1990, The British Journal of Radiology, 63, 363-364 Case reports HASLETON, P. S., KELEHAN, P., WHITTAKER, J. S., BURSLEM, R.
ROSENBLUM, N. G., LIVOLSI, V. A., EDMONDS, P. R. & MIKUTA,
W. & TURNER, L., 1978. Benign and malignant struma ovarii. Archives of Pathology and Laboratory Medicine, 102, 180-184.
J. J., 1989. Malignant struma ovarii. Gynecologic Oncology, 32, 224-227. TAGERMAN, A., 1982. Germ cell tumours of the ovary. In Pathology of the Female Genital Tract, ed. by A. Blaustein (Springer-Verlag, New York), pp. 636-639. UICC, 1987. TNM Classification of Malignant Tumours, 4th edn (International Union Against Cancer, Springer-Verlag, London).
KEMPERS, R.
D.,
DOCKERTY, M.
B., HOFFMAN, D.
L.
&
BARTHOLOMEW, L. G., 1970. Struma ovarii—ascitic, hyperthyroid and asymptomatic syndromes. Annals of Internal Medicine, 72, 883-893. MARCUS, C. C. & MARCUS, S. L., 1961. Struma ovarii: a report of 7 cases and a review of the subject. American Journal of Obstetrics and Gynecology, 81, 752-762. MEYER, R., 1903. Struma ovarii colloides. Virchows Archiv fur Pathologische Anatomie und Physiologie und fur Klinische Medizin, 173, 538-552. PARDO-MINDAN, F. J. & VAZQUEZ, J. J.,
1983. Malignant
struma ovarii: light and electron microscopic study. Cancer, 51, 337-343. PICK, L., 1901. Die Marchandschen Nebennieren und ihre Neoplasmen: Nebst Utersuchungen iiber glykogenreiche Eierstocksgeschwulste. Archiv fur Gyndkologie, 64, 670-838.
WlLLEMSE, P . H . B., OOSTERHUIS, J. W., AALDERS, J. G., PlERS, D. A., SLEIJFER, D. T H . , VERMEY, A. & DOORENBOS, H., 1987.
Malignant struma ovarii treated by thyroidectomy and 131-1 administration. 178-182.
ovariectomy, Cancer, 60,
WOODRUFF, J. D., RAUH, J. T. & MARKLEY, R. L.,
1966.
Ovarian struma. Obstetrics and Gynecology, 27, 194-201. YANNOPOULOS, D., YANNOPOULOS, K. & OSSOWSKI, R.,
1976.
Malignant struma ovarii. Pathology Annual, 11, 403-413.
Tuberculosis of the patella By Priti Shah, D M R D and Ravi Ramakantan, M D Department of Radiology, King Edward Memorial Hospital, Bombay, India
{Received August 1989)
Tuberculosis causing an osteolytic lesion in the patella is very rare, having been reported on only four previous occasions. We present such a case and discuss the radiological features which help in differentiating tuberculosis from other similar lesions. Case report A 25-year-old man in good health presented with a 3 month history of pain, swelling and restriction of movement of the right knee. There were no systemic symptoms or other joint involvement. Examination of the knee revealed an effusion with minimal terminal restriction of flexion. Radiographs of the knee joint demonstrated swelling (Fig. 1) and an osteolytic lesion in the patella (Fig. 2). Radionuclide bone scans showed an area of increased uptake in the right patella; no other lesions were seen on the scan. A chest radiograph revealed no abnormality. A patellectomy was performed; there was a small area of erosion on the patellar articular surface. Histopathology showed features of tuberculous osteomyelitis, and accordingly the patient was started on anti-tuberculous therapy. Discussion Although the knee joint is frequently affected by tuberculosis, isolated involvement of the patella is rare (Hartofilakidis-Garofalidis, 1969; Gimenez et al, 1987). To our knowledge, this is only the fifth such case in the English literature. Address for correspondence: Ravi Ramakantan, MD, 7/259, Seeta Sadan, Sion (West), Bombay 400 022, India. Vol. 63, No. 749
Figure 1. Lateral radiograph of the knee joint showing moderate osteoporosis and effusion. No effect on the articular surfaces is evident. 363
1990, The British Journal of Radiology, 63, 364-366
Case reports
diagnosis of such a lesion includes cartilage-based tumours such as chondroblastoma and inflammatory lesions such as gout, pyogenic osteomyelitis or occasionally a brown tumour. The presence of a sequestrum and joint involvement suggest osteomyelitis. Absence of sclerosis around the lesion and in the para-articular region should suggest tuberculosis. When a tuberculous lesion is suspected, a radionuclide bone scan should be done as cystic tuberculosis of bone can affect several sites (O'Connor et al, 1970). If a diagnosis is suspected radiologically, confirmation can be obtained by examination of the synovial fluid or by a synovial biopsy. The patient can then be treated with anti-tuberculous drugs without having to resort to a patellectomy. Figure 2. Axial view of the patella showing well-defined osteolytic lesion. Note that there is no sclerosis or sequestrum. No articular involvement is seen.
