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Crim J. Bone radiographs: sometimes overlooked, often difficult to read, and still important. Skeletal Radiol 2024; 53:1687-1698. [PMID: 37914896 DOI: 10.1007/s00256-023-04498-y] [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: 09/28/2023] [Revised: 10/21/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Julia Crim
- University of Missouri at Columbia, Columbia, MO, USA.
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Werenski JO, Hung YP, Chang CY, Nielsen GP, Lozano-Calderón SA. Myositis ossificans mimicking bone surface osteosarcoma: case report with literature review. APMIS 2024; 132:535-543. [PMID: 38741286 DOI: 10.1111/apm.13422] [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: 08/16/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Myositis ossificans, a benign tumor composed of spindle cells and osteoblasts, can clinically and radiologically mimic osteosarcoma. While recognition and accurate diagnosis of myositis ossificans can be a challenge, this is critical as it may allow a conservative surgical approach to maximize functional outcomes. Herein, we present a patient with surface myositis ossificans confirmed genetically by the presence of COL1A1::USP6 gene fusion, along with a literature review. Due to the enhanced visualization of the bone matrix, computed tomography (CT) imaging may be a superior imaging modality to magnetic resonance (MR) imaging. Staged biopsies with samples obtained from the periphery and center of the lesions may allow pathologists to discern the zonal distribution histologically. Furthermore, immunohistochemistry fluorescence in situ hybridization and molecular testing can aid in the distinction of myositis ossificans from mimics. Because of their resemblance to other bone tumors, these cases of myositis ossificans highlight the importance of a multidisciplinary approach integrating clinical, radiologic, and pathologic analysis and involving serial imaging, sampling, and judicious use of ancillary immunohistochemical and molecular testing.
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Affiliation(s)
- Joseph O Werenski
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging & Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Petur Nielsen
- Division of Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Orthopaedic Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Cherry I, Mutschler M, Samara E, Merckaert S, Zambelli PY, Tschopp B. Myositis ossificans in the pediatric population: a systematic scoping review. Front Pediatr 2023; 11:1295212. [PMID: 38161430 PMCID: PMC10757320 DOI: 10.3389/fped.2023.1295212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024] Open
Abstract
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.
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Kha ST, Sharma J, Kenney D, Daldrup-Link H, Steffner R. Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma. Pediatr Emerg Care 2023; 39:963-967. [PMID: 37567167 DOI: 10.1097/pec.0000000000003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
OBJECTIVES The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis. METHODS We conducted a retrospective review of pediatric patients (aged 1-18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis. RESULTS Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4-18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1-84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0-4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0-493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0-493; P = 0.018). CONCLUSIONS We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.
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Pu C, Su Y. Are open surgery and total resection good choices for traumatic myositis ossificans in children? INTERNATIONAL ORTHOPAEDICS 2021; 45:3147-3154. [PMID: 34559305 DOI: 10.1007/s00264-021-05225-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Traumatic myositis ossificans is a self-limited, non-neoplastic, ectopic bone formation in the soft tissues caused by trauma. Conservative treatment is the mainstay of management. However, open surgery and complete resection should be considered in patients with limited joint function and constant pain. Herein, we retrospectively analyzed the outcome of open surgical resection in children with myositis ossificans (MO). METHODS The data of patients diagnosed with MO between February 2010 and May 2019 were retrospectively analyzed. The clinical data included medical history, physical examination, and laboratory, imaging, and pathological findings. All patients underwent an open surgery and total resection. Radiography findings and joint function were evaluated. Patients with developing complications, such as recurrence and assessing joint function, were followed up. In total, 20 patients (sex, 15 male and 5 female patients; age, 8.1 ± 2.5 years) were included. RESULTS MO was located around the elbow, wrist, proximal humerus, and thigh in 13, one, one, and five patients, respectively. All patients were followed up for > 12 months. Two patients had partial recurrence after surgery. One patient with forearm MO had poor elbow function (Broberg-Morrey score of 70). Nineteen patients had good functional outcomes according to the Broberg-Morrey and Cooney methods. CONCLUSION Open surgical resection is an effective method for children with MO. The recurrence rate was low when the surgery was performed after the acute stage (1.5 months from disease presentation).
