Skeletal Radiology

, Volume 36, Issue 8, pp 747–753 | Cite as

Imaging of pseudoneoplastic masses associated with allografts

  • Taj M. Kattapuram
  • Deepak K. Ozhathil
  • Francis J. Hornicek
  • Mark C. Gebhardt
  • Henry J. Mankin
  • Andrew E. Rosenberg
  • Susan V. Kattapuram
Scientific Article
  • 80 Downloads

Abstract

Objective

The objective of this study is to describe the imaging features of non-neoplastic masses suspected of being tumor recurrences adjacent to allografts. The allografts were utilized for the treatment of various musculoskeletal tumors.

Materials and methods

We reviewed the medical records and imaging studies of 56 patients who were suspected of having recurrent tumors following surgical resection and allograft replacement treatment for a variety of musculoskeletal neoplasms. The imaging modalities included radiographs, CT, and MRI.

Results

There were 47 cases of recurrent tumors. All tumor recurrences were in the soft tissues of the surgical bed (41 patients), or in the native bone adjacent to the host/allograft junction (6 patients). None of the recurrences originated in the allografts. Nine patients suspected of having recurrences were discovered to have non-neoplastic masses. Five of these were very closely related to the allograft, wrapping around parts of the allograft, and the other 4 were in the surgical bed, 2 of which were abscesses and two were seromas.

Conclusion

Most masses arising in the vicinity of allografts implanted following resection of musculoskeletal tumors represent recurrent neoplasms. A minority are reactive processes or abscesses or fluid collections. These “pseudoneoplasms,” specifically those closely related to the allografts, have specific imaging characteristics that help distinguish them from recurrent tumors.

Keywords

Allografts Pseudoneoplasms Musculoskeletal tumors Imaging 

References

  1. 1.
    Mankin HJ. The changes in major limb reconstruction as a result of the development of allografts. Chir Org Mov 2003;88: 101–113.Google Scholar
  2. 2.
    Mankin HJ. Major limb reconstruction using massive cadaveric allografts. In: Phillips GO, ed. Advances in tissue banking, vol 7. Singapore: World Scientific; 2004: 389–415.Google Scholar
  3. 3.
    DiCaprio MR, Friedlaender GE. Malignant bone tumors: limb sparing versus amputation. J Am Acad Orthop Surg 2003;11: 25–37.PubMedGoogle Scholar
  4. 4.
    Friedlaender GE, Mankin HJ. Transplantation of osteochondral allografts. Ann Rev Med 1984;35: 311–324.PubMedCrossRefGoogle Scholar
  5. 5.
    Mankin HJ, Gebhardt MC, Tomford WW. The use of frozen cadaveric allografts in the management of patients with bone tumors of the extremities. Orthop Clin N Am 1987;18: 275–289.Google Scholar
  6. 6.
    Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long term results of allograft replacement in the management of bone tumors. Clin Orthop 1996;324: 86–97.PubMedCrossRefGoogle Scholar
  7. 7.
    Sorger JI, Hornicek FJ, Zavatta M, et al. Allograft fractures revisited. Clin Orthop 2001;382: 66–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Hornicek FJ, Gebhardt MC, Tomford WW, et al. Factors affecting non union of the allograft-host junction. Clin Orthop 2001;382: 87–98.PubMedCrossRefGoogle Scholar
  9. 9.
    Berrey WH, Lord CF, Gebhardt MC, Mankin HJ. Fractures of allografts. Frequency, treatment and end-results. J Bone Joint Surg Am 1990;72(6): 825–833.PubMedGoogle Scholar
  10. 10.
    Mankin HJ, Hornicek FJ, Raskin KA. Infection in massive bone allografts. Clin Orthop 2005;432: 210–216.PubMedGoogle Scholar
  11. 11.
    Mankin HJ. Complications of allograft surgery. In: Friedlaender GE, Mankin HJ, Sell KW, eds. Osteochondral allografts. Biology, banking, and clinical. Boston: Little, Brown; 1983: 259–274.Google Scholar
  12. 12.
    Mankin HJ, Hornicek FJ. Treatment of giant cell tumors with allograft transplants: a 30 year study. Clin Orthop 2005;439: 144–150.PubMedCrossRefGoogle Scholar
  13. 13.
    Mankin HJ, Hornicek FJ, Rosenberg AE, Harmon DC, Gebhardt MC. Survival data for 648 patients with osteosarcoma treated at one institution. Clin Orthop 2004;429: 286–291.PubMedCrossRefGoogle Scholar
  14. 14.
    Gebhardt MC, Flugstad DI, Springfield DS, Mankin HJ. The use of bone allografts for limb salvage in high-grade extremity osteosarcoma. Clin Orthop 1991;270: 181–196.PubMedGoogle Scholar
  15. 15.
    Mankin HJ. A computerized system for orthopaedic oncology. Clin Orthop 2002;399: 252–261.Google Scholar
  16. 16.
    Kattapuram SV, Rosol MS, Rosenthal DI, Palmer WP, Mankin HJ. Magnetic resonance imaging features of allografts. Skeletal Radiol 1999;28: 383–389.PubMedCrossRefGoogle Scholar
  17. 17.
    Kattapuram SV, Phillips WC, Mankin HJ. Intercalary bone allografts: radiographic evaluation. Radiology 1989;170: 137–141.PubMedGoogle Scholar
  18. 18.
    Reuther G, Mutschler W. Detection of local recurrent disease in musculoskeletal tumors. magnetic resonance imaging vs computed tomography. Skeletal Radiol 1990;19(2): 85–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Panicek DM, Schwartz LH, Heelan RT, Caravelli JF. Non-neoplastic causes of high signal intensity at T2-weighted MR imaging after treatment for musculoskeletal neoplasms. Skeletal Radiol 1995;24(3): 185–190.PubMedCrossRefGoogle Scholar
  20. 20.
    Biondetti PR, Ehman RL. Soft tissue sarcomas. Use of textural patterns in skeletal muscle as a diagnostic feature in postoperative MR imaging. Radiology 1992;183: 845–848.PubMedGoogle Scholar
  21. 21.
    Vanel D, Lacombe MJ, Couanet D, Kalifa C, Spielmann M, Genin J. Musculoskeletal tumors: follow-up with MR Imaging after treatment with surgery and radiation therapy. Radiology 1987;164: 243–245.PubMedGoogle Scholar
  22. 22.
    Vanel D, Shapeero LG, De Baere T, et al. MR imaging in the management of malignant and aggressive soft tissue tumors: results of 511 examinations. Radiology 1994;190: 263–268.PubMedGoogle Scholar

Copyright information

© ISS 2007

Authors and Affiliations

  • Taj M. Kattapuram
    • 1
  • Deepak K. Ozhathil
    • 1
  • Francis J. Hornicek
    • 2
  • Mark C. Gebhardt
    • 2
  • Henry J. Mankin
    • 2
  • Andrew E. Rosenberg
    • 3
  • Susan V. Kattapuram
    • 1
  1. 1.Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Orthopedics, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of Pathology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations