Multiple unexpected lesions of metachondromatosis detected by technetium-99m methylene diphosphonate SPECT/CT: A case report.

RATIONALE: Metachondromatosis (MC) is a very rare genetic disease, which is infrequently reported worldwide, which leads to osteochondroma and enchondromatosis. The disease has been shown to be associated with loss of function of the tumor suppressor gene "protein tyrosine phosphatase, non-receptor type 11" (PTPN11). PATIENT CONCERNS: A 12-year-old female was admitted to the hospital with pain due to an enlarged mass in her left fifth finger. DIAGNOSIS: Examination of the left hand by computed tomography (CT) revealed an expanding type of round and low-density lesion in the fifth proximal phalanx. The patient then underwent technetium-99m methylene diphosphonate single-photon emission CT/CT (Tc-MDP SPECT/CT) to assess the nature of the lesion. The SPECT/CT image revealed dilated osteopathy and increased activity of the fifth proximal phalanx on the left hand. Unexpectedly, the examination of the right hand revealed slight expanded lesions and increased activities of the third metacarpal and proximal phalange, as well as the fourth proximal phalange and the middle phalanx. On the basis of the patient's symptoms and the results of the above-mentioned examinations, we diagnosed the patient as having MC in her hands. INTERVENTION: Considering the pain of the fifth finger of the left hand, the patient underwent debridement of the fifth proximal phalanx of the left hand and internal fixation with bone graft taken from the body. OUTCOMES: The patient was discharged after a week of observation. One year later, she was admitted to the hospital again for removal of the bone healing internal fixation after osteoma surgery. Preoperative Tc-MDP SPECT/CT revealed that the left-handed lesions displayed postoperative changes, while the multiple lesions in the right hand increased in volume but remained unchanged in number. LESSONS: This case revealed the CT and Tc-MDP SPECT/CT imaging features of MC. Specifically, SPECT/CT imaging contributed to the diagnosis of clinically asymptomatic bone lesions, and the 3D SPECT/CT fusion allowed a more comprehensive and intuitive view of the lesion by combining anatomy and function.

[Chondromatose of the temporomandibular joint: Multicentric study and clarification from 14 cases]. / Chondromatose de l'articulation temporomandibulaire : étude multicentrique et mise au point à partir de 14 cas.

INTRODUCTION: The aim of our study was to analyse a series of patients suffering from temporomandibular joint (TMJ) chondromatosis treated in 2 departments of stomatology and maxillofacial surgery (University hospitals of the Conception in Marseille and of Caen) and to make a general review of this disease. MATERIAL AND METHODS: We conducted a retrospective study including all the patients treated for a TMJ chondromatosis in one of these 2 departments. Following parameters were analyzed: sex, ages at discovery and at surgery, symptoms, side, imaging, histology, recurrence and any other events considered as relevant. RESULTS: Fourteen patients could be included: 85.7 % were women. Average age at diagnosis was 40.14 (σ = 13.82; IC95: 32.90-47.38) (41 for women [σ = 14.74; IC95: 33.28-48.72] and 35 years for men [σ = 5.66, IC95: 27.16-42.84]). Average age at surgery was 40.86 (σ = 14.18; IC95: 33.43-48.28). There was no predominance of side; 57.14 % of the patients had a joint syndrome, 57.14 % a tumor syndrome, 28.57 % had pain and 14.29 % had headaches. Panoramic X-ray was informative in 3 cases only. CT scan showed intra-articular calcifications in half of the cases only but arthrosic modifications in all the cases. Magnetic resonance imaging (MRI) constantly showed intra-articular cartilage fragments. When histology was performed, it found the synovial to be normal in one case and multiple nodules with clear cartilaginous differentiation in another case. One patient suffered from a second contralateral localization 10 years later. DISCUSSION: Chondromatosis has a slow evolution and is asymptomatic for a long time. MRI allows to evoke the diagnosis and to locate precisely the osteochondromas. Diagnosis is confirmed by histology that highlights a synovial metaplasia and more or less calcified chondromas. The main differential diagnosis to be eliminated because of prognostic reasons is the synovial chondrosarcoma. Treatment consists in surgical removing of the chondromas. Evolution is usually favorable.

Bilateral vocal fold chondromas.