Osseous tuberculosis is usually believed to be due to hematogenous spread following a primary lesion in the lung. Tuberculous osteomyelitis is frequently associated with arthritis. Cystic lesions in the patella are rare. The differential
References GIMENEZ, M. H., BELTRAN, J. V. T., SEGUI, M. I. F. & GOMEZ,
E. P., 1987. Tuberculosis of the patella. Pediatric Radiology 17, 328-329. HARTOFILAKIDIS-GAROFALIDIS, G., 1969. Cystic tuberculosis of the patella. The Journal of Bone and Joint Surgery 51A 582-585. O'CONNOR,
B.
T.,
STEEL, W.
M.
&
SANDERS, R.,
1970.
Dissiminated bone tuberculosis. Journal of Bone and Joint Surgery, 52 A, 537-540.
Raynaud's disease in childhood with radiological features By T. Shono, *K. Okadome, G. Naritomi and S. Suita Department of Pediatric Surgery and "Second Surgery, Faculty of Medicine, Kyusyu University, Fukuoka, Japan
(Received September 1989)
There have been many descriptions of Raynaud's phenomenon in adults (Allen & Brown, 1932; Gifford & Hines, 1957), but Raynaud's phenomenon has been only rarely reported in childhood, and Raynaud's disease itself is even more rare (Guntheroth et al, 1967; Burns et al, 1985). We describe here a 5-year-old boy with Raynaud's disease who had a 4-month history of pain, coldness and pallor offingersin both hands on exposure to coldness. His right trans-femoral axillary arteriogram showed distal vascular abnormalities which were considerable owing to the peripheral arterial spasm. He had neither clinical haematological and serological evidence of collagen disease nor any other systemic disease, and has been successfully treated with oral prostaglandin El analogue (limaprost). Case report A 5-year-old boy noticed the first signs of Raynaud's phenomenon after developing paleness, coldness and pain in the
364
Figure 1. Epidermal ulceration revealed at the tip of the right middle finger.
The British Journal of Radiology, May 1990
ROSENBLUM, N. G., LIVOLSI, V. A., EDMONDS, P. R. & MIKUTA,
W. & TURNER, L., 1978. Benign and malignant struma ovarii. Archives of Pathology and Laboratory Medicine, 102, 180-184.
J. J., 1989. Malignant struma ovarii. Gynecologic Oncology, 32, 224-227. TAGERMAN, A., 1982. Germ cell tumours of the ovary. In Pathology of the Female Genital Tract, ed. by A. Blaustein (Springer-Verlag, New York), pp. 636-639. UICC, 1987. TNM Classification of Malignant Tumours, 4th edn (International Union Against Cancer, Springer-Verlag, London).
KEMPERS, R.
D.,
DOCKERTY, M.
B., HOFFMAN, D.
L.
&
BARTHOLOMEW, L. G., 1970. Struma ovarii—ascitic, hyperthyroid and asymptomatic syndromes. Annals of Internal Medicine, 72, 883-893. MARCUS, C. C. & MARCUS, S. L., 1961. Struma ovarii: a report of 7 cases and a review of the subject. American Journal of Obstetrics and Gynecology, 81, 752-762. MEYER, R., 1903. Struma ovarii colloides. Virchows Archiv fur Pathologische Anatomie und Physiologie und fur Klinische Medizin, 173, 538-552. PARDO-MINDAN, F. J. & VAZQUEZ, J. J.,
1983. Malignant
struma ovarii: light and electron microscopic study. Cancer, 51, 337-343. PICK, L., 1901. Die Marchandschen Nebennieren und ihre Neoplasmen: Nebst Utersuchungen iiber glykogenreiche Eierstocksgeschwulste. Archiv fur Gyndkologie, 64, 670-838.
WlLLEMSE, P . H . B., OOSTERHUIS, J. W., AALDERS, J. G., PlERS, D. A., SLEIJFER, D. T H . , VERMEY, A. & DOORENBOS, H., 1987.
Malignant struma ovarii treated by thyroidectomy and 131-1 administration. 178-182.
ovariectomy, Cancer, 60,
WOODRUFF, J. D., RAUH, J. T. & MARKLEY, R. L.,
1966.
