Vol 17

Volume 17
Chondroid tumors (soft tissue)
Synovial chondromatosis---------Case 364-370 & 1243-5
Juxtaarticular chondroma---------Case 371-377 & 1246-7
2ndary synovial chondromatosis-Case 378-382 & 1248
Myxoid chondrosarcoma----------Case 383-385
Epithelioid sarcoma------------------Case 386-389
Soft tissue Ewing’s sarcoma--------Case 390-392
Clear cell sarcoma--------------------Case 393-394
Myositis ossificans-------------------Case 395-405
Pigmented villonodular synovitis---Case 406-416 & 1249
Intramuscular myxoma---------------Case 1258
Ganglion cyst--------------------------Case 1259-60
Soft tissue lympoma------------------Case 1261
Metastatic CA to soft tissue---------Case 1262-63

Chondroid Tumors
(soft tissue)

Synovial Chondromatosis
Synovial chondromatosis is a rare dysplasia seen in younger
patients. It is associated with metaplastic cartilage within the
synovial lining of major joints such as the hip, knee, shoulder and
elbow. It is twice as common in males as females and usually
occurs in patients in the 20-40 age group. It is a monarticular
disease that presents with symptoms of crepitation in the affected
joint with mild, intermittent effusion sometimes associated with
pain. Because of chronic irritation to the joint and damage to the
articular cartilage, osteoarthritis is an ultimate problem with this
disease and can lead to a total joint replacement at a later age. In
rare instances this condition can mutate into a secondary chondro-
sarcoma, usually around the hip or knee joint but seldom in the
shoulder area. This usually occurs in the later years of life.
In the early stages before the cartilage becomes calcified, the
synovial chondromatosis may be difficult to pick up on routine
radiographic examination. As time passes, the cartilage begins

to calcify in a typical chondroid pattern that suggests the diagnosis
of a chondroid tumor in or about a major joint. With excessive
proliferation, the cartilage can extrude out of the joint into adjacent
soft tissue, similar to what occurs with pigmented villonodular
synovitis. As the disease progresses, it is not unusual to see
enchondral ossification occurring within the cartilage when it is
still attached to the synovial lining and has access to a blood supply.
Multiple loose bodies are common with this disease and can run as
high as 200 pellets within a major joint that sometimes aggregrate
into a large mass that has the appearance of a chondrosarcoma.
Treatment consists of a surgical resection of the loose bodies as
well as a subtotal synovectomy of the tissue that produces the loose
bodies. Multiple surgical procedures may be required because of a
high recurrence rate. As in PVNS, it is not unusual to see a solitary
focus of synovial chondromatosis with the remaining synovial
lining being normal in appearance with only a solitary mass of
cartilage attached to the synovial lining. This localized nodular form

is more common about the hip, knee and ankle area. It is very
common to find loose bodies in a major arthritic joint in older
patients secondary to osteoarthritis where the joint cartilage is
broken away from the joint surface and than becomes reattached
to the synovial lining and gives the pseudo-appearance of primary
synovial chondromatosis when, in fact, the primary etiology in
this so-called secondary form is degenerative osteoarthritis. The
secondary form is seen in patients past the age of 50 years, where-
as the primary dysplastic form arising from the synovial lining
is seen during the first three to four decades of life.

CLASSIC Case #364

33 year male with synovial chondromatoasis of shoulder

Sagittal T-2 MRI showing multiple calcified cartilage bodies

Coronal T-2 MRI
showing loose bodies

Surgical exposure showing loose bodies

Loose bodies and synovial lining following surgery

Cartilaginous bodies arising from synovial lining

Cartilaginous body formation in synovial villus

Case #365

26 year male with
synovial chondromatosis
knee joint

Gross appearance of synovial chondromatosis

Microscopic evidence of cartilage elements in synovium

Case #366

28 year female with synovial chondromatosis knee

Photomic showing cartilage in synovial lining

Case #366.1

63 year female with long history of synovial chondromatosis

Case #366.2 Synovial chondromatosis

42 year female with grinding sensations in knee for years

Case #367

38 year male with synovial chondromatosis left hip

Sagittal T-2 MRI cut
showing loose bodies

Surgical removal of cartilage bodies

Photo of largest cartilage body

Case #368

24 year female with large cartilaginous pelvic mass
arising from synovial chondromatosis of left hip

