Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions...Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBS<sub>x</sub>, and along the direction parallel to the forearm, TBS<sub>y</sub>, were calculated respectively. The statistics of TBS<sub>x</sub> and TBS<sub>y</sub> were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBS<sub>y</sub> to TBS<sub>x</sub> and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBS<sub>x</sub> and TBS<sub>y</sub> was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.展开更多
Background: When applied to trabecular bone X-ray images, a method for analyzing trabecular bone texture based on the initial slope of variogram (ISV) was used to assess the trabecular bone health. Methodology: Data f...Background: When applied to trabecular bone X-ray images, a method for analyzing trabecular bone texture based on the initial slope of variogram (ISV) was used to assess the trabecular bone health. Methodology: Data from more than two hundred subjects were retrospectively studied. For each subject, a DXA (GE Lunar Prodigy) scan of the forearm was performed, and bone mineral density (BMD) value was measured at the location of ultra-distal radius, X-ray digital image of the same forearm was taken on the same day, and ISV value over the same location of ultra-distal radius was calculated. Pearson’s correlation coefficients were calculated to examine the correlation between BMD and ISV of the trabecular bones located at the same ultra-distal radius. ISV values changed with subjects’ age were also reported. Results: The results show that ISV value was highly correlated with the DXA-measured BMD of the same trabecular bone located at the ultra-distal radius. The correlation coefficient between ISV and BMD with the 95% confident was 0.79 ± 0.09. They also demonstrated that the age-related changes in trabecular bone health and differentiated age patterns in males and females, respectively. The results showed that the decrease in BMD was accompanied by a decrease in the initial slope of variogram (ISV). Conclusions: This study suggests that ISV might be used to quantitatively evaluate trabecular health for osteoporosis and bone disease diagnosis.展开更多
Rheumatoid arthritis(RA) is a common chronic inflammatory disease and periarticular osteoporosis or osteopenia of the inflamed hand joints is an early feature of RA Quantitative measurement of hand bone loss may be an...Rheumatoid arthritis(RA) is a common chronic inflammatory disease and periarticular osteoporosis or osteopenia of the inflamed hand joints is an early feature of RA Quantitative measurement of hand bone loss may be an outcome measure for the detection of joint destruction and disease progression in early RA. This systematic review examines the published literature reporting hand bone mass in patients with RA, particularly those using the dual X-ray absorptiometry(DXA) methods The majority of the studies reported that hand bone loss is associated with disease activity, functional statusand radiological progression in early RA. Quantitative measurement of hand bone mineral density by DXA may be a useful and practical outcome measure in RA and may be predictive for radiographic progression or functional status in patients with early RA.展开更多
Age determination is one of the most important factors for identification. Unfortunately, births are not recorded regularly in Sudan, especially in rural areas. However, identification of age is very important for a v...Age determination is one of the most important factors for identification. Unfortunately, births are not recorded regularly in Sudan, especially in rural areas. However, identification of age is very important for a variety of reasons, including identifying legal and criminal responsibility, and for many other social events such as beginning a job, marriage, retirement and joining the army. The study aimed to find the reliability of using international methods to estimate bone age of people through hand bone radiograph in Sudanese people by studying the reliability of using hand bone age “the digital atlas of hand age” which depended on Greulich and Pyle (GP) and Tanner and Whitehouse (TW2/3) methods in Sudanese people in exact group of age, and to compare the hand and wrist bone development between Caucasian and Sudanese people. The study was conducted on 48 samples (26 males and 22 females) from the center of Sudan. The study was made by conventional X-Ray taken from Sudanese newborn babies to 2 and 3 years old for males and females respectively. Those images were taken mostly from the emergency and orthopedic outpatient departments. The ages were grouped in the same ways and periods used in the atlas. So the criteria were tested, and the outcomes were compared with international standards in the atlas of hand bone age. There is evidence that skeletal maturation may vary between difference ethnic and socioeconomic groups of children or among children living in various geographical locations. It is found that there is reliability and applicability of using the atlas in Sudanese people with considering that there might be mild variations between Sudanese and Caucasian people’s hand and wrist bone development in which Caucasian people bone growth was earlier than the Sudanese people bones about 1 - 2 months.展开更多
