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Upadhyay N.,Imperial College London | Saifuddin A.,The Royal National Orthopaedic Hospital NHS Trust
Skeletal Radiology | Year: 2015

Gout has been termed the “great mimicker”, for its ability to resemble other pathological conditions. Whilst the typical imaging features of gout are well described, there is a relative paucity of literature describing more challenging cases of gout, where a malignant tumour has been considered in the differential diagnosis. The aim of this article is to provide an overview of the radiographic and MRI features of 27 cases of gout that were initially referred to our centre as suspected soft tissue sarcoma, alongside a review of the literature. © 2014, ISS.


Rose B.,The Royal National Orthopaedic Hospital NHS Trust | Tamvakopoulos G.S.,The Royal National Orthopaedic Hospital NHS Trust | Dulay K.,The Royal National Orthopaedic Hospital NHS Trust | Pollock R.,The Royal National Orthopaedic Hospital NHS Trust | And 3 more authors.
Journal of Orthopaedic Surgery and Research | Year: 2011

Background: Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue neoplasm with a deceptively benign histological appearance. Local recurrences and metastases can manifest many years following excision. The FUS-CREB3L2 gene translocation, which occurs commonly in LGFMS, may be detected by reverse-transcriptase polymerase chain reaction (RT-PCR) and fluorescence in situ hybridisation (FISH). We assessed the relationship between clinical outcome and translocation test result by both methods.Methods: We report genetic analysis of 23 LGFMS cases and clinical outcomes of 18 patients with mean age of 40.6 years. During follow-up (mean 24.8 months), there were no cases of local recurrence or metastasis. One case was referred with a third recurrence of a para-spinal tumour previously incorrectly diagnosed as a neurofibroma.Results: Results showed 50% of cases tested positive for the FUS-CREB3L2 translocation by RT-PCR and 81.8% by FISH, suggesting FISH is more sensitive than RT-PCR for confirming LGFMS diagnosis. Patients testing positive by both methods tended to be younger and had larger tumours. Despite this, there was no difference in clinical outcome seen during short and medium-term follow-up.Conclusions: RT-PCR and FISH for the FUS-CREB3L2 fusion transcript are useful tools for confirming LGFMS diagnosis, but have no role in predicting medium-term clinical outcome. Due to the propensity for late recurrence or metastasis, wide excision is essential, and longer-term follow-up is required. This may identify a difference in long-term clinical outcome between translocation-positive and negative patients. © 2011 Rose et al; licensee BioMed Central Ltd.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: Journal Article | Journal: Foot (Edinburgh, Scotland) | Year: 2012

Ankle arthritis is a cause of major disability; however reports in the literature on the incidence of ankle osteoarthritis are rare.To explore the methodological challenges in obtaining an incidence of ankle osteoarthritis and to estimate the incidence of symptomatic osteoarthritis presenting to Foot & Ankle specialists in the UK.We searched available national diagnosis databases and also sent out a questionnaire-based survey to all Consultant members of the British Orthopaedic Foot & Ankle Society (n=180).123 completed survey questionnaires were returned (68%) with each surgeon seeing on average 160 cases of symptomatic ankle arthritis and performing on average 20 definitive procedures for end-stage ankle osteoarthritis per year. There are no internationally agreed diagnostic or treatment codes specific for ankle osteoarthritis.There are an estimated 29,000 cases of symptomatic ankle osteoarthritis being referred to specialists in the UK, representing a demand incidence of 47.7 per 100,000. 3000 definitive operations to treat end stage ankle osteoarthritis take place in the UK annually. We recommend that specific codes pertaining to ankle arthritis and its treatment be included in any future revisions of the WHO International Classification of Diseases (ICD) and operative procedure coding systems.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: Journal Article | Journal: Skeletal radiology | Year: 2010

Magnetic resonance imaging is the modality of choice for investigation of internal derangement of the knee. The reporting radiologist must be familiar with both normal anatomy and anatomical variants within the knee, in order to avoid mis-diagnosis, over-investigation and unnecessary intervention. This article reviews the recognised anatomical variants of the non-ligamentous/musculotendinous structures of the knee, their anatomy, incidence and typical appearances on MRI.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: Comparative Study | Journal: European radiology | Year: 2013

To identify magnetic resonance imaging (MRI) features which differentiate low-grade chondral lesions (atypical cartilaginous tumours/grade 1 chondrosarcoma) from high-grade chondrosarcomas (grade 2, grade 3 and dedifferentiated chondrosarcoma) of the major long bones.We identified all patients treated for central atypical cartilaginous tumours and central chondrosarcoma of major long bones (humerus, femur, tibia) over a 13-year period. The MRI studies were assessed for the following features: bone marrow oedema, soft tissue oedema, bone expansion, cortical thickening, cortical destruction, active periostitis, soft tissue mass and tumour length. The MRI-features were compared with the histopathological tumour grading using univariate, multivariate logistic regression and receiver operating characteristic curve (ROC) analyses.One hundred and seventy-nine tumours were included in this retrospective study. There were 28 atypical cartilaginous tumours, 79 grade 1 chondrosarcomas, 36 grade 2 chondrosarcomas, 13 grade 3 chondrosarcomas and 23 dedifferentiated chondrosarcomas. Multivariate analysis demonstrated that bone expansion (P=0.001), active periostitis (P=0.001), soft tissue mass (P<0.001) and tumour length (P<0.001) were statistically significant differentiating factors between low-grade and high-grade chondral lesions with an area under the ROC curve of 0.956.On MRI, bone expansion, active periostitis, soft tissue mass and tumour length can reliably differentiate high-grade chondrosarcomas from low-grade chondral lesions of the major long bones. Accurate differentiation of low-grade from high-grade chondrosarcomas is essential before surgery MRI can reliably differentiate high-grade from low-grade chondrosarcomas of long bone Differentiating features are bone expansion, periostitis, soft tissue mass and tumour length Presence of these four MRI features demonstrated a diagnostic accuracy (AUC) of 95.6% The findings may result in more accurate diagnosis before definitive surgery.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: | Journal: International journal of surgical oncology | Year: 2012

