<strong>Background: </strong>Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossifi...<strong>Background: </strong>Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF;so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare;the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. <strong>Aim: </strong>We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. <strong>Case presentation: </strong>The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibroblastic proliferation suggestive of nodular fasciitis (NF) was found. The next generation sequencing (NGS) demonstrated the presence of <em>MYH9-USP6</em> gene fusion, confirming the diagnosis of NF. The lesion was excised under arthroscopic control. At 1 year follow-up the patient is asymptomatic. <strong>Conclusion: </strong>The case is of interest because of its rare pathology. The decision how to treat was based on pathologic biopsy diagnostics including the USP6-gene rearrangement. In view of similar presentation of the rare malignancies we also want to stress the importance of definitive diagnostics which generally are possible only through biopsy.展开更多
Synovial osteochondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The mo...Synovial osteochondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Typically, radiographs can be diagnostic and mineralized nodules are pathognomonic. In as many as one-third of cases, however, no calcification or ossification of the cartilage occurs in the early stage of the disease because mineralization is time-dependent. In such cases, gadolinium-enhanced MRI can be useful. Unmineralized nodules are typically peripherally enhanced because they are attached to and derive a vascular supply from the synovium. We experienced an unmineralized case of synovial osteochondromatosis of the right knee joint, in which imaging diagnosis was difficult. Neither calcification nor ossification was observed, but all nodules were released from the synovium as loose bodies and there was no vascular supply. Therefore, MRI did not show a typical appearance. These findings suggest that synovial osteochondromatosis should be considered as a differential diagnosis in a case in which unmineralized loose bodies without a synovial lesion are found in an imaging examination.展开更多
Bone marrow lesions (BMLs) on magnetic resonance (MR) images in knee osteoarthritis patients are considered to predict the severity and progression of the disease. We evaluated the histological findings of BMLs on MR ...Bone marrow lesions (BMLs) on magnetic resonance (MR) images in knee osteoarthritis patients are considered to predict the severity and progression of the disease. We evaluated the histological findings of BMLs on MR images of the subchondral area of the medial femoral condyle in varus osteoarthritic knees. In 24 patients with varus knee osteoarthritis who underwent total knee arthroplasty (TKA), sagittal T1- and T2-weighted MR images of the affected knee were acquired before TKA. During TKA, resected bone pieces from the distal medial femoral condyle were obtained. Sagittal specimens obtained from the center of the bone pieces were histologically examined. Twenty patients had BMLs. Histological findings of BMLs in the subchondral area showed various features, such as fibrovascular tissue, cyst formation, active bone remodeling with bone formation and bone resorption, and hyaline cartilage. BMLs were not found in four patients;histological findings of these patients showed normal bone marrow tissue with normal-thickness trabeculae. Subchondral bony end plate in knees with BMLs was usually thin or destroyed, while that without BMLs was thick or normal. The condition of the subchondral bony end plate would explain the differences in the severity and progression between patients with or without BMLs.展开更多
Objective: The aim of this prospective study is <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to </span>...Objective: The aim of this prospective study is <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">evaluate how much damage the patellar cartilage presents during a total knee replacement. Methods: The damage of the articular patellar surface was analysed by visual inspection and photographs in 354 primary total knee replacement</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. The authors graded the degree of cartilage lesion in five groups. The cartilage status was analyzed and correlated with age, gender, side, body mass index (BMI), Kellgren-Lawrence radiographic scale and axial deviation. Results: After statistical analysis, we concluded: there was no evidence of an association between patellar arthrosis and age gender, side, weight and deformity. Conclusions: Articular cartilage was damaged in all 354 knees. Important subchondral bone exposure occurred in 274 knees (77</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">4%). Obese patients had more severe patellar osteoarthritis.</span></span></span>展开更多
目的探讨核磁共振(MRI)发现的膝关节软骨下局灶性骨髓病变(bone marrow lesions,BMLs)的组织学表现和特点。方法收集本院2013年9月至2015年2月因膝关节骨性关节炎行关节置换的40-70岁患者,术前完善患膝MRI,发现非负重区软骨下局灶性...目的探讨核磁共振(MRI)发现的膝关节软骨下局灶性骨髓病变(bone marrow lesions,BMLs)的组织学表现和特点。方法收集本院2013年9月至2015年2月因膝关节骨性关节炎行关节置换的40-70岁患者,术前完善患膝MRI,发现非负重区软骨下局灶性BMLs病灶(T1加权低信号区,T2加权及STIR脂肪抑制序列高信号区)者10例,其中男性3例,女性7例;术中获取病灶标本5例,其中男性2例,女性3例,年龄53-67(61±6)岁。标本切片均行HE染色及番红O/固绿染色,观察BMLs病灶区和相邻对照区组织学表现,Image Pro Plus 6.0图像分析软件测量各类病理组织所占面积比例和骨小梁体积分数(trabecular bone volume,BV/TV)。结果 5例局灶性BMLs病灶分别位于髌骨2例,股骨前髁2例,股骨后髁1例;术中见病灶部位表面软骨存在Ⅰ-Ⅳ度损伤,1例髌骨病灶截面为囊性变,其余为松质骨表现;术后病理学观察结果显示:除1例囊变外,其余4例病灶区以正常组织为主,占76.9%,异常组织占23.1%,BV/TV为26.7%,与对照区比较,骨髓坏死(t=-4.0,P=0.029)、异常骨小梁(t=-4.0,P=0.028)、BV/TV(t=6.4,P=0.008)差异有统计学意义。结论膝关节非负重区软骨下局灶性BMLs病灶表现出一些非特异性异常组织学表现和一定的共性,软骨损伤和骨小梁减少尤为明显。展开更多
文摘<strong>Background: </strong>Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF;so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare;the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. <strong>Aim: </strong>We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. <strong>Case presentation: </strong>The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibroblastic proliferation suggestive of nodular fasciitis (NF) was found. The next generation sequencing (NGS) demonstrated the presence of <em>MYH9-USP6</em> gene fusion, confirming the diagnosis of NF. The lesion was excised under arthroscopic control. At 1 year follow-up the patient is asymptomatic. <strong>Conclusion: </strong>The case is of interest because of its rare pathology. The decision how to treat was based on pathologic biopsy diagnostics including the USP6-gene rearrangement. In view of similar presentation of the rare malignancies we also want to stress the importance of definitive diagnostics which generally are possible only through biopsy.
