Abstract:OBJECTIVE
The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases.
MATERIALS AND METHODS
Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical ex… Show more
“…In some ES cases of the jaws, distinction from chronic osteomyelitis (OM) can be challenging on the basis of clinical findings (demographics, history, physical examination, and laboratory findings) and on the basis of cross-sectional imaging features. As recently suggested, other than ethnicity (African Americans are more likely to have OM than ES), no clinical feature improves diagnostic accuracy while among the morphologic features (without DWI), only the presence of a soft tissue mass at MRI appears to be significantly associated with ES [50]. On FDG PET CT, both OM and ES show increased tracer uptake within the bone and within the surrounding soft tissues due to increased glucose metabolism in inflammatory and malignant tissue, respectively.Fig.…”
Tumors of the pediatric facial skeleton represent a major challenge in clinical practice because they can lead to functional impairment, facial deformation, and long-term disfigurement. Their treatment often requires a multidisciplinary approach, and radiologists play a pivotal role in the diagnosis and management of these lesions. Although rare, pediatric tumors arising in the facial bones comprise a wide spectrum of benign and malignant lesions of osteogenic, fibrogenic, hematopoietic, neurogenic, or epithelial origin. The more common lesions include Langerhans cell histiocytosis and osteoma, while rare lesions include inflammatory myofibroblastic and desmoid tumors; juvenile ossifying fibroma; primary intraosseous lymphoma; Ewing sarcoma; and metastases to the facial bones from neuroblastoma, Ewing sarcoma, or retinoblastoma. This article provides a comprehensive approach for the evaluation of children with non-odontogenic tumors of the facial skeleton. Typical findings are discussed with emphasis on the added value of multimodality multiparametric imaging with computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), positron emission tomography CT (PET CT), and PET MRI. Key imaging findings and characteristic histologic features of benign and malignant lesions are reviewed and the respective role of each modality for pretherapeutic assessment and post-treatment follow-up. Pitfalls of image interpretation are addressed and how to avoid them.
“…In some ES cases of the jaws, distinction from chronic osteomyelitis (OM) can be challenging on the basis of clinical findings (demographics, history, physical examination, and laboratory findings) and on the basis of cross-sectional imaging features. As recently suggested, other than ethnicity (African Americans are more likely to have OM than ES), no clinical feature improves diagnostic accuracy while among the morphologic features (without DWI), only the presence of a soft tissue mass at MRI appears to be significantly associated with ES [50]. On FDG PET CT, both OM and ES show increased tracer uptake within the bone and within the surrounding soft tissues due to increased glucose metabolism in inflammatory and malignant tissue, respectively.Fig.…”
Tumors of the pediatric facial skeleton represent a major challenge in clinical practice because they can lead to functional impairment, facial deformation, and long-term disfigurement. Their treatment often requires a multidisciplinary approach, and radiologists play a pivotal role in the diagnosis and management of these lesions. Although rare, pediatric tumors arising in the facial bones comprise a wide spectrum of benign and malignant lesions of osteogenic, fibrogenic, hematopoietic, neurogenic, or epithelial origin. The more common lesions include Langerhans cell histiocytosis and osteoma, while rare lesions include inflammatory myofibroblastic and desmoid tumors; juvenile ossifying fibroma; primary intraosseous lymphoma; Ewing sarcoma; and metastases to the facial bones from neuroblastoma, Ewing sarcoma, or retinoblastoma. This article provides a comprehensive approach for the evaluation of children with non-odontogenic tumors of the facial skeleton. Typical findings are discussed with emphasis on the added value of multimodality multiparametric imaging with computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), positron emission tomography CT (PET CT), and PET MRI. Key imaging findings and characteristic histologic features of benign and malignant lesions are reviewed and the respective role of each modality for pretherapeutic assessment and post-treatment follow-up. Pitfalls of image interpretation are addressed and how to avoid them.
