Tuberculous Osteomyelitis Mimicking a Lytic Bone Tumor: Report of Two Cases and Literature Review / Osteomielite tuberculosa imitando um tumor ósseo lítico: Relato de dois casos e revisão da literatura

Abstract Tuberculous osteomyelitis is an uncommon form of tuberculosis (TB); the isolated involvement of the wrist joint is particularly rare. The symptoms and clinical manifestation mimic other conditions; hence, careful diagnosis is required. The authors present two cases of patients presenting with soft tissue mass and a lytic bone lesion. The biopsy revealed granulomatous osteomyelitis. Lesion culture identified Mycobacterium tuberculosis. The authors urge clinicians to include TB as a differential diagnosis when investigating the primary cause of lytic bone lesions, even in the absence of pulmonary symptoms or risk factors of TB infection. The inclusion of mycobacterial cultures when analyzing biopsies of lytic bone lesions is also advised.

Resumo A osteomielite tuberculosa é uma forma incomum de tuberculose (TB) e o acometimento isolado da articulação do punho pelo TB é particularmente raro. Os sintomas e a manifestação clínica imitam outras doenças; portanto, um diagnóstico cuidadoso é necessário. Os autores apresentam dois casos de pacientes com massa nas partes moles e lesão óssea lítica. A biópsia revelou osteomielite granulomatosa. A cultura da lesão identificou Mycobacterium tuberculosis. Os autores recomendam que médicos clínicos incluam a TB como um diagnóstico diferencial da causa primária das lesões ósseas líticas, mesmo na ausência de sintomas pulmonares ou fatores de risco de infecção por TB. A inclusão de culturas micobacterianas na análise de biópsias de lesões ósseas líticas também é recomendada.

Intraosseous lipoma of the iliac: case report / Lipoma intraósseo do ilíaco: relato de caso

Lipomas are benign tumors that attack fat cells and most often affecting soft tissues in adulthood. On rare occasions, they may affect bones, preferentially the metaphyses of the long bone. They are generally asymptomatic and radiography shows radiolucent lesions with a thin sclerotic rim or radiodense lesions with a thick sclerotic rim. Malignant transformation of these tumors is rare, as is their recurrence, and there is no need for surgery in most cases. In this report, we present a rare case of intraosseous lipoma in the iliac bone.

Os lipomas são tumores benignos que acometem células adiposas, mais comumente afetam os tecidos moles na idade adulta. Raramente podem afetar os ossos, preferencialmente metáfises dos ossos longos. São geralmente assintomáticos, na radiografia verifica-se lesão radiotransparente, com uma fina borda esclerótica ou lesão radiodensa com uma espessa borda esclerótica. A transformação maligna do tumor é rara, assim como a recorrência, sem necessidade cirúrgica na maioria dos casos. Neste relato apresentamos um caso raro de lipoma intraósseo do ilíaco.

Application of cross-linked telopeptide of type Ⅰ collagen, alkaline phosphatase in bone tumor / 中国医师杂志

Objective To determine the serum levels of cross-linked telopoptide of type Ⅰ collagen (ICTP),alkaline phosphatase (ALP) in patients with primary malignant bone tumor,primary benign bone tumor and malignant tumor metastasized to the bone,and to explore the clinical value of ICTP and ALP in identification and diagnosis of bone tumor.Methods Sixteen primary malignant bone tumor patients,16 primary benign bone tumor patients and 18 malignant tumor metastasized to the bone patients in 2012 were studied.Serum ALP was assayed by SFBC rate method and ICTP by enzyme linked immunosorbent assay (EIA).Results The serum levels of ICTP was not significantly different between primary benign bone tumors and normal control group (P ＞ 0.05),but the other between-groups had statistically significant difference (P ＜ 0.05).The serum levels of ALP in malignant tumor metastasized to the bone was significantly higher than the rest of the group (P ＜0.01),but the difference between the remaining groups was not statistically significant (P ＞ 0.05).The area under roc curve (AUC) of ICTP for diagnosis of primary benign bone tumors,malignant tumor metastasized to the bone,primary malignant bone tumor (0.923,0.926,0.874) was higher than the ALP (0.354,0.702,0.865).Conclusions Serum ICTP and ALP were sensitive and convenient biochemical indices which reflected metabolism of patients with bone tumor.Serum ICTP was more specific and sensitive than ALP and they have clinical importance for differential diagnosis as an index of bone tumor.

