IntroductionSeroma development is a known complication following extremity and trunk soft-tissue sarcoma (STS) resection. The purpose of this study is to evaluate and characterize seroma outcomes and the development of associated complications.MethodsA retrospective review of 123 patients who developed postoperative seromas following STS resection at a single institution was performed. Various patient and surgical factors were analyzed to determine their effect on overall seroma outcomes.Results77/123 seromas (62.6%) were uncomplicated, 30/123 (24.4%) developed infection, and 16/123 (13.0%) were symptomatic and required aspiration or drainage for symptom relief at an average of 12.2 months postoperatively. 65/123 (52.8%) seromas resolved spontaneously at an average time of 12.41 months. Seromas in the lower extremity (p=0.028), surgical resection volume >864 cm3, (p=<0.001) and initial seroma volume >42 cm3 (p=<0.001) increased the likelihood of infection. 90% of infected seromas developed the infection within the first three months following initial resection. No seromas which were aspirated or drained ultimately developed an infection following these procedures, though 50% recurred. DiscussionMost seromas following STS resection are uncomplicated and do not require intervention, though a large resection cavity >864 cm3 and a large seroma volume >42 cm3 are risk factors for complications.

RATIONALE AND OBJECTIVES:Diagnostic radiology residents may participate in an annual diagnostic imaging tournament that enables residents to engage in friendly competition, network with peers, and practice for board examinations. Medical students would likely enjoy a similar activity, which could increase their interest and knowledge in radiology. Given the lack of initiatives designed to promote competition and learning in medical school radiology education, we designed and implemented the RadiOlympics, the first known national medical student radiology competition in the United States. MATERIAL AND METHODS:A draft version of the competition was emailed to many medical schools in the United States. Medical students interested in assisting with implementation of the competition were invited to a meeting to refine the layout. Ultimately, the format of seven rounds of five questions each and a final round of ten questions all over four months was decided. Questions were written by students and approved by faculty. At the conclusion of the competition, surveys were sent out to gather feedback and gauge how this competition has influenced their interest in radiology. RESULTS:Out of 89 schools that were successfully contacted, 16 schools' radiology clubs agreed to participate, which made up 187 medical students on average per round. At the conclusion of the competition, feedback from students was very positive. Students' confidence in interpreting imaging studies increased after the competition (p < 0.001), although there was not an increased interest in radiology as a career (p = 0.77). CONCLUSION:The RadiOlympics is a national competition that can be successfully organized by medical students for medical students and is an engaging opportunity for medical students to be exposed to radiology.

Aim: To investigate the effect of knee osteoarthritis (OA) compartment location on pain relief following genicular radiofrequency ablation. Materials & methods: A retrospective chart review was performed on 62 patients. Visual analog scale scores at 3 and 6 months post procedure were compared with baseline and between compartment groups. Results: Pain significantly improved for all patients at 3 and 6 months (p < 0.001 and p = 0.005, respectively). Medial compartment OA was a significant predictor of improvement at 3 months (p = 0.042). Patellofemoral compartment OA was a significant predictor for a higher visual analog scale at 3 months (p = 0.018). Conclusion: Compartmental location of knee OA impacts pain relief following genicular radiofrequency ablation. Future protocols could target nerves based on which compartments are more affected on imaging.

Calcium pyrophosphate dihydrate (CPP) crystal deposition in the articular cartilage can often be seen radiographically as chondrocalcinosis (CC). CPP crystals preferentially deposit in fibrocartilages such as the knee menisci and symphysis pubis (SP). We sought to determine the prevalence of CC in the SP on computed tomography (CT) of the abdomen and pelvis. This retrospective study involved readings on 1070 consecutive CTs of the abdomen and pelvis performed over 3 months in patients over 65 years of age. Medical records of 226 patients found to have CC were reviewed to determine age, gender, documentation of CPPD on problem lists or in medical histories, and whether radiology readings of the CTs mentioned CC. SP CC was identified in 21.1 % (226/1070) of consecutive CT scans with the mean age of CT+ patients being 78.6. Of the 226 patients with SP CC, the observation of CC was documented in only 5.3 % (12/226) of the radiology reports. Of the 12 instances in which the radiology reports mentioned CC, this observation was never (0/12) transmitted to the medical history or problem list. The prevalence of SP CC in patients older than 65 was 21.1 %. Since the majority of CTs of the abdomen and pelvis are not ordered for evaluation of musculoskeletal conditions, this is likely a true prevalence without selection bias. When CC of the SP was present on images, radiologists routinely overlooked or chose not to report CC. Even in the rare instances when it was reported, that information was not added to the medical history or problem list. There are several clinical situations (e.g., acute monoarthritis or atypical osteoarthritis) in which recognizing that a patient has CPP deposition would be useful. Taking the time to review images may yield clinically important findings that are not mentioned anywhere on the patient chart.

