Medical Terms Learned today

pics 127x173 mm (5x7 inch)-203x254 mm (8x10 inch)
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Definition

More abstract quality suggested by Geneve researchers in the field of medical education.⁽¹⁾ In this way, two or more attributes are transformed into semantic qualifiers for building a global sense or representation. This may facilitate the next step in the process of diagnosis.

(1)Nendaz MR, Bordage G. Promoting diagnostic problem representation. Med Educ. 2002;36(8):760-6. 2002

For temporary archive for the papers regarding angiogensis and MRI.

Enchondroma

The most common neoplasm of the small bones in the hands and feet, accounting for 10-25% of cases. The age distribution is wide, ranging from 5-80 years. The long tubular bone, e.g. proximal humerus and femur are second common site. Uncommon in the flat bones. The tumours are usually located in the metaphysis, showing matrix calcification with well-defined margin. The minute endosteal erosion may be seen. In case of extensive erotion, low grade chondrosarcoma should be considered in the differential diagnosis. Macroscopically, most tumours measure less than 3cm. They frequently have a multinodular architecture, with nodules separated by trabecula of bone marrow.

Periosteal enchondroma

Uncommon benign cartilage tumours arising from thr periosteum, accounting for less than 2% of the cases. Proximal humerus is characterstic location. Occasionally, they can be more cellular and show greater degree of nuclear pleomorphism and binucleation.

J Hand Surg [Br]. 1997 Apr;22(2):235-6.
Arch Orthop Trauma Surg. 2002 Jul;122(6):369-70. Epub 2002 Feb 23.

Synonyms: plasma cell granuloma, plasma cell pseudotumor, inflammatory myofibrohistiocytic proliferation, omental myxoid hamartoma, inflammatory pseudo tumour

IMT is a distinctive lesion composed of myofibroblastic spindle cells accompanied by an inflammatory infiltrate, in children and young adults, with mean age of 10 years.
Common sites are the lungs, mesentery, omentum. Constitutinal symptoms is frequent, fever, growth failure, malaise, weight loss, anemia are seen in up to one-third of patients. Imaging findings include lobulated solid mass, inhomogenous, calcification.
Mean diameter is 6 cm with a range of 1 to 17 cm. ICH: positive for vimentin (diffuse cytoplasmic), SMA, MSA, desmin. Focal reactivity for cytokeratin is seen in approximately one- third of cases. Negative for myogenin, myoglobin, S100 protein, CD117 (KIT). In younger cases, ALK (Anaplastic Lymphoma Kinase) 1 rearrangement is frequently detected. Subset of IMT without ALK activation may show the rearrangements of HMGIC (HMGA2) gene.

Smooth Muscle Tumours

Angioleiomyoma (angiomyoma, vascular leiomyoma)

4.4 % of benign soft tissue tumours. Most angioleiomyomas occur in the extremities, especially the lower extremities. Between fouth and sixth decades. Painful lesion. most are less than 2 cm. Three histologic subtypes: Solid (66%), venous (23%), cavernous (11%). IHC: positive for SMA, vimentin, collagen type IV. Negative for HMB-45.

Leiomyoma of deep soft tissue

Leiomyomas of deep soft tissue are very rare and the existence of them are controversial. THey arise in the deep subcutis or skeletal muscles of the extremities. They affect both sexes equally, whereas those arising in the retroperitoneum or abdominal cavity occur exclusively in women.Mean diameter 7.7 to 16.2 cm. Mitoses number is less than 1/50 HPF. In peritoneal / retroperitoneal lesions in female, mitose may be up to 5/50 HPF. No necrosis.ICH: positive for actin, desmin, h-caldesmon. Negative for S100. Local recurrence is rare.

