Percutaneous needle biopsy of the irradiated skeleton.

Percutaneous needle biopsy was performed in 20 patients who had radiologic abnormalities after irradiation of the skeleton. The biopsies were performed to determine the nature of the bone changes and to differentiate radiation necrosis from metastases or local tumor extension. Eleven patients had tumors, two of which were radiation-induced sarcomas; nine patients did not show evidence of tumor. One patient had osteomyelitis rather than the suspected tumor. The value of percutaneous needle biopsy in the postirradiated skeleton is discussed.

Purely lytic osteosarcoma.

The radiographic features of 42 purely lytic osteosarcomas are presented. Purely lytic osteosarcoma is identified as a lytic lesion of bone with no demonstrable osteoid matrix by conventional radiographic modalities. Purely lytic osteosarcoma represented 13.7% of a group of 305 osteosarcomas. The most common presentation was that of a lytic ill-defined lesion with a moderate to large extraosseous mass component. Nine lesions presented with benign radiographic features. The differential diagnosis is outlined. The need for awareness of this type of presentation of osteosarcoma is stressed.

Periosteal chondroma: a radiographic spectrum.

The radiographic features of 22 cases of histologically proven periosteal chondroma are analyzed in detail. The typical tumor consisted in an area of outer cortex remodeling (scalloping) involving the metaphyseal lesion of a long bone with slightly overhanging edges and a small amount of cartilage calcified matrix adjacent to the scalloping. The presence of a visible soft tissue mass was uncommon, present in only third of the cases. The radiographic differential diagnosis is analyzed in detail and illustrated.

Computed tomography in liposarcoma.

Seventeen cases with proven liposarcoma were evaluated by computed tomography (CT) to assess the specificity and value of this radiographic modality. A specific diagnosis of liposarcoma could be made in only four cases (22%). Despite its relative nonspecificity, CT proved extremely useful in the clinical evaluation of this tumor and evidenced considerable superiority to other radiographic methods. In several cases, CT was the only radiographic modality to demonstrate the presence of the lesion. The use of CT gained additional important information in approximately 50% of the cases studied.

Diagnosis of eosinophilic granuloma of bone by cytology, histology, and electron microscopy of transcutaneous bone-aspiration biopsy.

The cytological, histological, and ultrastructural morphology of transcutaneous bone aspirates from five patients with eosinophilic granuloma of bone were studied. Use of this combined approach enabled us to make a definitive diagnosis of eosinophilic granuloma from a small quantity of tissue without having to resort to open biopsy. By light microscopy, eosinophilic granuloma is composed of a polymorphous infiltrate of characteristic lobulated histiocytes, eosinophils, polymorphonuclear leukocytes, and giant cells. Each specimen examined ultrastructurally demonstrated the characteristic Langerhans granule-containing histiocyte. Eosinophilic granuloma is a benign lesion which is readily diagnosed by this technique, and more aggressive diagnostic procedures usually are not warranted.

Computed tomography in the evaluation of small round cell tumors of bone.

The value of computed tomography (CT) in the management of 20 cases of round cell tumors of bone is reported. CT is useful in: (a) early diagnosis, particularly incomplex anatomical areas; (b) the evaluation of the extent of disease; (c) the determination of the radiation portals; (d) the evaluation of the response to therapy; and (e) the preoperative evaluation of those tumors removed surgically. In comparison with other radiographic modalities, CT was equally accurate in six and more accurate in 10 patients. In three cases CT alone revealed the presence of pathology.

Synovial hyperemia in giant cell tumor of bone: angiographic pitfall.

Arteriography has been found useful in the clinical staging of giant cell tumors of bone in its capacity to demonstrate the presence and extent of soft tissue, extraosseous extension of the tumor. A potential source of error is the presence of hyperemic synovial tissue that may closely resemble tumor vascularity, and therefore be confused with tumor extraosseous extension. Of the 48 giant cell tumors in this series, 21 demonstrated extraosseous vascularity representing synovial hyperemia. Two patients were considered to have extraosseous tumor extent but only hypertrophic synovial tissue was found at surgery. The angiographic features of synovial hyperemia are outlined.

Computed tomography in the evaluation of osteosarcoma: experience with 25 cases.

Experience with computed tomography (CT) in 25 patients with histologically proven osteosarcoma is presented. CT was as accurate as conventional radiographic methods in determining the presence of a lesion, but it was definitely superior in defining the extent of disease, particularly intramedullary extension and soft tissue extraosseous tumor component. CT was capable of demonstrating skip metastases in one patient. CT plays a key role in the preoperative evaluation of osteosarcoma patients, particularly when less than radical surgery is planned as primary treatment and when postoperative recurrence is suspected. CT is also useful in assessing the response to therapy in nonsurgical cases. The technique involved in the performance of this examination is discussed.

Metastatic osteogenic sarcoma to the brain.

