Delayed phlegmon with gallstone fragments masquerading as soft tissue sarcoma.

Complications from lost gallstones after cholecystectomy are rare but varied from simple perihepatic abscess to empyema and expectoration of gallstones. Gallstone complications have been reported in nearly every organ system, although reports of malignant masquerade of retained gallstones are few. We present the case of an 87-year-old woman with a flank soft tissue tumor 4 years after laparoscopic cholecystectomy. The initial clinical, radiographic and biopsy findings were consistent with soft tissue sarcoma (STS), but careful review of her case in multidisciplinary conference raised the suspicion for retained gallstones rather than STS. The patient was treated with incisional biopsy/drainage of the mass, and gallstones were retrieved. The patient recovered completely without an extensive resectional procedure, emphasizing the importance of multidisciplinary sarcoma care to optimize outcomes for potential sarcoma patients

Venous tumor thrombus from a pelvic osteosarcoma

AbstractWe present a case of pelvic osteosarcoma in an 18-year-old woman with a tumor thrombus in the left iliac vein, extending to the inferior vena cava. Tumor thrombus has been rarely described with osteosarcoma, with only 14 cases in the literature

Polyostotic osteoid osteoma: A case report.

Osteoid osteomas are common, benign osteoblastic tumors that can occur in any bone in the body. They are almost always solitary, with only rare reports of multiple tumors in the same patient. When multiple, they typically are found within the same bone. We present a unique case of a young female athlete who presented initially at 16 years old with a right tibial osteoid osteoma and later at 18 years old with a right acetabular osteoid osteoma. Our case demonstrates the rare entity of polyostotic osteoid osteoma, the potential limitations of MRI in the diagnosis of osteoid osteoma, and the utility of radiofrequency ablation in the treatment of osteoid osteoma

Retroperitoneal extramedullary hematopoietic pseudotumor in ataxia-telangiectasia.

Ataxia-telangiectasia confers a significant increase in the development of several cancer types, most commonly leukemia and lymphoma. However, as the natural history for these patients is evolving and their lifespan is increasing, there is the potential for the development of additional uncommon tumors in an already rare patient population. We report the first case, to our knowledge, of an incidental retroperitoneal tumor in a 26-year-old woman undergoing evaluation for hepatic dysfunction. The mass was suspicious for retroperitoneal sarcoma, but proved to be an extramedullary hematopoietic pseudotumor after extensive pathologic evaluation. The changing landscape of neoplasms associated with ataxia-telangiectasia is discussed with emphasis on previously underreported benign and malignant tumors

Ankle MRI and preceding radiographs: an evaluation of physician ordering practices.

ObjectiveMultiple guidelines have been published for appropriate imaging in patients with ankle-related symptoms which suggest radiographs as the initial imaging examination for both acute and chronic ankle abnormalities. Few studies have evaluated adherence to these imaging guidelines. This study retrospectively evaluated the utilization of ankle MRI and preceding radiographs based on ordering provider group and MRI indication.Materials and methodsA total of 4186 ankle MRIs performed over a 9-year period at a single institution were evaluated for the presence of preceding ankle and/or foot radiographs at two time points, within 3 months and within 6 months of the MRI examination. Ankle MRIs were then categorized based on 6 ordering provider groups and 13 MRI indications.ResultsOf the 4186 MRIs evaluated, 68% had preceding radiographs within 3 months and 77% had radiographs within 6 months. Primary care, sports medicine, and podiatry had the lowest rates of preceding radiographs (73%, 68%, and 64%, respectively, within 6 months). Eighty-six percent of ankle MRIs ordered by orthopedic surgery had preceding radiographs within 6 months and 89% of ankle MRIs ordered by emergency medicine and inpatient providers had preceding radiographs. MRIs intended for evaluation of Achilles tendon or plantar fascia abnormalities were among the least likely indications to have preceding radiographs.ConclusionBased on established clinical guidelines, there was a lower-than-expected rate of obtaining preceding radiographs for ankle MRIs among most provider groups, particularly non-orthopedic outpatient providers. Additional research is needed to address the lack of adherence to clinical imaging guidelines and ensure appropriate imaging

Radiographic Evaluation of Meniscal Extrusion.