Leiomyosarcoma

Soft tissue leiomyosarcomas occurs usually in middle-aged or older women. Leiomyosarcoma is predominant sarcoma arising in retroperitoneum or large blood vessels. Majority of retropetitoneal and inferior cena cava leiomyosarcomas occurs in women. Sarcomas of pulmonary artery other larger artery do not have the features of leiomyosarcoma, and most of them are better classified as intimal sarcoma. Tumours in inferior vena cava may obstruct hepatic vein, producing the Budd-Chiari syndrome. The tumour margin is commonly well-circumscribed, although infiltrativeness may be found. Histopathology may reveal hemangiopericytoma-like arrangement, myxoid change, necrosis,hyalinization, and non specific defifferentiated pattern. IHC: Positive for SMA, desmin, h-caldesmon. Although not absolutely specific, positivity for two of them are supportive. Negative for KIT(CD117), in contrast to GIST. Regional lymph node metastases are rare. Metastases occurs in the lungs, liver, skin, soft tissue, and bone. In immunocompromised patients, leiomyosarcoma may arise in parenchymal organs. They are predominant in children and young adults and are associated with EB virus. They may be multifocal.

Paal 2001
Kilpatrick 1994

Fibromas of the tendon sheath mainly involve the fingers, hands, and wrists [1, 2, 3, 4, 5 and 6]. Seventy-five to 82% of the tumors are found in these locations [1 and 2]. Fibromas of the tendon sheath comprise approximately 3% of soft tissue tumors in the hands and fingers [6]. The tumor usually forms as a slow-growing, firm, painless, small nodule in association with tendons and tendon sheaths. Male patients outnumber females with a ratio of 1.5–3:1 [1 and 2]. The peak incidence of the tumor is in the third to fourth decade [1 and 2].

AJR Am J Roentgenol. 2003 May;180(5):1449-53
MR imaging of fibroma of the tendon sheath.
Fox MG, Kransdorf MJ, Bancroft LW, Peterson JJ, Flemming DJ.
Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224-3899, USA.
OBJECTIVE: The purpose of our study was to describe the MR imaging characteristics of fibroma of the tendon sheath. CONCLUSION: The diagnosis of fibroma of the tendon sheath can be suggested when MR imaging reveals a focal nodular mass adjacent to a tendon sheath with decreased signal on all pulse sequences and little or no enhancement.

tendon sheath fibroma

Immunochemistry:

vimentin +
muscle-ŝpecific actin +
smooth muscle actin +
desmin -
CD68 +/-
factor XIIIa +
CD34 +

Differential diagnosis

fibrous histiocytoma
nodular fasciitis
giant cell tumor of the tendon sheath
if nuclear pleomorphism: malignant fibrous histiocytoma

Cytogenetics

transclocations involving chromosome 2
http://www.humpath.com

1. EB Chung and FM Enzinger, Fibroma of tendon sheath. Cancer 44 (1979), pp. 1945–1954. Abstract-EMBASE
| Abstract-MEDLINE

2. DR Pulitzer, PC Martin and RJ Reed, Fibroma of tendon sheath. A clincopathologic study of 32 cases. Am J Surg Pathol 13 (1989), pp. 472–479. Abstract-EMBASE
| Abstract-MEDLINE

3. S Humphreys, PH McKee and CD Fletcher, Fibroma of tendon sheath. A clinicopathologic study. J Cutan Pathol 13 (1986), pp. 331–338. Abstract-EMBASE
| Abstract-MEDLINE

4. H Hashimoto, M Tsuneyoshi, Y Daimaru, M Ushijima and M Enjoji, Fibroma of tendon sheath. A tumor of myofibroblasts. A clinicopathologic study of 18 cases. Acta Pathol Jpn 35 (1985), pp. 1099–1107. Abstract-MEDLINE
| Abstract-EMBASE

5. PS Smith, AS Pieterse and J McClure, Fibroma of tendon sheath. J Clin Pathol 35 (1982), pp. 842–848. Abstract-EMBASE
| Abstract-MEDLINE