Tumores ósseos benignos e lesões ósseas pseudotumorais: avanços e atualização diagnóstica / Benign bone tumors and pseudotumors bone lesions:diagnostic advances and upgrade

O diagnóstico de tumores ósseos benignos e lesões ósseas pseudotumorais apresentou grandes avanços nos últimos anos. Entre os métodos de imagens, a radiografia simples permanece como o método de mais especificidade. A ressonância magnética e a tomografia computadorizada são valiosas no estadiamento e no planejamento cirúrgico, permitindo melhor avaliação da extensão do tumor e de sua ressecabilidade. A utilização de contraste e métodos dinâmicos permite visualizar alterações funcionais. A tomografia computadorizada por emissão de fótons (SPECT) associada à tomografia computadorizada (TC) permite a fusão direta de dados morfológicos e funcionais, sendo promissores para o estudo de doenças ósseas. A biópsia cirúrgica aberta é o padrão-ouro para o diagnóstico histológico de tumores músculo-esqueléticos. As técnicas percutâneas com agulha orientada por fluoroscopia, ultrassonografia e TC tornaram-se difundidas e diminuíram a necessidade de biópsia aberta, mas com menos acurácia diagnóstica. No campo genético, a citometria de fluxo mostra grande valor na diferenciação entre lesões benignas e malignas e para estadiamento tumoral. A descoberta da origem genética da exostose múltipla hereditária e da displasia fibrosa abre novas perspectivas para o diagnóstico e tratamento dos tumores ósseos hereditários. A identificação de inúmeros novos marcadores tumorais, moleculares e celulares relacionados com o comportamento e a agressividade tumoral permitirá o refinamento dos estadiamentos, o prognóstico e a criação de novos protocolos de tratamento.

The diagnosis of benign bone tumors and pseudotumors bone lesions showed great advances last years. Among the imaging methods, plain radiography is still the most specific method. Magnetic resonance imaging and computed tomography are very important in the staging and surgical planning, thus it allows a better assessment of the extent of the tumor and its resectability. Use of contrast and dynamic methods allows visualizing functional variations. Computed tomography for photon emission (SPECT) in association with computed tomography (CT) allows the direct fusion of functional and morphological data, once they are promising for the study of bone diseases. Open surgical biopsy is the gold standard for the histological diagnosis of musculoskeletal tumors. Imaging-guided Injection techniques with fluoroscopy, ultrasound and CT have become widespread and decreased the need for open biopsy, but with less diagnostic accuracy. In genetics, flow cytometry shows great importance in differentiating between benign and malignant lesions and for tumor staging. Hereditary multiple exostosis and of fibrous dysplasia have genetic origin. This fact shows new perspectives for diagnosis and treatment of hereditary bone tumors. Identification of several new tumor markers, molecular and cellular related to tumor behavior and aggressiveness will allow the refinement of staging, prognosis and development of new treatment protocols.

MR Imaging Findings of a Primary Cardiac Osteosarcoma and Its Bone Metastasis with Histopathologic Correlation

An osteosarcoma of cardiac origin is extremely rare, and a comprehensive description of MR imaging (MRI) findings of cardiac osteosarcoma and its metastasis in the femur have not been reported in the literature. We present a case of cardiac osteosarcoma in a 47-year-old woman and its metastasis to the femur, focusing on the description of MRI findings of the cardiac and metastatic bony osteosarcoma with a histopathologic correlation.

