Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años / Giant cell tumour of bone: a series of 97 cases with a mean follow-up of 12 years

Objetivo. Describir una serie de tumores óseos de células gigantes con largo seguimiento, mostrando los resultados obtenidos con nuestro protocolo terapéutico. Material y método. Entre 1982-2009, 97 pacientes con lesiones histológicamente confirmadas como tumores óseos de células gigantes fueron tratados en nuestro centro con un seguimiento medio de 12 años (2-27 años). El tratamiento recibido lo determinó la clasificación de Campanacci. La serie la formaron 53 mujeres (54,6%) y 44 hombres (54,4%) con una edad media de 34,16 años (15-71 años). Los datos recogidos se centraron en la presentación clínica, localización, estadio, extensión, recurrencias y complicaciones. Resultados. El tratamiento más utilizado en los estadios i y ii de Campanacci fue escisión intralesional con fresado a alta velocidad y rellenado con injerto homólogo, mientras que en los estadios iii que no podían ser tratados con este método se abogó por la resección en bloque. Se halló una recurrencias global del 25,8%. Siete casos (7,2%) presentaron malignización. La tasa de exitus fue del 2,1% (2 casos). Conclusión. La opción terapéutica presentada para los tumores óseos de células gigantes que consiste en legrado con fresado a alta velocidad y aporte de injerto óseo en los grados i y ii de Campanacci obtiene resultados comparables con literatura actual. Los tumores de grado iii, que no pueden ser tratados con la opción terapéutica mencionada anteriormente, requieren resección en bloque y reconstrucción posterior (AU)

Purpose. To describe our series of patients with giant cell tumour of bone with a long-term follow-up to show the results obtained with our treatment protocol. Material and methods. A total of 97 histologically confirmed giant cell tumour of bone were treated in our center between 1982 and 2009. The mean follow-up period was 12 years (2-27 years). The treatment received was determined by the radiological grade based on the Campanacci classification. The series consisted of 53 women (54.6%) and 44 men (54.4%) with a median age of 34.16 years (15-71 years). The data collected was focused on the clinical presentation, location, phase, extension, recurrences, and complications. Results. The treatment most used in Campanacci grades i and ii was intralesional excision with high velocity drilling and filling with a graft. In grades iii that could not be treated with the aforementioned method, it was decided to perform en bloc resection. An overall recurrence rate of around 25.8% was observed. Seven cases (7.2%) presented with a recurrence of the malignancy. The death rate at the end of follow-up was 2.1% (2 cases). Conclusions. Curettage with a high-velocity drill and a bone graft in giant cell tumour of bone Campanacci grades i and ii obtain good results after long-term follow-up. Some grade iii giant cell tumour of bone that cannot be treated with this therapeutic option require en bloc resection and reconstruction (AU)

[Giant cell tumour of bone: a series of 97 cases with a mean follow-up of 12 years]. / Tumor de células gigantes óseo. Noventa y siete casos con seguimiento medio de 12 años.

PURPOSE: To describe our series of patients with giant cell tumour of bone with a long-term follow-up to show the results obtained with our treatment protocol. MATERIAL AND METHODS: A total of 97 histologically confirmed giant cell tumour of bone were treated in our center between 1982 and 2009. The mean follow-up period was 12 years (2-27 years). The treatment received was determined by the radiological grade based on the Campanacci classification. The series consisted of 53 women (54.6%) and 44 men (54.4%) with a median age of 34.16 years (15-71 years). The data collected was focused on the clinical presentation, location, phase, extension, recurrences, and complications. RESULTS: The treatment most used in Campanacci grades i and ii was intralesional excision with high velocity drilling and filling with a graft. In grades iii that could not be treated with the aforementioned method, it was decided to perform en bloc resection. An overall recurrence rate of around 25.8% was observed. Seven cases (7.2%) presented with a recurrence of the malignancy. The death rate at the end of follow-up was 2.1% (2 cases). CONCLUSIONS: Curettage with a high-velocity drill and a bone graft in giant cell tumour of bone Campanacci grades i and ii obtain good results after long-term follow-up. Some grade iii giant cell tumour of bone that cannot be treated with this therapeutic option require en bloc resection and reconstruction.

Schwannomas, benign tumors with a senescent phenotype.

