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MRI of Adamantinoma of Long Bones in Correlation with Histopathology

¹ Department of Radiology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, Amsterdam 1090 HM, The Netherlands.
² Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.

View larger version (75K): [in a new window]   Fig. 1A. —38-year-old man with classic adamantinoma of tibia. Radiologic diagnosis of fibrous dysplasia was established at 2 years old in 1961. At 6 years old, he had fracture, and anterior bowing developed after cast removal. Three years after en bloc resection in 1996, he developed recurrent tumor and lung metastases and died. Sagittal spin-echo T1-weighted image reveals anterior bowing of tibia due to presence of multinodular tumor with intermediate signal intensity showing extensive corticomedullary involvement and anterior soft-tissue extension (arrow).

View larger version (71K): [in a new window]   Fig. 1B. —38-year-old man with classic adamantinoma of tibia. Radiologic diagnosis of fibrous dysplasia was established at 2 years old in 1961. At 6 years old, he had fracture, and anterior bowing developed after cast removal. Three years after en bloc resection in 1996, he developed recurrent tumor and lung metastases and died. Sagittal spin-echo T1-weighted image obtained after administration of contrast medium shows homogeneous enhancement (same orientation as A).

View larger version (105K): [in a new window]   Fig. 1C. —38-year-old man with classic adamantinoma of tibia. Radiologic diagnosis of fibrous dysplasia was established at 2 years old in 1961. At 6 years old, he had fracture, and anterior bowing developed after cast removal. Three years after en bloc resection in 1996, he developed recurrent tumor and lung metastases and died. Axial spin-echo T1-weighted gadopentetate dimeglumine–enhanced image with fat suppression shows complete cortical destruction and soft-tissue extension (arrow). F = fibula.

View larger version (145K): [in a new window]   Fig. 1D. —38-year-old man with classic adamantinoma of tibia. Radiologic diagnosis of fibrous dysplasia was established at 2 years old in 1961. At 6 years old, he had fracture, and anterior bowing developed after cast removal. Three years after en bloc resection in 1996, he developed recurrent tumor and lung metastases and died. Photomicrographs of lesion after resection show bulging and thinning of cortical bone (C, D) by tumor (T, D) and cortical breakthrough and invasion of surrounding thickened periosteum (P, E). (H and E, x50)

View larger version (132K): [in a new window]   Fig. 1E. —38-year-old man with classic adamantinoma of tibia. Radiologic diagnosis of fibrous dysplasia was established at 2 years old in 1961. At 6 years old, he had fracture, and anterior bowing developed after cast removal. Three years after en bloc resection in 1996, he developed recurrent tumor and lung metastases and died. Photomicrographs of lesion after resection show bulging and thinning of cortical bone (C, D) by tumor (T, D) and cortical breakthrough and invasion of surrounding thickened periosteum (P, E). (H and E, x50)

View larger version (152K): [in a new window]   Fig. 1F. —38-year-old man with classic adamantinoma of tibia. Radiologic diagnosis of fibrous dysplasia was established at 2 years old in 1961. At 6 years old, he had fracture, and anterior bowing developed after cast removal. Three years after en bloc resection in 1996, he developed recurrent tumor and lung metastases and died. Photomicrograph of center of tumor after resection shows classic adamantinoma, strings of epithelial cells (arrow) embedded in fibrous tissue. (H and E, x100)

View larger version (117K): [in a new window]   Fig. 2A. —6-year-old boy with classic adamantinoma of tibia and fibula. Sagittal spin-echo T1-weighted images show multiple lesions in both anterior and posterior cortical bone and in bone marrow compartment of tibia (arrows). Note lesion in distal fibula (arrowhead).

View larger version (114K): [in a new window]   Fig. 2B. —6-year-old boy with classic adamantinoma of tibia and fibula. On coronal spin-echo T1-weighted images with fat-selective presaturation after contrast medium administration, lesions show intense enhancement and are well demarcated.

View larger version (29K): [in a new window]   Fig. 2C. —6-year-old boy with classic adamantinoma of tibia and fibula. Photograph of histologic macrosection in this specific sagittal plane shows similar anterior cortical bowing of tibia with two tumor foci; one (middle part) with intramedullary extension and one (distal) mainly intracortical.

View larger version (144K): [in a new window]   Fig. 2D. —6-year-old boy with classic adamantinoma of tibia and fibula. Photomicrograph of histopathologic specimen reveals invasion of tumor (T) in bone marrow (BM). (H and E, x100)

View larger version (131K): [in a new window]   Fig. 3. —20-year-old woman with adamantinoma of tibia. Gadolinium-enhanced sagittal T1-weighted images with fat-selective presaturation show lesion consisting of multiple small nodules within anterior cortical bone of diaphysis (arrow). Separate focus is seen in proximal epiphysis (arrowhead).

View larger version (137K): [in a new window]   Fig. 4A. —29-year-old woman with osteofibrous dysplasia-like adamantinoma of tibia. Axial spin-echo T2-weighted image with fat suppression shows well-demarcated single lobulated lesion in thickened anterior cortical bone with high signal intensity. No cortical breakthrough is noted.

View larger version (121K): [in a new window]   Fig. 4B. —29-year-old woman with osteofibrous dysplasia-like adamantinoma of tibia. Sagittal spin-echo T1-weighted image shows lesion to be well-demarcated relative to bone marrow compartment by sclerotic rim.

View larger version (138K): [in a new window]   Fig. 4C. —29-year-old woman with osteofibrous dysplasia-like adamantinoma of tibia. Sagittal spin-echo T1-weighted image obtained after contrast medium injection shows intense and homogeneous enhancement (same orientation as B).

View larger version (150K): [in a new window]   Fig. 4D. —29-year-old woman with osteofibrous dysplasia-like adamantinoma of tibia. Photomicrograph of resected specimen shows intracortical osteofibrous dysplasia-like adamantinoma composed of osteofibrous tissue with woven bone trabeculae (center) rimmed by osteoblasts. No epithelial component is visible at plain section. (H and E, x50)

View larger version (49K): [in a new window]   Fig. 5. —Radiograph of adamantinoma of tibia in 22-year-old man. Eccentric relatively well-demarcated intracortical lesion in anterior tibia diaphysis shows pattern of mixed lysis and sclerosis and geographic destruction.

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