao Zhang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
| | - Xin-Li Zhan
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Gopinathan NR, Prakash M, Saibaba B, Das A. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis. Indian J Radiol Imaging 2016; 26:290-3. [PMID: 27413281 PMCID: PMC4931793 DOI: 10.4103/0971-3026.184411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.
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Affiliation(s)
- Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Mahesh Prakash
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Balaji Saibaba
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
| | - Ashim Das
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
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9
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Dounousi E, Duni A, Xiromeriti S, Pappas C, Siamopoulos KC. Acute bacterial sternoclavicular osteomyelitis in a long-term renal transplant recipient. World J Transplant 2016; 6:442-446. [PMID: 27358791 PMCID: PMC4919750 DOI: 10.5500/wjt.v6.i2.442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/02/2016] [Accepted: 05/27/2016] [Indexed: 02/05/2023] Open
Abstract
Kidney transplantation is the treatment of choice for a significant number of patients with end-stage renal disease. Although immunosuppression therapy improves graft and patient’s survival, it is a major risk factor for infection following kidney transplantation altering clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature is very limited regarding osteomyelitis in RTRs. Sternoclavicular osteomyelitis is rare and has been mainly reported after contiguous spread of infection or direct traumatic seeding of the bacteria. We present an interesting case of acute, bacterial sternoclavicular osteomyelitis in a long-term RTR. Blood cultures were positive for Streptococcus mitis, while the portal entry site was not identified. Magnetic resonance imaging of the sternoclavicluar region and a three-phase bone scan were positive for sternoclavicular osteomyelitis. Eventually, the patient was successfully treated with Daptomycin as monotherapy. In the presence of immunosuppression, the transplant physician should always remain alert for opportunistic pathogens or unusual location of osteomyelitis.
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Krishnamurthy A. Clavicle metastasis from carcinoma thyroid- an atypical skeletal event and a management dilemma. Indian J Surg Oncol 2015; 6:267-70. [PMID: 27217676 PMCID: PMC4856680 DOI: 10.1007/s13193-015-0387-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
Bone metastases is a well described event in the natural history of thyroid cancers and has the potential to severely impact the quality of life by causing pain, fractures and spinal cord compression. Follicular thyroid carcinomas have a greater propensity for distal metastasis than papillary and anaplastic thyroid carcinomas. The most common sites of skeletal metastasis among thyroid cancer patients are femur followed by humerus, pelvis, radius, and scapula. Clavicle metastasis at initial presentation is exceedingly rare. Although many studies have examined the various prognostic factors for patients with bony metastases from thyroid cancers, very few have actually evaluated the effects of surgical management. We present an unusual case of metastatic papillary carcinoma thyroid presenting with clavicle metastasis and review the role of surgical management of bone metastases. Clavicular resection as a part of the management of metastatic papillary carcinoma thyroid has, to the best of our knowledge never been reported before.
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Affiliation(s)
- Arvind Krishnamurthy
- Surgical Oncology, Cancer Institute (WIA), 38, Sardar Patel Rd, Adyar, Chennai 600036 India
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11
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Northrup BE, Slat DF, Loomans RU, Menias CO, Baker JC, Hillen TJ. The myriad of diseases that present with polyostotic bone lesions. Curr Probl Diagn Radiol 2015; 43:186-204. [PMID: 24948212 DOI: 10.1067/j.cpradiol.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Many diseases result in polyostotic bone lesions including benign entities, benign entities with malignant potential, intermediate entities, and malignant entities. Imaging plays a key role in identifying complications of these disorders, most importantly malignant transformation of a benign lesion. The most common polyostotic bone lesions are reviewed and examples of malignant transformation are highlighted.