tumor
tumor

Close up of deformed femoral neck

tumor

Note deformity of medial femoral neck

femoral N

Exposure of large pelvic tumor by removal ant pubic ramus

pubic groove

Resected cartilage masses and loose hip joint bodies

Cut specimen of one mass formed from compressed pellets

cartilage

Photomic of cartilage forming in synovial lining

Post op x-ray showing ramus surgical defect

9 years later with DOA requiring THA

Case #369

59 year male with
right hip for 20 years

5 years later with 2ndary
chondrosarcoma in
femoral neck

Frog leg lateral showing chondrosarcoma

Femoral head & neck specimen from THA showing
chondrosarcoma in lower neck area

chondrosarcoma

Synovectomy specimen obtained at time if THA

1 yr later we see recurrent tumor requiring hemipelvectomy

Case #370

50 year female with
25 year history of

Coronal T-2 MRI several years later with 2ndary chondrosarc

Case #370.1 Synovial chondromatosis

29 yr female with grinding sensation in elbow for years without inj.

Dedifferentiated
Case #370.1
Cor T-1 T-2 chondrosarcoma

60 yr male with swollen knee for years with recent increase in size

Case #1243

20 year female with
hip

Case #1244

26 year female with
hip

Photomic showing embryonic cartilage in synovial lining

Case #1245 Synovial Chondromatosis of Wrist

49 year female with synovial chondromatosis wrist

loose pellets

fluid

Sagittal T-1 MRI showing wrist effusion and loose pellets

Case #1245.1 Synovial Chondromatosis Wrist

66 yr male with recurrent soft tissue mass volar aspect of wrist
with two prior surgical resections over past 7 years

Axial PD Sag PD

Axial Gad Axial PD

CLASSIC Case #371

25 year old with juxta-articular chondroma posterior knee

Case #372

41 year male with juxta-articular chondroma ant knee

Case #372.1 Juxta-articular chondroma

60 yr female with lump in anterior knee area for years

Case #373

58 year male with juxta-articular chondroma posterior knee

Case #374 Sagittal T-1 MRI

tumor

37 year male with juxta-articular chondroma post knee

tumor

Sagittal gad contrast MRI with rim enhancement

tumor

Axial gad contrast with rim enhancement

Case #1248

36 year male with soft tissue chondrosarc behind knee

Case #375

13 year male with juxta-articular chondroma posterior knee

Case #376

18 year male with juxta-articular chondroma ankle

Case #376.1 Juxta-articular chondroma

38 old male with long history of catching sensations in ankle

Case #377

19 year male with tenosynovial chondromatosis

Case #377.1 Tenosynovial chondroma

45 yr. Female with a none tender lump in 2nd toe for years

Case #1247

44 year male with
solitary synovial
chondroma hip

Photomic from resected specimen

Secondary
Synovial
Chondromatosis

CLASSIC
Case #378

49 year female with
2ndary synovial
chondromatosis from
osteoarthritis of knee

AP x-ray

Axial proton
density MRI

fluid

Case 379 Coronal T-1 MRI

osteoarthritis

76 year male with 2ndary synovial chondromatosis knee

Sagittal T-2 MRI
showing loose
bodies in popliteal
synovial cyst

Axial T-2 MRI with loose body in popliteal cyst

Axial T-2 MRI with many loose bodies in popliteal cyst

Case #379.1 Secondary synovial chondromatosis

57 year old soccer player with prior history of knee surgery

Case #380

70 year female
2ndary synovial
chondromatosis from
osteoarthritis knee

Case #381

55 year female
2ndary synovial
chondromatosis from
osteoarthritis knee

Sagittal proton density MRI showing loose bodies
in popliteal cyst

Case #381.1 Secondary Synovial Osteochondromatosis

62 year old male with DOA and large
necrotizing mass over tibia

T-2 Gad

Axial
T-2 Gad

Post op surgical
debriedment

Post op flap
coverage over
tibia

Case #381.2 Secondary Synovial Osteochondromatosis Knee

85 yr male with mild pain & swelling in knee for 4 yrs

Case #382

69 year male with 2ndary
from traumatic arthritis
of elbow

Surgical removal of loose bodies

Loose bodies and pieces of synovium

Case #1246

46 year female 2ndary synovial chondromatosis talonarvicular
second to old trauma of subtalar joint