Percutaneous biopsies allow for precise diagnosis in soft tissue sarcomas and have a low rate of complications. However, it is unknown whether biopsies performed in a community setting lead to higher rates of wound complications at the time of resection. The goal of this study was to determine whether percutaneous biopsies performed at a sarcoma center have lower rates of wound complications compared with those performed in the community setting. A total of 125 patients with soft tissue sarcomas were treated with neoadjuvant radiation followed by limb-sparing resection. Of these, 92 underwent percutaneous biopsy. Patient, demographic, and treatment variables and postoperative wound complications were reviewed. Predictors of wound complications were evaluated with Fisher's exact test for univariate analysis and with logistic regression for multivariate analysis. The wound complication rate was 27% for open or percutaneous biopsies. When only percutaneous biopsies were assessed, the wound complication rate was 25%. The wound complication rate for percutaneous biopsies was 18% when the biopsy was performed at the authors' sarcoma center and 46% when the biopsy was performed in the community setting (P=.01). The Common Terminology Criteria for Adverse Events grade 4 wound complication rate was 73% in patients who underwent percutaneous biopsy at a community hospital vs 14% in those who underwent percutaneous biopsy at the authors' sarcoma center (P=.005). Multivariate analysis showed that lower-extremity soft tissue sarcomas (P=.03) and biopsies performed in the community setting (P=.01) had an increased rate of postoperative wound complications. Percutaneous biopsies performed at community hospitals had an increased incidence of grade 4 postoperative wound toxicity compared with biopsies done at tertiary centers. These wound results confirmed previous recommendations that biopsy of soft tissue sarcomas should be performed at an experienced sarcoma center.

Avulsion injuries of the knee are common sequelae of significant trauma given the number of ligamentous and tendinous insertions around the joint. Commonly discussed avulsion fractures of the lateral knee include the Segond fracture of the lateral tibial plateau and the arcuate complex avulsion fracture of the fibular styloid process. A less common avulsion fracture is the iliotibial (IT) band avulsion fracture involving the anterolateral corner of the tibia (Gerdy’s tubercle). It is crucial to identify IT band avulsion fractures because of the frequent associated internal derangements of the knee. This case report describes the imaging of an acute IT band avulsion fracture and compares these findings with other lateral knee avulsion fractures.

A variety of conditions can produce clinical and imaging appearances similar to articular masses. MRI is the imaging method of choice for detection and characterization of articular mass-like lesions. Although many of these lesions have nonspecific findings at MRI, careful analysis of lesion morphology and signal characteristics helps to narrow the differential diagnosis. This CME article will aid radiologists to recognize important MRI findings that help to diagnose and characterize articular mass-like lesions.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a promising imaging technique that allows measurement of tumor kinetics indirectly. The feasibility and importance of DCE-MRI kinetics in soft tissue sarcomas (STS) who undergo neoadjuvant therapy (NAT) remains to be determined. The goal of this study was to prospectively examine kinetic parameters of patients (pts) with STS who received preoperative therapy. A prospective study was performed on 11 pts with STS of the extremity who underwent neoadjuvant radiation (RT) +/- chemotherapy. Imaging was performed on a 3T scanner prior to and after