Myositis ossificans on the forearm in a 10-year-old girl

Myositis ossificans in the pediatric population: a systematic scoping review

Introduction

Circumscribed or pseudomalignant myositis ossificans (MO) is a rare and benign condition characterized by heterotopic bone formation in soft tissues. The clinical presentation of MO, imaging investigations, histological findings, and treatment strategies are unclear, especially in the pediatric population.

Materials and methods

A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French of traumatic and non-traumatic MO. Studies were selected by 2 independent reviewers following the PRISMA recommendation and descriptive data were extracted. We harvest in each case the sex, age at diagnosis, location, presence of initial trauma, pre-emptive diagnosis, modalities of imagery used, realized biopsy, treatment performed, and type of follow-up.

Results

Sixty pediatric cases of MO were identified between 2002 and 2023. Twenty-three patients (38.3%) were diagnosed with idiopathic/pseudomalignant and 37 patients (61.7%) with circumscribed. The mean age at diagnosis was 9.5 years (range 0.2-17 years), with a male-to-female ratio of 1:1. The initial pre-emptive diagnosis was neoplasia in 13 patients (21.7%). The biopsy was percutaneous in 9 patients (15%) and incisional in 7 patients (11.7%). Histological analysis was achieved in 35 cases (57%). Surgical excision was the first line treatment in 46.7% of patients, and non-surgical in the remaining patients. The follow-up strategy was clinical in 16 patients (26.7%) or based on imaging investigation in 23 patients (38.3%).

Discussion

Although MO in children is described as a rare pathology, identifying the benignity of the condition is essential to avoid unnecessary invasive treatment and to avoid delaying the treatment of a potentially life-threatening entity. It seems that there is no consensus established concerning the proper imaging for diagnosis. Clinicians should acknowledge that the absence of a triggering trauma tends to direct the investigation and the management toward a surgical attitude. Conservative management is key, however, surgical excision can be proposed on matured lesions on a case-by-case basis. The absence of recurrence is not excluded. Therefore, a close clinical follow-up is suggested for all cases. The true benefit of a radiological is questioned in a question known to be self-resolving.

Aggressive atraumatic myositis ossificans in a toddler

Myositis ossificans (MO) is a benign disorder where bone forms within muscles or other soft tissues. This condition usually follows trauma and is rare in pediatric patients. Here we present the case of a 2-year-old male who developed MO of his right elbow without obvious trauma to the area. Imaging of MO in the initial phase is highly unspecific and obtaining tissue samples through a biopsy can render misleading reports. In most cases MO is a self-limited process with complete resolution, however, some cases may present a diagnostic and therapeutic challenge.

Giant nontraumatic myositis ossificans in a child: A case report

BACKGROUND

Nontraumatic myositis ossificans is a rare disease whose specific pathogenesis is unclear. Early diagnosis of this disease is very difficult in children because of difficulties in determining medical history and nonspecific early clinical manifestations, which may lead to the failure of timely and effective diagnosis and treatment in some patients. We report the diagnosis and treatment of a child with nontraumatic myositis ossificans and summarize the clinical characteristics and diagnosis and treatment of the disease.

CASE SUMMARY

An 8-year-old girl first came to our hospital for more than a week with pain in the right lower limb. There was no history of trauma or strenuous activities. On physical examination, no mass on the right thigh was found, and the movement of the right lower extremity was limited. Ultrasonography showed synovitis of the hip, and bed rest was recommended. Three days later, the child’s pain persisted and worsened, accompanied by fever and other discomforts. She came to our hospital again and a mass was found on the right thigh with redness and swelling on the surface. The images showed a soft tissue tumor on the right thigh with calcification. Routine blood tests revealed that the inflammation index was significantly increased. In case of infection, the patient was given antibiotics, and the pain was relieved soon after, without fever. However, the right thigh mass persisted and hardened. The patient underwent incision biopsy more than 1 mo later, and the postoperative pathology showed nontraumatic myositis ossificans. After approximately 9 mo of observation, the tumor still persisted, which affected the life of the child, and then resection was performed. Since follow-up, there has been no recurrence.

CONCLUSION

Due to the difficulty in discerning a child's medical history and the diverse early manifestations, it is difficult to diagnose nonossifying muscle disease in children in its early stage. Measures such as timely follow-up and periodic image monitoring are conducive to early diagnosis of the disease. The disease has a certain degree of self-limitation, and it can be observed and treated first. If the tumor persists in the later stage or affects functioning, then surgery is considered.

Giant nontraumatic myositis ossificans in a child: A case report

BACKGROUND

Nontraumatic myositis ossificans is a rare disease whose specific pathogenesis is unclear. Early diagnosis of this disease is very difficult in children because of difficulties in determining medical history and nonspecific early clinical manifestations, which may lead to the failure of timely and effective diagnosis and treatment in some patients. We report the diagnosis and treatment of a child with nontraumatic myositis ossificans and summarize the clinical characteristics and diagnosis and treatment of the disease.