Sagittal T-1 MRI showing traumatic arthritic changes

Sagittal T-2 MRI showing excessive synovial fluid

Myxoid Chondrosarcoma
(Chordoid Sarcoma)
The extra-skeletal myxoid chondrosarcoma is a very rare soft
tissue tumor in the deep muscle belly, occurring most often in the
extremities in patients over 40 years of age. Males are affected
twice as often as females. The tumor is slow growing and may
cause local pain and tenderness. Common locations are the thigh,
popliteal fossa, and shoulder girdle. It presents with the clinical
appearance of a myxoid liposarcoma. Pathologically, the tumors
are greyish to tannish brown, depending on the amount of
hemorrhage into the tumor. Because hemorrhage often occurs, it
can be mistaken for a hematoma. Histologically, the tumor has a
myxoid appearance with chords and nests of anastomosing cells
that have a chondroblastic appearance. The histology is very
similar to that of chordoma of the sacrum. The tumor is considered
low grade in most instances; it is slow growing but has the potential

for local recurrence and pulmonary metastases in about one-third
of cases. Treatment consists of aggressive wide local resection or
amputation, if needed, followed by local radiation therapy. Chemo-
therapy is usually not indicated.

CLASSIC Case #383 Coronal T-1 MRI

tumor

55 year male with myxoid chondrosarcoma distal thigh

Coronal T-2 MRI
tumor

Resected hemorrhagic surgical specimen

Photomic showing chordoid myxoid pattern like chordoma

Pathology similar to that of a chordoma


tumor

41 year female with myxoid chondrosarcoma shoulder

tumor

Axial gad contrast MRI

Case #385

65 year male with
soft tissue myxoid
chondrosarcoma leg
eroding tibia

AP view

Sagittal T-2 MRI

tumor

tumor

Another axial T-2 MRI

Epithelioid Sarcoma
The epithelioid sarcoma affects young adults and is most
commonly seen in the fingers, hand and forearm where it is
considered the most common soft tissue sarcoma next to the
alveolar rhabdomysarcoma and synovial sarcoma. It can also occur
in the popliteal area, the buttock, thigh, shoulder, foot and ankle
area. It affects twice as many males as females. These tumors are
frequently misdiagnosed as a benign granulomatous process and
are often attached to tendon sheaths and facial planes with
associated cutaneous ulcerations that may be multiple in nature.
Calcification or even bone formation can occur in about 15% of
cases. The histological appearance of this lesion displays a distinct
nodular growth pattern with epithelioid nests of cells at the center
surrounded by lymphocytic infiltration. The differential diagnosis
would include necrotizing infectious diseases such as tuberculosis
or granuloma annulare or rheumatoid nodules. Regional lymph

node involvement occurs in about 35% of cases and metastases to
the lung in about 50% of cases. Because of the benign clinical
appearance of this lesion, it is common for surgeons to attempt
local resection but there is a high recurrence rate that eventually
leads to amputation. Local radiation therapy can help to decrease
the chance of local recurrence.

CLASSIC
Case #386

36 year male with
epithelioid sarcoma
foot
ulceration

necrotic center
necrotic center

Scanning lens photomic

Higher power of epithelioid cells

Case #387

34 year male with
epithelioid sarcoma
forearm

Sagittal T-2 MRI

Sagittal Gad contrast MRI

tumor

necrosis

tumor


Photomic showing epithelioid cells

Case #387.1 Epithelioid sarcoma

22 year old male with spontaneous fungating wound volar wrist

Axial T-1 T-2 FS

Gad

Case #388

27 year female with epithelioid sarcoma sole of foot

Case #388

Sagittal T-1 MRI

Case #389

50 year male with epithelioid sarcoma middle finger

Case #389.1 Sag T-1 T-2

Granuloma
Annularae

Gad

35 yr female with tender red lump over patellar tendon many yrs

Axial T-1 PD FS

Gad

Extra-skeletal Ewing’s Sarcoma
Ewing’s sarcoma is usually associated with primary tumor of
bone but in a small percentage of cases, Ewing’s sarcoma can
occur in soft tissue completely unattached to the skeletal system.
However, the histological appearance and the clinical picture
associated with soft tissue Ewing’s sarcoma is basically the same
as that of skeletal Ewing’s. This condition is seen in patients
between the age of 15 and 30 years. It occurs in males and females
equally and is rare in black patients. The most common location
is the chest wall, followed by the lower extremities, paraspinous
area, pelvis, hip and retroperitoneum. The least common location
is the upper extremity. The reciprocal translocation of the long
arm of chromosomes 11 and 22 is seen in soft tissue Ewing’s,
just as it is in skeletal Ewing’s. The prognosis for five year survival
is approximately 65%, similar to that of skeletal Ewing’s. Treatment
consists of wide local resection when possible, followed by

local radiation therapy if indicated. Adjuvant chemotherapy is
commonly used because of the excellent response, similar to
that of skeletal Ewing’s sarcoma.