RT. A 3D VIBE sequence was used to acquire DCE images before, during, and after injection of contrast. Pharmacokinetic (PK) parameters: ktrans, kep, ve, and vp were obtained from linear least squares fitting of the extended Tofts model to DCE concentration-time curves. Also, semi-quantitative (SQ) parameters: peak height, time to peak, uptake rate, washout rate, and initial area under the curve 60 seconds post-injection (IAUC60) were obtained from the normalized DCE signal-time courses. Mean PK and SQ parameter estimates in tumor were obtained from contours drawn on delta T1 images, generated to eliminate confounding effects of incomplete fat suppression, flow, and blood products on post-contrast T1 images. Median age at diagnosis was 55. Median radiation therapy dose was 50 Gy. Three of the 11 pts received neoadjuvant chemotherapy consisting of adriamycin-ifosfamide. Two pts had myxoid liposarcoma, 3 had spindle cell sarcoma, 3 had undifferentiated sarcoma, 1 had epithelioid sarcoma, 1 had leiomyosarcoma, and 1 had a malignant peripheral nerve sheath tumor. The median preoperative, post-operative and change in PK and SQ parameters are listed in Table. All PK parameters, except ve, decreased after NAT. Of the SQ parameters, peak height, iAUC60 and uptake rate all decreased after NAT. Only iAUC60 (p = 0.02) and time to peak (p = 0.02) were significantly different after therapies sustained. Of the 11 patients, two demonstrated increased postoperative PK parameters estimates. Of these, both developed metastasis. This is the first report of DCE-MRI parameters in STS pts receiving NAT. Although more data is needed, this study suggests that increased postoperative PK parameters may serve as a metastatic biomarker for pts with STS undergoing NAT.Poster Viewing Abstract 3082; TableChange in kinetic and semi-quantitative parametersKinetic and semi-quantitative parametersMedian pre-radiation parametersMedian post-radiation parametersMedian change in parametersKtrans0.0250.020−0.028Kep0.1920.159−0.065ve0.3390.4240.061vp0.0010.002−0.001Peak height3.9991.731−0.766Time to peak163.003227.89458.703iAUC60133.17621.166−60.224Uptake rate0.0620.015−0.049Washout rate0.1780.1680.003 Open table in a new tab

Digital imaging combined with picture archiving and communication system (PACS) access allows detailed image retrieval and magnification. Calcium pyrophosphate dihydrate (CPPD) crystals preferentially deposit in fibrocartilages, the cartilage of the acromioclavicular (AC) joint being one such structure. We sought to determine if examination of the AC joints on magnified PACS imaging of chest films would be useful in identifying chondrocalcinosis (CC). Retrospective radiographic readings and chart reviews involving 1,920 patients aged 50 or more who had routine outpatient chest radiographs over a 4-month period were performed. Knee radiographs were available for comparison in 489 patients. Medical records were reviewed to abstract demographics, chest film reports, and diagnoses. AC joint CC was identified in 1.1 % (21/1,920) of consecutive chest films. Patients with AC joint CC were 75 years of age versus 65.4 in those without CC (p < 0.0002). Four hundred eighty-nine patients had knee films. Six of these patients had AC joint CC, and of these, five also had knee CC (83 %). Of the 483 without AC joint CC, 62 (12 %) had knee CC (p = 0.002). Patients with AC joint CC were more likely to have a recorded history of CPPD crystal deposition disease than those without AC joint CC (14 versus 1 %, p = 0.0017). The prevalence of AC joint CC increases with age and is associated with knee CC. A finding of AC joint CC should heighten suspicion of pseudogout or secondary osteoarthritis in appropriate clinical settings and, in a young patient, should alert the clinician to the possibility of an associated metabolic condition.