Ovarian struma. Obstetrics and Gynecology, 27, 194-201. YANNOPOULOS, D., YANNOPOULOS, K. & OSSOWSKI, R.,
1976.
Malignant struma ovarii. Pathology Annual, 11, 403-413.
Tuberculosis of the patella By Priti Shah, D M R D and Ravi Ramakantan, M D Department of Radiology, King Edward Memorial Hospital, Bombay, India
{Received August 1989)
Tuberculosis causing an osteolytic lesion in the patella is very rare, having been reported on only four previous occasions. We present such a case and discuss the radiological features which help in differentiating tuberculosis from other similar lesions. Case report A 25-year-old man in good health presented with a 3 month history of pain, swelling and restriction of movement of the right knee. There were no systemic symptoms or other joint involvement. Examination of the knee revealed an effusion with minimal terminal restriction of flexion. Radiographs of the knee joint demonstrated swelling (Fig. 1) and an osteolytic lesion in the patella (Fig. 2). Radionuclide bone scans showed an area of increased uptake in the right patella; no other lesions were seen on the scan. A chest radiograph revealed no abnormality. A patellectomy was performed; there was a small area of erosion on the patellar articular surface. Histopathology showed features of tuberculous osteomyelitis, and accordingly the patient was started on anti-tuberculous therapy. Discussion Although the knee joint is frequently affected by tuberculosis, isolated involvement of the patella is rare (Hartofilakidis-Garofalidis, 1969; Gimenez et al, 1987). To our knowledge, this is only the fifth such case in the English literature. Address for correspondence: Ravi Ramakantan, MD, 7/259, Seeta Sadan, Sion (West), Bombay 400 022, India. Vol. 63, No. 749
Figure 1. Lateral radiograph of the knee joint showing moderate osteoporosis and effusion. No effect on the articular surfaces is evident. 363
1990, The British Journal of Radiology, 63, 364-366
Case reports
diagnosis of such a lesion includes cartilage-based tumours such as chondroblastoma and inflammatory lesions such as gout, pyogenic osteomyelitis or occasionally a brown tumour. The presence of a sequestrum and joint involvement suggest osteomyelitis. Absence of sclerosis around the lesion and in the para-articular region should suggest tuberculosis. When a tuberculous lesion is suspected, a radionuclide bone scan should be done as cystic tuberculosis of bone can affect several sites (O'Connor et al, 1970). If a diagnosis is suspected radiologically, confirmation can be obtained by examination of the synovial fluid or by a synovial biopsy. The patient can then be treated with anti-tuberculous drugs without having to resort to a patellectomy. Figure 2. Axial view of the patella showing well-defined osteolytic lesion. Note that there is no sclerosis or sequestrum. No articular involvement is seen.
Osseous tuberculosis is usually believed to be due to hematogenous spread following a primary lesion in the lung. Tuberculous osteomyelitis is frequently associated with arthritis. Cystic lesions in the patella are rare. The differential
References GIMENEZ, M. H., BELTRAN, J. V. T., SEGUI, M. I. F. & GOMEZ,
E. P., 1987. Tuberculosis of the patella. Pediatric Radiology 17, 328-329. HARTOFILAKIDIS-GAROFALIDIS, G., 1969. Cystic tuberculosis of the patella. The Journal of Bone and Joint Surgery 51A 582-585. O'CONNOR,
B.
T.,
STEEL, W.
M.
&
SANDERS, R.,
1970.
Dissiminated bone tuberculosis. Journal of Bone and Joint Surgery, 52 A, 537-540.
Raynaud's disease in childhood with radiological features By T. Shono, *K. Okadome, G. Naritomi and S. Suita Department of Pediatric Surgery and "Second Surgery, Faculty of Medicine, Kyusyu University, Fukuoka, Japan
(Received September 1989)
There have been many descriptions of Raynaud's phenomenon in adults (Allen & Brown, 1932; Gifford & Hines, 1957), but Raynaud's phenomenon has been only rarely reported in childhood, and Raynaud's disease itself is even more rare (Guntheroth et al, 1967; Burns et al, 1985). We describe here a 5-year-old boy with Raynaud's disease who had a 4-month history of pain, coldness and pallor offingersin both hands on exposure to coldness. His right trans-femoral axillary arteriogram showed distal vascular abnormalities which were considerable owing to the peripheral arterial spasm. He had neither clinical haematological and serological evidence of collagen disease nor any other systemic disease, and has been successfully treated with oral prostaglandin El analogue (limaprost). Case report A 5-year-old boy noticed the first signs of Raynaud's phenomenon after developing paleness, coldness and pain in the
364
Figure 1. Epidermal ulceration revealed at the tip of the right middle finger.
The British Journal of Radiology, May 1990