Laryngeal chondromas are uncommon, benign, slow-growing neoplasms with few reports in the literature. Vocal fold chondromas are even more rare, and all reported cases are unilateral. Here, we present the first case of bilateral vocal fold chondromas. Detailed evaluation, careful resection with phonomicrosurgery technique, and perioperative voice therapy are considered essential for the management.

A case of bilateral multiple pulmonary chondroma: necessity of follow-up for Carney's triad.

We report a case of pulmonary bilateral multiple chondromas that were possibly an initial clinical presentation of Carney's triad. A 56-year-old Japanese non-smoking asymptomatic woman was admitted to the hospital for further examination of small, multiple, bilateral nodules in the lungs. Although chest radiological findings suggested that the nodules were possibly metastatic pulmonary tumors, the malignant origin was not detected. During diagnostic video-assisted thoracic surgery, wedge resections including the nodules were performed. Since pathological examination showed nodules were surrounded by fibrous and eosinophilic stroma, we diagnose the nodules as chondromas. These chondromas were possibly components of Carney's triad, because each nodule had a thin fibrous pseudocapsule and did not have an entrapped epithelium and fat. Some patients die of Carney's triad because of malignant alteration of lesions. Therefore, the patients with Carney's triad should be taken a medical check periodically. This patient was scheduled to undergo the check-up for several years.

Soft tissue pathology of the ankle.

Derangements of the soft tissues within the ankle joint are associated with a wide variety of pathophysiology, and typically can be classified as secondary to traumatic injury, rheumatic disease, or congenital lesions. Patients often present with persistent pain, swelling, and limitations on function, usually focused on the anterior aspect of the joint. Evaluation should be guided by a detailed history and physical examination, followed by clinical, laboratory, and imaging studies as indicated. The pathophysiology, diagnosis, and management of these conditions will be the focus of this article.

Arthroscopic and open options for surgical treatment of chondromatosis of the elbow.

PURPOSE: The purpose of this study was to evaluate the treatment-specific outcome of surgical therapy of chondromatosis of the elbow with special attention on the complication and recurrence rate as well as induction of secondary osteoarthritis. METHODS: A consecutive patient group from 1989 to 2003 was evaluated retrospectively and followed up clinically and radiologically. Special attention was paid to locking and catching, swelling, pain, loose bodies, and signs of osteoarthritis. In the case of a causal pathology, mostly osteoarthritis, the condition was classified as secondary; otherwise, it was classified as primary. The following scores were calculated: modified American Shoulder and Elbow Surgeons questionnaire for elbows; Disabilities of the Arm, Shoulder and Hand questionnaire; and Short Form 36. RESULTS: Of 24 patients operated on, 19 (79%) were followed up after 56 months (range, 11 to 177 months). Of these, 10 were primary types and 9 secondary types. The extension deficit of 12 degrees preoperatively decreased to -9 degrees , and pain was significantly (P = .001) reduced. Postoperatively, 1 patient still reported occasional locking and 1 patient had swelling. In both patients no loose bodies could be identified by radiography. Comparison of the arthroscopic and open techniques showed a trend toward a shorter rehabilitation time of 2.4 months after arthroscopic intervention, in contrast to 4.6 months for an open procedure, and a trend toward higher patient satisfaction after arthroscopy. Comparison of the primary and secondary forms showed significantly (P = .042) better pain reduction for primary chondromatosis. Of the patients with distinct preoperative osteoarthritis, 44% showed ongoing osteophytic growth; there were no cases of new osteoarthritis. CONCLUSIONS: Both open and arthroscopic approaches give satisfactory results with a trend toward shorter rehabilitation and higher patient satisfaction for the arthroscopic approach. Osteoarthritis is not induced and there is no danger of recurrence in the medium term. LEVEL OF EVIDENCE: Level III, therapeutic, retrospective comparative study.

Chondromyxoid fibroma of the seventh cervical vertebra.

