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Wilsher M, Rajaratnam S, Brown W, Bonar SF. Intraosseous pseudotumour of tibial plateau following migration of viscosupplementation material: a rarely documented complication. Skeletal Radiol 2025:10.1007/s00256-025-04914-5. [PMID: 40119226 DOI: 10.1007/s00256-025-04914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 03/09/2025] [Accepted: 03/12/2025] [Indexed: 03/24/2025]
Abstract
Intraosseous pseudotumour following intra-articular injection of hyaluronic acid polymers (viscosupplementation) is very rare and has only once previously been documented in the tibial plateau. Herein reported is a further example in a 63-year-old female who underwent total knee replacement 11 months following a diagnosis of breast carcinoma for which low-level suspicion for intraarticular metastasis persisted following extensive investigation. On imaging and gross examination, there was moderate osteoarthritis. Symptoms warranted total knee arthroplasty which was performed with subchondral bone sampling. Histologically, there was mild degenerative articular change and within the subchondral marrow space, there was deposition of uniform, Alcian blue positive mucoid material, surrounding a small degenerative cyst. No associated epithelial cells were demonstrated. A subsequent history of viscosupplementation administration was obtained by pathology, and the material was determined to represent intraosseous displacement of hyaluronic acid polymer. The breast carcinoma was also discovered to represent in situ disease. This case is a cautionary tale of the importance of careful history taking and a multidisciplinary approach to patient management.
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Affiliation(s)
- Mark Wilsher
- North West London Pathology, Imperial College Healthcare NHS Trust, London, W6 8RF, UK.
- Unilabs IHS, London, NW1 2HD, UK.
| | | | - Wendy Brown
- Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, 2050, Australia
| | - Sally F Bonar
- Douglass Hanly Moir Pathology, Macquarie Park, Sydney, NSW, 2113, Australia
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Bloem JL, Vriens D, Krol ADG, Özdemir M, Sande MAJVD, Gelderblom H, Bovee JVMG, Hage JAVD, Noebauer-Huhmann IM. Therapy-Related Imaging Findings in Patients with Sarcoma. Semin Musculoskelet Radiol 2020; 24:676-691. [PMID: 33307584 DOI: 10.1055/s-0040-1721097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Knowledge of imaging findings related to therapy administered to patients with sarcoma is pivotal in selecting appropriate care for these patients. Imaging studies are performed as surveillance in asymptomatic patients or because symptoms, including anxiety, develop. In addition to detection of recurrent disease and assessment of response to therapy, diagnosis of conditions related to therapy that may or may not need treatment has a marked positive impact on quality of life. The purpose of this review is to assist radiologists, nuclear physicians, and others clinicians involved in the diagnosis and treatment of these patients in recognizing imaging findings related to therapy and not to activity of the previously treated sarcoma. Imaging findings are time dependent and often specific in relation to therapy given.
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Affiliation(s)
- Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis Vriens
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Augustinus D G Krol
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Murat Özdemir
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith V M G Bovee
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos A van der Hage
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris M Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
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Sung CW, Hsieh KLC, Lin YH, Lin CY, Lee CH, Tsuang YH, Kuo YJ. Serous degeneration of bone marrow mimics spinal tumor. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:80-84. [PMID: 27652677 DOI: 10.1007/s00586-016-4778-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/10/2016] [Accepted: 09/10/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present a rare case of serous degeneration of bone marrow which resembles primary spinal tumor or bony metastasis to spine. Serous degeneration of bone marrow or gelatinous marrow transformation is a rare disease characterized by focal marrow hypoplasia, fat atrophy, and accumulation of extracellular mucopolysaccharides abundant in hyaluronic acid. Few literature was reviewed and few clinical case was presented. METHODS Two cases of serous marrow transformation were reported. RESULTS In the first case, a 29-year-old man suffered from severe left buttock pain. Bone metastasis was impressed in radiology examinations. Percutaneous endoscopic lumbar discectomy was performed along with bone biopsy. In the second case, a 49-year-old man presented lower back pain with radiation to bilateral lower legs. Magnetic resonance imaging revealed a water-like signal lesion in sacrum. Serous marrow transformation was confirmed pathologically in both cases. CONCLUSION To the best of our knowledge, a case of serous degeneration of bone marrow resembling malignancy has not been reported in the literature. In this report, two cases demonstrate serous transformation of bone marrow mimics spinal tumor.