文摘Synovial osteochondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Typically, radiographs can be diagnostic and mineralized nodules are pathognomonic. In as many as one-third of cases, however, no calcification or ossification of the cartilage occurs in the early stage of the disease because mineralization is time-dependent. In such cases, gadolinium-enhanced MRI can be useful. Unmineralized nodules are typically peripherally enhanced because they are attached to and derive a vascular supply from the synovium. We experienced an unmineralized case of synovial osteochondromatosis of the right knee joint, in which imaging diagnosis was difficult. Neither calcification nor ossification was observed, but all nodules were released from the synovium as loose bodies and there was no vascular supply. Therefore, MRI did not show a typical appearance. These findings suggest that synovial osteochondromatosis should be considered as a differential diagnosis in a case in which unmineralized loose bodies without a synovial lesion are found in an imaging examination.
文摘Bone marrow lesions (BMLs) on magnetic resonance (MR) images in knee osteoarthritis patients are considered to predict the severity and progression of the disease. We evaluated the histological findings of BMLs on MR images of the subchondral area of the medial femoral condyle in varus osteoarthritic knees. In 24 patients with varus knee osteoarthritis who underwent total knee arthroplasty (TKA), sagittal T1- and T2-weighted MR images of the affected knee were acquired before TKA. During TKA, resected bone pieces from the distal medial femoral condyle were obtained. Sagittal specimens obtained from the center of the bone pieces were histologically examined. Twenty patients had BMLs. Histological findings of BMLs in the subchondral area showed various features, such as fibrovascular tissue, cyst formation, active bone remodeling with bone formation and bone resorption, and hyaline cartilage. BMLs were not found in four patients;histological findings of these patients showed normal bone marrow tissue with normal-thickness trabeculae. Subchondral bony end plate in knees with BMLs was usually thin or destroyed, while that without BMLs was thick or normal. The condition of the subchondral bony end plate would explain the differences in the severity and progression between patients with or without BMLs.
文摘Objective: The aim of this prospective study is <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">to </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">evaluate how much damage the patellar cartilage presents during a total knee replacement. Methods: The damage of the articular patellar surface was analysed by visual inspection and photographs in 354 primary total knee replacement</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">. The authors graded the degree of cartilage lesion in five groups. The cartilage status was analyzed and correlated with age, gender, side, body mass index (BMI), Kellgren-Lawrence radiographic scale and axial deviation. Results: After statistical analysis, we concluded: there was no evidence of an association between patellar arthrosis and age gender, side, weight and deformity. Conclusions: Articular cartilage was damaged in all 354 knees. Important subchondral bone exposure occurred in 274 knees (77</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">4%). Obese patients had more severe patellar osteoarthritis.</span></span></span>
文摘目的探讨核磁共振(MRI)发现的膝关节软骨下局灶性骨髓病变(bone marrow lesions,BMLs)的组织学表现和特点。方法收集本院2013年9月至2015年2月因膝关节骨性关节炎行关节置换的40-70岁患者,术前完善患膝MRI,发现非负重区软骨下局灶性BMLs病灶(T1加权低信号区,T2加权及STIR脂肪抑制序列高信号区)者10例,其中男性3例,女性7例;术中获取病灶标本5例,其中男性2例,女性3例,年龄53-67(61±6)岁。标本切片均行HE染色及番红O/固绿染色,观察BMLs病灶区和相邻对照区组织学表现,Image Pro Plus 6.0图像分析软件测量各类病理组织所占面积比例和骨小梁体积分数(trabecular bone volume,BV/TV)。结果 5例局灶性BMLs病灶分别位于髌骨2例,股骨前髁2例,股骨后髁1例;术中见病灶部位表面软骨存在Ⅰ-Ⅳ度损伤,1例髌骨病灶截面为囊性变,其余为松质骨表现;术后病理学观察结果显示:除1例囊变外,其余4例病灶区以正常组织为主,占76.9%,异常组织占23.1%,BV/TV为26.7%,与对照区比较,骨髓坏死(t=-4.0,P=0.029)、异常骨小梁(t=-4.0,P=0.028)、BV/TV(t=6.4,P=0.008)差异有统计学意义。结论膝关节非负重区软骨下局灶性BMLs病灶表现出一些非特异性异常组织学表现和一定的共性,软骨损伤和骨小梁减少尤为明显。