array:24 [
  "pii" => "S2173574318301394"
  "issn" => "21735743"
  "doi" => "10.1016/j.reumae.2018.10.007"
  "estado" => "S300"
  "fechaPublicacion" => "2019-09-01"
  "aid" => "1082"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Reumatol Clin. 2019;15:e47-e48"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1699258X17301705"
      "issn" => "1699258X"
      "doi" => "10.1016/j.reuma.2017.06.011"
      "estado" => "S300"
      "fechaPublicacion" => "2019-09-01"
      "aid" => "1082"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Reumatol Clin. 2019;15:e47-e48"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1904
        "formatos" => array:3 [
          "EPUB" => 93
          "HTML" => 1448
          "PDF" => 363
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Reumatolog&#237;a Cl&#237;nica en im&#225;genes</span>"
        "titulo" => "Sarcoma miofibrobl&#225;stico de trapecio"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "e47"
            "paginaFinal" => "e48"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Myofibroblastic sarcoma of the trapezius muscle"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1667
                "Ancho" => 1667
                "Tamanyo" => 171993
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#41; Ecograf&#237;a de trapecio &#40;TP&#41;&#44; corte longitudinal sobre el borde cef&#225;lico&#46; Se aprecia una masa hipoecoica de aspecto homog&#233;neo incluida por completo en el espesor del m&#250;sculo sin establecer contacto con la fascia &#40;F&#41; ni el tejido celular subcut&#225;neo &#40;TCSC&#41;&#46; La se&#241;al power doppler se concentra fundamentalmente en territorios perif&#233;ricos&#46; B&#41; RMN de hombro&#44; secuencia DP&#47;SPIR para suprimir el tejido graso&#46; Se aprecia el corte transversal del trapecio &#40;flecha&#41; en cuyo interior destaca una estructura hiperintensa de bordes bien definidos y que ocupa casi la talidad de la masa muscular &#40;&#42;&#41;&#46; C&#41; RMN de hombro&#44; secuencia T1&#44; corte sagital&#46; En esta proyecci&#243;n se aprecia la extensi&#243;n longitudinal del trapecio &#40;flecha&#41; y la ocupaci&#243;n por la misma estructura de aspecto fusiforme hipointensa respecto de los tejidos adyacentes &#40;&#42;&#41;&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Carlos Antonio Guillen Astete, Carmen Larena Grijalva"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Carlos Antonio"
                "apellidos" => "Guillen Astete"
              ]
              1 => array:2 [
                "nombre" => "Carmen"
                "apellidos" => "Larena Grijalva"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173574318301394"
          "doi" => "10.1016/j.reumae.2018.10.007"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301394?idApp=UINPBA00004M"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301705?idApp=UINPBA00004M"
      "url" => "/1699258X/0000001500000005/v1_201910230648/S1699258X17301705/v1_201910230648/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173574318301254"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2018.09.008"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "1077"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2019;15:e49-e50"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 5
      "formatos" => array:2 [
        "HTML" => 2
        "PDF" => 3
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Subcutaneous Edema in Juvenile Dermatomyositis"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "e49"
          "paginaFinal" => "e50"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Edema subcut&#225;neo en dermatomiositis juvenil"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1225
              "Ancho" => 1633
              "Tamanyo" => 363494
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Muscle biopsy which shows endomysial lymphocytary infiltrate and myocyte necrosis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alfonso Ragnar Torres Jim&#233;nez, Eunice Sol&#237;s-Vallejo, Adriana Ivonne C&#233;spedes-Cruz, Magdalena S&#225;nchez-Uribe"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Alfonso Ragnar"
              "apellidos" => "Torres Jim&#233;nez"
            ]
            1 => array:2 [
              "nombre" => "Eunice"
              "apellidos" => "Sol&#237;s-Vallejo"
            ]
            2 => array:2 [
              "nombre" => "Adriana Ivonne"
              "apellidos" => "C&#233;spedes-Cruz"
            ]
            3 => array:2 [
              "nombre" => "Magdalena"
              "apellidos" => "S&#225;nchez-Uribe"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17301389"
        "doi" => "10.1016/j.reuma.2017.06.006"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301389?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301254?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301254/v1_201910260908/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173574318301084"
    "issn" => "21735743"
    "doi" => "10.1016/j.reumae.2017.03.012"
    "estado" => "S300"
    "fechaPublicacion" => "2019-09-01"
    "aid" => "1042"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Reumatolog&#237;a y Colegio Mexicano de Reumatolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Reumatol Clin. 2019;15:307-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
      "titulo" => "Single-photon Emission Computed Tomography in the Diagnosis of a Case of Forestier&#39;s Disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "307"
          "paginaFinal" => "308"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "<span class="elsevierStyleItalic">Single-photon emission computed tomography</span> en el diagn&#243;stico de un caso de enfermedad de Forestier"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Fig&#46; 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 734