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Affiliation(s)
- Changsheng Pu
- Orthopedics Department, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China
| | - Yuxi Su
- Orthopedics Department, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, Chongqing, 400014, People's Republic of China.
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Cao J, Zheng HJ, Sun JH, Zhu HY, Gao C. Case Report: Unusual Presentation of Myositis Ossificans of the Elbow in a Child Who Underwent Excessive Postoperative Rehabilitation Exercise. Front Pediatr 2021; 9:757147. [PMID: 34869112 PMCID: PMC8633484 DOI: 10.3389/fped.2021.757147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
Traumatic myositis ossificans (MO) is an unusual complication after muscle injury and is predominantly seen in young adults and adolescents. Pediatric MO cases are even rarer. We report an 8-year-old girl who was diagnosed with a lateral humeral condyle fracture. She was treated surgically, and her elbow joint was fixed with plaster. Rehabilitation exercise was administered 1 month after the operation. Due to the wrong exercise method, a palpable bony mass appeared around the elbow 1 month later. The clinical radiological diagnosis showed MO, and conservative treatment was administered. After 3 years of follow-up, the affected limb functioned well, with no sign of recurrence. Here, we report this long-term follow-up case of MO resulting from excessive rehabilitation exercise.
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Affiliation(s)
- Jin Cao
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Hua Jiang Zheng
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Jing Hua Sun
- Department of Pathology, Ningbo Diagnostic Pathology Center, Ningbo, China
| | - Huan Ye Zhu
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
| | - Chao Gao
- Department of Orthopedics, Ningbo Sixth Hospital, Ningbo, China
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Abstract
Shoulder lesions range from tumor-like lesions such as simple bone cysts to aggressive high-grade sarcomas. The clinical presentation is often nonspecific with shoulder pain as the primary complaint, which may lead to a delayed or missed diagnosis. Delayed diagnosis or a poorly planned biopsy of a malignant shoulder lesion can have a detrimental effect on the patient's prognosis and treatment options. Because the initial patient assessment is crucial for successful treatment, knowledge of the key features of common shoulder tumors and tumor-like conditions can help determine the diagnosis and treatment plan. This article reviews the key features and treatment options of the more commonly encountered benign and malignant shoulder bone and soft-tissue tumors and tumor-like conditions.
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Gholamrezanezhad A, Basques K, Kosmas C. Peering beneath the surface: juxtacortical tumors of bone (part II). Clin Imaging 2018; 50:113-122. [PMID: 29353715 DOI: 10.1016/j.clinimag.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 01/26/2023]
Abstract
Juxtacortical or surface tumors of bone are neoplasms arising from or just outside the cortex, and are composed of different histologic types. Although the imaging appearances of these lesions have similarities to their intramedullary counterparts, their location alters their radiographic and MR characteristics, creating difficulties in diagnosis. Meanwhile, several non-neoplastic lesions, such as stress reaction/stress fracture and indolent infectious processes, compound the differential diagnosis. Neoplastic juxtacortical lesions of bone have been classified into five categories: cartilaginous, fibrous, lipomatous, osseous, and metastatic tumors. Our goal in part two of this review is to illustrate the characteristic radiographic, CT and MR imaging features of various juxtacortical neoplasms, including pathognomonic imaging findings that can aid in diagnosis, and to develop an appropriate differential diagnosis for surface lesions based on imaging characteristics, lesion location and patient age.
