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Maldonado AA, Spinner RJ, Broski SM, Stone JJ, Howe BM, Carter JM. Neuromuscular choristoma-associated desmoid-type fibromatosis: Establishing a nerve territory concept. Acta Neurochir (Wien) 2020; 162:1137-1146. [PMID: 31897730 DOI: 10.1007/s00701-019-04178-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/12/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Desmoid-type fibromatosis (DTF) frequently arises in patients with neuromuscular choristoma (NMC). We hypothesize that NMC-associated DTF occurs in soft tissues innervated by the NMC-affected nerve, and arises from CTNNB1-mutated (myo) fibroblasts within or directly adjacent to the NMC. MATERIALS AND METHODS A retrospective review of patients treated at our institution was performed for patients with biopsy-confirmed diagnosis of NMC-DTF. Clinical presentation, physical examination, electrodiagnostic findings and radiological features (MR and FDG PET/CT images for each NMC-DTF) and pathologic re-review of available materials were analyzed. A literature review was also performed. RESULTS Eight patients from our institution met the inclusion criteria. All patients presented with neuropathic symptoms and soft tissue or bone changes in the nerve territory innervated by the NMC. All MR images (N=8 cases) showed the characteristic features of NMC, and also showed direct contact between unifocal (N=5) or multifocal (N=3) DTF(s) and the NMC-affected nerve NMC. FDG PET/CT (N=2 cases) showed diffuse, increased FDG uptake along the entire affected nerve segment, contiguous with the FDG-avid DTF. In all cases, the DTFs arose in the soft tissues of the NMC-affected nerve's territory. No patient developed DTF at any other anatomic site. CONCLUSIONS These data demonstrate that NMC-DTF arises solely within the NMC-affected nerve territory, and has direct contact with the NMC itself. Based on all these findings and the multifocality of NMC in several cases, we recommend imaging and surveillance of the entire NMC-affected nerve (from spine to distal extremity) to identify clinically-occult DTF in patients with NMC.
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Affiliation(s)
- Andrés A Maldonado
- Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Stephen M Broski
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jonathan J Stone
- Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - B Matthew Howe
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
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Stone JJ, Prasad NK, Laumonerie P, Howe BM, Amrami KK, Carter JM, Jentoft ME, Spinner RJ. Recurrent desmoid-type fibromatosis associated with underlying neuromuscular choristoma. J Neurosurg 2019; 131:175-183. [PMID: 30168738 DOI: 10.3171/2018.3.jns152935] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/21/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Desmoid-type fibromatosis (DTF) presents a therapeutic dilemma. While lacking metastatic potential, it is a locally aggressive tumor with a strong propensity for occurrence near nerve(s) and recurrence following resection. In this study, the authors introduce the association of an occult neuromuscular choristoma (NMC) identified in patients with DTF. METHODS After experiencing a case of DTF found to have an occult NMC, the authors performed a retrospective database review of all other cases of biopsy-proven DTF involving the extremities or limb girdles in patients with available MRI data. Two musculoskeletal radiologists with expertise in peripheral nerve imaging reviewed the MRI studies of the eligible cases for evidence of previously unrecognized NMC. RESULTS The initial case of a patient with an occult sciatic NMC is described. The database review yielded 40 patients with DTF-18 (45%) in the upper limb and 22 (55%) in the lower limb. Two cases (5%) had MRI findings of NMC associated with the DTF, one in the proximal sciatic nerve and the other in the proximal tibial and sural nerves. CONCLUSIONS The coexistence of NMC may be under-recognized in a subset of patients with extremity DTF. This finding poses implications for DTF treatment and the likelihood of recurrence after resection or biopsy. Further study may reveal crucial links between the pathogenesis of NMC and DTF and offer novel therapeutic strategies.
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Affiliation(s)
- Jonathan J Stone
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nikhil K Prasad
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Pierre Laumonerie
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 2Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, Toulouse, France
| | - B Matthew Howe
- 3Department of Radiology, Mayo Clinic, Rochester, Minnesota; and
| | | | - Jodi M Carter
- 4Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mark E Jentoft
- 4Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Robert J Spinner
- 1Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Ribeiro BNDF, Muniz BC, Salata TM, Corrêa DG, Marchiori E. Squamous cell carcinoma of the paranasal sinuses: cutaneous metastases with bone involvement. Radiol Bras 2018. [PMID: 29540947 PMCID: PMC5844444 DOI: 10.1590/0100-3984.2016.0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | | | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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de Carvalho AD, Garcia FL, Nogueira-Barbosa MH. Ischiofemoral impingement secondary to valgus intertrochanteric osteotomy: a case report. Radiol Bras 2017; 50:335-337. [PMID: 29085168 PMCID: PMC5656075 DOI: 10.1590/0100-3984.2013.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report an unusual case of ischiofemoral impingement secondary to valgus
intertrochanteric osteotomy. The osteotomy was performed for treatment of
epiphysiolysis of the left femoral head.