“…Lamellar periosteal reaction was seen in 13 subjects with Ewing's sarcoma and five with osteomyelitis, spiculated periosteal reaction was seen in five subjects with Ewing's sarcoma and one with osteomyelitis, and a serpiginous medullary or cortical tract (i.e., a longitudinally oriented tortuous medullary or cortical lucency seen on radiographs or signal abnormality seen on MR images traversing the medulla and cortex) was seen in none of the subjects with Ewing's sarcoma and in four subjects with osteomyelitis. 19 McCarville reported that nonpredictive MRI parameters included cortical thinning (in 17 subjects with Ewing's sarcoma and seven subjects with osteomyelitis) (p = 0.08), spiculated periosteal reaction (in five subjects with Ewing's sarcoma and in none of the subjects with osteomyelitis) (p = 0.06), and a cavity in bone (in one subject with Ewing's sarcoma and three subjects with osteomyelitis) (p = 0 .33). Two of the three cavities in bone in patients with osteomyelitis (67%) showed the penumbra sign (a peripheral hyperintense layer on unenhanced T1-weighted images that shows intense enhancement on contrast-enhanced images).…”
Section: Discussionmentioning
confidence: 99%
“…Two of the three cavities in bone in patients with osteomyelitis (67%) showed the penumbra sign (a peripheral hyperintense layer on unenhanced T1-weighted images that shows intense enhancement on contrast-enhanced images). 19 Plain film findings of osteomyelitis lag the onset of infection by days to weeks. Initial findings may include only subtle soft tissue edema near the involved metaphysis.…”
Metaphyseal osteomyelitis in children due to direct bone trauma or vascular insufficiency is a frequent problem in orthopaedic surgery. In contrast, diaphyseal osteomyelitis represents a rare entity that almost exclusively affects child with bony infarct in sickle cell anemia. Differentiating neoplasm from musculoskeletal infection can sometimes be very challenging. In particular, Ewing sarcoma can masquerade as osteomyelitis with the presenting symptoms of fever, localized bone pain, and elevated inflammatory markers common to both entities, although osteomyelitis is a totally different type of disease. In this article, we report the case of chronic osteomyelitis of the femur in an immunocompetent and otherwise healthy 8 years old boy with minor inflammation signs and misleading clinical features. The X-ray showed onion skin periosteal reaction. We evacuated about 200 cc of abscess. Biopsy report revealed polimononuclear, mononuclear, and necrotic inflammatory cells. The patient was treated with antibiotic for two weeks and discharged with improved general condition. Six months follow-up shows clinical and radiological improvement. The diagnosis had to be confirmed by surgery which allowed the initiation of a targeted therapy. A case of diaphyseal osteomyelitis of a femur, lacking predisposing factors or trauma, is unique in children and never been reported previously.
“…The main differential diagnoses consist of osteolytic osteosarcoma and small-cell osteosarcoma in children and adolescents, osteomyelitis in all age groups, and non-Hodgkin's lymphoma in adulthood. 12 In children, unifocal Langerhans cell histiocytosis is another differential, but the periosteal reaction is often less aggressive, and an eosinophilic granuloma may have a sequestrum. In the spine, ES may mimic spondylitis because of its high signal intensity in T2-weighted images, 4,13 whereas in the rare case of sacroiliac joint involvement, it should be distinguished from septic sacroiliitis (►Fig.…”
Ewing's sarcoma (ES) is a rare, highly malignant anaplastic stem cell tumor. Histologically, the tumor consists of uniform densely packed small monomorphic cells with round nuclei. The typical appearance at hematoxylin and eosin (H&E) staining is small blue round cells without any matrix formation. On conventional radiography, ES typically presents as a permeative lesion in the diaphysis of a long bone in a child. A large soft tissue component is another characteristic feature, best depicted by magnetic resonance imaging.Primary osseous lymphomas are most commonly highly malignant B-cell lymphomas. At H&E histologic staining, the tumor stroma consists of diffuse round-cell infiltrates that resembles the appearance of ES. Although there is no typical imaging appearance of an osseous lymphoma, it should be considered in an adult presenting with a Lodwick grade II or III lesion in the metaphysis or diaphysis of a large long bone, the pelvis, or the vertebral column. Histologic confirmation is mandatory.
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