Pseudo-malignant heterotopic ossification in children

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Abstract

Among 26 children with soft tissue ossification 5 patients with pseudomalignant heterotopic ossification were analysed. All patients underwent surgery and were cured. Authors’ presentation emphasizes the importance of the performance of sparing operation after ossification «maturation» as well as local application of steroids, appropriate use of immobilization and accurate rehabilitation.

About the authors

A. P. Berezhny

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

A. K. Morozov

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

A. I. Snetkov

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

G. N. Berchenko

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

A. R. Frantov

Central Institute of Traumatology and Orthopedics. N.N. Priorova

Email: info@eco-vector.com
Russian Federation, Moscow

References

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2. Fig. 1. Patient U. Heterotopic ossification of the right thigh. a — radiograph of the right thigh: parossal ossification of the ribbon-like shape with clear contours along the m. vastus lateralis; b — computed tomogram: parossal ossification is connected with the femur and is located in the thickness of the muscle along its fibers; c — CT scan: parossal ossification in 3D reconstruction mode; d — magnetic resonance tomogram: hyperintense heterogeneous signal in the T2 mode of suspension.

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3. Fig. 2. Microphotograms of the surgical preparation of the patient U. a - significantly thickened bone trabeculae with uneven calcification. There are numerous dilated and full-blooded vessels in the spaces between the beams (stained with hematoxylin and eosin, uv. 60); b - immature, gradually calcifying bone beams. Histiocytes and fibroblasts are visible in the connective tissue of the spaces between the beams (stained with hematoxylin and eosin. Mag. 160).

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4. Fig. 3. Radiographs of patient K. Heterotopic ossification of the right thigh (differential diagnosis with parossal sarcoma). Fuzzy outline of ossificate, structure with areas of osteosclerosis and rarefaction. Partially assimilated linear periostitis of the femur.

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5. Fig. 4. Patient Z. Heterotopic ossification of the right knee joint. 2 months from the onset of the disease. a — radiographs of the right knee joint: uneven structure of the ossificate with areas of rarefaction and sclerosis. Clear, uneven contour; b — computed tomograms: uneven rarefaction of the bone structure in the center of the ossification. Fuzziness of the boundaries between the ossificate and the femur over a limited extent. Increase in volume and fuzziness of contours m. vastus medialis; c — magnetic resonance tomogram: in the T2 mode of suspension, an isointense heterogeneous signal from ossificate and a hyperintense signal from m. vastus medialis.

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6. Fig. 5. The same patient Z. 4 months after the onset of the disease. a - radiographs: most of the ossificate is occupied by a cyst; b — computed tomography: the cyst has a scalloped contour and a relative density of 40 to 60 HU; c — magnetic resonance tomograms: in the T1 mode of suspension, an isointense heterogeneous signal from ossificate. In the T2 mode of suspension, a hyperintense signal from ossificate and an isointense signal from m. vastus medialis; d — angiogram: displacement of arterial vessels of the third order by ossificate.

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