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Affiliation(s)
- Benjamin E Northrup
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
| | - David F Slat
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Rachel U Loomans
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | | | - Jonathan C Baker
- Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Travis J Hillen
- Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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Pressney I, Saifuddin A. Percutaneous image-guided needle biopsy of clavicle lesions: a retrospective study of diagnostic yield with description of safe biopsy routes in 55 cases. Skeletal Radiol 2015; 44:497-503. [PMID: 25331354 DOI: 10.1007/s00256-014-2016-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/11/2014] [Accepted: 09/16/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess the diagnostic yield and diagnostic accuracy of image-guided percutaneous needle biopsy of clavicle lesions and to analyse the diagnostic spectrum of clavicular lesions referred to a tertiary musculoskeletal oncology centre. To further describe safe biopsy routes for biopsy of the unique clavicle bone. MATERIALS AND METHODS A retrospective review of all patients who underwent an image-guided clavicle biopsy during the period from August 2006 to December 2013. A total of 52 patients with 55 consecutive biopsies were identified and included in the study. Image-guided percutaneous biopsy was performed using CT (n = 38) or ultrasound (n = 17). RESULTS There were 23 males and 29 females, with a mean age of 40 years (range 2 to 87 years). Forty-six of the 55 biopsies (83.6 %) yielded a diagnostic sample and 9 (16.4 %) were non-diagnostic. Thirty of 46 (65.2 %) lesions were malignant and 16 (34.8 %) were benign/non-neoplastic. The most common malignant lesions were metastases, 22 of 30 (73.3 %), followed by primary tumours in 8 of 30 (26.7 %). The most common benign/non-neoplastic lesion was chronic recurrent multifocal osteomyelitis (4 of 16, 25 %) followed by Langerhans cell histiocytosis, epithelioid haemangioma and osteomyelitis (each with 2 of 16, 12.5 %). There was complete agreement between the needle and surgical histology specimen in 12 of 13 subjects (92.3 %). No post-biopsy complications were reported. CONCLUSIONS Image-guided percutaneous biopsy has high diagnostic yield and accuracy and the described approaches are a safe means of biopsy for clavicle lesions.
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Affiliation(s)
- I Pressney
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HL7 4LP, UK,
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13
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Nontraumatic Lesions of the Clavicle in a Paediatric Population: Incidence and Management. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:261952. [PMID: 27355009 PMCID: PMC4897527 DOI: 10.1155/2014/261952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 11/18/2022]
Abstract
Background. The incidence of paediatric nontraumatic clavicle lesions is unknown and there is limited literature regarding the management of such patients. Methods. A review of a prospectively complied radiological database held at the study was conducted for a defined 10-year period. The study centre is the only paediatric service available for a defined catchment population. The case notes of all patients with nontraumatic lesions were reviewed, and the mode of presentation, the diagnostic dilemmas, and the management were recorded. Results. A total of 2133 clavicle radiographs were performed during the study period, with only five having a nontraumatic history. The overall incidence of paediatric nontraumatic clavicle lesions was 0.38 per 100,000 per year. Three patients were diagnosed with chronic recurrent osteomyelitis, one with chronic bifocal osteomyelitis, and one with Langerhans cell histiocytosis. All patients with osteomyelitis demonstrated a typical natural history of a chronic relapsing remitting infection. Three underwent bone biopsy; however, no organism was identified. Conclusion. This study demonstrated that the incidence of nontraumatic clavicle lesions is small, and those patients presenting with osteomyelitis should not routinely undergo a bone biopsy and close observation with the appropriate antibiotic therapy is advised.
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Lin B, He Y, Xu Y, Sha M. Outcome of bone defect reconstruction with clavicle bone cement prosthesis after tumor resection: a case series study. BMC Musculoskelet Disord 2014; 15:183. [PMID: 24885109 PMCID: PMC4046063 DOI: 10.1186/1471-2474-15-183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 05/21/2014] [Indexed: 11/24/2022] Open
Abstract
Background To investigate the short and medium term outcomes of bone defect reconstruction with bone cement prosthesis after clavicle malignancies resection. Methods A total of 5 clavicular malignancy patients experienced bone cement prosthesis reconstruction after subtotal claviculectomy were enrolled the study from January 2005 to May 2012. Musculoskeletal Tumor Society score (MSTS), Visual Analogue scale (VAS) and American Shoulder and Elbow Surgeons shoulder outcome score (ASES) were adopted for assessment. Results The mean follow-up period was 25.8 months. All patients were performed bone cement defect reconstruction after claviculectomy. In which, 3 cases showed disease-free and other 2 cases were alive with sickness. The average Musculoskeletal Tumor Society score was 85.40% ± 5.68%(77%-90%), Visual Analogue Scale was 1.40 ± 0.55 (1–2) and American Shoulder and Elbow Surgeons Shoulder Outcome Score was 92.40 ± 3.29(87–96). Conclusions Adoption of clavicle bone cement prosthesis for bone defect reconstruction after tumor resection can maintain the contour of shoulder and reduce the complications ascribe to the claviculectomy. It is an effective and feasible therapeutic procedure in clinical setting.