Metastatic Bone Tumors with Sunburst Periosteal Reaction

PURPOSE: The purpose of this study was to describe the clinical and imaging features of metastatic bone tumors with sunburst periosteal reaction and to define the characteristic findings which would be helpful for differentiating metastatic bone tumors from primary malignant bone tumors. MATERIALS AND METHODS: The authors retrospectively reviewed the cases of nine patients with pathologically confirmed metastatic bone tumors with sunburst periosteal reaction, for which imaging studies (plain radiographs [n=9], radioisotope [RI] scans [n=4], magnetic resonance [MR] images [n=6], and computed tomographic [CT] scans [n=4]) were performed. The imaging studies of each lesion were analyzed by two musculoskeletal radiologists focusing on the metastatic site, patterns of bone response, signal intensity characteristics and pattern of contrast enhancement on MR. The clinical records of the patients were reviewed with regard to the age and sex of the subjects, the clinical presentation, and the origin of the primary tumors. RESULTS: The cases consisted of six men and three women, whose mean age was 62 years (age range, 50-88 years). The primary tumors were adenocarcinoma of the stomach [n=4], adenocarcinoma of the lung [n=2], adenocarcinoma of the prostate [n=1], hepatocellular carcinoma of the liver [n=1], and adenocarcinoma of unknown origin [n=1]. The sites of metastatic involvement exhibiting sunburst periosteal reaction were the scapula [n=2], proximal humerus [n=2], rib [n=1], iliac bone [n=1], tibia [n=1], spine [n=1], and proximal phalanx [n=1]. In all patients, the imaging findings showed osteolytic [n=3] or osteoblastic [n=6] lesions with sunburst periosteal reaction. In six cases, the lesions were iso-intense on the T1-weighted images and heterogeneously hyperintense on the T2-weighted images. The gadolinium-enhanced T1-weighted images showed a nearly homogenous enhancement of the lesions without any central necrotic portion. CONCLUSION: Although metastatic bone tumor exhibiting sunburst periosteal reaction is rare, it should be included along with primary malignant bone tumors in the differential diagnosis of bone lesions with sunburst periosteal reaction, especially in older patients with or without a known primary malignancy.

Disseminated Primary Non-Hodgkin's Lymphoma of Bone: A Case Report

Primary lymphoma of bone is uncommon and disseminated non-Hodgkin's lymphoma is extremely rare. The authors report a case of primary non-Hodgkin's lymphoma of bone involving the whole skeleton without evidence of invo l vement of lymph nodes or other tissue. Radiographic examination demonstrated moth-eaten or permeative bone destruction with endosteal scalloping. The MRI revealed hypointense bone marrow to fat on T2 weighted image before treatment. Bone marrow biopsy and subsegment immunohistochemical studies demonstrated the presence of non-Hodgkin's lymphoma, T-cell type. The patient underwent standard chemotherapy and showed marked resolution, clinically and radiologically.

MR Imaging Findings of Chondroblastic Osteosarcoma

PURPOSE: To evaluate the MR imaging findings of chondroblastic osteosarcoma. MATERIALS AND METHODS: Weincluded 11patients (8 men, 3 women, mean age of 19 years) with pathologically proven chondroblastic osteosarcomaand, as a control group, 20 patients with conventional osteosarcoma. We obtained pre- and post-enhanced MR imagesof all patients and retrospectively reviewed the signal intensity and enhancement pattern of tumors. MR imageswere correlated with histopathology. RESULT: In chondroblastic osteosarcomas, the major portion (< 75%) of thetumor showed low signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weightedimages, but did not show enhancement. The margin of the area showed a lobular pattern. Enhanced nodules (n=11) andstrands (n=8) were seen in the nonenhanced portion. Histopathologically, the nonenhanced portion, nodules, andstrands revealed a chondroid matrix, hypercellular area, and fibrovascular septa, respectively. Conventionalosteosarcomas showed heterogeneous enhancement ; six showed a focal (<25%) nonenhanced area representing necrosis. CONCLUSION: Chondroblastic osteosarcoma showed characteristic MR imaging findings.