              "Ancho" => 1000
              "Tamanyo" => 56437
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone scan with normal pattern of uptake on the cervico dorsal skeleton and discrete uptake on the right-hand side of the lumbar rachis&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a Isabel Morales Lozano, Enrique Ornilla, Lidia Sancho, Edgar Fernando Guill&#233;n"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mar&#237;a Isabel"
              "apellidos" => "Morales Lozano"
            ]
            1 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Ornilla"
            ]
            2 => array:2 [
              "nombre" => "Lidia"
              "apellidos" => "Sancho"
            ]
            3 => array:2 [
              "nombre" => "Edgar Fernando"
              "apellidos" => "Guill&#233;n"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1699258X17300840"
        "doi" => "10.1016/j.reuma.2017.03.014"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17300840?idApp=UINPBA00004M"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301084?idApp=UINPBA00004M"
    "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301084/v1_201910260908/en/main.assets"
  ]
  "en" => array:17 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>"
    "titulo" => "Myofibroblastic Sarcoma of the Trapezius Muscle"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "e47"
        "paginaFinal" => "e48"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Carlos Antonio Guillen Astete, Carmen Larena Grijalva"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Carlos Antonio"
            "apellidos" => "Guillen Astete"
            "email" => array:1 [
              0 => "cguillen.hrc@salud.madrid.org"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Carmen"
            "apellidos" => "Larena Grijalva"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitario Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Sarcoma miofibrobl&#225;stico de trapecio"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1667
            "Ancho" => 1667
            "Tamanyo" => 171993
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Trapezius &#40;TP&#41; ultrasound scan&#44; longitudinal slice on cephalic edge&#46; A hypoechoic mass is observed&#44; homogenous in appearance and completed contained within the thickness of the muscle with no contact with the fascia &#40;F&#41; or subcutaneous cellular tissue &#40;SCCT&#41;&#46; The power Doppler signal is essentially concentrated in peripheral regions&#46; &#40;B&#41; NMR of the shoulder&#44; DP&#47;SPIR sequence to remove fatty tissue&#46; Transversal slice of the trapezius &#40;arrow&#41;&#46; In its interior a hyperintense structure with well defined edges is enhanced and this occupies almost all of the muscle matter &#40;&#42;&#41;&#46; &#40;C&#41; NMR of the shoulder&#44; T1 sequence&#44; sagittal slice&#46; In this projection the longitudinal extension of the trapezius &#40;arrow&#41; is appreciated and the occupation by the same fusiform&#44; hypointense structure&#44; with respect to the adjacent tissues&#46; &#40;&#42;&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Musculoskeletal ultrasound is groundbreaking in making direct assessment of diseases with musculoskeletal symptoms because of its accessibility and usefulness in diagnosis and in the treatment of many diseases of the locomotor apparatus&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1&#8211;3</span></a> Its use quickly resolves doubts on differential diagnosis and accelerates decision making&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We recently assessed a woman aged 26&#44; a new mother of 3 months who had presented at the emergency department on 3 occasions over 15 days due to right paracervical pain&#46; The patient had no other history of interest&#46; She took exercise sporadically and had an athletic constitution&#46; On 3 occasions she had been diagnosed with mechanical cervicalgia associated with muscular contracture attributed to the tasks of looking after a newborn&#46; She consulted for a fourth time after failure of 3 lines of analgesic&#44; muscle relaxant and anti-inflammatory treatment&#46; There was obvious asymmetry of the trapezius muscles with swelling of the right and limitation in rotation and passive lateralisation of the neck towards the left and lateralisation towards the right&#46; An X-ray of the cervical spine made in the second assessment showed no changes to the axial vertebral disposition&#46; Due to the striking lack of improvement an ultrasound scan of the right trapezius muscle was performed where a tumour was found to be contained within its thickness&#44; with smooth and well defined edges&#44; homogeneous in appearance&#44; hypochoic with respect to the adjacent muscle tissue and with a positive power Doppler signal &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; The longitudinal diameter of the mass was 7<span class="elsevierStyleHsp" style=""></span>cm and anterolateral diameter was 5&#46;5<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">On suspicion of a tumour dependent on striated tissue the patient was admitted to hospital for further study&#46; NMR imaging confirmed the finding of a tumour mass contained within the right trapezius muscle &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B and <span class="elsevierStyleSmallCaps">C</span>&#41;&#46; After fine needle aspiration and complete resection a 158<span class="elsevierStyleHsp" style=""></span>g