Automated and autonomous decisions of image classification systems have essential applicability in this modern age even.Image-based decisions are commonly taken through explicit or auto-feature engineering of images.I...Automated and autonomous decisions of image classification systems have essential applicability in this modern age even.Image-based decisions are commonly taken through explicit or auto-feature engineering of images.In forensic radiology,auto decisions based on images significantly affect the automation of various tasks.This study aims to assist forensic radiology in its biological profile estimation when only bones are left.A benchmarked dataset Radiology Society of North America(RSNA)has been used for research and experiments.Additionally,a locally developed dataset has also been used for research and experiments to cross-validate the results.A Convolutional Neural Network(CNN)-based model named computer vision and image processing-net(CVIP-Net)has been proposed to learn and classify image features.Experiments have also been performed on state-of-the-art pertained models,which are alex_net,inceptionv_3,google_net,Residual Network(resnet)_50,and Visual Geometry Group(VGG)-19.Experiments proved that the proposed CNN model is more accurate than other models when panoramic dental x-ray images are used to identify age and gender.The specially designed CNN-based achieved results in terms of standard evaluation measures including accuracy(98.90%),specificity(97.99%),sensitivity(99.34%),and Area under the Curve(AUC)-value(0.99)on the locally developed dataset to detect age.The classification rates of the proposed model for gender estimation were 99.57%,97.67%,98.99%,and 0.98,achieved in terms of accuracy,specificity,sensitivity,and AUC-value,respectively,on the local dataset.The classification rates of the proposed model for age estimation were 96.80%,96.80%,97.03%,and 0.99 achieved in terms of accuracy,specificity,sensitivity,and AUC-value,respectively,on the RSNA dataset.展开更多
In this paper, the interferences of X-ray image noise on a bone age model, Xception model, were studied. We conduct a comparative experiment test according to the output performance of the neural network model using b...In this paper, the interferences of X-ray image noise on a bone age model, Xception model, were studied. We conduct a comparative experiment test according to the output performance of the neural network model using both the original image training and noise-added (Gaussian noise plus salt-pepper noise) training, and analyze the anti-interference ability of the Xception model, hoping to improve it through noise enhancement training and generalize the application ability of the model. The results show that the model trained with noise-added (Gaussian noise plussalt-pepper noise) images can make predictions that are more robust and less affected by the image disturbances, such as image noise.展开更多
Background Recent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral densi...Background Recent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral density and apparent diffusion coefficient (ADC). This study aimed to prospectively explore the efficacy of MR spectroscopy (MRS) and diffusion-weighted MR imaging (DWl) in detecting vertebral marrow changes in postmenopausal women with varying bone densities. Methods Both MRS and DWl of the lumber spine were performed in 102 postmenopausal women (mean age, (67.3±6.5) years; range, 55-83 years), who underwent dual X-ray absorptiometry. Marrow fat content and ADC were compared and correlated among three groups: 24 with normal bone density, 31 with osteopenia and 47 with osteoporosis. Results Vertebral marrow fat content was significantly increased in the osteoporotic group ((65.60±7.68)%, P 〈0.001) and the osteopenic group ((57.68±6.45)%, P 〈0.001), when compared with the normal bone density group ((51.67±3.27)%). ADC values were significantly decreased in the osteoporotic group ((0.39±0.03)×10^-3mm^2/s, P 〈0.001) and in the osteopenic group ((0.42±0.02)×10^-3mm^2/s, P 〈0.001), when compared with the normal bone density group ((0.47±0.03)×10^-3mm^2/s). The marrow fat content negatively correlated with both bone density (r=-0.731, P 〈0.001) and marrow ADC (r=-0.572, P 〈0.001). The bone density positively correlated with the ADC values (r=0.802, P 〈0.001). Conclusions Postmenopausal women experience a corresponding increase in vertebral marrow fat content as the bone density decreases. Marrow fat content and ADC correlate to the bone density. MRS and DWl may indirectly assess the early bone marrow changes in postmenopausal women.展开更多
Background Hyperparathyroidism (HPT) occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symp...Background Hyperparathyroidism (HPT) occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symptoms and signs, and when treatment does not produce any desirable effect. It has become urgent to find a method that would detect early bone diseases in HPT to obtain time for the ideal treatment. This study evaluated the accuracy of high field magnetic resonance imaging (MRI) combined with spiral computed tomography (SCT) scan in detecting early bone diseases in HPT, through imaging techniques and histopathological examinations on an animal model of HPT. Methods Eighty adult rabbits were randomly divided into two groups with forty in each. The control group was fed normal diet (Ca:P = 1:0.7); the experimental group was fed high