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Cubitt C, Ariyaratne S, Vaiyapuri S, Kurisunkal V, Botchu R. An unusual case of metastatic melanoma in subcutaneous tissue presenting as a solitary cystic mass with fluid levels. J Ultrasound 2024:10.1007/s40477-023-00864-7. [PMID: 38400991 DOI: 10.1007/s40477-023-00864-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/13/2023] [Indexed: 02/26/2024] Open
Abstract
Malignant melanoma is a common and often aggressive neoplasm of the skin arising from melanocytes. Metastatic melanoma is known for its diverse clinical manifestations, and can present with atypical features prior to diagnosis of the primary lesion, which can pose a diagnostic challenge. We report a rare case of metastatic melanoma in a 67 year-old male who presented with a painless, enlarging mass in the right axilla over a 4 week period. Ultrasound and magnetic resonance imaging (MRI) scans revealed a well-defined solitary, cystic appearing lesion in the right axilla with a distinct fluid-fluid level. An ultrasound guided biopsy of the lesion diagnosed a metastatic melanoma. While haemorrhagic distant metastases are a well-recognised complication of malignant melanoma, particularly in the brain and lung, soft tissue metastases presenting with fluid-fluid levels is not well described in the literature. The case highlights the importance of considering the differential of melanoma metastasis when encountered with such a lesion and importance of ultrasound guided biopsy for histopathological confirmation, as the imaging features can mimic that of a haemorrhagic soft tissue sarcoma, the management of which differs substantially from that of melanoma.
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Affiliation(s)
- Catherine Cubitt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sisith Ariyaratne
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, UK.
| | - Sumathi Vaiyapuri
- Department of Pathology, University Hospitals Birmingham, Birmingham, UK
| | - Vineet Kurisunkal
- Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopaedic Hospital, Birmingham, UK
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2
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Christophel E, Ladas C, Patterson F, Lelkes V. Statin-related muscle complications masquerading as soft tissue sarcomas. Trauma Case Rep 2023; 47:100887. [PMID: 37608879 PMCID: PMC10440552 DOI: 10.1016/j.tcr.2023.100887] [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] [Accepted: 08/06/2023] [Indexed: 08/24/2023] Open
Abstract
Musculoskeletal injuries are a known side effect of long-term statin use. These injuries include sudden, atraumatic muscle rupture which can cause extremity hematomas that motivate patients to seek evaluation and physicians to send referrals for oncologic workup. We discuss two cases where malignancy was suspected rather than statin-induced muscle injury. Using these cases as examples, we discuss subtleties between the two diagnoses so that muscle rupture may be considered prior to subspecialist referral. This paper aims to serve as a reminder and guide for physicians who encounter long-term statin users with nonspecific, improving musculoskeletal symptoms and hemorrhagic MRI findings that lack nodular or mass-like enhancements. While referral to orthopedic oncology is always encouraged in cases of uncertainty, it may not always be necessary.
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Affiliation(s)
- Elizabeth Christophel
- Hackensack Meridian Health Department of Orthopedic Oncology, 20 Prospect Avenue, Suite 901, Hackensack, NJ 07601, United States of America
| | - Cassidy Ladas
- Hackensack Meridian Health Department of Orthopedic Oncology, 20 Prospect Avenue, Suite 901, Hackensack, NJ 07601, United States of America
| | - Francis Patterson
- Hackensack Meridian Health Department of Orthopedic Oncology, 20 Prospect Avenue, Suite 901, Hackensack, NJ 07601, United States of America
| | - Valdis Lelkes
- Hackensack Meridian Health Department of Orthopedic Oncology, 20 Prospect Avenue, Suite 901, Hackensack, NJ 07601, United States of America
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3
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Wells ME, Qiao J, Decker KE, Parnes N, Rajani R, Eckhoff M. A Masquerading Hematoma Resulting in the Delayed Diagnosis of a Soft Tissue Sarcoma: A Case Report. Cureus 2023; 15:e44822. [PMID: 37809226 PMCID: PMC10559263 DOI: 10.7759/cureus.44822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
A 27-year-old male with insidious right arm swelling was diagnosed with a hematoma secondary to a partial biceps tear, later identified as a rhabdomyosarcoma. Soft tissue sarcomas (STS) may present with misleading patient histories and nonspecific symptoms, resulting in misdiagnosis and delayed treatment. One of the classic masqueraders of soft tissue sarcomas is hematomas secondary to trauma. Obtaining a prudent history with careful scrutiny of appropriate imaging often helps establish the correct diagnosis. Ultimately, tissue biopsy can resolve any ambiguous cases and prevent delays in diagnosis and treatment.