specimen was extracted&#44; the pathological analysis of which revealed low grade myofibroblastic sarcoma &#40;LGSM&#41; which did not affect the resection margins&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">LGSM are atypical tumours which are rare and usually diagnosed in the neck and oral cavity&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;5</span></a> They are composed of an uncontrolled proliferation of myofibroblasts which are connective tissue cells that share physiological properties with smooth muscle cells and firbroblasts&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#44;7</span></a> These tumours have a high tendency to produce early metastasis and local relapses&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> Most of shoulder sarcomas usually present in the deltoid muscles&#46; There have been no reported cases of myofibroblastic sarcomas of the trapezius in the literature&#44; although it may be the exceptional location of other tumours&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Signal capture from power Doppler is an unequivocal sign of hyperaemia which in the context of tumours occupying spaces denotes inflammatory &#40;infectious or not&#41; activity or neoangiogenesis &#40;correlationable with neoprolipherative processes&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Notwithstanding the prevalence of these sarcomas in the described location&#44; we believe it is right to point out the importance ultrasound of the locomotor apparatus has in differential diagnosis of musculoskeletal processes with atypical disease courses and to highlight its use in identification of expansive soft tissue tumours&#44; especially those which demonstrate hyperaemia through power Doppler signal detection&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experiments have been carried out on humans or animals&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocols of their centre of work on the publication of patient data&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of Interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:3 [
        0 => array:3 [
          "identificador" => "sec0005"
          "titulo" => "Ethical Disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0010"
              "titulo" => "Protection of people and animals"
            ]
            1 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflict of Interests"
        ]
        2 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-05-08"
    "fechaAceptado" => "2017-06-15"
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Guillen Astete CA&#44; Larena Grijalva C&#46; Sarcoma miofibrobl&#225;stico de trapecio&#46; Reumatol Clin&#46; 2019&#59;15&#58;e47&#8211;e48&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1667
            "Ancho" => 1667
            "Tamanyo" => 171993
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Trapezius &#40;TP&#41; ultrasound scan&#44; longitudinal slice on cephalic edge&#46; A hypoechoic mass is observed&#44; homogenous in appearance and completed contained within the thickness of the muscle with no contact with the fascia &#40;F&#41; or subcutaneous cellular tissue &#40;SCCT&#41;&#46; The power Doppler signal is essentially concentrated in peripheral regions&#46; &#40;B&#41; NMR of the shoulder&#44; DP&#47;SPIR sequence to remove fatty tissue&#46; Transversal slice of the trapezius &#40;arrow&#41;&#46; In its interior a hyperintense structure with well defined edges is enhanced and this occupies almost all of the muscle matter &#40;&#42;&#41;&#46; &#40;C&#41; NMR of the shoulder&#44; T1 sequence&#44; sagittal slice&#46; In this projection the longitudinal extension of the trapezius &#40;arrow&#41; is appreciated and the occupation by the same fusiform&#44; hypointense structure&#44; with respect to the adjacent tissues&#46; &#40;&#42;&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound in rheumatology&#58; where are we and where are we going&#63;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Grupo de Trabajo de Ecograf&#237;a de la Sociedad Espa&#241;ola de Reumatolog&#237;a &#40;ECOSER&#41;"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; de Miguel"
                            1 => "J&#46;L&#46; Andreu"
                            2 => "E&#46; Naredo"
                            3 => "I&#46; M&#246;ller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.reuma.2013.04.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reumatol Clin"
                        "fecha" => "2014"
                        "volumen" => "10"
                        "paginaInicial" => "6"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23856277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Importancia de la ecograf&#237;a musculoesquel&#233;tica en el diagn&#243;stico diferencial de la patolog&#237;a inflamatoria de rodilla"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Guillen"
                            1 => "L&#46; Alba"
                            2 => "C&#46; de la Casa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Emergencias"
                        "fecha" => "2015"
                        "volumen" => "27"
                        "paginaInicial" => "350"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29087070"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bedside musculoskeletal ultrasonography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;J&#46; Connell"
                            1 => "T&#46;S&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ccc.2013.10.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Clin"
                        "fecha" => "2014"
                        "volumen" => "30"