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Affiliation(s)
- Ali Gholamrezanezhad
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Kyle Basques
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Christos Kosmas
- Department of Radiology, Cleveland Medical Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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Wang H, Nie P, Li Y, Hou F, Dong C, Huang Y, Hao D. MRI Findings of Early Myositis Ossificans without Calcification or Ossification. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4186324. [PMID: 30255094 PMCID: PMC6140134 DOI: 10.1155/2018/4186324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/26/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To characterize and evaluate the MR imaging features of early myositis ossificans (MO) without calcification or ossification. METHODS The MRI manifestations of seven patients with pathologically proven early MO were retrospectively analyzed with regard to tumor location, size, margins, signal intensity, and enhancement appearance in MR images. Additionally, the surrounding soft-tissue edema and adjacent bone change were assessed. RESULTS All cases (n=7) had intramuscular tumor-like masses without calcifications. The lesions appeared as isointense in T1-weighted images (T1-WI) and inhomogeneous hyperintense in T2-weighted MR images (T2-WI). On T2-WI and postcontrast T1-WI, the heterogeneously high signal intensity in the expanded muscle interspersed with a few hypointense linear structures consistent with intact muscle fibers showed "striate pattern" in the plane parallel with muscle fibers. The relatively hypointense areas with geometrical pattern consistent with the bundles of intact muscle fibers are found within the lesion with diffuse high signal intensity, displaying the "checkerboard-like pattern" in the plane vertical to muscle fibers. A "striate pattern" (n = 7) and "checkerboard-like pattern" (n = 3) in the lesion appeared in T2-WI. In contrast-enhanced MRI images, all cases showed diffuse "striate pattern" enhancement. Among them, one case demonstrated "checkerboard-like pattern" enhancement. All cases had diffuse and prominent muscle edema that preserved the muscle fascicles. For two lesions located in the deep muscle group, the adjacent bone showed bone marrow edema. CONCLUSION MR imaging has unique advantages for diagnosis of early MO without calcification or ossification: the "striate pattern" and "checkerboard-like pattern" appearance shown in T2-WI and contrast-enhanced MRI images can be helpful for differential diagnosis. MRI can delineate the extent of the tumor and provides accurate anatomical information, which is important in diagnosis, treatment, and follow-up.
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Affiliation(s)
- Hexiang Wang
- 1Department of Radiology, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Pei Nie
- 1Department of Radiology, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Yang Li
- 2Department of Radiology, The Qingdao Women and Children Hospital Qingdao, Shandong, China
| | - Feng Hou
- 3Department of Pathology, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Cheng Dong
- 1Department of Radiology, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
| | - Yonghua Huang
- 4Department of Radiology, The Puyang City Oilfield General Hospital, Puyang, Henan, China
| | - Dapeng Hao
- 1Department of Radiology, The Affiliated Hospital of Qingdao University Qingdao, Shandong, China
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Sferopoulos NK, Kotakidou R, Petropoulos AS. Myositis ossificans in children: a review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:491-502. [DOI: 10.1007/s00590-017-1932-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/16/2017] [Indexed: 12/29/2022]
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Lee KR, Park SY, Jin W, Won KY. MR imaging and ultrasonography findings of early myositis ossificans: a case report. Skeletal Radiol 2016; 45:1413-7. [PMID: 27511030 DOI: 10.1007/s00256-016-2441-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/07/2016] [Accepted: 07/15/2016] [Indexed: 02/02/2023]
Abstract
Myositis ossificans (MO) is a benign soft tissue lesion with non-neoplastic heterotopic bone formation. MO in the intermediate and mature stages can be easily diagnosed if characteristic imaging findings such as a peripheral zonal pattern of ossification with variable thickness is observed. However, it is difficult to correctly diagnose early MO because it can mimic malignancy clinically, radiologically, and histopathologically. We report a case of early pseudosarcomatous phase of non-traumatic MO with atypical imaging findings. A 59-year-old woman presented with pain followed by a mass in the left thigh within a week. MR imaging and ultrasonography showed an intramuscular lesion with preserved muscle fascicles in the vastus lateralis muscle. Intralesional ossification or calcification was not seen on ultrasonography. A diagnosis of myositis ossificans was made by ultrasonographically guided biopsy.
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Affiliation(s)
- Kyung Ryeol Lee
- Department of Radiology, Jeju National University Hospital, Aran 13 gil 15 (Ara-1-dong), Jeju-si, Jeju Special Self-Governing Province, 63241, Republic of Korea
| | - So Young Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea.
| | - Wook Jin
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea
| | - Kyu Yeoun Won
- Department of Pathology, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea
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