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Affiliation(s)
- Alice Duarte de Carvalho
- Fellow in Musculoskeletal Radiology, Radiology Division, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Flávio Luís Garcia
- Associate Professor, Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Associate Professor, Division of Radiology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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de Sá Neto JL, Simão MN, Crema MD, Engel EE, Nogueira-Barbosa MH. Diagnostic performance of magnetic resonance imaging in the assessment of periosteal reactions in bone sarcomas using conventional radiography as the reference. Radiol Bras 2017; 50:176-181. [PMID: 28670029 PMCID: PMC5487232 DOI: 10.1590/0100-3984.2015.0166] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To evaluate the performance of magnetic resonance imaging (MRI) in detecting
periosteal reactions and to compare MRI and conventional radiography (CR) in
terms of the classification of periosteal reactions. Materials and Methods: Retrospective study of 42 consecutive patients (mean age, 22 years; 20 men)
with a confirmed diagnosis of osteosarcoma or Ewing's sarcoma, MRI and CR
images having been acquired pretreatment. Three blinded radiologists
detected periosteal reactions and evaluated each periosteal reaction subtype
in CR and MRI images: Codman's triangle; laminated; and spiculated. The CR
was used as a benchmark to calculate the diagnostic performance. We used the
kappa coefficient to assess interobserver reproducibility. A two-tailed
Fisher's exact test was used in order to assess contingency between CR and
MRI classifications. Results: In the detection of periosteal reactions, MRI showed high specificity, a high
negative predictive value, and low-to-moderate sensitivity. For CR and for
MRI, the interobserver agreement for periosteal reaction was almost perfect,
whereas, for the classification of different subtypes of periosteal
reaction, it was higher for the Codman's triangle subtype and lower for the
spiculated subtype. There was no significant difference between MRI and CR
in terms of the classifications (p < 0.05). Conclusion: We found no difference between MRI and CR in terms of their ability to
classify periosteal reactions. MRI showed high specificity and almost
perfect interobserver agreement for the detection of periosteal reactions.
The interobserver agreement was variable for the different subtypes of
periosteal reaction.
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Affiliation(s)
- José Luiz de Sá Neto
- MSc, Attending Physician in the Department of Radiology and Diagnostic Imaging at the Celso Pierro Maternity Hospital of the Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brazil
| | - Marcelo Novelino Simão
- PhD, Radiologist at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Michel Daoud Crema
- MD, Radiologist, Musculoskeletal Radiology Service, Hôpital Saint-Antoine, Université Paris IV, Paris, France
| | - Edgard Eduard Engel
- PhD, Professor in the Department of Biomechanics, Medicine, and Rehabilitation of the Locomotor System of the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Tenured Associate Professor of Radiology and Diagnostic Imaging in the Radiology Division of the Department of Clinical Medicine at the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
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Boaventura CS, Rodrigues DP, Silva OAC, Beltrani FH, de Melo RAB, Bitencourt AGV, Mendes GG, Chojniak R. Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria. Radiol Bras 2017; 50:1-6. [PMID: 28298725 PMCID: PMC5347495 DOI: 10.1590/0100-3984.2015.0123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the indications for performing magnetic resonance imaging of the
female pelvis at a referral center for cancer. Materials and Methods This was a retrospective, single-center study, conducted by reviewing medical
records and imaging reports. We included 1060 female patients who underwent
magnetic resonance imaging of the pelvis at a cancer center between January
2013 and June 2014. The indications for performing the examination were
classified according to the American College of Radiology (ACR)
criteria. Results The mean age of the patients was 52.6 ± 14.8 years, and 49.8% were
perimenopausal or postmenopausal. The majority (63.9%) had a history of
cancer, which was gynecologic in 29.5% and nongynecologic in 34.4%. Of the
patients evaluated, 44.0% had clinical complaints, the most common being
pelvic pain (in 11.5%) and bleeding (in 9.8%), and 34.7% of patients had
previously had abnormal findings on ultrasound. Most (76.7%) of the patients
met the criteria for undergoing magnetic resonance imaging, according to the
ACR guidelines. The main indications were evaluation of tumor recurrence
after surgical resection (in 25.9%); detection and staging of gynecologic
neoplasms (in 23.3%); and evaluation of pelvic pain or of a mass (in
17.1%). Conclusion In the majority of the cases evaluated, magnetic resonance imaging was
clearly indicated according to the ACR criteria. The main indication was
local recurrence after surgical treatment of pelvic malignancies, which is
consistent with the routine protocols at cancer centers.
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Affiliation(s)
| | | | | | | | | | | | | | - Rubens Chojniak
- PhD, MD, Head of the Imaging Department, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
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de Lima LTB, de Albuquerque Filho ES, Batista LL, de Moraes TP, Pereira BPG. Unusual lesions that distend the knee joint: pictorial essay. Radiol Bras 2016; 49:322-328. [PMID: 27818547 PMCID: PMC5094822 DOI: 10.1590/0100-3984.2015.0154] [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] [Indexed: 12/20/2022] Open
Abstract
The high number of knee imaging exams at radiology clinics, together with the wide variety of knee disorders, calls for expanding the knowledge about the less common lesions seen in routine diagnostic practice. The purpose of this pictorial essay was to illustrate unusual lesions that distend the knee joint, selected by relevance and evaluated with multiple imaging modalities, including X-ray, computed tomography, and magnetic resonance imaging, as well as to perform a brief review of the literature.
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Affiliation(s)
- Luana T Barros de Lima
- MD, Radiologist at Hospital Universitário Professor Alberto Antunes (HUPAA) - Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil
| | - Eolo Santana de Albuquerque Filho
- MD, Radiologist, Head of the Residency Program in Radiology and Diagnostic Imaging at Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Laecio Leitão Batista
- PhD, Head of the Residency Program in Angiography and Endovascular Surgery at Hospital das Clínicas da Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | | | - Bruno Perez Guedes Pereira
- MD, Radiologist at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife, PE, Brazil
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Ribeiro BNDF, Marchiori E. Rosai-Dorfman disease affecting the nasal cavities and paranasal sinuses. Radiol Bras 2016; 49:275-276. [PMID: 27777489 PMCID: PMC5073402 DOI: 10.1590/0100-3984.2015.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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