The radiographic appearances of intracranial metastases from primary osteogenic sarcomas in three patients are presented. In two patients, the diagnosis of metastatic disease could be made on conventional roentgenograms of the skull since mineralization of tumor osteoid could be seen within the brain parenchyma. This had a similar appearance to the primary bone tumor. Angiography in two of the three patients revealed the cerebral metastases to be hypervascular with tumor vessels, tumor stain and early draining veins.

The value of percutaneous needle biopsy in the management of primary bone tumors.

Thirty-four suspected primary bone neoplasms were evaluated by needle biopsy at M. D. Anderson Hospital and Tumor Institute between September 1976 and February 1978. Adequate material for evaluation was obtained in 31 cases. The accuracy rate of the procedure was 93%. Needle biopsy is a rapid, effective and safe method of evaluating unsuspected primary lesions of bone. The indications, contraindications, and technique are emphasized. The benefits over open biopsy are indicated.

Angiography in giant-cell bone tumors.

Angiography was performed on 48 patients with giant-cell bone tumors. Sixty-four per cent were hypervascular; 25% were hypo- or moderately vascular; and 10% were avascular. Findings were similar in the 45 benign and 3 malignant tumors. There was no correlation between the findings and degree of histological aggressiveness. There was a high (60%) incidence of aneurysmal bone cyst component in the hypovascular group. Hyperemic synovium, occasionally simulating tumor, was seen in 80% of surgically proved lesions. Angiography was useful in assessing tumor extent, particularly when an extraosseous component was present.

Arterial occlusion of pelvic bone tumors.

Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, 1 aneurysmal bone cyst, 1 recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and 1 metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.

Computed tomography in the evaluation of post-nephrectomy patients.

Twenty-one CT examinations were performed in 19 patients who had undergone previous nephrectomy for renal carcinoma or retroperitoneal malignancy. Nine patients were free of disease and 10 had recurrence. Findings of recurrent disease included masses in the vacant renal fossa, inability to visualize the inferior vena cava or aorta, and ipsilateral psoas muscle thickening. Possible pitfalls in diagnosis are discussed.

Osteogenic sarcoma after the age of 50: a radiographic evaluation.

Twenty-four cases of primary osteosarcoma in individuals over the age of 50 are described. This represents 6% of all osteosarcomas and 80% of osteosarcomas occurring over the age of 50 at this institution. Radiographically, features were similar to osteosarcoma in younger individuals. Females were more frequently affected than males (2.4:1). The radiographic features are discussed in detail, and the differential diagnosis outlined.

Computed tomography in the evaluation of musculoskeletal neoplasms.

In a study of 62 musculoskeletal neoplasms, computed tomography contributed little to establishing tissue diagnosis. Its primary value lay in the assessment of intraosseous and/or extraosseous extent of disease. CT also established the presence or absence of disease in a small number of cases with clinically questionable findings. In most cases, conventional radiographic methods were superior in diagnosing musculoskeletal neoplasms.

Case report: computed tomography of cystadenoma of the pancreas.

Cystadenoma is an unusual pancreatic tumor characterized by large-sized polycystic components. It is located totally within the pancreas and may cause retroperitoneal collateral venous return. These characteristics can be easily visualized by computed tomography, thus making it a very effective modality in the differential diagnosis of pancreatic lesions.

Percutaneous needle biopsy of bone in the cancer patient.

Needle biopsy of skeletal lesions is easily accomplished by the percutaneous technique. Although this approach has been utilized for many years, the frequency has definitely increased of the 91 cases performed at M. D. Anderson Hospital and Tumor Institute from September 1976 to September 1977, adequate material was obtained in 92.3% of the patients, and the diagnosis was established accurately in 83.5% of the cases. No complications were encountered. The technique, indications, and contraindications are discussed and illustrated with representative cases. The contribution of this technique to the management of patients with malignant disease is significant. The benefits include rapid and accurate establishment of a tissue diagnosis, avoidance of a surgical procedure with its associated risks and cost, and simplicity and safety of the procedure facilitating its repetition if needed.

The radiographic spectrum of periosteal osteosarcoma.

Fifteen cases of a recently described variety of osteosarcoma, periosteal osteosarcoma, were studied to define their radiographic characteristics. All the lesions were limited to the cortex that was always thickened but without invasion of the medulla cavity. The tumors presented as non-homogeneous masses of spiculated osteoid matrix progressively denser from the periphery to their cortical base. The average age was 28 and the most common location was the proximal third of the femur; all the lesions were diaphyseal in location. The spectrum of radiographic features and differential diagnosis are described in detail.

Calcification within metastatic pulmonary nodules from synovial sarcoma.

A case of calcified metastatic lung deposits from synovial sarcoma of the leg is reported. Calcification within metastatic lung nodules from synovial sarcoma has not been previously reported. The differential diagnoses of calcified lung metastases are presented.