A Case of Senile Langerhans Cell Histiocytosis with Soft Tissue Mass as the Main Manifestation / 罕见病研究

Langerhans cell histiocytosis (LCH) is a rare disease characterized by the proliferation of Langerhans cells and the destruction of local tissue. LCH large occurs in children, whilst incidence of the elderly population is extremely low, and there are few related studies. LCH lesions can involve multiple organs and systems, including bone tissue, lymph nodes, skin, liver, and spleen. However, it is rare that multiple soft tissues are implicated for eldly patients with LCH and present with soft tissue mass as the main manifestation. Here is a report on the clinical features, treatment and prognosis of an elderly LCH with multiple soft tissue masses as the main manifestation, in order to provide clinical reference.

Rare case of intramuscular hemangioma of infraspinatous muscle.

Intramuscular hemangiomas are rare benign neoplasms accounting for <1% of all hemangiomas. Intramuscular hemangiomas are relatively uncommon and frequently misdiagnosed, due to their vague presentations. In any patient with soft-tissue mass suspected of a hemangioma, MR imaging may provide very specific information regarding the characteristics, the origin, and the extent of the lesion than other imaging modalities. The definitive diagnosis is made by histopathological study of the surgical specimen. Here, we present a case report of intramuscular hemangioma occurring in the left infraspinatous muscle in an 18-year-old boy. Due to rare nature of such lesions, the patient's diagnosis was delayed and patient was treated for chronic pain in left shoulder joint. Magnetic resonance imaging finally clinched the diagnosis and patient was successfully operated upon and subsequently cured.

Factors Influencing the Finding of Strain Ultrasound Elastography in Benign Subcutaneous Tumors

PURPOSE: The purpose of this study is to investigate factors influencing strain sonoelastography findings in evaluation of subcutaneous tumors. MATERIALS AND METHODS: Retrospective analysis of sonoelastography findings performed by two radiologists in 38 consecutive patients with 38 pathologically confirmed benign subcutaneous tumors was performed. Elastographic finding of the lesions was graded from 1 (softer) to 3 (harder) according to stiffness. Analysis of correlations between elastographic findings and height, width and depth of the lesion, and the distance from bone was performed using the Kruskal-Wallis test. RESULTS: By reviewer 1, 11 lesions were grade 1 on sonoelastography, eight were grade 2, and 19 were grade 3, respectively. By reviewer 2, 11 lesions were grade 1 on sonoelastography, nine were grade 2, and 18 were grade 3, respectively. The distance from bone differed significantly among the three grades groups for both reviewers; grade 1, 2, and 3, 0.78 +/- 0.75 cm, 1.56 +/- 0.68 cm, and 1.77 +/- 0.63 cm, for reviewer 1 (P = .006) and 0.86 +/- 0.79 cm, 1.55 +/- 0.72 cm, and 1.74 +/- 0.65 cm for reviewer 2 (P = .016). No significant difference in height, width, and depth of the lesion was observed among the three groups. CONCLUSION: Distance from bone showed a significant association with strain sonoelastographic findings of benign subcutaneous tumors.

Periprosthetic Mass after Total Hip Replacement / 대한고관절학회지

PURPOSE: To analyze the characteristics and causes of periprosthetic huge mass which occur after treatment by total hip arthroplasty. MATERIALS AND METHODS: Of the patients who had undergone total hip arthroplasty from January 2000 to October 2007, we retrospectively evaluated the 10 patients who suffered huge soft tissue mass. Five of these patients had received metal-on-metal bearing (group 1) prostheses, and the other 5 had received metal-on-polyethylene bearings (group 2). We evaluated the size and location of the mass, the extent of osteolysis, and the hematologic and pathologic examination results. RESULTS: Roentgenographically, the location of the masses varied from the acetabular area to the distal femoral stem. The mean mass diameter of all 10 patients was 14.6 cm(7-21 cm)x6.2 cm(3-9 cm)x7.2 cm(4-12 cm). Osteolytic lesions were found in 3 group 1 patients and 3 patients in group 2. High counts of lymphocytes and eosinophils were present in group 1. High counts of macrophages were present in group 2. CONCLUSION: The occurrence of osteolysis and huge soft mass after total hip arthroplasty is thought to be related to foreign body reaction by polyethylene wear particles and metal hypersensitivity. Outside-in patterned cortical thinning was considered to be indicative of a long standing periprosthetic soft tissue mass effect.

Superficial Soft Tissue Masses: Sonographic and Pathologic Findings

Superficial soft tissue masses are frequently encountered in clinical practice. Sonographic imaging is a first-choice screening modality to confirm or exclude the presence of a soft tissue mass at a site of clinical concern. In this pictorial review, we demonstrate the sonographic and pathologic findings of superficial soft tissue masses including benign and malignant lesions, which can occur in the skin and subcutaneous layer.

Calcific Myonecrosis of the Antetibial Area

Calcific myonecrosis is a rare late post-traumatic condition, in which a single muscle is replaced by a fusiform mass with central liquefaction and peripheral calcification. Compartment syndrome is suggested to be the underlying cause. The resulting mass may expand with time due to recurrent intralesional hemorrhage into the chronic calcified mass. A diagnosis may be difficult due to the long time between the original trauma and the symptoms of calcific myonecrosis. We encountered a 53-year-old male patient diagnosed with calcific myonecrosis in the lower leg. We report the case with a review of the relevant literature.