phosphate diet (Ca:P = 1:7) for 3, 4, 5, or 6-month intervals to establish the animal model of HPT. The staging and imaging findings of the early bone diseases in HPT were determined by high field MRI and SCT scan at the 3rd, 4th, 5th and 6th month. Each rabbit was sacrificed after high field MRI and SCT scan, and the parathyroid and bones were removed for pathological examination to evaluate the accuracy of imaging diagnosis. Results Parathyroid histopathological studies revealed hyperplasia, osteoporosis and early cortical bone resorption. The bone diseases in HPT displayed different levels of low signal intensity on T1WI and low to intermediate signal intensity on T2WI in bone of stage 0, Ⅰ, Ⅱ or Ⅲ, but showed correspondingly absent, probable, osteoporotic and subperiosteal cortical resorption on SCT scan. Conclusion High field MRI combined with SCT scan not only detects early bone diseases in HPT, but also indicates staging, and might be a reliable method of studying early bone diseases in HPT.展开更多
BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of l...BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.展开更多
BACKGROUND Giant cell tumor of soft tissue(GCT-ST)is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper.GCT-ST has unpredictable behavior.It is mainly beni...BACKGROUND Giant cell tumor of soft tissue(GCT-ST)is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper.GCT-ST has unpredictable behavior.It is mainly benign,but may sometimes become aggressive and potentially increase in size within a short period of time.CASE SUMMARY A 17-year-old man was suspected of having a fracture,based on radiography following left shoulder trauma.One month later,the swelling of the left shoulder continued to increase and the pain was obvious.Computed tomography(CT)revealed a soft tissue mass with strip-like calcifications in the left shoulder.The mass invaded the adjacent humerus and showed an insect-like area of destruction at the edge of the cortical bone of the upper humerus.The marrow cavity of the upper humerus was enlarged,and a soft tissue density was seen in the medullary cavity.Thoracic CT revealed multiple small nodules beneath the pleura of both lungs.A bone scan demonstrated increased activity in the left shoulder joint and proximal humerus.The mass showed mixed moderate hypointensity and hyperintensity on T1-weighted images,and mixed hyperintensity on T2-weighted fat-saturated images.The final diagnosis of GCT-ST was confirmed by pathology.CONCLUSION GCT-STs should be considered in the differential diagnosis of soft tissue tumors and monitored for large increases in size.展开更多
文摘Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBS<sub>x</sub>, and along the direction parallel to the forearm, TBS<sub>y</sub>, were calculated respectively. The statistics of TBS<sub>x</sub> and TBS<sub>y</sub> were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBS<sub>y</sub> to TBS<sub>x</sub> and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBS<sub>x</sub> and TBS<sub>y</sub> was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.
文摘Background: When applied to trabecular bone X-ray images, a method for analyzing trabecular bone texture based on the initial slope of variogram (ISV) was used to assess the trabecular bone health. Methodology: Data from more than two hundred subjects were retrospectively studied. For each subject, a DXA (GE Lunar Prodigy) scan of the forearm was performed, and bone mineral density (BMD) value was measured at the location of ultra-distal radius, X-ray digital image of the same forearm was taken on the same day, and ISV value over the same location of ultra-distal radius was calculated. Pearson’s correlation coefficients were calculated to examine the correlation between BMD and ISV of the trabecular bones located at the same ultra-distal radius. ISV values changed with subjects’ age were also reported. Results: The results show that ISV value was highly correlated with the DXA-measured BMD of the same trabecular bone located at the ultra-distal radius. The correlation coefficient between ISV and BMD with the 95% confident was 0.79 ± 0.09. They also demonstrated that the age-related changes in trabecular bone health and differentiated age patterns in males and females, respectively. The results showed that the decrease in BMD was accompanied by a decrease in the initial slope of variogram (ISV). Conclusions: This study suggests that ISV might be used to quantitatively evaluate trabecular health for osteoporosis and bone disease diagnosis.
文摘Rheumatoid arthritis(RA) is a common chronic inflammatory disease and periarticular osteoporosis or osteopenia of the inflamed hand joints is an early feature of RA Quantitative measurement of hand bone loss may be an outcome measure for the detection of joint destruction and disease progression in early RA. This systematic review examines the published literature reporting hand bone mass in patients with RA, particularly those using the dual X-ray absorptiometry(DXA) methods The majority of the studies reported that hand bone loss is associated with disease activity, functional statusand radiological progression in early RA. Quantitative measurement of hand bone mineral density by DXA may be a useful and practical outcome measure in RA and may be predictive for radiographic progression or functional status in patients with early RA.