CLASSIC
Case #390

28 year female with
soft tissue Ewing’s
sarcoma anterior thigh

Coronal proton density
MRI

Coronal T-2 MRI

tumor

Surgical specimen inked and cut in path lab

Case #390.1 Axial T-1 MRI

38 year female with painful thigh mass 2 months

Axial T-2

Axial Gad
necrosis

necrosis

Coronal T-2 Coronal Gad contrast

Case #391

14 year male with
sarcoma distal thigh

Axial proton
density MRI

tumor

Axial T-2 MRI

tumor

Case #391.1 T-1 Sag MRI T-2 Sag

18 yr female with Ewing’s sarcoma in sciatic nerve looking
like a benign neurilemoma

Axial Gad MRI at two different levels

Lower level Upper level

Case #392

16 year female with
sarcoma thigh

Clear Cell Sarcoma
The clear cell sarcoma is thought to be a deep, non-cutaneous
variant of the pigmented melanoma. It is a very rare tumor affecting
females more than males. It is typically seen between the ages of
20 and 40 years. It usually occurs in tendon sheaths and fascial
planes, especially around the foot and ankle area, similar to the
clinical appearance seen with synovial sarcoma with which it can
be confused. The tumor usually begins as a slow growing lump that
has a benign appearance but after a period of several years the tumor
will start growing more rapidly and become painful. It has a high
potential to metastasize to local lymph nodes and to the lung.
Approximately 50% of patients with this tumor will be dead in five
years. The microscopic appearance is similar to that of the epithelioid
sarcoma, especially if melanin is not found in the specimen.
Treatment usually consists of wide local resection, if possible, but a
high local recurrence rate is common because of its location in

extracompartmental structures such as tendon sheaths. If that
occurs, amputation is carried out for local control of the disease.
Local radiation therapy is utilized with attempts at wide resection.
Adjuvant chemotherapy has been advised because of the poor
prognosis but the response is usually not beneficial.

CLASSIC Case #393

35 year female with clear cell sarcoma hand

Surgical exposure reveals extensive tendon sheath involvement

Case#394 Sagittal gad contrast MRI

tumor

73 year female with clear cell sarcoma ankle

tibia
heel cord

tumor


Case #394.1 Cor T-1 Clear Cell Sarcoma T-2 FS

Gad

52 yr female with painful
mass over the posterior medial
aspect of the knee

Myositis Ossificans
Myositis ossificans is a heterotopic ossification within muscle
fascial planes seen typically in young athletic individuals in their
adolescence and early adult life. It occurs primarily in males and
usually results from a significant injury to a muscle, such as a
tearing of the quadriceps muscle which is the most common
location for this problem. It is also seen in the gluteus maximus
and the brachialis muscle at the elbow. The calcification is typically
noted on x-ray three to four weeks after the injury. It tends to occur
at the periphery of the damaged muscle and hematoma is usually
seen in the central area. As the lesion matures the calcific rim
around the damaged muscle will appear as fairly mature bone
and the central area will remain radiolucent, giving the so-called
zonal pattern that is almost diagnostic of traumatic myositis
ossificans. This is the opposite of osteosarcoma of soft tissue that
has the most dense portion of the calcifying lesion occurring centrally
and the more lytic portion at the periphery of the lesion. Myositis

ossificans can also be seen in older patients with no history of
trauma in which case the clinician becomes concerned about the
possibility of a neoplasm such as a synovial sarcoma or soft tissue
osteosarcoma. Histologically, the lesion will have the appearance
of a healing fracture, including immature cartilage and bone
formation, along with hematoma in the early stages. In rare cases,
after a period of 25 or 30 years, these dormant lesions can reactivate
and develop into an osteosarcoma. Treatment usually consists of
rest until the lesion matures after six months, at which point the
patient is usually asymptomatic. There is no reason to remove the
lesion unless there is significant clinical disability related to
stiffness of the adjacent joint.
There is a hereditary congenital form of myositis ossificans
referred to as myositis ossificans progressiva, or the newer term-
inology is fibrodysplasia ossificans progressiva, that is typically
seen in children under the age of ten years. It presents with a
clinical picture of progressive fibroblastic proliferation and