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Affiliation(s)
- Matthew E Wells
- Department of Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Jesse Qiao
- Department of Pathology, University of California Irvine, Irvine, USA
| | - Katelyn E Decker
- Department of Orthopaedic Surgery and Rehabilitation, Carthage Area Hospital, Carthage, USA
| | - Nata Parnes
- Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, USA
- Department of Orthopaedic Surgery and Rehabilitation, Carthage Area Hospital, Carthage, USA
| | - Rajiv Rajani
- Department of Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso Paul L. Foster School of Medicine, El Paso, USA
| | - Michael Eckhoff
- Department of Orthopedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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Kerkhoff M, Grunewald S, Schaefer C, Zöllner SK, Plaumann P, Busch M, Dünker N, Ketzer J, Kersting J, Bauer S, Hardes J, Streitbürger A, Dirksen U, Hartmann W, Guder WK. Evaluation of the Effect of Photodynamic Therapy on CAM-Grown Sarcomas. Bioengineering (Basel) 2023; 10:bioengineering10040464. [PMID: 37106651 PMCID: PMC10136229 DOI: 10.3390/bioengineering10040464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Resection margin adequacy plays a critical role in the local control of sarcomas. Fluorescence-guided surgery has increased complete resection rates and local recurrence-free survival in several oncological disciplines. The purpose of this study was to determine whether sarcomas exhibit sufficient tumor fluorescence (photodynamic diagnosis (PDD)) after administration of 5-aminolevulinic acid (5-ALA) and whether photodynamic therapy (PDT) has an impact on tumor vitality in vivo. Sixteen primary cell cultures were derived from patient samples of 12 different sarcoma subtypes and transplanted onto the chorio-allantoic membrane (CAM) of chick embryos to generate 3-dimensional cell-derived xenografts (CDXs). After treatment with 5-ALA, the CDXs were incubated for another 4 h. Subsequently accumulated protoporphyrin IX (PPIX) was excited by blue light and the intensity of tumor fluorescence was analyzed. A subset of CDXs was exposed to red light and morphological changes of both CAMs and tumors were documented. Twenty-four hours after PDT, the tumors were excised and examined histologically. High rates of cell-derived engraftments on the CAM were achieved in all sarcoma subtypes and an intense PPIX fluorescence was observed. PDT of CDXs resulted in a disruption of tumor-feeding vessels and 52.4% of CDXs presented as regressive after PDT treatment, whereas control CDXs remained vital in all cases. Therefore, 5-ALA mediated PDD and PDT appear to be promising tools in defining sarcoma resection margins (PDD) and adjuvant treatment of the tumor bed (PDT).
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Affiliation(s)
- Maximilian Kerkhoff
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
| | - Susanne Grunewald
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- West German Cancer Center, University Hospital Essen, 45147 Essen, Germany
| | - Christiane Schaefer
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
| | - Stefan K Zöllner
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
| | - Pauline Plaumann
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
| | - Maike Busch
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- Department of Neuroanatomy, Institute for Anatomy II, University Hospital Essen, 45147 Essen, Germany
| | - Nicole Dünker
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- Department of Neuroanatomy, Institute for Anatomy II, University Hospital Essen, 45147 Essen, Germany
| | - Julia Ketzer
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- West German Cancer Center, University Hospital Essen, 45147 Essen, Germany
| | - Josephine Kersting
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- West German Cancer Center, University Hospital Essen, 45147 Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, 45147 Essen, Germany
| | - Uta Dirksen
- Pediatrics III, University Hospital Essen, West German Cancer Center, 45147 Essen, Germany
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
| | - Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, 48149 Muenster, Germany
| | - Wiebke K Guder
- German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany
- Faculty of Medicine, University Duisburg-Essen, 45141 Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, 45147 Essen, Germany
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Warden D, Cieply K, Armstrong B, Nelson M. Rhabdomyosarcoma presenting as intramuscular haematoma due to brachioradialis tear after trauma. BMJ Case Rep 2023; 16:e250699. [PMID: 36977508 PMCID: PMC10069546 DOI: 10.1136/bcr-2022-250699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
A man in his 40s with a history of neurofibromatosis type 1 presented to the emergency department with worsening anterior elbow pain and swelling after falling from a chair 2 months prior. An X-ray showed soft tissue swelling without fracture and the patient was diagnosed with a rupture of the biceps muscle. MRI of the right elbow showed a brachioradialis tear with a large haematoma along the humerus. This was initially thought to be a haematoma; therefore, wound evacuation was done twice. When the injury failed to resolve, a tissue biopsy was performed. This revealed a grade 3 pleomorphic rhabdomyosarcoma. It is important to consider malignancy in the differential diagnosis with rapidly growing masses even if the initial presentation is suggestive of a benign condition. Neurofibromatosis type 1 is also associated with a higher risk of malignancy than the general population.