文摘Age determination is one of the most important factors for identification. Unfortunately, births are not recorded regularly in Sudan, especially in rural areas. However, identification of age is very important for a variety of reasons, including identifying legal and criminal responsibility, and for many other social events such as beginning a job, marriage, retirement and joining the army. The study aimed to find the reliability of using international methods to estimate bone age of people through hand bone radiograph in Sudanese people by studying the reliability of using hand bone age “the digital atlas of hand age” which depended on Greulich and Pyle (GP) and Tanner and Whitehouse (TW2/3) methods in Sudanese people in exact group of age, and to compare the hand and wrist bone development between Caucasian and Sudanese people. The study was conducted on 48 samples (26 males and 22 females) from the center of Sudan. The study was made by conventional X-Ray taken from Sudanese newborn babies to 2 and 3 years old for males and females respectively. Those images were taken mostly from the emergency and orthopedic outpatient departments. The ages were grouped in the same ways and periods used in the atlas. So the criteria were tested, and the outcomes were compared with international standards in the atlas of hand bone age. There is evidence that skeletal maturation may vary between difference ethnic and socioeconomic groups of children or among children living in various geographical locations. It is found that there is reliability and applicability of using the atlas in Sudanese people with considering that there might be mild variations between Sudanese and Caucasian people’s hand and wrist bone development in which Caucasian people bone growth was earlier than the Sudanese people bones about 1 - 2 months.
文摘Automated and autonomous decisions of image classification systems have essential applicability in this modern age even.Image-based decisions are commonly taken through explicit or auto-feature engineering of images.In forensic radiology,auto decisions based on images significantly affect the automation of various tasks.This study aims to assist forensic radiology in its biological profile estimation when only bones are left.A benchmarked dataset Radiology Society of North America(RSNA)has been used for research and experiments.Additionally,a locally developed dataset has also been used for research and experiments to cross-validate the results.A Convolutional Neural Network(CNN)-based model named computer vision and image processing-net(CVIP-Net)has been proposed to learn and classify image features.Experiments have also been performed on state-of-the-art pertained models,which are alex_net,inceptionv_3,google_net,Residual Network(resnet)_50,and Visual Geometry Group(VGG)-19.Experiments proved that the proposed CNN model is more accurate than other models when panoramic dental x-ray images are used to identify age and gender.The specially designed CNN-based achieved results in terms of standard evaluation measures including accuracy(98.90%),specificity(97.99%),sensitivity(99.34%),and Area under the Curve(AUC)-value(0.99)on the locally developed dataset to detect age.The classification rates of the proposed model for gender estimation were 99.57%,97.67%,98.99%,and 0.98,achieved in terms of accuracy,specificity,sensitivity,and AUC-value,respectively,on the local dataset.The classification rates of the proposed model for age estimation were 96.80%,96.80%,97.03%,and 0.99 achieved in terms of accuracy,specificity,sensitivity,and AUC-value,respectively,on the RSNA dataset.
文摘In this paper, the interferences of X-ray image noise on a bone age model, Xception model, were studied. We conduct a comparative experiment test according to the output performance of the neural network model using both the original image training and noise-added (Gaussian noise plus salt-pepper noise) training, and analyze the anti-interference ability of the Xception model, hoping to improve it through noise enhancement training and generalize the application ability of the model. The results show that the model trained with noise-added (Gaussian noise plussalt-pepper noise) images can make predictions that are more robust and less affected by the image disturbances, such as image noise.
文摘为提高在体骨骼模型的3D重建精度,对CT扫描方式和利用CT图像重建骨骼模型的方法进行研究,提出一种基于灰度特征搜索匹配点的图像层间插值算法.该算法根据插值点相邻层邻近点的灰度值特征选择参考点;以参考点为依据在另一相邻层图像某区域内搜索与参考点灰度相近并且距离较小的匹配点;利用参考点和匹配点灰度值以及距离关系计算插值点灰度值.对人体9块手骨进行模型重建,将原始CT图像重建模型和插值优化后的重建模型分别与解剖模型进行比较的结果表明,优化前与优化后平均正偏差均值由0.30 mm减小到0.11 mm,平均负偏差均值由0.27 mm减小到0.09 mm.