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Affiliation(s)
- Chih-Wei Sung
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Translational Imaging Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Ho Lin
- Division of Oral Pathology, Department of Dentistry, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Yi Lin
- Department of Orthopaedics Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chian-Her Lee
- Department of Orthopaedics Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopaedics Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yang-Hwei Tsuang
- Department of Orthopaedics Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopaedics Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopaedics Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Orthopaedics Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Nouh MR, Eid AF. Magnetic resonance imaging of the spinal marrow: Basic understanding of the normal marrow pattern and its variant. World J Radiol 2015; 7:448-458. [PMID: 26753060 PMCID: PMC4697119 DOI: 10.4329/wjr.v7.i12.448] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/29/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023] Open
Abstract
For now, magnetic resonance (MR) is the best noninvasive imaging modality to evaluate vertebral bone marrow thanks to its inherent soft-tissue contrast and non-ionizing nature. A daily challenging scenario for every radiologist interpreting MR of the vertebral column is discerning the diseased from normal marrow. This requires the radiologist to be acquainted with the used MR techniques to judge the spinal marrow as well as its normal MR variants. Conventional sequences used basically to image marrow include T1W, fat-suppressed T2W and short tau inversion recovery (STIR) imaging provides gross morphological data. Interestingly, using non-routine MR sequences; such as opposed phase, diffusion weighted, MR spectroscopy and contrasted-enhanced imaging; may elucidate the nature of bone marrow heterogeneities; by inferring cellular and chemical composition; and adding new functional prospects. Recalling the normal composition of bone marrow elements and the physiologic processes of spinal marrow conversion and reconversion eases basic understanding of spinal marrow imaging. Additionally, orientation with some common variants seen during spinal marrow MR imaging as hemangiomas and bone islands is a must. Moreover, awareness of the age-associated bone marrow changes as well as changes accompanying different variations of the subject’s health state is essential for radiologists to avoid overrating normal MR marrow patterns as pathologic states and metigate unnecessary further work-up.
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Adams HJA, Nievelstein RAJ, Kwee TC. Opportunities and limitations of bone marrow biopsy and bone marrow FDG-PET in lymphoma. Blood Rev 2015; 29:417-25. [PMID: 26113144 DOI: 10.1016/j.blre.2015.06.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 12/17/2022]
Abstract
Bone marrow involvement in lymphoma may have prognostic and therapeutic consequences. Bone marrow biopsy (BMB) is the established method for the evaluation of the bone marrow. (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) plays an important role in lymphoma staging, but its value in the assessment of the bone marrow and whether it can replace BMB is still a topic of debate and investigation. The purpose of this scientific communication is to provide an evidence-based overview about the opportunities and limitations of BMB and FDG-PET in the evaluation of the bone marrow in patients with lymphoma. This article first reviews the basic properties, opportunities and limitations of BMB and bone marrow FDG-PET, and then focuses on the clinical utility of BMB and bone marrow FDG-PET in three major lymphoma subtypes including Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma.
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Affiliation(s)
- Hugo J A Adams
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rutger A J Nievelstein
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas C Kwee
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Orii T, Okumura M, Yoshimura M, Kitahara H, Karasawa Y. An FDG-PET/CT-positive lesion mimicking local recurrence of colon cancer 5 years after radical colectomy. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:149-52. [PMID: 25761604 PMCID: PMC4370278 DOI: 10.12659/ajcr.891129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Female, 75 Final Diagnosis: False positive findings Symptoms: — Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Takashi Orii
- Department of Surgery, Show Inan General Hospital, Akaho, Komagane, Nagano, Japan
| | - Motohiro Okumura
- Department of Surgery, Show Inan General Hospital, Akaho, Komagane, Nagano, Japan
| | - Masaki Yoshimura
- Department of Surgery, Show Inan General Hospital, Akaho, Komagane, Nagano, Japan
| | - Hiroe Kitahara
- Department of Surgery, Show Inan General Hospital, Akaho, Komagane, Nagano, Japan
| | - Yukihiko Karasawa
- Department of Surgery, Show Inan General Hospital, Akaho, Komagane, Nagano, Japan
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