BACKGROUND: Schwannomas are benign nerve sheath tumors that only very rarely undergo malignant changes. Oncogenic-induced senescence is a defense mechanism against such malignant transformation. Different molecular pathways are involved in this process, such as RAS-RAF-MAPK. Based on the fact that the RAS-RAF-MAPK pathway is known to be activated in peripheral nerve sheath tumors, this study analyzes senescence markers in Schwannomas to demonstrate the possible role of senescence in their genesis. METHODS: A retrospective immunohistochemical study was done in 39 schwannoma and 18 malignant peripheral nerve sheath tumors (MPNST). Staining for p16INK4a, Ki67, p53 and CyclinD1 was performed in all the cases. Additionally, ß-galactosidase staining was done in those cases in which frozen tissue was available (n=8). RESULTS: Higher levels of p16INK4a (p=0.0001) and lower levels of Ki67 (p=0.0001) were found in Schwannomas. Beta-galactosidase activity was positive in 5/5 Schwannomas and negative in 3/3 MPNST. CONCLUSIONS: Our results support the senescence nature of Schwannomas and the absence of a senescence phenotype in MPNST.

Elastofibroma dorsi: 7 años de seguimiento de 37 casos y revisión de la literatura / Elastofibroma dorsi: a 7-year follow-up of 37 cases and a review of the literature

Introducción. El elastofibroma dorsi (ED) es una tumoración benigna infrecuente de partes blandas, crecimiento lento y localización preferentemente escapular. Material y método. Revisión retrospectiva de 37 ED diagnosticados y tratados en nuestro centro entre agosto de 1993 y noviembre de 2009, con un seguimiento medio de 7 años. La presentación clínica, los resultados anatomopatológicos y los estudios por imagen han sido revisados. En 10 ocasiones la presentación fue bilateral. El ratio varón/mujer fue (4:23) con una edad media de 57 años. La duración media de los síntomas fue de 14 meses. En todos los casos se realizó estudio de RM y confirmación del diagnóstico mediante anatomía patológica. Siete casos fueron tratados conservadoramente. Los pacientes fueron estudiados por un traumatólogo especialista en oncología, así como por un radiólogo experimentado. Los resultados clínicos fueron evaluados mediante Escala Visual Analógica (EVA) para el dolor y comparación del rango de movilidad durante el seguimiento. Resultados. No se halló ningún caso de antecedentes familiares de ED. El 18% de los pacientes realizaban trabajos o deportes que implicaban la extremidad afectada. El 40% de los pacientes requirieron transfusión postoperatoria por hemoglobina <8g/dl. La EVA mejoró de 6 preoperatoriamente, a 2 postoperatoriamente. El rango de movilidad mejoró de media en 40°. Las complicaciones incluyen una infección de la herida, un caso de cicatriz hiperálgica, 8 hematomas y 3 seromas posquirúrgicos que se solucionaron sin incidencias en el seguimiento. Tras un seguimiento medio de 85 meses todos los pacientes se encuentran libres de enfermedad. Conclusiones. Se han obtenido buenos resultados con un amplio seguimiento. Basándonos en estos resultados y en una revisión bibliográfica del estado actual de esta patología sugerimos un algoritmo para su diagnóstico y tratamiento (AU)

Background. Elastofibroma dorsi (ED) is an infrequent benign, slow growing, soft tissue tumour that is usually located in the scapular zone. Material and methods. A series of 37 ED patients diagnosed and treated in our hospital between August 1993 and November 2009 were retrospectively reviewed. The average follow up was 7 years. Ten of them presented bilaterally. The male/female ratio was 4:3, and the mean age was 57 years. An MRI was performed, and the diagnosis confirmed by histopathology. Seven cases were treated conservatively. The clinical results were evaluated using a visual analogue score (VAS) for pain and a comparison of the range of movement during follow up. Results. Some 18% of the patients worked or practiced sports that called for the use of the affected limb. The 40% of the patients required a post-operative transfusion was required by 40% of the patients, due to having a haemoglobin <8g/d. The VAS improved from 6 to 2 after the surgery. The range of movement improved on an average of 40. The complications included an infection, 1 hyperalgesic scar, 8 haematomas and 3 seromas, which were resolved in the follow up without incidence. All the patients were free of illness after a mean follow-up of 85 months. Conclusions. Good results were achieved with a long follow-up. Based on these results and a literature review of the current state of this pathology, an algorithm for its diagnosis and treatment is suggested (AU)

[Elastofibroma dorsi: a 7-year follow-up of 37 cases and a review of the literature]. / Elastofibroma dorsi: 7 años de seguimiento de 37 casos y revisión de la literatura.