subsequent calcification and ossification of subcutaneous fat,
muscles, tendons, appeneuroses, and ligaments. This condition can
be associated with symmetrical malformations of the digits with
microdactyly of the thumbs and great toes, sometimes associated
with a failure of segmentation of the digital bony structures. The
condition usually presents between birth and the first six years of
age. It is inherited as an autosomal dominant trait. Males and
females are equally affected and the calcification in soft tissues is
usually precipitated by a local injury to the soft tissue. It occurs
typically in the musculature of the back, shoulder, paravertebral
region and upper arms. Fusion of the tempromandibular joint can
be seen. If the respiratory muscles are affected, death can result
because of respiratory failure or pneumonia in early adult life. The
prognosis for survival is very poor and most patients die within the
first ten to fifteen years of life. Biopsy or trauma of the affected
areas should be avoided because of new lesions that might
develop. There is no effective treatment or this condition.

CLASSIC
Case #395

12 year female with
myositis ossificans
medial thigh

fibrous tissue

Cut surgical specimen showing mature bone at periphery

Photomic showing reactive bone at periphery of lesion

Less bone maturity toward center of lesion

Healing rhabdomyoblasts in center of lesion

Case #396

59 year male with
early myositis
ossificans ant thigh

Macro section of resected specimen

bone

Reactive bone at periphery

Case #397
biopsy
biopsy

22 year male with early
myositis ossificans
anterior thigh

bone

fibrous

Biopsy specimen with typical benign zonal pattern

Mature myositis
ossificans 6 mos later

Case #398

2 mos later
early

17 year male with myositis ossificans of thigh 2 mos apart

Case #399

24 year female
myositis ossificans
2 months post injury

Biopsy specimen showing reactive bone

cartilage

bone

Close up of reactive bone and cartilage

Case #400

14 month male with
myositis ossificans
brachialis muscle from
fall 2 weeks ago

Case #401

14 year male with
myositis ossificans
triceps muscle
mature

Case #402

10 year old female with myositis ossificans of shoulder

Case #403

62 year female with old myositis ossificans teres major

Superficial biopsy specimen shows benign reactive bone

A deeper specimen reveals OGS arising from
previous myositis ossificans

Myositis
Ossificans
Progressiva

CLASSIC
Case #404

22 year male with
myositis ossificans
progressiva

Heavy ossification of
latissimus dorsi muscle

X-ray showing
ossification of
latissimus dorsi muscle

Spontaneous fusion
cervical spine

Heterotopic ossification seen muscle biopsy

X-ray of feet showing failure of segmentation great toes

Hands showing stiff thumbs and hypoplastic 5th digits

X-ray showing hypoplasia of 1st and 5th digits

Case #405

26 year male with
myositis ossificans
progressiva with
spontaneous fusion
scoliotic spine

Spontaneous extra-articular fusion left hip

Pigmented
Villonodular
Synovitis

Pigmented Villonodular Synovitis
The etiology of pigmented villonodular synovitis (PVNS)
remains controversial. It presents as an inflammatory synovial
disease, usually involving only one joint, but histologically the
disease presents with histiocytic proliferation in the subsynovial
tissue that takes on the characteristics of a neoplastic condition
similar to that of a giant cell tumor. PVNS occurs typically in the
subsynovial tissue about major joints of the lower extremity in
patients between the ages of 20 and 40 years. The knee joint is the
most common site, followed next by the hip, ankle and foot. It is
rare to see this disease in the upper extremity. The histiocytic
proliferation in subsynovial tissues is similar to that seen in giant
cell tumor of tendon sheathes in the hand and foot., The clinical
picture in the knee joint is that of spontaneous swelling associated
with pain and synovial hypertrophy. Hemarthrosis can result in
massive swelling about the knee joint and can occasionally result

in juxta-articular erosion of bone, similar to what is seen in
rheumatoid synovitis. Other clinical conditions with a similar
presentation include hemophilia and coccydiomycosis. In fewer
than 10 % of cases this condition will present as a localized focal
mass in the suprapatellar pouch of the knee or high in the popliteal
space posteriorly that can masquerade as a neoplastic condition
such as a synovial sarcoma.
Treatment for the more generalized synovial involvement of
the knee joint or other lower extremity joints consists of a subtotal
synovectomy that in many cases can be performed through an
arthroscope. In more extensive cases an open procedure may be
necessary. The recurrence rate is fairly high, in the range of 30%.
In cases where multiple recurrences result, treatment with radiation
therapy in the neighborhood of 1500-3000 centigray by external
beam is used. Injectable isotopes have also been used for radiation
treatment of recurrent cases. Secondary arthritic changes, especially
in the knee joint, can occur as a late complication of this disease

