Precervical myositis ossificans in an infant secondary to child abuse

Harmon, Jenna; Rabe, Andrew J.; Nichol, Kathleen; Shiels, William E.

doi:10.1007/s00247-011-2270-5

Cited by 10 publications

(2 citation statements)

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“…Pseudo-malignant and circumscribed MO is a benign and self-limiting ossification within the soft tissue. The typical evolution of MO is the growth of a firm extraskeletal mass for several months until reaching its peak dimension and then spontaneously resolving (20). The exact causes of MO are not well understood.…”

Section: Discussionmentioning

confidence: 99%

Myositis ossificans in the pediatric population: a systematic scoping review

Cherry,

Mutschler,

Samara

et al. 2023

Front. Pediatr.

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IntroductionCircumscribed or pseudomalignant myositis ossificans (MO) is a rare and benign condition characterized by heterotopic bone formation in soft tissues. The clinical presentation of MO, imaging investigations, histological findings, and treatment strategies are unclear, especially in the pediatric population.Materials and methodsA literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French of traumatic and non-traumatic MO. Studies were selected by 2 independent reviewers following the PRISMA recommendation and descriptive data were extracted. We harvest in each case the sex, age at diagnosis, location, presence of initial trauma, pre-emptive diagnosis, modalities of imagery used, realized biopsy, treatment performed, and type of follow-up.ResultsSixty pediatric cases of MO were identified between 2002 and 2023. Twenty-three patients (38.3%) were diagnosed with idiopathic/pseudomalignant and 37 patients (61.7%) with circumscribed. The mean age at diagnosis was 9.5 years (range 0.2–17 years), with a male-to-female ratio of 1:1. The initial pre-emptive diagnosis was neoplasia in 13 patients (21.7%). The biopsy was percutaneous in 9 patients (15%) and incisional in 7 patients (11.7%). Histological analysis was achieved in 35 cases (57%). Surgical excision was the first line treatment in 46.7% of patients, and non-surgical in the remaining patients. The follow-up strategy was clinical in 16 patients (26.7%) or based on imaging investigation in 23 patients (38.3%).DiscussionAlthough MO in children is described as a rare pathology, identifying the benignity of the condition is essential to avoid unnecessary invasive treatment and to avoid delaying the treatment of a potentially life-threatening entity. It seems that there is no consensus established concerning the proper imaging for diagnosis. Clinicians should acknowledge that the absence of a triggering trauma tends to direct the investigation and the management toward a surgical attitude. Conservative management is key, however, surgical excision can be proposed on matured lesions on a case-by-case basis. The absence of recurrence is not excluded. Therefore, a close clinical follow-up is suggested for all cases. The true benefit of a radiological is questioned in a question known to be self-resolving.

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Section: Discussionmentioning

confidence: 99%

Myositis ossificans in the pediatric population: a systematic scoping review

Cherry,

Mutschler,

Samara

et al. 2023

Front. Pediatr.

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“…Two different forms of acquired MO can be recognized: neurogenic and non-neurogenic; the latter can be divided, in turn, into post-traumatic circumscribed MO (60–75% of cases) [ 3 ] and idiopathic/pseudomalignant. Post-traumatic MO can result from both severe direct injuries and recurrent minor trauma, even in the form of abuse [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Myositis ossificans mimicking sarcoma: a not so rare bioptic diagnostic pitfall

et al. 2020

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Background: Myositis ossificans (MO) is a heterotopic bone formation in soft tissues, usually caused by traumas or neuropathies. Although the aetiology remains unclear, MO is supposed to be an osteoblast metaplasia with a benign and self-limiting course. Remarkably, at onset MO can be clinically, radiologically and histologically indistinguishable to soft tissue malignancies, especially in cases lacking a history of trauma, leading to misdiagnoses and improper treatments. Case presentation: A 13-year-old male was referred to the Oncology Department because of a previous diagnosis of osteogenic sarcoma of his left thigh. The diagnosis was made upon a history of isolated thigh pain in the absence of traumas, the evidence of a contrast-enhanced soft tissue mass on magnetic resonance imaging and the histological findings of atypical nuclei and mitotic figures. The lesion was eventually radiologically unchanged after five cycles of chemotherapy; thus, the child was referred for radical surgery. At admission, endorsing the child wellappearance, together with the evidence of a reduced calcified lesion on a further magnetic resonance, a clinical suspicion of myositis ossificans was raised. Hence, the excisional biopsy confirmed the pathognomonic zonal pattern of myositis ossificans. Conclusions: This case highlights some frequent diagnostic pitfalls facing myositis ossificans. A lacking history of traumas, along with a too early radiological and histological evaluation can lead to a misdiagnosis of soft tissue malignancies. Even in the absence of a clear history of trauma, a painful soft tissue swelling with a benign clinical course should raise the suspicion of myositis ossificans.

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