MRI is used to evaluate treatment response to neoadjuvant therapy for primary soft tissue sarcomas (STS) of the extremity and body wall. However, it is not well understood whether radiographic response predicts for treatment outcomes. The primary objective of this study was to evaluate whether radiographic changes following preoperative treatment predict for pathologic response and overall survival. Between 2003 and 2010, 62 patients (pts) with STS of the extremity and body wall, who were treated with neoadjuvant radiation (median dose 50 Gy in 25 fx) with or without neoadjuvant chemotherapy, had MRI's before and 3-4 weeks after neoadjuvant radiation therapy. Tumor and area of contrast enhancement were measured in the anterior-posterior, craniocaudal, and medio-lateral dimensions on T1-weighted sequences. Change in MRI volume was assessed for correlations with percent necrosis, viable cells, and fibrosis on final pathology. The Kaplan-Meier method was used to assess survival. ROC curve analysis was performed to assess the change in volume that best predicted for >70% necrosis. Median age was 56.5 years with a median size of 8.6 cm on MRI. Forty-eight pts (77%) had high grade, 2 pts (3%) had intermediate grade and 12 pts (19%) had low-grade tumors. 22 pts (35%) received neoadjuvant chemotherapy. The median change in MRI volume was a decrease in 15.08 cm3 after neoadjuvant therapy. An increase in MRI tumor volume after neoadjuvant therapy was associated with greater pathologic necrosis (R = 0.39, p = 0.001), less viable cells (R = -0.39, p = 0.005) and less fibrosis (R = -0.51, p < 0.001) on final pathology. High-grade tumors had more pathologic necrosis (R = 0.42, p < 0.001) and comprised the majority of pts with increases in volume following neoadjuvant treatment (87%). On ROC analysis, a tumor volume increase of at least 66% predicted for ≥70% necrosis on final pathology with 94% specificity (CI, 88-99%). At a median of follow-up of 33 months, the cumulative incidence of local failure and distant metastases were 3.2% and 27.4%, respectively. The 3-year disease-free survival and overall survival (OS) were 70% and 82%, respectively. In pts with an increase in tumor volume following neoadjuvant treatment, the 3-year OS was 65% compared to 93% in pts with a decrease in tumor volume (p = 0.004). In tumors with ≥70% pathologic necrosis, the 3-year OS was 38% compared to 91% if pathologic necrosis was <70% (p < 0.001). MR-based increase in tumor size after neoadjuvant radiation therapy with or without chemotherapy is associated with greater percent necrosis, less viable cells, and less fibrosis on final pathology. However, pts with tumor swelling and necrosis following neoadjuvant treatment are more likely to have high-grade tumors and a worse OS.

HomeRadioGraphicsVol. 32, No. 5 PreviousNext Musculoskeletal ImagingAIRP/AFIP ArchivesAIRP Best Cases in Radiologic-Pathologic Correlation: Intraosseous LipomaRajeev R. Mannem , Alan P. Mautz, Keith E. Baynes, Eduardo V. Zambrano, David M. KingRajeev R. Mannem , Alan P. Mautz, Keith E. Baynes, Eduardo V. Zambrano, David M. KingAuthor AffiliationsFrom the Departments of Radiology (R.R.M., A.P.M., K.E.B.), Pathology (E.V.Z.), and Orthopedic Surgery (D.M.K.), Medical College of Wisconsin and Froedtert Hospital, 9200 W Wisconsin Ave, Milwaukee, WI 53226.Address correspondence to R.R.M. (e-mail: [email protected]).Rajeev R. Mannem Alan P. MautzKeith E. BaynesEduardo V. ZambranoDavid M. KingPublished Online:Aug 31 2012https://doi.org/10.1148/rg.325115031MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In References1 Greenspan A. Orthopedic imaging: a practical approach. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2004; 677–679. Google Scholar2 Lam FC, Leung JL, Shu SJ, Chan AC, Chan MK, Fung DH. Intraosseous lipoma: report of 2 cases. J Hong Kong Coll Radiol 2004;7:145–148. Google Scholar3 Ozdemir H, Bozgeyik Z, Kocakoc E, Kalender O. MRI findings of intraosseous lipoma: case report. Magn Reson Imaging 2004;22(2):281–284. Crossref, Medline, Google Scholar4 Rosenberg AE, Bridge JA. Myogenic, lipogenic, neural, and epithelial tumours. In: Fletcher CDMUnni KKMertens F, eds. Pathology & genetics: tumours of soft tissue and bone. World Health Organization Classification of Tumours. Lyon, France: IARC, 2002; 328–329. Google Scholar5 Propeck T, Bullard MA, Lin J, Doi K, Martel W. Radiologic-pathologic correlation of intraosseous lipomas. AJR Am J Roentgenol 