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Affiliation(s)
- Daniel Warden
- Family Medicine, Michigan State University/MyMichigan Medical Center Alma, Alma, Michigan, USA
| | - Kamil Cieply
- Family Medicine, Michigan State University/MyMichigan Medical Center Alma, Alma, Michigan, USA
| | - Brandon Armstrong
- Family Medicine, Michigan State University/MyMichigan Medical Center Alma, Alma, Michigan, USA
| | - Michelle Nelson
- Family Medicine, Michigan State University/MyMichigan Medical Center Alma, Alma, Michigan, USA
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Maes DJ, Alaqeel M, Parry M, Botchu R, Sumathi V, Jeys LM, Stevenson JD. Haemorrhagic soft-tissue sarcoma: Oncological outcomes and prognostic factors for survival. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:345-352. [PMID: 36031468 DOI: 10.1016/j.ejso.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Haemorrhagic soft-tissue sarcomas (HSTS) are characterised by aggressive local growth and highly metastatic behaviour. We aimed to describe oncological outcomes and prognostic factors. MATERIALS AND METHODS Retrospective review including 64 patients treated with palliation (n = 7), with limb salvage surgery (LSS) (n = 9), with neoadjuvant radiotherapy (RT) + LSS (n = 12), with LSS + adjuvant RT (n = 30) or amputation (n = 6). Kaplan-Meier survival analysis estimated overall survival (OS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). After uni- and multivariate analysis, prognostic factors affecting OS, MFS and LRFS were identified. RESULTS Median age was 67 years (IQR 23 years) with median follow-up of 11 months (IQR 28 months). All cases were high grade. Eight (13%) had pulmonary metastases at presentation and another 40 (63%) developed metastases after median 9 months (IQR 19 months). Median OS was 12 months (IQR 38 months), and estimated OS after two-years was 15.9% and 52.9% for patients with and without metastatic disease at presentation, respectively. Improved OS was associated with negative resection margins (p = 0.031), RT (p = 0.045), neoadjuvant RT (versus adjuvant RT, p = 0.044) and amputation (versus LSS, p < 0.001). MFS was 35.1% after two-years. LR occurred in 18 of 51 (35.3%) patients with surgically treated localised disease. LRFS was 63.4% after two-years and significantly affected by a negative margin (p = 0.042) and RT (p = 0.001). CONCLUSION Haemorrhagic soft-tissue sarcomas should be excised, either with amputation or LSS with a clear resection margin. If LSS is attempted, neoadjuvant RT reduces the risk of tumour spillage and early LR, enhances the feasibility of achieving clear resection margins, and offers superior overall survival compared to adjuvant RT.
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Affiliation(s)
- Danielle J Maes
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Motaz Alaqeel
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Michael Parry
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Rajesh Botchu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Vaiyapuri Sumathi
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Lee M Jeys
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Jonathan D Stevenson
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK; Aston Medical School, Aston University, Birmingham, B4 7ET, UK.