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Affiliation(s)
| | | | | | - Mo Sha
- Department of Orthopedics, the 175th Hospital of PLA, Southeast Hospital of Xiamen University, Zhang Zhou, Fu Jian, China.
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15
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Ren K, Wu S, Shi X, Zhao J, Liu X. Primary clavicle tumors and tumorous lesions: a review of 206 cases in East Asia. Arch Orthop Trauma Surg 2012; 132:883-9. [PMID: 22314398 DOI: 10.1007/s00402-012-1462-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study is to systematically review the published literature from East Asia on the clinical, pathological, and epidemiological characteristics of primary clavicle tumor and tumorous lesions. METHODS A computerized search based on keywords "clavicle," "tumor," and "tumorous lesion" (both in Chinese and in English) was performed on literature published from 1980 to 2011 in East Asian countries, including China, Japan, South Korea, North Korea, and Mongolia. An analysis was carried out with unified inclusion and exclusion criteria. RESULTS Two hundred and six cases were identified. The age of onset ranged from 1.5 to 70, with an average age of 29.4, and a male/female ratio of 1.53:1. Lesion locations included 28.9% in medial third, 18.8% in the middle third, and 33.6% in the lateral third of the clavicle. Another 7.4% involved both the medial and middle thirds, 7.4% involved both the middle and lateral thirds, and 4.0% involved the entire length of the clavicle. Major pathological types included 18.5% eosinophilic granuloma, 10.2% plasmocytoma, 7.8% Ewing sarcoma, 8.7% osteosarcoma, 8.7% osteochondroma, and 5.3% chondrosarcoma. The age of onset was found to be strongly correlated with the benign/ malignant ratio. Clavicle malignancy was rarely found in patients younger than 10 years, while the incidence of malignancy greatly increased among patients over 40 years old. Total or subtotal claviculectomy was the most common treatment in cases for which treatment information was available. Of these, 40.8% of patients received reconstruction with allograft or autograft. CONCLUSIONS Clavicle tumors and tumorous lesions in East Asia had an inclined occurrence in respect to age and gender. The most common tumors were eosinophilic granuloma and tumors derived from the bone marrow hematopoietic system. Age of onset was found to be a risk factor for malignancy. These characteristics may be related to the special tissue structures and mode of development in the clavicle as well as to the genetic traits of the typical Mongoloids in East Asia.
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Affiliation(s)
- Ke Ren
- Department of Orthopedics, Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, Jiangsu, People's Republic of China.
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Kennedy MT, Murphy T, Murphy M, Laffan E, Connolly P. Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis. Orthop Traumatol Surg Res 2012; 98:461-4. [PMID: 22579507 DOI: 10.1016/j.otsr.2012.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 01/13/2012] [Accepted: 02/22/2012] [Indexed: 02/02/2023]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.
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Affiliation(s)
- M T Kennedy
- Department of Orthopaedic Surgery, Children's University Hospital, Temple Street, Dublin 1, Ireland.