                        "paginaInicial" => "243"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24606776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myofibrosarcoma&#58; a clinicopathologic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Montgomery"
                            1 => "J&#46;R&#46; Goldblum"
                            2 => "C&#46; Fisher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00000478-200102000-00010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "2001"
                        "volumen" => "25"
                        "paginaInicial" => "219"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11176071"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-grade myofibroblastic sarcoma&#58; a population-based study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;Y&#46; Chan"
                            1 => "Z&#46; Gooi"
                            2 => "E&#46;W&#46; Wong"
                            3 => "S&#46;K&#46; Ng"
                            4 => "M&#46;C&#46; Tong"
                            5 => "A&#46;C&#46; Vlantis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/lary.26146"
                      "Revista" => array:6 [
                        "tituloSerie" => "Laryngoscope"
                        "fecha" => "2017"
                        "volumen" => "127"
                        "paginaInicial" => "116"
                        "paginaFinal" => "121"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27377169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The story of the myofibroblasts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Majno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00000478-197912000-00006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg Pathol"
                        "fecha" => "1979"
                        "volumen" => "3"
                        "paginaInicial" => "535"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/534390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low grade myofibroblastic sarcoma occurred in the scalp"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;R&#46; Han"
                            1 => "G&#46;T&#46; Yee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3340/jkns.2015.58.4.385"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Korean Neurosurg Soc"
                        "fecha" => "2015"
                        "volumen" => "58"
                        "paginaInicial" => "385"
                        "paginaFinal" => "388"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26587195"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Myofibroblastic sarcoma of the base of tongue&#46; Case report and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Z&#46; Tak&#225;csi-Nagy"
                            1 => "G&#46; Murak&#246;zy"
                            2 => "P&#46; Pog&#225;ny"
                            3 => "J&#46; Fodor"
                            4 => "Z&#46; Orosz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00066-009-1925-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Strahlenther Onkol"
                        "fecha" => "2009"
                        "volumen" => "185"
                        "paginaInicial" => "198"
                        "paginaFinal" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19330298"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metastatic meningioma presenting as a malignant soft tissue tumour"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; McCarthy"
                            1 => "M&#46; Hofer"
                            2 => "M&#46; Vlychou"
                            3 => "R&#46; Khundkar"
                            4 => "P&#46; Critchley"
                            5 => "S&#46; Cudlip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13569-016-0063-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Sarcoma Res"
                        "fecha" => "2016"
                        "volumen" => "6"
                        "paginaInicial" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28042470"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contrast-enhanced color Doppler ultrasonography increases diagnostic accuracy for soft tissue tumors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Oebisu"
                            1 => "M&#46; Hoshi"
                            2 => "M&#46; Ieguchi"
                            3 => "J&#46; Takada"
                            4 => "T&#46; Iwai"
                            5 => "M&#46; Ohsawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3892/or.2014.3378"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncol Rep"
                        "fecha" => "2014"
                        "volumen" => "32"
                        "paginaInicial" => "1654"
                        "paginaFinal" => "1660"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25109621"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301394/v1_201910260908/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "5795"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Images in Clinical Rheumatology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000005/v1_201910260908/S2173574318301394/v1_201910260908/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301394?idApp=UINPBA00004M"
]
Share
Journal Information
Vol. 15. Issue 5.
Pages e47-e48 (September - October 2019)
Vol. 15. Issue 5.
Pages e47-e48 (September - October 2019)
Images in Clinical Rheumatology
Full text access
Myofibroblastic Sarcoma of the Trapezius Muscle
Sarcoma miofibroblástico de trapecio
Visits
21890
Carlos Antonio Guillen Astete
Corresponding author
cguillen.hrc@salud.madrid.org