BACKGROUND: Elastofibroma dorsi (ED) is an infrequent benign, slow growing, soft tissue tumour that is usually located in the scapular zone. MATERIAL AND METHODS: A series of 37 ED patients diagnosed and treated in our hospital between August 1993 and November 2009 were retrospectively reviewed. The average follow up was 7 years. Ten of them presented bilaterally. The male/female ratio was 4:3, and the mean age was 57 years. An MRI was performed, and the diagnosis confirmed by histopathology. Seven cases were treated conservatively. The clinical results were evaluated using a visual analogue score (VAS) for pain and a comparison of the range of movement during follow up. RESULTS: Some 18% of the patients worked or practiced sports that called for the use of the affected limb. The 40% of the patients required a post-operative transfusion was required by 40% of the patients, due to having a haemoglobin <8 g/d. The VAS improved from 6 to 2 after the surgery. The range of movement improved on an average of 40. The complications included an infection, 1 hyperalgesic scar, 8 haematomas and 3 seromas, which were resolved in the follow up without incidence. All the patients were free of illness after a mean follow-up of 85 months. CONCLUSIONS: Good results were achieved with a long follow-up. Based on these results and a literature review of the current state of this pathology, an algorithm for its diagnosis and treatment is suggested.

[Imaging findings in chondroblastoma]. / Manifestaciones radiológicas del condroblastoma.

OBJECTIVE: To describe the imaging findings, with special emphasis on the magnetic resonance (MRI) findings and the clinical and radiological presentation of chondroblastoma. MATERIAL AND METHODS: This is a retrospective study of 18 patients (12 men and 6 women; mean age, 19 years) diagnosed with chondroblastoma. All patients underwent plain-film radiography, 16 underwent MRI, and 12 underwent CT. We evaluated the location, size, pattern of bone destruction, calcification of the tumor matrix, periosteal reaction, signal intensity on T1- and T2-weighted sequences, and the presence of bone or soft-tissue edema. RESULTS: The lesions were located in the distal femur (n = 6), proximal humerus (n = 5), ilium (n = 3), proximal femur, proximal tibia, patella, and scapula. Mean lesion diameter was 3.5 cm (range: 1 to 10 cm). A calcified tumor matrix was observed in 50% of the cases and a periosteal reaction was seen in 44%. MRI showed a homogeneous intramedullary lesion that was isointense to muscle on T1-weighted sequences. On T2-weighted sequences, the signal intensity was more variable and was always heterogeneous. Perilesional edema affecting the bone and/or soft tissues was demonstrated in 94% of the cases and is a distinctive finding for this tumor. CONCLUSIONS: Chondroblastoma should be suspected in a young patient with an osteolytic epiphyseal lesion. It is usually a localized lesion that often shows calcification of the tumor matrix and periosteal reaction. CT and especially MRI are useful in the study of the extension of the lesion and in the characterization of this tumor. Chondroblastoma typically shows bone edema, periosteal reaction, and soft-tissue edema.

Manifestaciones radiológicas del condroblastoma / Imaging findings in chondroblastoma

Objetivo. Describir los hallazgos radiológicos, en especial los de la resonancia magnética (RM), y el cuadro clínico-radiológico del condroblastoma. Material y métodos. Se trata de un estudio retrospectivo de 18 pacientes con diagnóstico de condroblastoma. El grupo de pacientes estaba formado por 12 hombres y 6 mujeres. Su edad media era de 19 años. Todos fueron estudiados con radiología convencional; se practicó tomografía computarizada (TC) en 12 y RM en 16 casos. Se valoró la localización, tamaño, patrón de destrucción ósea, calcificación de la matriz tumoral, reacción perióstica y la señal en secuencias potenciadas en T1 y T2, así como la presencia de edema óseo o de partes blandas. Resultados. Las lesiones estaban localizadas en el fémur distal (n = 6), el húmero proximal (n = 5), ilíaco (n = 3), el fémur proximal, la tibia proximal, la rótula y la escápula. Su diámetro varió entre 1 y 10 cm, con una media de 3,5 cm. Se observó calcificación de la matriz tumoral en el 50% de los casos y reacción perióstica en el 44%. La RM mostró una lesión intramedular homogénea e isointensa respecto al músculo en T1. En T2 la señal es más variable y siempre heterogénea. El edema perilesional, óseo o de partes blandas se demostró en el 94% de los casos y constituye un hallazgo distintivo de este tumor. Conclusiones. El condroblastoma debe sospecharse en un paciente joven con una lesión osteolítica epifisaria. Suele tratarse de una lesión geográfica que, a menudo, muestra calcificación de su matriz y reacción perióstica. La TC y especialmente la RM facilitan el estudio de extensión y contribuyen a la caracterización de este tumor. El condroblastoma muestra típicamente edema óseo, reacción perióstica y edema de partes blandas (AU)