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Primary malignant clavicular tumours: a clinicopathological analysis of six cases and evaluation of surgical management. Arch Orthop Trauma Surg 2011; 131:935-9. [PMID: 21188396 DOI: 10.1007/s00402-010-1237-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Indexed: 02/09/2023]
Abstract
Primary malignant tumours of the clavicle are extremely rare and little is known regarding their clinicopathological characteristics and outcomes of surgical management. The aim of the study is to analyse the clinical, imaging, and histological features of six patients with malignant tumours of the clavicle and present the outcome of cleidectomy in four of them. A review of the literature is also provided. Six cases were included in this series: two plasmocytomas; three PNETs, one non-Hodgkin lymphoma, one high-grade chondrosarcoma and one post-irradiation fibrosarcoma. Apart from one patient with plasmocytoma and another one with non-Hodgkin lymphoma, the remaining four patients underwent partial or complete cleidectomy according to tumour location. At the time of latest follow-up all patients were alive. Neither local recurrence nor metastases were observed in patients that underwent cleidectomy. In this group, the average score was 86.6% of the expected normal function according to the Musculoskeletal Tumour Society (MSTS) evaluation form. The mean Constant-Murley score of the affected side was 80. Patients after cleidectomy were pain free, they had almost full shoulder range of motion and no significant functional deficit was reported. Primary malignant clavicular tumours may be easily undiagnosed due to their insidious clinical onset. Partial or total cleidectomy is associated with adequate shoulder mobility and mild functional deficit. Therefore, the extent of clavicle excision during tumour removal does not seem to determine the functional outcome of the affected shoulder.
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Basarir K, Polat O, Saglik Y, Yildiz Y. Bone tumors of the clavicle: risk of malignancy in the elderly and safe needle biopsy. Orthopedics 2010; 33:397. [PMID: 20806767 DOI: 10.3928/01477447-20100429-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The clavicle is a rare site for bone tumors and little is known from the limited literature about the prognostic factors and management techniques, including biopsy. The method of biopsy is controversial in the clavicle because of the risk of injury to the neighboring neurovascular structures. Twenty patients with clavicular lesions were retrospectively reviewed with clinical, radiological, and histopathological reports. A needle biopsy was planned in the presence of an osteolytic lesion providing nonforceful entry of the needle, detailed knowledge obtained about the local anatomy, and known availability of an oblique angle for the needle entry away from vascular structures. A needle or tru-cut biopsy was performed for preoperative histopathological diagnosis in 6 selected patients with no complications. Considering the histological diagnosis and prevalence of clavicular bone tumors, benign and malignant lesions had a similar prevalence rate; however, malignant tumors occurred in an older (>50 years) population (P=005). Statistical analysis revealed that the best cutoff point for age for discriminating malignant lesions was 50 years with high sensitivity. The main concern for these patients is primary lesion site treatment and symptom palliation. Every clavicular lesion in patients older than 50 years should be considered as malignant unless proven otherwise. This article demonstrates that needle biopsy can be performed safely in selected lesions with particular attention to cross-sectional local anatomy during needle insertion.
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Affiliation(s)
- Kerem Basarir
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey.
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Khanna G, Sato TSP, Ferguson P. Imaging of chronic recurrent multifocal osteomyelitis. Radiographics 2009; 29:1159-77. [PMID: 19605663 DOI: 10.1148/rg.294085244] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder of children and young adults that is characterized by nonbacterial osteomyelitis. Patients typically present with multifocal bone pain secondary to sterile osseous inflammation, and the disease has a relapsing and remitting course. The cause of CRMO remains unclear, although the results of several studies have suggested a genetic component. The typical imaging findings of CRMO include lytic and sclerotic lesions in the metaphyses of long bones and the medial clavicles. Other common sites of disease are the vertebral bodies, pelvis, ribs, and mandible. CRMO is often bilateral and multifocal at presentation. Owing to the lack of a diagnostic test, CRMO remains a diagnosis of exclusion. Although generally a self-limiting disease, CRMO can have a prolonged course and result in significant morbidity. Radiologists can be the first to suggest this diagnosis given its characteristic radiographic appearance and distribution of disease. Radiologists should be familiar with the typical imaging findings of CRMO to prevent unnecessary multiple biopsies and long-term antibiotic treatment in children with CRMO.
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Affiliation(s)
- Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, St Louis, MO 63110, USA.
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