Chondromyxoid fibroma is a rare benign bone tumor representing less than 0.5% of all bone tumors. It commonly involves the long tubular bones. Involvement of the spine is rare. A 35-year-old man presented with history of neck pain, restriction of neck movements, pain and numbness along the medial aspect of the left forearm and weakness with wasting of the left hand. A presumptive diagnosis of a bony tumor such as an aneurysmal bone cyst or a giant cell tumor involving the seventh vertebral body was made on plain X-rays, MRI and bone scan. He underwent C7 central corpectomy, incomplete intralesional curettage with iliac bone grafting and C6 to T1 interspinous wiring. The histological diagnosis was chondromyxoid fibroma. On eight years' follow-up, CT scan showed no progression of the tumor with good alignment and fusion of the graft at the site of the corpectomy. The authors conclude that corpectomy and iliac bone grafting for chondromyxoid fibroma has a good outcome on long-term follow-up.

Multifocal tracheal chondromata.

Chondromata of the trachea occur rarely. There are only 10 prior case reports in the literature, all of which have been of unifocal chondromata. We present the first case report, to our knowledge, of multifocal tracheal chondromata in a patient with laryngopharyngeal reflux. Evaluation, diagnosis, and management are discussed.

Synovial chondromatosis in the temporomandibular joint complicated by displacement and calcification of the articular disk: report of two cases.

Two cases of synovial chondromatosis of the temporomandibular joint (TMJ) are presented, including correlation of CT and MR imaging characteristics with surgical and pathologic findings. The usefulness of CT and MR imaging in the diagnosis of TMJ disorders is discussed.

Synovial chondromatosis of the temporomandibular joint.

We report two cases of temporomandibular joint (TMJ) synovial chondromatosis, one of which was in the early stage and treated arthroscopically. The second was more advanced and recurred after removal of the free bodies, and so required condylectomy and synovectomy.

Intraspinal synovial cyst in a dog.

An eight-year-old, male Siberian husky cross was referred with a history of an acute onset of pelvic-limb ataxia and paraparesis. Radiography and subsequent myelography of the spine revealed an extradural compression of the spinal cord at the level of the 13th thoracic (T13) to first lumbar (L1) vertebrae. Hemilaminectomy resulted in the successful removal of an extradural cystic lesion. The morphological diagnosis based on histopathology was a synovial cyst with chondromatosis. There were no postoperative complications, and the dog's condition improved markedly. At two years postoperatively, the animal remains normal on both physical and neurological examination. To the authors' knowledge, this article is the first report of an intraspinal synovial cyst in a dog.

Arthroscopy of the hip: 12 years of experience.

The purpose of this study was to evaluate the results of and temporal trends in hip arthroscopy by reviewing 413 procedures performed over a 12-year period. The two anatomic areas of the hip can be examined separately, the periphery without distraction and the iliofemoral joint per se with distraction. Combined use of both these techniques should be decided preoperatively. Technical explanations and a description of three clearly demarcated portal site areas are given to improve standardization of the hip arthroscopy technique. Diagnostic use of hip arthroscopy (undiagnosed hip pain, catching, or popping of the joint) accounted for 68% of all procedures in our series, although this proportion declined over time. The main indication for operative hip arthroscopy was removal of loose bodies. Debridement is an important indication reported in the literature, but it was not performed in our patients. Numerous other operative procedures can be done but are indicated in smaller numbers of patients.

[Arthroscopic treatment for synovial chondromatosis of the shoulder--case report]. / Artroskopowe leczenie chrzestniakowatosci maziówkowej stawu ramiennego--opis przypadku.

A case of 15 years old schoolgirl with synovial chondromatosis of the right shoulder is presented. The diagnosis has been confirmed by MRI. At arthroscopy approximately 70 oval loose bodies 5-8 mm in size have been removed. Postoperatively, no complication occurred. The case presented demonstrates advantage of arthroscopic treatment of this rare condition.

[Multiple enchondromatosis of the child apropos of 2 cases]. / Enchondromatose multiple de l'enfant à propos de deux observations.

Enchondromatosis or OLLIER's disease or multiple chondromatosis can be marked in his development by features like: malignant degeneration, pathological fracture, deformity or shortening of a limb. The limb deformity like a varus knee was for our two little patients their admission motive. The varus gravity (equal to 30%) was treated by a early tibial valgus osteotomy in one case and a femoral one in the other case. We evocate the unusualness of this disease, the clinical diagnostic difficulties composed by the knee varus in childhood, at the radiographic stage those of a benignant metaphysis or metaphyso-diaphysis tumor in the same year old. We discuss the osteotomy moment, its type, its site and expose the concomitant problems composed by the shortening of the limb.