Objective. To describe the imaging findings, with special emphasis on the magnetic resonance (MRI) findings and the clinical and radiological presentation of chondroblastoma. Material and methods. This is a retrospective study of 18 patients (12 men and 6 women; mean age, 19 years) diagnosed with chondroblastoma. All patients underwent plain-film radiography, 16 underwent MRI, and 12 underwent CT. We evaluated the location, size, pattern of bone destruction, calcification of the tumor matrix, periosteal reaction, signal intensity on T1- and T2-weighted sequences, and the presence of bone or soft-tissue edema. Results. The lesions were located in the distal femur (n = 6), proximal humerus (n = 5), ilium (n = 3), proximal femur, proximal tibia, patella, and scapula. Mean lesion diameter was 3.5 cm (range: 1 to 10 cm). A calcified tumor matrix was observed in 50% of the cases and a periosteal reaction was seen in 44%. MRI showed a homogeneous intramedullary lesion that was isointense to muscle on T1-weighted sequences. On T2-weighted sequences, the signal intensity was more variable and was always heterogeneous. Perilesional edema affecting the bone and/or soft tissues was demonstrated in 94% of the cases and is a distinctive finding for this tumor. Conclusions. Chondroblastoma should be suspected in a young patient with an osteolytic epiphyseal lesion. It is usually a localized lesion that often shows calcification of the tumor matrix and periosteal reaction. CT and especially MRI are useful in the study of the extension of the lesion and in the characterization of this tumor. Chondroblastoma typically shows bone edema, periosteal reaction, and soft-tissue edema (AU)

Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings.

Aspergillosis is a serious pathologic condition caused by Aspergillus organisms and is frequently seen in immunocompromised patients. At computed tomography (CT), saprophytic aspergillosis (aspergilloma) is characterized by a mass with soft-tissue attenuation within a lung cavity. The mass is typically separated from the cavity wall by an airspace ("air crescent" sign) and is often associated with thickening of the wall and adjacent pleura. CT findings in allergic bronchopulmonary aspergillosis consist primarily of mucoid impaction and bronchiectasis involving predominantly the segmental and subsegmental bronchi of the upper lobes. Aspergillus necrotizing bronchitis may manifest as an endobronchial mass, obstructive pneumonitis or collapse, or a hilar mass. Bronchiolitis is characterized by centrilobular nodules and branching linear or nodular areas of increased attenuation ("tree-in-bud" pattern). Obstructing bronchopulmonary aspergillosis mimics allergic bronchopulmonary aspergillosis at CT and manifests as bilateral bronchial and bronchiolar dilatation, large mucoid impactions, and diffuse lower lobe consolidation caused by postobstructive atelectasis. Characteristic CT findings in angioinvasive aspergillosis consist of nodules surrounded by a halo of ground-glass attenuation ("halo sign") or pleura-based, wedge-shaped areas of consolidation. Although imaging findings in pulmonary aspergillosis may be nonspecific, in the appropriate clinical setting, familiarity with the CT findings may suggest or even help establish the diagnosis.

Selective dissection of levels II-III with intraoperative control of the upper and middle jugular nodes: a therapeutic option for the N0 neck.