2000;175(3):673–678. Crossref, Medline, Google Scholar6 Murphey MD, Carroll JF, Flemming DJ, Pope TL, Gannon FH, Kransdorf MJ. From the archives of the AFIP: benign musculoskeletal lipomatous lesions. RadioGraphics 2004;24(5):1433–1466. Link, Google Scholar7 Milgram JW. Intraosseous lipomas: radiologic and pathologic manifestations. Radiology 1988;167(1):155–160. Link, Google Scholar8 Solak O, Esme H, Sahin DA, Aktepe F. Giant intraosseous lipoma of the rib. Thorac Cardiovasc Surg 2007;55(4):273–274. Crossref, Medline, Google ScholarArticle HistoryReceived: Feb 22 2011Revision requested: Mar 29 2011Revision received: May 25 2011Accepted: June 13 2011Published online: Aug 31 2012Published in print: Sept 2012 FiguresReferencesRelatedDetailsCited ByAggressive intraosseous lipoma of the scapula: A case reportNaohiroOka, KazuhikoHashimoto, YuShinyashiki, ShunjiNishimura, MasaoAkagi2023 | Experimental and Therapeutic Medicine, Vol. 26, No. 2Common Skeletal Neoplasms and Nonneoplastic Lesions at 18F-FDG PET/CTHoiwan Cheung, Alekhya Yechoor, Fatemeh Behnia, Alireza Behrad Abadi, Iman Khodarahmi, Maryam Soltanolkotabi, Mehrzad Shafiei, Majid Chalian, 17 December 2021 | RadioGraphics, Vol. 42, No. 1Untreated plasmacytoma of bone containing macroscopic intralesional fat and mimicking intraosseous lipoma: A case report and review of the literatureBarry G.Hansford, Christopher J.Hanrahan, NicoleGirard, RebeccaSilbermann, YoavMorag2020 | Clinical Imaging, Vol. 64Intraosseous lipoma of the clavicle with extraosseous extensionAna C.Belzarena, Lucas PaulPaladino, EvitaHenderson-Jackson, David M.Joyce2020 | Radiology Case Reports, Vol. 15, No. 6Intraosseous Lipoma of the SacrumScott PPatterson, DinaPatterson, Shaka MWalker2020 | Applied RadiologyComputed Tomography and Magnetic Resonance Imaging of Bone TumorsLauren M.Ladd, Trenton D.Roth2017 | Seminars in Roentgenology, Vol. 52, No. 4Benign and malignant tumors of the foot and ankleAdam D.Singer, AbhijitDatir, JonathanTresley, TravisLangley, Paul D.Clifford, JeanJose, Ty K.Subhawong2016 | Skeletal Radiology, Vol. 45, No. 3Diagnostic Imaging: Musculoskeletal Non-Traumatic Disease2016“Do Not Touch”: An Uncommon Benign Fatty Bone TumourSumer NShikhare, Wilfred CGPeh2016 | Annals of the Academy of Medicine, Singapore, Vol. 45, No. 9Recommended Articles Common Skeletal Neoplasms and Nonneoplastic Lesions at 18F-FDG PET/CTRadioGraphics2021Volume: 42Issue: 1pp. 250-267Pediatric Benign Bone Tumors: What Does the Radiologist Need to Know?: Pediatric ImagingRadioGraphics2017Volume: 37Issue: 3pp. 1001-1002Imaging Review of Normal and Abnormal Skeletal MaturationRadioGraphics2022Volume: 42Issue: 3pp. 861-879Imaging Spectrum of Calvarial AbnormalitiesRadioGraphics2021Volume: 41Issue: 4pp. 1144-1163Diagnostic and Imaging Approaches to Chest Wall LesionsRadioGraphics2022Volume: 42Issue: 2pp. 359-378See More RSNA Education Exhibits Pediatric Bone Tumors and Mimickers: Focused Imaging Overview with Pathologic CorrelationDigital Posters2019Deciphering Surface Bone LesionsDigital Posters2019Does This Make Me Look Fat? 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Purpose/Objective(s)Neoadjuvant radiotherapy (NRT) or chemoradiotherapy (NCRT) followed by limb-salvage surgery is an effective strategy to treat soft tissue sarcomas (STS). However, prognostic predictors for survival in patients treated with this approach remain to be determined.Materials/MethodsFrom May 1999 to July 2010, 112 patients with primary localized STS of extremity and trunk were treated with NRT or NCRT followed by surgery at our institution. Each patient had an MRI of the primary tumor before and after neoadjuvant treatment. Tumor characteristics and treatment information were retrospectively reviewed. Tumor response on MRI was measured using the RECIST criteria. Clinical outcomes including overall survival (OS), disease-free survival (DFS), and distant metastasis free survival (DMFS) were calculated using Kaplan-Meier survival analyses. Prognostic variables were determined by univariate (UVA) and multivariate analyses (MVA).ResultsMedian follow-up was 37 months (range, 6-124 months). Median RT dose was 50.4 Gy. Fifty-one (46%) patients received NCRT (Doxorubicin-Ifosfamide based regimen), and 14 (12.5%) patients received adjuvant chemotherapy. The most common histology was malignant fibrous histiocytoma (30.4%), with the proximal thigh as the most common primary site (64.3%). Median tumor size was 8.6 cm. Overall limb-preservation