Article

Soft-tissue metastases: their presentation and origin.

Royal Orthopaedic Hospital, Bristol Road South, Birmingham B312AP, UK.
The Bone & Joint Journal (Impact Factor: 2.8). 09/2009; 91(8):1083-5. DOI: 10.1302/0301-620X.91B8.21680
Source: PubMed

ABSTRACT In our database of 7935 patients referred for investigation of a soft-tissue mass, only 100 were found to have a soft-tissue metastasis (1.3%). Our aim was to define the clinical features of such patients and to identify the site of their primary tumour. The most common presentation was a painful lump, deep to the fascia, ranging between 2 cm and 35 cm (mean 8.3 cm) with 78% of the lumps located deep to the fascia. The mean age of the patients at presentation was 64 years (22 to 84) and there were almost equal numbers of men and women. Of 53 patients with a history of malignancy, 52 had metastases from the same primary (lung in 12, melanoma in ten, kidney in nine, gastrointestinal track in four, breast in five, bladder in four, and others in eight). The other 47 had no history of malignancy and the metastasis was the first presentation. The primary sites in these cases were the lung in 19, gastro-intestinal track in four, kidney in two, melanoma in nine, other in three, and unknown (despite investigations) in ten. There was no correlation between the site of the metastases and the primary tumour. Of the 7935 patients, 516 had a history of malignancy. Of these, only 10% had a soft-tissue metastasis, 29% had a benign diagnosis, 55% a soft-tissue sarcoma and 6% another malignancy. Patients with soft-tissue metastases have similar clinical features to those with soft-tissue sarcomas and should be considered for assessment at appropriate diagnostic centres for patients with suspicious soft-tissue lumps.

0 Bookmarks
 · 
110 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper describes custom designed VLSI coder and decoder, which transmit time division multiplexed (TDM) color signals at 32 Mbit/sec. Two-dimensional intraframe DPCM prediction, variable word length coding, and data buffer to smooth the data rate are devised on one coder chip. Reverse function are devised on one decoder chip. Test sequence is investigated for logic design purposes. Several techniques, e.g., double phased clock and prediction loop modification are employed to simplify the configuration and to ensure the operation rate of video processing.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cystic-appearing lesions are commonly seen in clinical practice at imaging of the extremities. However, only some of these lesions are truly cystic lesions (eg, ganglia or synovial cysts, bursae) and may be managed conservatively. Fluid-filled lesions usually have homogeneous high T2 signal at magnetic resonance (MR) imaging. A broad array of solid benign masses (eg, myxomas, peripheral nerve sheath tumors [PNSTs], certain vascular lesions, glomus tumors) and malignant solid masses (including undifferentiated pleomorphic sarcomas, myxofibrosarcomas, myxoid liposarcomas, synovial sarcomas, extraskeletal myxoid chondrosarcomas, and, less frequently, soft-tissue metastases) may also exhibit bright T2 signal at MR imaging, thereby simulating a cyst. On the other hand, fluid-filled lesions with associated complications (eg, bleeding or inflammatory changes) may have a more complex appearance. MR imaging plays a major role in distinguishing truly cystic lesions from solid lesions. If a cystic-appearing lesion demonstrates wall thickening or internal complexity (heterogeneous signal, nodules, or thick septa), evaluation with contrast material enhancement is mandatory, and a solid lesion must be suspected if any internal enhancement is present. In addition to categorizing the lesions as truly cystic or solid, the differential diagnosis may be further narrowed by considering the anatomic location of the lesion or characteristic imaging features (eg, internal linear or patchy enhancement at contrast-enhanced MR imaging and an intramuscular location in myxomas; the "split fat sign," "string sign," and "target sign" in PNSTs; tiny foci of fat in myxoid liposarcomas). In most cases, however, histologic analysis is required to achieve a definitive diagnosis. © RSNA, 2013.
    Radiographics 05/2013; 33(3):833-855. DOI:10.1148/rg.333115062 · 2.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Positron emission tomography/computed tomography (PET/CT) is a hybrid imaging technique that combines the anatomic information from CT with the metabolic information acquired from PET after the administration of specific radiotracers, the most commonly used of which is F18-fluorodeoxyglucose (FDG). In oncology, this technique is based on the increased uptake of FDG by malignant lesions. In the locomotor apparatus, some uptake by bones and soft tissues is physiological or benign and this uptake must be differentiated from uptake by malignancies, whether primary or secondary. The most important limitations are active inflammatory or infectious processes, which are positive on PET images, and malignant lesions that are smaller than 1cm, cystic, necrotic, or low-grade, which are negative on PET images. PET/CT in the locomotor apparatus is especially useful for the detection of metastases from the most common tumors. It is also used for staging and monitoring the response to treatment of some hematological tumors like lymphoma, where it is fundamental to determine whether the bone marrow has been infiltrated, or myeloma. Lastly, although it is not yet an established indication, PET/CT is being increasingly used to study sarcomas, because it can provide additional information that can be useful for the characterization and grading of tumors, for guiding biopsies, for staging and re-staging, and for evaluating the response to neoadjuvant therapy as well as for evaluating new drugs in clinical trials.
    Radiología 09/2012; DOI:10.1016/j.rx.2012.07.002