and these changes could lead to a total joint replacement at the
age of 50 or 60 years. On very rare occasion, this disease can
convert to a neoplastic sarcoma with a high degree of giant cell
activity. This is similar to the conversion of a giant cell tumor to
a malignant sarcoma.

CLASSIC
Case #406

36 year male with
PVNS knee

Lateral x-ray of knee
showing soft tissue
swelling

AP x-ray showing
early osteoarthritis

Sagittal T-1 MRI
showing hypertrophic
synovitis
bone
erosion

hemosiderin cyst
laden

Sagittal T-2 MRI
erosion

Axial T-1 MRI showing hypertrophic synovitis

Brown discoloration of hypertrophic synovitis at surgery

Photomic showing giant cell activity

Photomic showing hemosiderin laden macrophages

Surgical appearance following subtotal synovectomy

Case #407 Sagittal proton density MRI

41 year female with PVNS knee

fluid

hemosiderin laden
synovitis

Axial GRE T-2 MRI

Surgical exposure of brown hypertrophic synovitis

Case #407.1

38 year male with intermittent pain and swelling R knee 2 years

Case #407.2 Recurrent PVNS

43 yr male with 5 scopes over 7 yrs for intermittent painful swelling
about the left knee

Case #407.3
Sag T-1 T-2 Gad

28 male with painful swelling of both knees for 4 years

Cor T-1 T-2

T-2 Gad

Axial T-1 T-2

T-2 Gad

Case #407.4 PVNS with 2ndary synovial osteochondromatosis

36 yr male with patellar injury
7 yrs ago and now swollen painful knee

Cor PD FS Cor PD FS

Cor gad Cor gad

Axial PD FS Axial PD FS

Axial gad Axil gad

Sag PD FS Sag PD FS

Sag T-2 Sag T-2

Case #408

55 year female
PVNS knee with
large subchondral
lytic granuloma

Case #409

38 year male with
PVNS hip joint with
large supra-acetabular
granuloma

Diffuse synovial
hypertrophic nodularity
seen with arthrogram

Treatment in the 60’s
with a cup arthoplasty
and bone graft to the
acetabular granuloma


17 male with localized nodular form of PVNS

Case #410.1 Sag T-1 PD Nodular PVNS

45 year female with knee pain for 5 months

Case #410.2 Localized nodular form of PVNS

32 yr male with dull pain R knee for 5 months


tumor

bony
erosion
erosion

50 year male with PVNS knee with large popliteal mass


17 year female with PVNS ankle


39 year female with diffuse form of PVNS in the foot

Case #413.1 Diffuse PVNS of Forefoot
Cor PD Gad

29 yr male with one yr of pain and swelling in foot

Ray resection of 4th toe with tumor

Case #414

67 year female with
giant cell tumor of
tendon sheath

Case #415

14 year female with GCT tendon sheath

digital nerve

Surgical resection

Case #415.1 GCT Tendon sheath

37 yr female with tender swelling base of 4th toe for 1 yr

Sag T-1 Sag Gad

Cor Gad Axial Gad

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decompressor

MP joint amputation of fourth toe

Case #416

14 year female with xanthomatous variant of giant cell
tumor of tendon sheath on index finger

Photomic showing cholesterol laden foam cells

Case # 1249

20 year female with PVNS knee

Case #1250

PVNS

DOA

68 year male with PVNS and DOA left knee

Lateral view showing subchondral erosions

Axial T-1 MRI with subpatellar synovial hypertrophy

Sagittal T-1 MRI showing extensive
suprapatellar pouch involvement

Sagittal T-2 MRI showing fluid in suprapatellar pouch

Coronal T-2 MRI with
dark signal hemosiderin
laden synovitis and
bright signal synovial
fluid