rate was 99% and local control was 97%. The estimated 3-year OS, DFS, and DMFS were 86%, 68%, and 72%, respectively. Ninety-two percent of patients had negative margins upon wide local excision. MRI-based tumor response showed 2% of patients had a complete response, 11% had a partial response, 76% had stable disease, and 11% had progressive disease. Examination of necrosis on final pathology revealed 8.9% of patients had 100% necrosis, 12.5% had ≥99%, 22.6% had ≥95%, 18.9% had 80-94%, 18.9% had 50-79%, and 39.6% had < 50% necrosis after neoadjuvant treatment. Neither percentage necrosis or MRI-based tumor response significantly impacted OS, DFS, or DMFS on UVA or MVA. Moreover, tumor site, grade, stage, median change in MRI volume and the addition and number of chemotherapy cycles did not correlate with OS. However, both neoadjuvant chemotherapy and Stage 1 and 2 vs. 3 were significant in terms of DFS (p = 0.028 and p = 0.005, respectively) and DMFS (p = 0.024 and p = 0.003, respectively) by MVA.ConclusionsExcellent rates of local control and limb-preservation were observed in patients with primary STS of the extremity and trunk treated with NRT or NCRT followed by surgery. None of the examined variables alone were found to be prognostic for survival. However, results of the MVA suggest that neoadjuvant chemotherapy may be considered for patients with Stage III STS (high grade and large tumor size) of the extremity and trunk. Purpose/Objective(s)Neoadjuvant radiotherapy (NRT) or chemoradiotherapy (NCRT) followed by limb-salvage surgery is an effective strategy to treat soft tissue sarcomas (STS). However, prognostic predictors for survival in patients treated with this approach remain to be determined. Neoadjuvant radiotherapy (NRT) or chemoradiotherapy (NCRT) followed by limb-salvage surgery is an effective strategy to treat soft tissue sarcomas (STS). However, prognostic predictors for survival in patients treated with this approach remain to be determined. Materials/MethodsFrom May 1999 to July 2010, 112 patients with primary localized STS of extremity and trunk were treated with NRT or NCRT followed by surgery at our institution. Each patient had an MRI of the primary tumor before and after neoadjuvant treatment. Tumor characteristics and treatment information were retrospectively reviewed. Tumor response on MRI was measured using the RECIST criteria. Clinical outcomes including overall survival (OS), disease-free survival (DFS), and distant metastasis free survival (DMFS) were calculated using Kaplan-Meier survival analyses. Prognostic variables were determined by univariate (UVA) and multivariate analyses (MVA). From May 1999 to July 2010, 112 patients with primary localized STS of extremity and trunk were treated with NRT or NCRT followed by surgery at our institution. Each patient had an MRI of the primary tumor before and after neoadjuvant treatment. Tumor characteristics and treatment information were retrospectively reviewed. Tumor response on MRI was measured using the RECIST criteria. Clinical outcomes including overall survival (OS), disease-free survival (DFS), and distant metastasis free survival (DMFS) were calculated using Kaplan-Meier survival analyses. Prognostic variables were determined by univariate (UVA) and multivariate analyses (MVA). ResultsMedian follow-up was 37 months (range, 6-124 months). Median RT dose was 50.4 Gy. Fifty-one (46%) patients received NCRT (Doxorubicin-Ifosfamide based regimen), and 14 (12.5%) patients received adjuvant chemotherapy. The most common histology was malignant fibrous histiocytoma (30.4%), with the proximal thigh as the most common primary site (64.3%). Median tumor size was 8.6 cm. Overall limb-preservation rate was 99% and local control was 97%. The estimated 3-year OS, DFS, and DMFS were 86%, 68%, and 72%, respectively. Ninety-two percent of patients had negative margins upon wide local excision. MRI-based tumor response showed 2% of patients had a complete response, 11% had a partial response, 76% had stable disease, and 11% had progressive disease. Examination of necrosis on final pathology revealed 8.9% of patients had 100% necrosis, 12.5% had ≥99%, 22.6% had ≥95%, 18.9% had 80-94%, 18.9% had 50-79%, and 39.6% had < 50% necrosis after neoadjuvant treatment. Neither percentage necrosis or MRI-based tumor response significantly impacted OS, DFS, or DMFS on UVA or MVA. Moreover, tumor site, grade, stage, median change in MRI volume and the