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Malik DG, Dahiya N, Young SW, Heng LXX, Patel MD. Non-Vascular Considerations When Interpreting Extremity Arterial and Venous Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3145-3158. [PMID: 35984099 DOI: 10.1002/jum.16087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Peripheral arterial and venous examinations are performed regularly in vascular labs and interpreted by physicians of different specialities. Many vascular examinations have nonvascular pathology that is either inadvertently imaged by the sonographer or imaged with intent as it relates to patient's symptoms. It is prudent for every reader of vascular studies to be acquainted with the sonographic appearance of these non-vascular lesions to enable appropriate and optimal interpretation that has a direct bearing on patient's clinical care. Our review includes a discussion of the nonvascular pathologies like lymph nodes, soft tissue edema, soft tissue fluid collections, musculotendinous injuries, soft tissue masses, and joint and bursal pathologies that may be encountered during interpretation of vascular exams. The pictorial essay includes a discussion of their sonographic appearances and pitfalls in interpretation. Multiple illustrative examples and sonographic images of the non-vascular pathologies found during interpretation of vascular studies have been utilized to highlight their appearances.
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Affiliation(s)
- Dania G Malik
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Habibollahi S, Lozano-Calderon S, Chang CY. Common Soft Tissue Mass-like Lesions that Mimic Malignancy. Radiol Clin North Am 2022; 60:301-310. [DOI: 10.1016/j.rcl.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Telangiectatic soft tissue sarcoma and chronic expanding haematoma: a comparative review of MRI features. Skeletal Radiol 2021; 50:2365-2380. [PMID: 34184096 DOI: 10.1007/s00256-021-03853-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 02/02/2023]
Abstract
Soft tissue sarcomas containing a dominant component of haemorrhage are known to be aggressive tumours associated with a poor prognosis. Importantly, the clinical behaviour and imaging characteristics of extensively haemorrhagic soft tissue sarcomas (also termed telangiectatic soft tissue sarcomas) can resemble those of benign haematomas, particularly those that continue to expand over a prolonged period, so-called chronic expanding haematomas (CEH). The following review evaluates the current literature to identify the clinical, imaging and pathological characteristics of telangiectatic soft tissue sarcomas and to determine features that may help distinguish them from CEH. Ultimately, we suggest that lesions with sizeable regions of internal haemorrhage should be regarded with a high degree of suspicion for underlying malignancy and require referral to a tertiary sarcoma centre, where a carefully planned approach to biopsy and follow-up is needed to avoid errors in diagnosis.
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10
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Iqbal A, McLoughlin E, Patel A, James SL, Botchu R, Davies AM. Osteochondroma-induced pseudoaneurysms of the extremities mimicking sarcoma: a report of seven contemporary and one historical case. Clin Radiol 2020; 75:642.e9-642.e13. [PMID: 32317165 DOI: 10.1016/j.crad.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
AIM To provide a diagnostic approach to distinguish osteochondroma-induced pseudoaneurysm from sarcoma on imaging and prevent biopsy which may be fatal. MATERIALS AND METHODS A retrospective study of the orthopaedic oncology database was performed to identify all patients referred to specialist orthopaedic oncology service with a final diagnosis of osteochondroma-induced pseudoaneurysm. The demographics of the cohort, the anatomical location of the osteochondromas and pseudoaneurysms, and the imaging appearances were assessed. RESULTS Seven contemporary and one historical case of osteochondroma-induced-pseudoaneurysm were identified. There were five patients with solitary osteochondroma and three cases of hereditary multiple exostosis. Five cases underwent magnetic resonance imaging (MRI) of which pulsation artefact was present in 40%. On MRI, all the present cases demonstrated a small central pseudoaneurysm surrounded by multiple eccentric layers of thrombus and haemorrhage, which was termed the "eccentric-whorl sign". CONCLUSION Osteochondroma-induced pseudoaneurysms are often misdiagnosed as malignant transformation of an osteochondroma or a soft-tissue sarcoma and referred for urgent biopsy. This study presents the largest case series, which includes the first documented case diagnosed in 1934. Differentiating and characterising pseudoaneurysms from sarcomas is imperative in order to prevent a biopsy, which could be fatal.