CASE SUMMARY

An 8-year-old girl first came to our hospital for more than a week with pain in the right lower limb. There was no history of trauma or strenuous activities. On physical examination, no mass on the right thigh was found, and the movement of the right lower extremity was limited. Ultrasonography showed synovitis of the hip, and bed rest was recommended. Three days later, the child’s pain persisted and worsened, accompanied by fever and other discomforts. She came to our hospital again and a mass was found on the right thigh with redness and swelling on the surface. The images showed a soft tissue tumor on the right thigh with calcification. Routine blood tests revealed that the inflammation index was significantly increased. In case of infection, the patient was given antibiotics, and the pain was relieved soon after, without fever. However, the right thigh mass persisted and hardened. The patient underwent incision biopsy more than 1 mo later, and the postoperative pathology showed nontraumatic myositis ossificans. After approximately 9 mo of observation, the tumor still persisted, which affected the life of the child, and then resection was performed. Since follow-up, there has been no recurrence.

CONCLUSION

Due to the difficulty in discerning a child's medical history and the diverse early manifestations, it is difficult to diagnose nonossifying muscle disease in children in its early stage. Measures such as timely follow-up and periodic image monitoring are conducive to early diagnosis of the disease. The disease has a certain degree of self-limitation, and it can be observed and treated first. If the tumor persists in the later stage or affects functioning, then surgery is considered.

Post-traumatic myositis ossificans: a benign lesion that simulates malignant bone and soft tissue tumours

Myositis ossificans (MO) is a benign bone formation in an extra-skeletal location. The most common subtype of MO, the post-traumatic, usually develops in young males after a traumatic event or sports injury.MO may simulate malignant bone lesions such as extra-skeletal or surface osteosarcomas, or soft tissue sarcomas such as synovial sarcoma or undifferentiated pleomorphic sarcoma. In the early phase the diagnosis of MO is challenging because imaging and histopathological findings may be non-characteristic.Detailed medical history as well as clinical examination, follow-up imaging studies and histological assessment are crucial for a proper diagnosis. Early and accurate differential diagnosis between MO and malignant soft tissue and bone tumours is important to maximize. Cite this article: EFORT Open Rev 2021;6:572-583. DOI: 10.1302/2058-5241.6.210002.

A nontraumatic myositis ossificans case of the forearm: Case report and literature review

Myositis ossificans (MO) is a rare, benign ossifying lesion characterized by focal formation of heterotopic bone and cartilage in extraskeletal soft-tissue that most commonly occurs in young adults. In most cases, no causative factor can be identified. The diagnosis of MO is usually based on the patient's history of trauma, clinical signs, on imaging appearance and histological examination. We present a non-traumatic MO case of the forearm in a 40-year-old man with weakness in left finger motion, a decrease in prehension for more than three weeks, without any weight loss, malaise, anorexia or fever. The clinical symptoms and radiological findings can be easily confused with malignant lesions. Treatment is usually conservative but, due to the limited strength and range of motion of the left hand, the tumor was extirpated and the diagnosis of MO was made by biopsy. The patient had no neurological deficits after surgical treatment and was discharged on the fifth day after the surgery in good condition with the recommendation to begin a rehabilitation program.

Myositis ossificans mimicking sarcoma: a not so rare bioptic diagnostic pitfall

Background

Myositis ossificans (MO) is a heterotopic bone formation in soft tissues, usually caused by traumas or neuropathies. Although the aetiology remains unclear, MO is supposed to be an osteoblast metaplasia with a benign and self-limiting course. Remarkably, at onset MO can be clinically, radiologically and histologically indistinguishable to soft tissue malignancies, especially in cases lacking a history of trauma, leading to misdiagnoses and improper treatments.

Case presentation

A 13-year-old male was referred to the Oncology Department because of a previous diagnosis of osteogenic sarcoma of his left thigh. The diagnosis was made upon a history of isolated thigh pain in the absence of traumas, the evidence of a contrast-enhanced soft tissue mass on magnetic resonance imaging and the histological findings of atypical nuclei and mitotic figures. The lesion was eventually radiologically unchanged after five cycles of chemotherapy; thus, the child was referred for radical surgery. At admission, endorsing the child well-appearance, together with the evidence of a reduced calcified lesion on a further magnetic resonance, a clinical suspicion of myositis ossificans was raised. Hence, the excisional biopsy confirmed the pathognomonic zonal pattern of myositis ossificans.

Conclusions

This case highlights some frequent diagnostic pitfalls facing myositis ossificans. A lacking history of traumas, along with a too early radiological and histological evaluation can lead to a misdiagnosis of soft tissue malignancies. Even in the absence of a clear history of trauma, a painful soft tissue swelling with a benign clinical course should raise the suspicion of myositis ossificans.

Ossifying myositis in the infant. About a case

Myositis ossificans is a benign disorder characterized by the formation of heterotopic bone in skeletal muscle or soft tissues. It is extremely rare in children, <1% of cases occur in children under 10 years. We present a 17-day-old boy that, after 10 days of Intermediate Care Unit stay, was referred to our hospital for a developmental dysplasia of the hip. On clinical examination, he had swelling on the left thigh and increase in size compared to the contralateral one, therefore was admitted for studying. Imaging findings including plain radiographs, CT, MRI and bone scintigraphy, as well as treatment performed, are described. To the best of our knowledge, is the youngest case reported in the literature.

Non-traumatic myositis ossificans circumscripta at elbow joint in a 9-year old child

Myositis ossificans circumscripta (MOC) is a kind of self-localized, benign and tumor-like lesions often seen in adults, with approximately 75% of cases caused by trauma. We reported a case of non-traumatic MOC occurred at the elbow joint in a 9-year old child and it has been excised by surgery. After 18 months follow-up, a favorable outcome has been achieved with the Broberg-Morrey score of 100. We suggest that surgical resection should be done as soon as the diagnosis is confirmed.