Another coronal
T-2 MRI

Subchondral erosions

Case #1251

34 year male with
PVNS knee

Sagittal T-1 MRI

Case #1252

23 year male with PVNS
suprapatellar pouch area

Coronal T-1 MRI


19 year male with localized nodular form of PVNS knee

Case #1254

40 year female with PVNS hip joint

Case #1255

32 year male with
PVNS hip joint

Case #1256

40 year female with
pigmented villonodular
tenosynovitis flexor
hallicus longus tendon
sheath

Sagittal T-1 MRI

hemosiderin

histiocytes

Photomic showing giant cell activity

Case #1256.1

12 year old male with tender lump under heel cord 4 months

Case #1257

8 year female with
GCT tendon sheath
2nd toe

Case #1257.1 GCT tendon sheath

53 yr female with tender and swollen 2nd toe for 1 yr

Case #1258 Intramuscular myxoma
Axial T-2 Axial Gad

46 yr female with painless lump in post axilla for 8 years

Coronal Gad

Surgical specimen

Case #1258.1
Intramuscular myxoma

68 year old male with painless lump right shoulder for 1 yr

Case #1258.2 Axial T-1 T-2

59 year male with painless soft
tissue mass medial calf for 6 mos.

Gad

Intramuscular myxoma

Sagittal

T-1 T-2 Gad

Case #1259 Ganglion Cyst
Axial T-1

48 yr male with
painless lump in
anterior thigh 1 yr
T-2

Axial Gad

Shows rim enhancement
Sagittal Gad

Case #1259.1 Cor PD Gad

60 year old male with painless lump in groin for 6 months

Case #1259.1 Ganglion cyst
Cor T-1 T-2 Gad

57 year old female with painless lump inner aspect upper arm 1 yr

Case #1260 Ganglion cyst

49 year female with tender lump medial knee for 6 mos


65 year female with non tender mass over patellar ligament

Cystic lateral meniscus
Case #1261
Axial T-1 T-2

49 year male with prior history of subcutaneous ganglion cyst
removed from knee area 6 years ago

Path specimen of resected cystic meniscus

Photo of cyst Macro section of cyst & meniscus

Macro section of cyst Micro of cyst

Case #1261.1 Ganglion cyst prox. fibula

52 yr male with tender lump anterior below knee for 1 yr
and recent weakness of dosiflexion at ankle

Case #1261.1 Spino-glenoid ganglion cyst

43 yr male sheet rock worker with shoulder pain for months

Case #1261.2 Juxta articular ganglion cysts of shoulder

78 yr old male with mild shoulder pain and stiffness for years and now
has a recent soft none tender mass over distal end of clavicle

2002 2010

Axial CT scan

Axial T-2 Gad

upper

lower

Case #1261.3 Ganglion Cyst of Bone

46 yr female with mild ankle pain for one year

Case #1261.1
Axial T-1 T-2

Gad

72 year male with painless lump
lateral ankle for 1 year

Case #1261.2
Cor T-2 Gad

10 yr male with none tender lump beneath medial malleolus 6 mos

Case #1261.3 Ganglion Cyst in Tarsal Tunnel

Cor T-1 T-2 Gad

53 yr male with tarsal tunnel symptoms for 8 months

Ganglion cyst
Case #1261.2
Axial T-2

45 year male runner
With tender nodule in
Medial gastroc head

Gad


60 year male with mild R hip pain for 1 year

Case #1261.4 Baker’s cyst
Cor T-2 Cor Gad Sag T-2

34 yr female with prior history of myxosarcoma medial knee 17 yrs
ago treated with surgery and post op RT

Case #1261.5 Baker’sCyst

Sag T-1 T-2 Gad
62 yr female noticed non tender lump behind knee 3 weeks ago

Case #1261.6 Baker’s Cyst
Sag PD Gad

4 yr male with none tender lump on back of knee for 3 mos.

Case #1262 Axial T-1 T-2 Lymphoma

100 year old male with chronic edema
in legs but recent tender lump in calf
for 3 months

Gad

Case #1262.1 Lymphoma Sciatic Nerve
Sag STIR Sag Gad Cor Gad

71 yr male with sciatica for 4 months


tumor tumor

64 year female with soft tissue lymphoma forearm

tumor

Axial proton density MRI

Metastatic CA to soft
tissue

Case #1263 Metastatic Breast
Axial T-1 T-2

62 year female with
history of breast CA

Gad

Case #1264 Metastatic mesothelioma to arm

77 yr female with
recent diagnosis of
mesothelioma

Sag STIR Gad

Recent onset of painful mass anterior to elbow

Axial T-1 T-2

PD FS Gad

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