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Affiliation(s)
- A Iqbal
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - E McLoughlin
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Patel
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK.
| | - A M Davies
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital NHS Foundation Trust, Birmingham, UK
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11
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Charnock M. Soft-Tissue Sarcoma Masquerading as a Haematoma. J Med Ultrasound 2019; 27:50-53. [PMID: 31031537 PMCID: PMC6445040 DOI: 10.4103/jmu.jmu_65_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/17/2018] [Indexed: 02/04/2023] Open
Abstract
Sarcomas commonly occur in the buttock and thigh, although the clinical presentation varies with no specific symptoms other than a painless lump. This case study reports on a soft-tissue sarcoma that was initially thought to be a haematoma on ultrasound, despite being rescanned 6 weeks later. The patient presented back to their general practitioner 8 months later with the subsequent ultrasound showing an irregular and hypervascular soft-tissue mass. Further imaging and ultrasound-guided biopsy led to a surgical excision of a myxofibrosarcoma. This case demonstrates the difficulty of differentiating between a haematoma and sarcoma, especially in patients presenting with a history of trauma.
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Affiliation(s)
- Mark Charnock
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, UK
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12
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Omori T, Fujiwara T, Kunisada T, Takeda K, Hasei J, Yoshida A, Yanai H, Ozaki T. A rare manifestation of extraskeletal myxoid chondrosarcoma with a huge expanding hematoma. J Orthop Sci 2019; 24:377-381. [PMID: 28187993 DOI: 10.1016/j.jos.2016.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 11/12/2016] [Accepted: 12/06/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Toshinori Omori
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohiro Fujiwara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
| | - Toshiyuki Kunisada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Ken Takeda
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan; Department of Intelligent Orthopaedic System Development, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Joe Hasei
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Diagnostic Pathology, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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13
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Abstract
Soft tissue masses and fluid collections are frequently encountered in sonographic practice, either as principal indication for diagnostic examination or as an incidental finding during an examination performed for other indications. Sonography is a good first-line imaging modality for evaluation of superficial masses and fluid collections, but requires meticulous attention to technique to avoid diagnostic pitfalls. Although many superficial masses are diagnosed with ultrasound, there are several potential diagnostic challenges, including differentiating hematomas from sarcomas. This article provides an image-rich review of the sonographic features of common soft tissue masses, with emphasis on practical tips to accurately recognize important pathology.
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Affiliation(s)
- Jason M Wagner
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA.
| | - Kristin Rebik
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA
| | - Paul J Spicer
- Department of Radiology, University of Kentucky, 800 Rose Street, HX-315D, Lexington, KY 40536-0293, USA
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14
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Kontogeorgakos VA, Eward WC, Brigman BE. Microsurgery in musculoskeletal oncology. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:271-278. [PMID: 30623252 DOI: 10.1007/s00590-019-02373-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
Sarcomas are rare mesenchymal bone and soft tissue tumors of the musculoskeletal system. In the past, the primary treatment modality was amputation of the involved limb and the 5-year survival was very low for high-grade tumors. During the last three decades, limb salvage has become the rule rather than the exception and the use of neoadjuvant and adjuvant therapies (radiation and chemotherapy) has dramatically increased disease-free survival. Reconstruction of large bone and soft tissue defects, though, still remains a significant challenge in sarcoma patients. In particular, vascularized tissue transfer has proved extremely helpful in dealing with complex bone and soft tissue or functional defects that are frequently encountered as a result of the tumor or as a complication of surgery and adjuvant therapies. The principles, indications and results of microsurgical reconstruction differ from trauma patients and are directly related not only to the underlying disease process, but also to the local and systemic therapeutic modalities applied to the individual patient. Although plastic reconstruction in the oncological patients is not free of complications, usually these complications are manageable and do not jeopardize oncological outcome. The overall treatment strategy should be tailored to the patient's and sarcoma profile.
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Affiliation(s)
- Vasileios A Kontogeorgakos
- Department of Orthopaedics, National and Kapodistrian University of Athens, Rimini 1, Xaidari, Athens, Greece.
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Choi KS, Haroon Al Rasheed MR, Ross J, Guzman G, Mar WA. Angiosarcoma of the hand associated with pseudoaneurysm. Radiol Case Rep 2018; 12:807-810. [PMID: 29484076 PMCID: PMC5823321 DOI: 10.1016/j.radcr.2017.07.018] [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: 05/16/2017] [Revised: 07/13/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
Angiosarcoma is a rare malignancy of vascular endothelial origin. We describe a case of angiosarcoma of the hand initially histopathologically diagnosed as a pseudoaneurysm, emphasizing the diagnostic importance of radiological pathologic concordance. Here we highlight the distinctive imaging and the histopathologic features of angiosarcoma, invaluable to its accurate and timely diagnosis.