Anaplastic Large Cell Lymphoma Presenting as a Soft

Anaplastic large cell lymphoma (ALCL) is a rare tumour, accounting for approximately 3% of adult non-Hodgkin lymphomas.1 Primary systemic ALCL frequently involves both lymph nodes and extranodal sites. A 44-year-old woman presented with a firm, mobile mass in the left iliac fossa region. Ultrasound findings showed a well defined inhomogenous soft tissue mass, measuring 4x4x2.6cm in the deep subcutaneous region. Histopathological examination revealed that the mass was infiltrated by large lymphoid cells with marked nuclear atypia including kidney-shaped nuclei. These neoplastic cells expressed anaplastic lymphoma kinase (ALK) (both nuclear & cytoplasmic staining), CD30 and EMA but not for T-cell (CD45RO and CD3), and B-cell (CD20 & CD79α) markers. Fluorescence in situ hybridization (FISH) analysis showed a t(2;5)(p23;q35) chromosomal translocation. Subsequently the patient developed shortness of the breath and a thoracic computed tomography (CT) scan showed a mass encasing the right upper lobe bronchus. She also had bilateral axillary lymph nodes, measuring 1 cm in diameter (biopsy was not done). The mediastinum and endobronchial region did not show any abnormalities. She received 6 cycles of CHOP chemotherapy and remained disease free 2 years after diagnosis. ALCL, rarely present as a soft tissue tumour and this disease should be included as a differential diagnosis of any soft tissue mass.

Ultrasonographic Evaluation of Osteosarcomas / 华中科技大学学报（医学）（英德文版）

The ultrasonographic appearances of osteosarcomas and the roles of ultrasonography in the diagnosis and surgical staging of osteosarcomas were investigated. A comparative study was performed on 45 cases of osteosarcomas by ultrasonography and radiography. Bony changes, periosteal reaction and soft tissue mass were evaluated for each lesion. The results showed that ultrasonography revealed a solid mass around bone in 42 patients, bone destruction in 24 patients and periosteal reaction in 16 patients. Plain radiographs showed bony changes in 44 patients and no bony change in remaining one patient, shadowing of soft tissue swelling in 30 patients, and pulmonary metastases in 3patients. Surgical biopsy and pathological examination confirmed osteosarcoma in all 45 patients.Soft tissue mass was confirmed in 42 patients surgically. The diagnostic accuracy of soft tissue masses by ultrasonography and radiography was 100 % (42/42) and 71.4 % (30/42), respectively. The positive rate of ultrasonography and radiography in displaying bony changes was 53.3 % (24/45) and 97.8 % (44/45), respectively. In conclusion, in the detection of soft tissue mass of osteosarcoma, ultrasonography is superior to radiography, and in displaying bony changes of osteosarcomas, radiography is superior to ultrasonography. So it may come to a conclusion that plain radiography combined with ultrasonography can completely display the bony and soft tissue lesion of osteosarcomas.

Malignant Intracranial Osteolytic Meningioma Appearing as an Extracranial Soft Tissue Mass: A Cases Report

Malignant intracranial meningioma is a rare pathologic entity. Although the topic is widely discussed, there is little agreement in the literatures as to the histological and radiological features that warrant the diagnosis of malignant meningioma. An osteolytic lesion of the skull may have been suggested in several cases. But in adults, the most commonly suspected lesion is metastatic lesion;while meningioma is rarely suspected. Meningiomas are occasionally associated even with extracranial masses. However, most of these masses are firm, and are caused by hyperostosis. Extracranial soft-tissue masses rarely arise in meningiomas, thus, the presence of both osteolytic skull lesion and soft-tissue mass is exceedingly rare in meningiomas. The authors report a case of osteolytic malignant meningioma located at the frontal fossa extending to the subgaleal space appearing as an extracranial soft-tissue mass in a 19-year-old female. The clinical, radiological, neurosurgical, and histopathological features of these lesions are discussed together with a review of the literatures.

An Application of the Ultrasonograhy to the Musculoskeletal Masses / 대한정형외과학회잡지

Ultrasonography is suited for screening patients with a mass in the soft tissue because of its safety, low cost, apparent sensitivity and non-invasiveness. But the application in orthopaedic surgery is insufficient. Authors examined 102 patients who had a palpable soft tissue mass of extremities and trunk with ultrasonography. Location, internal echogenicity, margin, and extent of soft tissue involvement, especially neurovascular bundle by tumor were evaluated. The diagnosis of mass was confirmed by histopathology after excision or biopsy of the mass. The ultrasonography correctly identified and differentiated the cystic lesions of 34 cases. The sonograms of all 16 malignant lesions showed ill-defined margin and heterogenous internal echo. The extent of soft tissue involvement, especially neurovascular bundle was confirmed exactly with ultrasonography. Therefore, in malignant tumor, after confirmation of no neurovascular involvemment with ultrasonography, limb-salvage operation could be considered and planned. In one case of abscess, percutaneous biopsy was done under guidance of ultrasonography. Therefore, ultrasonography can be used as a guide for percutaneous biopsy without exposure to radiation.