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Hughes ECM, Rosenbaum DG, Branson HM, Tshuma M, Marie E, Frayn CS, Rajani H, Gerrie SK. Imaging approach to pediatric calvarial bulges. Pediatr Radiol 2024:10.1007/s00247-024-05967-9. [PMID: 38940907 DOI: 10.1007/s00247-024-05967-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Palpable calvarial lesions in children may require multi-modality imaging for adequate characterization due to non-specific clinical features. Causative lesions range from benign incidental lesions to highly aggressive pathologies. While tissue sampling may be required for some lesions, others have a typical imaging appearance, and an informed imaging approach facilitates diagnosis. This review illustrates imaging findings of common and clinically important focal pediatric calvarial bulges to aid the radiologist in narrowing the differential diagnosis and directing appropriate referral. We focus on birth-related lesions, congenital abnormalities, and modeling disturbances (i.e., those that produce a change in calvarial contour early in development), normal variants, and neoplastic lesions with their mimics.
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Affiliation(s)
- Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
- Department of Radiology, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
| | - Daniel G Rosenbaum
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Makabongwe Tshuma
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Najwa A, Zineb I, Sara EG, Lamiae R, Najlaa L, Siham EH, Nazik A, Latifa C. Solitary infantile myofibromatosis in the upper extremities: Case report. Radiol Case Rep 2024; 19:21-23. [PMID: 38046916 PMCID: PMC10692447 DOI: 10.1016/j.radcr.2023.09.063] [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: 06/17/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 12/05/2023] Open
Abstract
Infantile myofibromatosis (IM) is a mesenchymal tumor that may present in infants in a couple of major forms: solitary (myofibroma) and multicentric (myofibromatosis) which can be more subdivided into IM without or with visceral involvement. The tumors present as nodular lesions in the soft tissues, bones, and/or internal organs. Although the success of imaging in suggesting the correct diagnosis can't be denied, histopathology and Immunohistochemical examinations are necessary to confirm the diagnosis of IM as it might be misdiagnosed as a malignant tumor. We report a case of solitary infantile myofibromatosis in the upper extremities discovered in a 9-year-old girl. She had swelling and an enlargement on the posterior forearm on the ulnar side. The X-ray showed a lytic lesion with swollen soft tissue. The patient underwent an MRI which suggested the diagnosis of myofibroma. Then, solitary myofibroma was confirmed histologically. Infancy's most prevalent fibrous tumor is IM. Its prognosis depends on the visceral involvement. Imaging, especially MRI is the ideal tool to diagnose it.
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Affiliation(s)
- Amsiguine Najwa
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Izi Zineb
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - El Ghaffouli Sara
- Department of Pediatric Anatomopathology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Rouas Lamiae
- Department of Pediatric Anatomopathology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Lrhorfi Najlaa
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - El Haddad Siham
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Allali Nazik
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
| | - Chat Latifa
- Department of Pediatric Radiology, Faculty of Medicine, Hospital Ibn Sina, Rabat, Morocco
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Weidlich A, Pablik J, Schaser KD, Winkler D, Mehnert E, Fritzsche H. Solitary, adult-onset, intraosseous myofibroma of the rib: a case report and literature review. SAGE Open Med Case Rep 2023; 11:2050313X231182791. [PMID: 37359281 PMCID: PMC10288404 DOI: 10.1177/2050313x231182791] [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] [Received: 01/07/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Myofibromas are rare benign tumors with myofibroblastic origin. They occur especially in cutis and subcutaneous tissue of the head and the neck, less frequently on the extremities. Myofibromas grow very slowly and are often painless, which is why patients often present relatively late. In the literature, there were many reports about intraosseous myofibromas of the craniofascial bones but reports of the trunk and extremities in adults are very rare. The authors present a very rare case of an intraosseous myofibroma of the ribs resulting in pathological fracture, including a research of literature from other cases of intraosseous myofibromas of the trunk or extremities.
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Affiliation(s)
- Anne Weidlich
- Anne Weidlich, University Hospital Carl Gustav Carus Dresden, Fetscherstr 74, 01307 Dresden, Germany.
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El Ouali I, Berrada K, Dokal ID, Saouab R, El Fenni J, Salaheddine T. A misleading tumor: A rare form of infantile fibromatosis. SAGE Open Med Case Rep 2023; 11:2050313X231157485. [PMID: 36860305 PMCID: PMC9969429 DOI: 10.1177/2050313x231157485] [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: 11/17/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
Infantile fibromatosis is a rare mesenchymal disorder characterized by the fibrous proliferation of the skin, bone, muscle, and viscera. The clinical features vary from solitary to multicentric forms with similar pathological features. Although the tumor is histologically benign, it is a highly infiltrating lesion making the prognosis poor for patients with craniofacial involvement affection due to the major risk of nerve vascular and airway compression syndrome. The solitary form of infantile fibromatosis observed in the dermis, subcutis, or fibromatosis tends to occur predominantly in males and typically affects craniofacial deep soft tissues. We present a case of an unusual symptom presentation and a rarely observed location of a solitary fibromatosis form, affecting the muscle of the forearm and infiltrating the bone in a 12-year-old girl. Imaging findings were suggestive of rhabdomyosarcoma, but histopathology set the diagnosis of an infantile fibromatosis. The patient, then, received chemotherapy, and amputation was proposed due to the inextricability of this benign yet aggressive tumor, an option that was refused by her parents. We discuss through this article the clinical, radiological, and pathological features of this benign yet aggressive condition, the potential differential diagnosis, the prognosis, and treatment options substantiated with concrete examples from the literature.