文摘Background Recent studies suggest that bone marrow adipose tissue might play a role in the pathogenesis of osteoporosis. There are inconsistent findings on the relationship among marrow fat content, bone mineral density and apparent diffusion coefficient (ADC). This study aimed to prospectively explore the efficacy of MR spectroscopy (MRS) and diffusion-weighted MR imaging (DWl) in detecting vertebral marrow changes in postmenopausal women with varying bone densities. Methods Both MRS and DWl of the lumber spine were performed in 102 postmenopausal women (mean age, (67.3±6.5) years; range, 55-83 years), who underwent dual X-ray absorptiometry. Marrow fat content and ADC were compared and correlated among three groups: 24 with normal bone density, 31 with osteopenia and 47 with osteoporosis. Results Vertebral marrow fat content was significantly increased in the osteoporotic group ((65.60±7.68)%, P 〈0.001) and the osteopenic group ((57.68±6.45)%, P 〈0.001), when compared with the normal bone density group ((51.67±3.27)%). ADC values were significantly decreased in the osteoporotic group ((0.39±0.03)×10^-3mm^2/s, P 〈0.001) and in the osteopenic group ((0.42±0.02)×10^-3mm^2/s, P 〈0.001), when compared with the normal bone density group ((0.47±0.03)×10^-3mm^2/s). The marrow fat content negatively correlated with both bone density (r=-0.731, P 〈0.001) and marrow ADC (r=-0.572, P 〈0.001). The bone density positively correlated with the ADC values (r=0.802, P 〈0.001). Conclusions Postmenopausal women experience a corresponding increase in vertebral marrow fat content as the bone density decreases. Marrow fat content and ADC correlate to the bone density. MRS and DWl may indirectly assess the early bone marrow changes in postmenopausal women.
文摘Background Hyperparathyroidism (HPT) occurs at an early age and has a high disability rate. Unfortunately, confirmed diagnosis in most patients is done at a very late stage, when the patients have shown typical symptoms and signs, and when treatment does not produce any desirable effect. It has become urgent to find a method that would detect early bone diseases in HPT to obtain time for the ideal treatment. This study evaluated the accuracy of high field magnetic resonance imaging (MRI) combined with spiral computed tomography (SCT) scan in detecting early bone diseases in HPT, through imaging techniques and histopathological examinations on an animal model of HPT. Methods Eighty adult rabbits were randomly divided into two groups with forty in each. The control group was fed normal diet (Ca:P = 1:0.7); the experimental group was fed high phosphate diet (Ca:P = 1:7) for 3, 4, 5, or 6-month intervals to establish the animal model of HPT. The staging and imaging findings of the early bone diseases in HPT were determined by high field MRI and SCT scan at the 3rd, 4th, 5th and 6th month. Each rabbit was sacrificed after high field MRI and SCT scan, and the parathyroid and bones were removed for pathological examination to evaluate the accuracy of imaging diagnosis. Results Parathyroid histopathological studies revealed hyperplasia, osteoporosis and early cortical bone resorption. The bone diseases in HPT displayed different levels of low signal intensity on T1WI and low to intermediate signal intensity on T2WI in bone of stage 0, Ⅰ, Ⅱ or Ⅲ, but showed correspondingly absent, probable, osteoporotic and subperiosteal cortical resorption on SCT scan. Conclusion High field MRI combined with SCT scan not only detects early bone diseases in HPT, but also indicates staging, and might be a reliable method of studying early bone diseases in HPT.
基金Supported by The Beijing Science Foundation for Distinguished Young Scholars,No.JQ21025。
文摘BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.
文摘BACKGROUND Giant cell tumor of soft tissue(GCT-ST)is an extremely rare low-grade soft tissue tumor that is originates in superficial tissue and rarely spreads deeper.GCT-ST has unpredictable behavior.It is mainly benign,but may sometimes become aggressive and potentially increase in size within a short period of time.CASE SUMMARY A 17-year-old man was suspected of having a fracture,based on radiography following left shoulder trauma.One month later,the swelling of the left shoulder continued to increase and the pain was obvious.Computed tomography(CT)revealed a soft tissue mass with strip-like calcifications in the left shoulder.The mass invaded the adjacent humerus and showed an insect-like area of destruction at the edge of the cortical bone of the upper humerus.The marrow cavity of the upper humerus was enlarged,and a soft tissue density was seen in the medullary cavity.Thoracic CT revealed multiple small nodules beneath the pleura of both lungs.A bone scan demonstrated increased activity in the left shoulder joint and proximal humerus.The mass showed mixed moderate hypointensity and hyperintensity on T1-weighted images,and mixed hyperintensity on T2-weighted fat-saturated images.The final diagnosis of GCT-ST was confirmed by pathology.CONCLUSION GCT-STs should be considered in the differential diagnosis of soft tissue tumors and monitored for large increases in size.