Background Magnetic resonance imaging (MRI) is well established as the preferred noninvasive tool for meniscal evaluation. To our knowledge, there has been no study examining the utility of diagnosing meniscal extrusion from radiography alone. We hypothesize that with appropriate window settings, meniscal extrusion may be diagnosed on radiography with high sensitivity and specificity. Materials and methods We included 190 patients with MRI of the knee performed within three months of knee radiography. As defined within the literature, we utilized the MRI criteria of meniscal extrusion as meniscal tissue extending 3 mm or greater beyond the tibial plateau, excluding osteophytes. Two attending radiologists blindly and independently identified the absence or presence, in millimeters, of medial meniscal extrusion on plain film radiography. Kappa test and Pearson correlation coefficient were calculated to assess the extent of inter-reader agreement and correlation. Sensitivity and specificity were calculated for each reader, assuming the concurrent MRI served as the gold standard. Results Ninety-six patients had medial meniscal extrusion and 94 had no medial extrusion by MRI. Kappa test for inter-reader agreement = 0.61. Pearson coefficient for inter-reader measurement correlation = 0.69. Reader A had sensitivity of 0.59 (95% CI 0.49-0.69) and specificity of 0.88 (95% CI 0.79-0.94). Reader B had sensitivity of 0.61 (95% CI 0.51-0.71) and specificity of 0.85 (95% CI 0.76-0.91). Conclusion There is substantial inter-reader agreement and high correlation of meniscal extrusion measurement between readers. Our results suggest that while radiographs have low sensitivity for evaluation of meniscal extrusion, their high specificity may be of clinical utility

A rare case of chondroblastoma involving the distal phalanx of the ring finger

Chondroblastoma, a rare benign bone tumor, is typically found in the epiphysis of long bones, with hand involvement being particularly uncommon. We present a case of an 11-year-old female with chondroblastoma involving the fourth distal phalanx of the hand. Imaging revealed a lytic, expansile lesion with sclerotic margins and no soft tissue component. A preoperative differential diagnosis included intraosseous glomus tumor, epidermal inclusion cyst, enchondroma, and chronic infection. The patient underwent open surgical biopsy and curettage for both diagnostic and treatment purpose. The final histopathologic diagnosis was chondroblastoma

Delayed phlegmon with gallstone fragments masquerading as soft tissue sarcoma

Complications from lost gallstones after cholecystectomy are rare but varied from simple perihepatic abscess to empyema and expectoration of gallstones. Gallstone complications have been reported in nearly every organ system, although reports of malignant masquerade of retained gallstones are few. We present the case of an 87-year-old woman with a flank soft tissue tumor 4 years after laparoscopic cholecystectomy. The initial clinical, radiographic and biopsy findings were consistent with soft tissue sarcoma (STS), but careful review of her case in multidisciplinary conference raised the suspicion for retained gallstones rather than STS. The patient was treated with incisional biopsy/drainage of the mass, and gallstones were retrieved. The patient recovered completely without an extensive resectional procedure, emphasizing the importance of multidisciplinary sarcoma care to optimize outcomes for potential sarcoma patients

Recurrent chondroblastoma of the acetabulum in an adult

Chondroblastoma is a rare, benign neoplasm of chondroblast cell origin, accounting for less than 1% of primary bone tumors. It is usually diagnosed in the second decade of life with most of the cases involving the long bones such as the femur and humerus. Furthermore, over 90% of cases are in individuals under 30 years of age. In older adults, chondroblastomas are typically found in bones in the foot, such as the talus and calcaneus. Treatment is usually local curettage of the lesion with a relatively low rate of recurrence. In this case report, we present a patient with an atypical age of initial presentation at 49 years, a rare location of the chondroblastoma in the acetabulum, and a recurrence 14 years after surgical resection in the same location. The lesion's radiographic findings of intralesional calcifications alongside the high-signal, heterogeneous composition on T2-weighted MRI were supportive of the atypical diagnosis of chondroblastoma in this patient