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Pušnik L, Šekoranja D, Plut D. A Unique Case of Multicentric Infantile Myofibromatosis with Radiologic-Pathologic Correlation. CHILDREN 2022; 9:children9010053. [PMID: 35053678 PMCID: PMC8774631 DOI: 10.3390/children9010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/23/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022]
Abstract
Infantile myofibromatosis (IM) is a rare condition with a variable clinical presentation that characteristically affects young children. Most frequently it presents as one or more benign nodules of the skin, bones, soft tissues, or, rarely, visceral organs. According to the location and number of lesions, there are three different forms: solitary, multicentric without visceral involvement, and multicentric with visceral involvement (generalised), with the latter having the least favourable prognosis. We present a unique case of severe congenital generalised IM in a new-born male who required intubation and mechanical ventilation immediately after the birth due to respiratory distress. A chest radiograph showed numerous tumours involving the entire lung, resembling a metastatic lung disease. Additionally, the neonate had multiple, bluish, papular skin nodules and a biopsy of a skin nodule ultimately led to the diagnosis of IM. Diffuse lung involvement prevented adequate ventilation which resulted in multiorgan failure and death before targeted treatment could have been initiated. The presented case is unique, as such atypical extensive involvement of the lung and leptomeninges in IM has not been reported before. In this brief report, we present the findings of radiographic and ultrasonographic examinations in correlation with autopsy and histopathology.
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Affiliation(s)
- Luka Pušnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Correspondence: ; Tel.: +386-31-573-832
| | - Daja Šekoranja
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Domen Plut
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Clinical Radiology Institute, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Rodriguez JD, Selleck AM, Abdel Razek AAK, Huang BY. Update on MR Imaging of Soft Tissue Tumors of Head and Neck. Magn Reson Imaging Clin N Am 2021; 30:151-198. [PMID: 34802577 DOI: 10.1016/j.mric.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.
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Affiliation(s)
- Justin D Rodriguez
- Department of Radiology, Duke University, 2301 Erwin Rd, Durham, NC 27705, USA
| | - A Morgan Selleck
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina Hospitals, 170 Manning Drive, CB 7070, Physicians Office Building, Rm G190A, Chapel Hill, NC 27599, USA
| | | | - Benjamin Y Huang
- Department of Radiology, UNC School of Medicine, 101 Manning Drive, CB#7510, Chapel Hill, NC 27599, USA.
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Cunha B, Kuroedov D, Conceição C. Imaging of pediatric nasal masses: A review. J Neuroimaging 2021; 32:230-244. [PMID: 34705308 DOI: 10.1111/jon.12942] [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: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/28/2022] Open
Abstract
Several conditions may present as nasal masses in pediatric age, including congenital and developmental disorders, inflammatory and infectious conditions, neoplastic and neoplastic-like lesions, and other miscellaneous disorders. A confident presurgical diagnosis can be challenging and imaging is often key in the management of these lesions. We provide a pictorial review of pediatric nasal masses and discuss a location-based approach to the diagnosis of these lesions on imaging studies. Acquaintance with the most common pathologies and awareness for its characteristic imaging features can aid the physician in the differential diagnosis. Location and extension of the lesion can be particularly helpful. Midline masses raise suspicion for developmental nasal midline lesions, including frontoethmoidal cephalocele, dermoid/epidermoid cyst, and neuroglial heterotopia. In case of trauma, nasal septum hematoma/abscess should be considered. Developmental or odontogenic cystic lesions and osseous neoplasms and neoplasm-like lesions can originate from the maxilla and palate. Although most nasal tumors show overlapping imaging characteristics, some have suggestive features, such as nasopharyngeal angiofibroma and esthesioneuroblastoma. Malignant tumors tend to be locally aggressive, demonstrating invasive features, bony erosion, intermediate signal on T2-weighted images, and restricted diffusion on diffusion-weighted imaging. In certain cases, a definite diagnosis can only be made histologically. Nonetheless, detailed characterization of the lesion is crucial prior to invasive procedures in order to avoid complications.
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Affiliation(s)
- Bruno Cunha
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Danila Kuroedov
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.,NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carla Conceição
- Neuroradiology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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