Corresponding author.
, Carmen Larena Grijalva
Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

Musculoskeletal ultrasound is groundbreaking in making direct assessment of diseases with musculoskeletal symptoms because of its accessibility and usefulness in diagnosis and in the treatment of many diseases of the locomotor apparatus.1–3 Its use quickly resolves doubts on differential diagnosis and accelerates decision making.

We recently assessed a woman aged 26, a new mother of 3 months who had presented at the emergency department on 3 occasions over 15 days due to right paracervical pain. The patient had no other history of interest. She took exercise sporadically and had an athletic constitution. On 3 occasions she had been diagnosed with mechanical cervicalgia associated with muscular contracture attributed to the tasks of looking after a newborn. She consulted for a fourth time after failure of 3 lines of analgesic, muscle relaxant and anti-inflammatory treatment. There was obvious asymmetry of the trapezius muscles with swelling of the right and limitation in rotation and passive lateralisation of the neck towards the left and lateralisation towards the right. An X-ray of the cervical spine made in the second assessment showed no changes to the axial vertebral disposition. Due to the striking lack of improvement an ultrasound scan of the right trapezius muscle was performed where a tumour was found to be contained within its thickness, with smooth and well defined edges, homogeneous in appearance, hypochoic with respect to the adjacent muscle tissue and with a positive power Doppler signal (Fig. 1A). The longitudinal diameter of the mass was 7cm and anterolateral diameter was 5.5cm.