Chondrosarcoma is the second most common primary malignant bone tumour. Distinguishing between grades is not necessarily straightforward and may alter the disease management. We evaluated the correlation between histological grading of the preoperative image-guided needle biopsy and the resection specimen of 78 consecutive cases of chondrosarcoma of the femur, humerus, and tibia. In 11 instances, there was a discrepancy in histological grade between the biopsy and surgical specimen. Therefore, there was an 85.9% (67/78) accuracy rate for pre-operative histological grading of chondrosarcoma, based on needle biopsy. However, the accuracy of the diagnostic biopsy to distinguish low-grade from high-grade chondrosarcoma was 93.6% (73/78). We conclude that accurate image-guided biopsy is a very useful adjunct in determining histological grade of chondrosarcoma and the subsequent treatment plan. At present, a multidisciplinary approach, comprising experienced orthopaedic surgeons, radiologists, and pathologists, offers the most reliable means of accurately diagnosing and grading of chondrosarcoma of long bones.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: | Journal: Journal of orthopaedic surgery and research | Year: 2011

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft-tissue neoplasm with a deceptively benign histological appearance. Local recurrences and metastases can manifest many years following excision. The FUS-CREB3L2 gene translocation, which occurs commonly in LGFMS, may be detected by reverse-transcriptase polymerase chain reaction (RT-PCR) and fluorescence in situ hybridisation (FISH). We assessed the relationship between clinical outcome and translocation test result by both methods.We report genetic analysis of 23 LGFMS cases and clinical outcomes of 18 patients with mean age of 40.6 years. During follow-up (mean 24.8 months), there were no cases of local recurrence or metastasis. One case was referred with a third recurrence of a para-spinal tumour previously incorrectly diagnosed as a neurofibroma.Results showed 50% of cases tested positive for the FUS-CREB3L2 translocation by RT-PCR and 81.8% by FISH, suggesting FISH is more sensitive than RT-PCR for confirming LGFMS diagnosis. Patients testing positive by both methods tended to be younger and had larger tumours. Despite this, there was no difference in clinical outcome seen during short and medium-term follow-up.RT-PCR and FISH for the FUS-CREB3L2 fusion transcript are useful tools for confirming LGFMS diagnosis, but have no role in predicting medium-term clinical outcome. Due to the propensity for late recurrence or metastasis, wide excision is essential, and longer-term follow-up is required. This may identify a difference in long-term clinical outcome between translocation-positive and negative patients.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: Journal Article | Journal: Skeletal radiology | Year: 2012

Benign cartilage tumours of bone are the most common benign primary bone tumours and include osteochondroma, (en)chondroma, periosteal chondroma, chondroblastoma and chondromyxoid fibroma. These neoplasms often demonstrate typical imaging features, which in conjunction with lesion location and clinical history, often allow an accurate diagnosis. The aim of this article is to review the clinical and imaging features of benign cartilage neoplasms of bone, as well as the complications of these lesions.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: Journal Article | Journal: Skeletal radiology | Year: 2013

Chondrosarcoma is the third most common primary malignant bone tumour. There are various histological subtypes of chondrosarcomas, of which conventional intramedullary chondrosarcoma is by far the most common. Rarer sub-types include clear cell chondrosarcoma, myxoid chondrosarcoma, mesenchymal chondrosarcoma and dedifferentiated chondrosarcoma. Chondrosarcoma is also classified into central, peripheral and periosteal, dependent upon the lesion site, and into primary chondrosarcoma if the lesion arises de novo and secondary chondrosarcoma if the tumour arises in a pre-existing lesion. The various subtypes of chondrosarcoma have characteristic imaging features that may aid diagnosis and may guide biopsy, therefore potentially preventing misdiagnosis. The aim of this article is to provide an overview of the pertinent clinical and imaging findings of the different forms of chondrosarcoma.


PubMed | The Royal National Orthopaedic Hospital NHS Trust
Type: Journal Article | Journal: Skeletal radiology | Year: 2010

Magnetic resonance imaging (MRI) is now the modality of choice for the investigation of internal derangement of the knee. Technological advances, including the wider availability of stronger magnets and new sequences, allows improved visualisation of smaller structures. Normal variants must be recognised as such, so that both over-investigation and mis-diagnosis are avoided. This article reviews both the well-recognised and the less common ligamentous and musculotendinous anatomical variants within the knee and illustrates their imaging characteristics on MRI.

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