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Affiliation(s)
- Kevin S Choi
- College of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL
| | | | - Jeremy Ross
- College of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Grace Guzman
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60612
| | - Winnie A Mar
- Department of Radiology, University of Illinois at Chicago, 1740 W Taylor Street Rm 2483 (MC 931), Chicago, IL 60612
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Hoshi M, Oebisu N, Ieguchi M, Ban Y, Takami M, Nakamura H. Clinical features of soft tissue sarcoma presenting intra-tumour haematoma: case series and review of the literature. INTERNATIONAL ORTHOPAEDICS 2016; 41:203-209. [PMID: 27826764 DOI: 10.1007/s00264-016-3322-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Intra-tumour haematoma is an uncommon clinical presentation in malignant soft tissue tumours. This study aimed to highlight the clinical features of patients with soft tissue sarcomas with intra-tumour haematoma. METHODS The patient group was composed of eight men and one woman aged between 29 and 83 years (mean 44.0 ± 20.8). The average follow-up was 29.8 months. Clinical information, including clinical features, radiological information and treatment course, was retrospectively investigated. RESULTS Tumours were predominantly located in the chest wall and thigh, and average diameter was 10.3 cm. Six patients underwent needle biopsy with ultrasound sonography, and three underwent an open biopsy. Histological diagnoses indicated that all tumours were high grade, three of which were undifferentiated pleomorphic sarcomas, three synovial sarcomas, two pleomorphic liposarcomas, one a leiomyosarcoma and one a malignant peripheral nerve sheath tumour. The median diagnostic delay time was 3.0 months. Magnetic resonance imaging (MRI) indicated a haematoma area <25 % in three, 25-50 % in four and 50 % two. A wide resection was performed in eight patients, and radiotherapy was administered to one patient for the initial local treatment of a primary tumour. Local recurrence was detected in four patients, whilst five developed lung metastases. The five-year survival rate was 57.1 % and median survival 34.0 months. CONCLUSIONS Soft tissue sarcomas with intra-tumour haematoma presented with locally aggressive and highly metastatic behavior, consistent with high-grade tumours.
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Affiliation(s)
- Manabu Hoshi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Naoto Oebisu
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Makoto Ieguchi
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshitaka Ban
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masatsugu Takami
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-ku, Osaka, 545-8585, Japan
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Abstract
Pediatric non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) are a heterogeneous group encompassing more than 50 different histological diagnoses arising from primitive mesenchymal tissue. Together, they comprise about half the soft tissue sarcomas diagnosed in children and young adults. Despite each histologies relative rarity, their management schema is similar among the different NRSTS histologies. Surgical management is an important component of the multimodal treatment strategy of all these tumors. Resection with negative margins, while maintaining function, plays an important role as a primary treatment of these patients as well as diminishing the risks of local and distant recurrence.
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Affiliation(s)
- Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children׳s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229.
| | - David Rodeberg
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Golub IJ, Garcia RA, Wittig JC. A 15-Year-Old Male Baseball Player With a Mass in the Brachialis Muscle. Orthopedics 2016; 39:e545-8. [PMID: 27045482 DOI: 10.3928/01477447-20160324-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/29/2015] [Indexed: 02/03/2023]
Abstract
A 15-year-old boy presented with a mass in his right arm after suffering a minor injury playing baseball. He had been diagnosed with a hematoma. There was no other outstanding medical/surgical history. Magnetic resonance images showed a heterogeneous mass arising from the brachialis muscle that mainly enhanced peripherally with extremely scant internal nodular enhancement. Core needle biopsy cells were positive for CD31 and CD34, markers for atypical endothelial cells, as well as MIB-1 and p53. The final diagnosis was an angiosarcoma of the brachialis muscle. Pediatric angiosarcoma, particularly within deep tissue, is exceedingly rare. Histological and immunohistochemical modalities led to the diagnosis. Magnetic resonance images suggested a mass with a large cystic/hemorrhagic space that could have been misconstrued as a hematoma had there been absolutely no nodular or septal enhancement. The patient underwent neoadjuvant chemotherapy and radiation before undergoing limb-sparing surgery that included resection of the mass with the brachialis muscle and short head of the biceps muscle. Neoadjuvant treatment was deemed successful due to a drastic reduction in the size of the tumor and 95% tumor necrosis. The patient was disease free 2 years postoperatively. There had been no local/systemic recurrences. He was pain free, had normal elbow function, and had returned to playing baseball. It is important to be extremely suspicious when a patient presents with a hemorrhagic, painless, enlarging mass after sustaining minor trauma. A careful and meticulous biopsy must be completed to achieve the correct diagnosis. Magnetic resonance imaging with gadolinium is recommended for evaluation because these masses can be often misinterpreted as hematomas. [Orthopedics. 2016; 39(3):e545-e548.].