Fig. 1.

(A) Trapezius (TP) ultrasound scan, longitudinal slice on cephalic edge. A hypoechoic mass is observed, homogenous in appearance and completed contained within the thickness of the muscle with no contact with the fascia (F) or subcutaneous cellular tissue (SCCT). The power Doppler signal is essentially concentrated in peripheral regions. (B) NMR of the shoulder, DP/SPIR sequence to remove fatty tissue. Transversal slice of the trapezius (arrow). In its interior a hyperintense structure with well defined edges is enhanced and this occupies almost all of the muscle matter (*). (C) NMR of the shoulder, T1 sequence, sagittal slice. In this projection the longitudinal extension of the trapezius (arrow) is appreciated and the occupation by the same fusiform, hypointense structure, with respect to the adjacent tissues. (*).

(0.16MB).

On suspicion of a tumour dependent on striated tissue the patient was admitted to hospital for further study. NMR imaging confirmed the finding of a tumour mass contained within the right trapezius muscle (Fig. 1B and C). After fine needle aspiration and complete resection a 158g specimen was extracted, the pathological analysis of which revealed low grade myofibroblastic sarcoma (LGSM) which did not affect the resection margins.

LGSM are atypical tumours which are rare and usually diagnosed in the neck and oral cavity.4,5 They are composed of an uncontrolled proliferation of myofibroblasts which are connective tissue cells that share physiological properties with smooth muscle cells and firbroblasts.6,7 These tumours have a high tendency to produce early metastasis and local relapses.6–8 Most of shoulder sarcomas usually present in the deltoid muscles. There have been no reported cases of myofibroblastic sarcomas of the trapezius in the literature, although it may be the exceptional location of other tumours.9

Signal capture from power Doppler is an unequivocal sign of hyperaemia which in the context of tumours occupying spaces denotes inflammatory (infectious or not) activity or neoangiogenesis (correlationable with neoprolipherative processes).10

Notwithstanding the prevalence of these sarcomas in the described location, we believe it is right to point out the importance ultrasound of the locomotor apparatus has in differential diagnosis of musculoskeletal processes with atypical disease courses and to highlight its use in identification of expansive soft tissue tumours, especially those which demonstrate hyperaemia through power Doppler signal detection.

Ethical DisclosuresProtection of people and animals

The authors declare that for this research no experiments have been carried out on humans or animals.

Data confidentiality

The authors declare that they have adhered to the protocols of their centre of work on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article

Conflict of Interests

The authors have no conflict of interests to declare.

References
[1]
E. de Miguel, J.L. Andreu, E. Naredo, I. Möller, Grupo de Trabajo de Ecografía de la Sociedad Española de Reumatología (ECOSER).
Ultrasound in rheumatology: where are we and where are we going?.
Reumatol Clin, 10 (2014), pp. 6-9
[2]
C. Guillen, L. Alba, C. de la Casa.
Importancia de la ecografía musculoesquelética en el diagnóstico diferencial de la patología inflamatoria de rodilla.
Emergencias, 27 (2015), pp. 350-351
[3]
M.J. Connell, T.S. Wu.
Bedside musculoskeletal ultrasonography.
Crit Care Clin, 30 (2014), pp. 243-273
[4]
E. Montgomery, J.R. Goldblum, C. Fisher.
Myofibrosarcoma: a clinicopathologic study.
Am J Surg Pathol, 25 (2001), pp. 219-228
[5]
J.Y. Chan, Z. Gooi, E.W. Wong, S.K. Ng, M.C. Tong, A.C. Vlantis.
Low-grade myofibroblastic sarcoma: a population-based study.
Laryngoscope, 127 (2017), pp. 116-121
[6]
G. Majno.
The story of the myofibroblasts.
Am J Surg Pathol, 3 (1979), pp. 535-542
[7]
S.R. Han, G.T. Yee.
Low grade myofibroblastic sarcoma occurred in the scalp.
J Korean Neurosurg Soc, 58 (2015), pp. 385-388
[8]
Z. Takácsi-Nagy, G. Muraközy, P. Pogány, J. Fodor, Z. Orosz.
Myofibroblastic sarcoma of the base of tongue. Case report and review of the literature.
Strahlenther Onkol, 185 (2009), pp. 198-201
[9]
C. McCarthy, M. Hofer, M. Vlychou, R. Khundkar, P. Critchley, S. Cudlip, et al.
Metastatic meningioma presenting as a malignant soft tissue tumour.
Clin Sarcoma Res, 6 (2016), pp. 23
[10]
N. Oebisu, M. Hoshi, M. Ieguchi, J. Takada, T. Iwai, M. Ohsawa, et al.
Contrast-enhanced color Doppler ultrasonography increases diagnostic accuracy for soft tissue tumors.
Oncol Rep, 32 (2014), pp. 1654-1660

Please cite this article as: Guillen Astete CA, Larena Grijalva C. Sarcoma miofibroblástico de trapecio. Reumatol Clin. 2019;15:e47–e48.

Copyright © 2017. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Idiomas
Reumatología Clínica (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?