BACKGROUND: Selective neck dissections are accepted elective treatment in N0 patients. We present the results of a dissection of levels II to III and intraoperative pathologic control of a sample of subdigastric and supraomohyoid nodes in a group of patients with laryngeal carcinoma. When intraoperative analysis was positive, dissection of levels IV and V was completed. METHODS: Between 1991 and 1997, 145 neck dissections with intraoperative control were carried out in 79 patients with laryngeal carcinomas. Postoperative radiotherapy was used in 49 patients. RESULTS: There were occult metastases in 29 neck dissections (20%). In 22 cases (15%), tumor was found in the nodes sent to intraoperative pathologic study, and dissection of levels IV and V was completed. In 7 additional cases tumor was found in the postoperative study. The sensitivity of the use of frozen sections in the detection of occult metastases was 76%. In no case were positive nodes found at level V. There was no regional relapse in any of the 145 selective neck dissections. CONCLUSIONS: The lateral selective neck dissection is an effective method in the elective treatment of the neck of N0 laryngeal carcinoma patients. Dissection of level IV can be spared when intraoperative biopsy specimens of a sample of the subdigastric and supraomohyoid nodes are negative. According to our results, at present we do not consider it necessary to dissect level V in selective neck dissections in patients with laryngeal carcinoma.

Nonseptic monoarthritis: imaging features with clinical and histopathologic correlation.

Diagnosis of septic arthritis requires aspiration and analysis of joint fluid. However, nonseptic articular disorders are fairly common and represent a significant diagnostic and therapeutic challenge. Such disorders include gout, Milwaukee shoulder, rapidly destructive articular disease, amyloid arthropathy, hemophilic arthropathy, primary synovial osteochondromatosis, pigmented villonodular synovitis, neuropathic arthropathy, and foreign-body synovitis. The clinical signs of articular disease, which include pain, swelling, and limitation of motion, are often nonspecific and can overlap with those of osseous or extraarticular disorders. Many articular processes have characteristic radiologic appearances that allow definitive diagnosis. Radiography is an important part of the evaluation of patients with articular disease. However, magnetic resonance (MR) imaging is the method of choice for characterizing the various disorders and assessing the full extent of osseous, chondral, and soft-tissue involvement. MR imaging can exquisitely demonstrate joint effusions, synovial proliferation, articular cartilage abnormalities, subchondral bone, ligaments, muscles, and juxtaarticular soft tissues. Although a wide spectrum of noninfectious processes may involve the joints, careful analysis of the imaging findings and correlation of these findings with the patient's clinical history can suggest a more specific diagnosis in most cases. Awareness and understanding of the underlying histopathologic findings aids in interpretation of MR images.

Graves' disease presenting as localized myxoedematous infiltration in a smallpox vaccination scar.

We describe a 54-year-old woman with diffuse myxoedematous infiltration at the site of a smallpox vaccination scar as the presenting symptom of Graves' disease. Associated features included acute ocular symptoms (vascular congestion of the sclera, epiphora and blurred vision) and transient erythema on both shins. However, there were no signs of pretibial myxoedema. A number of neoplastic, inflammatory and systemic diseases may localize to scar tissue in skin, including at smallpox vaccination sites, but this case demonstrates the unusual occurrence of myxoedematous infiltration at such a site and illustrates a most atypical cutaneous presentation of Graves'disease.

MR imaging of benign soft-tissue masses of the foot and ankle.

Approximately 75% of all biopsy-proved soft-tissue masses of the foot and ankle are benign tumors or nontumoral lesions representing a variety of histologic types. In some cases, it may be difficult if not impossible to identify the lesion; however, careful analysis of the magnetic resonance (MR) imaging findings and correlation of these findings with the patient's clinical history can usually suggest a more specific diagnosis, particularly in the most common benign tumors of the foot (e.g., fibromatosis, cavernous hemangioma) and in nonneoplastic soft-tissue lesions such as Morton neuroma, ganglion cyst, and plantar fasciitis. In addition, a specific diagnosis can almost always be made in patients with pigmented villonodular synovitis (PVNS) or giant cell tumor (GCT) of the tendon sheath. The MR imaging appearance of PVNS consists of multiple synovial lesions with low or intermediate signal intensity on T1-weighted images and low signal intensity on T2-weighted and gradient-echo images. GCTs of the tendon sheath usually have areas of low signal intensity on both T1- and T2-weighted images due to the paramagnetic effect of hemosiderin. Awareness and understanding of the underlying pathologic findings in lesions of the foot and ankle aid in MR imaging interpretation.