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Glenn CA, Fung KM, Tullos HJ, McNall-Knapp RY, Gunda D, Mapstone TB. Primary Intracranial Sarcoma Presenting as Chronic Subdural Fluid Collections in a Child. World Neurosurg 2016; 86:514.e13-8. [DOI: 10.1016/j.wneu.2015.08.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
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Relea Sarabia A, Bahamonde Cabria S, González Rebollo M, Encinas Gaspar MB. [Breast hematoma masking a sarcoma]. RADIOLOGIA 2015; 57:445-8. [PMID: 26160042 DOI: 10.1016/j.rx.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 05/18/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
Sarcomas account for less than 1% of malignant breast tumors. We present the case of a sarcoma (malignant fibrous histiocytoma) of the breast that debuted as a lump. The patient associated the lump with trauma, and the clinical, sonographic, and cytological findings were suggestive of a hematoma. The lump grew rapidly, and the follow-up sonogram one month later clearly revealed hypervascular solid poles. This atypical presentation is useful for reviewing the management of lesions suggestive of hematomas, which are often associated with nonspecific findings and occasionally with signs that raise suspicion of malignancy. The emergence of what appears to be a hematoma in the breast, even when accompanied by a history of trauma or a tendency toward bleeding, calls for prudence: very short-term follow-up and biopsy, even excisional biopsy, are recommended if the lesion does not evolve like a hematoma.
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Affiliation(s)
- A Relea Sarabia
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, España.
| | - S Bahamonde Cabria
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, España
| | - M González Rebollo
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, España
| | - M B Encinas Gaspar
- Servicio de Radiodiagnóstico, Complejo Asistencial Universitario de Palencia, España
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Patel A, Davies AM, James SL. Imaging of extremity soft tissue masses: pitfalls in diagnosis. Br J Hosp Med (Lond) 2015; 76:344-52. [PMID: 26053905 DOI: 10.12968/hmed.2015.76.6.344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Soft tissue sarcomas are rare tumours which can be clinically difficult to differentiate from more common benign lesions. Imaging plays a fundamental role in diagnosis, but in some cases it can be difficult to differentiate benign from malignant conditions. This article reviews potential pitfalls in soft tissue sarcoma imaging.
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Affiliation(s)
| | | | - S L James
- Consultant Radiologist in the Department of Radiology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP
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From Tumor to Trauma: Etiologically Deconstructing a Unique Differential Diagnosis of Musculoskeletal Entities With High Signal Intensity on T1-Weighted MRI. AJR Am J Roentgenol 2015; 204:817-26. [DOI: 10.2214/ajr.14.13360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Fulminant soft-tissue extension of anaplastic multiple myeloma masquerading as postoperative abscess. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Colman MW, Lozano-Calderon S, Raskin KA, Hornicek FJ, Gebhardt M. Non-neoplastic soft tissue masses that mimic sarcoma. Orthop Clin North Am 2014; 45:245-55. [PMID: 24684918 DOI: 10.1016/j.ocl.2013.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Non-neoplastic soft tissue masses may mimic soft tissue sarcoma in a wide variety of clinical settings. Systematic and thorough review of patient history, physical examination, imaging, laboratory results, and biopsy will allow the clinician to differentiate between the two in most cases. We describe several common non-neoplastic entities that may mimic soft tissue sarcoma in case presentation format along with the characteristics that help distinguish them.