addition and number of chemotherapy cycles did not correlate with OS. However, both neoadjuvant chemotherapy and Stage 1 and 2 vs. 3 were significant in terms of DFS (p = 0.028 and p = 0.005, respectively) and DMFS (p = 0.024 and p = 0.003, respectively) by MVA. Median follow-up was 37 months (range, 6-124 months). Median RT dose was 50.4 Gy. Fifty-one (46%) patients received NCRT (Doxorubicin-Ifosfamide based regimen), and 14 (12.5%) patients received adjuvant chemotherapy. The most common histology was malignant fibrous histiocytoma (30.4%), with the proximal thigh as the most common primary site (64.3%). Median tumor size was 8.6 cm. Overall limb-preservation rate was 99% and local control was 97%. The estimated 3-year OS, DFS, and DMFS were 86%, 68%, and 72%, respectively. Ninety-two percent of patients had negative margins upon wide local excision. MRI-based tumor response showed 2% of patients had a complete response, 11% had a partial response, 76% had stable disease, and 11% had progressive disease. Examination of necrosis on final pathology revealed 8.9% of patients had 100% necrosis, 12.5% had ≥99%, 22.6% had ≥95%, 18.9% had 80-94%, 18.9% had 50-79%, and 39.6% had < 50% necrosis after neoadjuvant treatment. Neither percentage necrosis or MRI-based tumor response significantly impacted OS, DFS, or DMFS on UVA or MVA. Moreover, tumor site, grade, stage, median change in MRI volume and the addition and number of chemotherapy cycles did not correlate with OS. However, both neoadjuvant chemotherapy and Stage 1 and 2 vs. 3 were significant in terms of DFS (p = 0.028 and p = 0.005, respectively) and DMFS (p = 0.024 and p = 0.003, respectively) by MVA. ConclusionsExcellent rates of local control and limb-preservation were observed in patients with primary STS of the extremity and trunk treated with NRT or NCRT followed by surgery. None of the examined variables alone were found to be prognostic for survival. However, results of the MVA suggest that neoadjuvant chemotherapy may be considered for patients with Stage III STS (high grade and large tumor size) of the extremity and trunk. Excellent rates of local control and limb-preservation were observed in patients with primary STS of the extremity and trunk treated with NRT or NCRT followed by surgery. None of the examined variables alone were found to be prognostic for survival. However, results of the MVA suggest that neoadjuvant chemotherapy may be considered for patients with Stage III STS (high grade and large tumor size) of the extremity and trunk.

Adamantinoma is a rare neoplasm that characteristically involves the tibia. In many instances, typical location within the tibia, very slow course, and a typical radiographic appearance can strongly suggest the correct diagnosis. We present a case that has both unusual radiographic findings and uncharacteristic histology. In this case, radiologic imaging showed a poorly defined lytic lesion within the distal, lateral tibia extending to the joint with central necrosis, overlying periosteal reaction and possible tumor spread into soft tissue. The histology of this lesion showed pronounced vascularity and surrounding large neoplastic cells with plasmacytoid morphology. The combination of these features led to an initial misdiagnosis as metastatic carcinoma from unknown primary.

Fracture of the fabella is rare, may be easily overlooked, and can be a clinically important cause of posterolateral knee pain following traumatic injury or total knee arthroplasty. To date, nine case reports of fabella fracture with radiographic documentation have been reported in the literature. This report documents a 55-year-old male pedestrian who was struck by an automobile and presented with radiographs demonstrating depressed lateral tibial plateau and proximal fibula fractures. Computed tomography (CT) was performed for surgical planning and demonstrated the additional finding of a radiographically occult nondisplaced fabella fracture. To the best of our knowledge, this is the first case in which CT documentation of a fabella fracture is reported. Fracture of the fabella is a rare but important clinical entity which may be overlooked clinically and radiographically. Clinical information can provide a high index of suspicion, and when coupled with radiographic and CT findings, may lead to the correct diagnosis. CT imaging of the knee may confirm a suspected fabella fracture or may help detect a radiographically occult fracture.