An update of diagnostic strategies using molecular genetic and magnetic resonance imaging techniques for musculoskeletal tumors

Rheumatologists may be incidentally confronted by bone and soft tissue lesi ons presenting in and around joints that require early recognition and appr opriate referral, The diagnostic and therapeutic management of patients wit h musculoskeletal tumors is critically dependent on a multidisciplinary app roach. Advances, particularly in the fields of histopathology, molecular (c yto)genetics and radiologic imaging techniques, have resulted in significan t improvements in reaching a correct (differential) diagnosis, essential fo r implementing optimal treatment modalities. Magnetic resonance imaging is becoming increasingly important in planning preoperative and postoperative management strategies, and should precede all invasive procedures, Improvem ents in the fields of immunohistochemistry, together with the realization t hat certain tumor groups may be associated with specific genetic alteration s, has significantly improved diagnostic accuracy. Additionally, the presen ce of certain genetic alterations within the tumoral genome have been found to be of prognostic value, and the hereditary context recognized for a num ber of specific bone and soft tissue tumors should be taken into account in the management of a patient with such a neoplasm. It is envisaged that an increasing understanding of the molecular biology and histogenesis of indiv idual musculoskeletal tumor types will lead to tailor-made therapeutic opti ons and consequently prognostic improvements, This update serves to highlig ht some important recent developments in fundamental and diagnostic aspects of musculoskeletal tumors. (C) 2000 Lippincott Williams & Wilkins, Inc.