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Affiliation(s)
- Matthew W Colman
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3B, Boston, MA 02114, USA; Department of Orthopedic Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Santiago Lozano-Calderon
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3B, Boston, MA 02114, USA; Department of Orthopedic Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kevin A Raskin
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3B, Boston, MA 02114, USA
| | - Francis J Hornicek
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3B, Boston, MA 02114, USA
| | - Mark Gebhardt
- Department of Orthopedic Surgery, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Dilemmas in distinguishing between tumor and the posttraumatic lesion with surgical or pathologic correlation. Clin Sports Med 2013; 32:559-76. [PMID: 23773881 DOI: 10.1016/j.csm.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article discusses the most common diagnostic dilemmas when trying to distinguish between tumor and sports injury or other trauma. Bone tumors frequently occur in the same young active patients who experience sports injuries. If the pain persists longer than expected, imaging studies should be obtained to prevent a delay in diagnosis or an inappropriate arthroscopy. A history of spontaneous fracture or a fracture after minor trauma should raise suspicion for underlying lesion as the cause. Occasionally necrosis and/or hemorrhage within a soft tissue sarcoma is so extensive that only a small cuff of viable tumor tissue is present.
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Kose R, Erkut A, Mordeniz C, Karantinacı ABT. Chronic hematoma on the forearm mimicking soft tissue sarcoma. EUROPEAN JOURNAL OF PLASTIC SURGERY 2013. [DOI: 10.1007/s00238-012-0710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vasileios KA, Eward WC, Brigman BE. Surgical treatment and prognosis in patients with high-grade soft tissue malignant fibrous histiocytoma of the extremities. Arch Orthop Trauma Surg 2012; 132:955-61. [PMID: 22487849 DOI: 10.1007/s00402-012-1510-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malignant fibrous histiocytoma (MFH) of soft tissue is one of the most common sarcoma in adulthood. However, only a few series have separately studied the clinical behavior and prognosis of this malignancy. METHODS We retrospectively reviewed 61 patients treated for extremity soft tissue high-grade MFH. Four patients had a history of another malignancy and were excluded from analysis. In 12 referred patients with incomplete excision, re-excision of the tumor bed was offered. Clinical and treatment variables were analyzed for their impact on treatment complications, local recurrence (LR), metastatic disease (MD) and overall survival (OS). RESULTS Four patients underwent primary amputation. Twenty-three patients necessitated a primary reconstructive procedure for wound closure. Wound healing complication (WHC) developed in 28.3 % of the limb sparing group of patients. LR developed in 11 patients (19.3 %), while 6 of them had second LR. Eighteen patients (31.5 %) developed MD, involving lung at least. Patients who developed MD <12 vs >12 months, died within 19.3 vs 8 months mean time (p < 0.05). Overall survivorship was 66.7 % at 5 years. No statistically significant variables were identified for LR, while multivariate analysis for MD revealed tumor size >5 cm as the only statistically significant variable. For OS, development of MD and age >70 years emerged as independent prognostic factors. CONCLUSIONS The overall prognosis is poor. LR, although can be managed with tumor re-excision, has high second recurrence rate. Increased tumor size is associated with shorter metastasis-free interval which significantly decreases survival.
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Affiliation(s)
- Kontogeorgakos A Vasileios
- Department of Orthopaedic Surgery, Orthopaedic Oncology, University Hospital of Larissa, Larissa, Greece.
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Murray IR, Perks FJ, Beggs I, Moran M. Femoral nerve palsy secondary to traumatic iliacus haematoma--a young athlete's injury. BMJ Case Rep 2010; 2010:2010/oct22_1/bcr0520103045. [PMID: 22791579 DOI: 10.1136/bcr.05.2010.3045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Femoral neuropathy secondary to iliacus haematoma in the absence of a bleeding diathesis is rare. Of the few documented cases in the literature, most have occurred in adolescents participating in sport. We report a case of femoral nerve palsy complicating an iliacus haematoma occurring in a young person with minimal trauma that resolved with non-operative management. Although rare, iliacus haematoma should be included in the differential diagnosis of groin pain as the number of children and young adults participating in sport increases.
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Affiliation(s)
- Iain R Murray
- Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
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