Osteoblastoma


Osteoblastoma vs. Osteoid Osteoma
inconsistent pain vs.persistent, nocturnal pain
irregular tissue pattern vs. regular pattern
>2 cm vs. < I cm
Osteoblastoma is a solitary, benign and self-limited tumor that produces osteoid and bone. The tumor occurs in the dorsal aspect of vertebrae, the metaphysis or diaphysis of long bones, and rarely in the pelvis. In the spine, the tumor is usually located in the posterior processes while the vertebral bodies are spared. The differential diagnosis of osteoblastoma includes osteoid osteoma, osteosarcoma, giant cell tumor and aneurysmal bone cyst.
The common symptoms are pain of long duration, swelling and tenderness. Tumors of the spine can cause scoliosis and neurological symptoms.
On x-ray, osteoblastomas appear as a radio-lucent defect with a central density due to ossification. The lesion is well circumscribed and may have a surrounding sclerosis. The tumor demonstrates increased isotope
uptake on bone scan.
On gross examination, osteoblastomas are red to tan in color with hemorrhagic areas. The compact tissue is granular, friable and gritty. Hyperemia is particularly evident in the spongy bone of vertebrae, ribs and the pelvis.
The classic microscopic finding of osteoblastoma is irregular spicules of mineralized bone and eosinophilic osteoid rimmed by osteoblasts. The vascular stroma is characterized by pleomorphic spindle cells. The tumor cells differentiate into osteoblasts which make varying amounts of osteoid and woven bone. Cartilage production is a very rare finding in an osteoblastoma and should raise the suspicion of osteosarcoma.
A biopsy is usually performed to confirm the diagnosis. Surgical resection by curettage, intralesional excision or en-bloc excision are all treatment options depending on the site. Cryosurgery, radiation and chemotherapy may have a role in aggressive and surgically unresectable lesions of the spine.

Very rare in children below 10 years. Dominant in age of 20 and 45.

Radiological grading system
Type 1: 'quiescent', well-defined margin with sclerotic rim.
Type 2: 'active', well-defined margin w/o sclertotic rim, expansile.
Type 3: 'aggressive, ill-defined margin with cortical destruction.
* no relation with histologic finding.
> Matrix calcification occasionaly in long standing case.
> Giant cells are not neoplstic. Mono-nuclear cells are thought to be neoplastic.
> They produce RANKL, which stimulates formation and maturation of osteoclasts from osteoclast precursors.
> ABC formation occurs in 10% of cases.
> In one-third of cases, intravascular plugs are found (not prognostic significance)
Local reccure occurs in approximately 25% of patients.

ML of the bone.
Primary ML of the bone usually lack B symptoms.
Large proportion of the bone is involved.
Most of them are of the large B cell type (92%).
"Fish-Flesh appearance" means fish meat like colour/touch of specimens.

Recapitulate:
recapitulate
SYLLABICATION: re·ca·pit·u·late
PRONUNCIATION: AUDIO: rk-pch-lt KEY
VERB: Inflected forms: re·ca·pit·u·lat·ed, re·ca·pit·u·lat·ing, re·ca·pit·u·lates
TRANSITIVE VERB: 1. To repeat in concise form.
2. Biology To appear to repeat (the evolutionary stages of the species) during the embryonic development of the individual organism.
INTRANSITIVE VERB: To make a summary.
ETYMOLOGY: Latin recapitulre, recapitult- : re-, re- + capitulum, main point, heading, diminutive of caput, capit-, head. See kaput- in Appendix I.
OTHER FORMS: re·ca·pitu·lative, re·ca·pitu·la·tory (-l-tôr, -tr) —ADJECTIVE

1. Plasma Cell Myeloma
Usually osteolytic. Osteosclerotic lesions are associated with peripheral neuropathy (POEMS syndrome).
Russel bodies are extracellular globules of polymerized immunoglobulines.
Mott cells have characteristic vacuoles.
CD38 is distinct antigen. CD138 is reliable marker for differentiating normal and neoplastic plasma cells.

Diagnostic criteria of solitary myeloma.
> A single tumour in the bone marrow.
> Solitary osteolytic lesion.
> Absence of other lesions on whole bone survey.
> No evidence of plasmacytosis in the bone marrow.