Medial Inguino-Femoral Lymphadenectomy for Vulvar Cancer: An Approach to Decrease Lymphedema without Compromising Survival

Background: Lower limb lymphedema is a long-term complication of inguino-femoral lymphadenectomy and is related to the number of lymph nodes removed. Our hypothesis was that lymph nodes lateral to the femoral artery could be left in situ if the medial nodes were negative, thereby decreasing this risk. Methods: We included patients with vulvar cancer of any histological type, even if the cancer extended medially to involve the urethra, anus, or vagina. We excluded patients whose tumor extended (i) laterally onto the thigh, (ii) posteriorly onto the buttocks, or (iii) anteriorly onto the mons pubis. After resection, the inguinal nodes were divided into a medial and a lateral group, based on the lateral border of the femoral artery. Results: Between December 2010 and July 2018, 76 patients underwent some form of groin node dissection, and data were obtained from 112 groins. Approximately one-third of nodes were located lateral to the femoral artery. Positive groin nodes were found in 29 patients (38.2%). All patients with positive nodes had positive nodes medial to the femoral artery. Five patients (6.6%) had positive lateral inguinal nodes. The probability of having a positive lateral node given a negative medial node was estimated to be 0.00002. Conclusion: Provided the medial nodes are negative, medial inguino-femoral lymphadenectomy may suffice and should reduce lower limb lymphedema without compromising survival.

Granular Cell Tumor of the Tongue: A Rare Case Presentation of a 14 Years Old Girl

Granular cell tumor or Abrikossoff ’s tumor is an infrequent tumor that can arise in most organs, and especially in the ENT area. It is a usually benign neoplasm, that can lead to a misdiagnose of malignancy. It affects both sex, between the fourth and the sixth decade. We present in this report a case of a 14 years old girl with a slowly growing lesion on the right lateral border of the mobile tongue. The biopsy showed a proliferation of large cells with a granular cytoplasm that expressed two immunohistochemistry markers: CD68 and S100 antibodies. Surgical resection was completed with a one centimeter margin.The rare issue about this case is the age of presentation: the age of the patient is 14, whereas this tumor usually affects adult patients.

Unknown variant of the accessory subscapularis muscle?

Acting in medial rotation of the arm, the subscapularis (SM) is the most powerful and largest muscle of the rotator cuff. It is morphologically variable, especially in the number of tendons, place of insertion, and number of bellies, and it is sometimes fused with another muscle. An accessory subscapularis muscle (ASM) is among the morphological variations of the SM, but it is a really rare variant. The present case describes a very rare ASM that is divided into proximal tendinous attachment, intermediate fleshy muscular belly and distal tendinous attachment. Its origin is located on the lateral border of the scapula, but some fibers are connected with the muscular part of the SM. Its distal attachment is fused with the capsule of shoulder joint, above the tendinous insertion of the SM. Such an arrangement allows for greater stabilization of the joint. Moreover, there is a possibility that it could be used during treatment of ruptured SM tendons.

Rare location of Universal tumor

Lipomas are one of the most common benign mesenchymal tumor in human. Lipoma occurring in the tongue is rare as tongue has paucity of normal adipose tissue. Here we present an unusual case of lipoma presented in the tongue, and removal of which comforted patient by regaining of the functional task of tongue. Fifty two year’s old Muslim women presented with painless swelling on right lateral border of tongue for 5 years for which excision was done and histopathology evaluation was performed. The histopathology was consistent with the diagnosis of Lingual Lipoma. Existence of lipoma in the tongue is very rare, which can be managed by simple excision. Histopathology is the gold standard in the diagnosis.

Morphometric study of nutrient foramen of tibia in Jharkhand population

Background: Nutrient foramen gives passage to the nutrient vessels which supply major portion of the bone even bone marrow. Many vascular foramina are present in all bones for the passage of blood vessels. In long bones many small vascular foramina are present at the ends through which epiphyseal and metaphyseal blood vessels passes. In the shaft of long bones one or two larger foramina are present through which nutrient vessels passes. Nutrient artery provides 70% to 80% blood supply of long bones in children and if blood supply is decreased, it may lead to ischemia of bone resulting into less vascularisation of metaphysis and growth plate. Thus precise topographical knowledge of nutrient foramen is necessary for the surgeons to save the nutrient vessels during surgical procedures i.e. fracture fixation, bone grafting etc. Damage to the nutrient artery causes avascular necrosis of bone.Methods: Total 70 dry bones of tibia were taken in the study, without knowledge of sex of the bone. Position, number and direction of the nutrient foramen were noted.Results: single nutrient foramina present in 91.43% of cases and double in 6% of cases. 97.14 % nutrient foramina are directed downward and 2.86% directed upward. 90% nutrient foramina present on posterior surface, 1.42% on lateral surface and 8.57% on lateral border. 75% of nutrient foramina present in upper 1/3 and 25% in middle 1/3. Primary nutrient foramina (>24 G) present in 89.47% and secondary nutrient foramina (<24 G) present in 10.53% of cases.Conclusions: A sound knowledge of nutrient foramen topography, prevent the injuries of vasculature of bone during surgeries.

The concept of “whole perforator system” in the lateral thoracic region for latissimus dorsi muscle-preserving large flaps: An anatomical study and case series

Background Previous studies have reported on the abundant cutaneous perforating blood vessels around the latissimus dorsi (LD) lateral border, such as a thoracodorsal artery perforator (TDAP) of septocutaneous type (TDAP-sc) and muscle-perforating type (TDAP-mp), or the lateral thoracic artery perforator (LTAP). These perforators have been clinically utilized for flap elevation; however, there have been few studies that accurately examined all the cutaneous perforators (TDAP-sc, TDAP-mp, LTAP) around the LD lateral border. Here, we propose a new “whole perforator system” (WPS) concept in the lateral thoracic region and a methodology that enables elevating large flaps with reliable perfusion in a muscle-preserving manner. Methods We first performed an anatomical study that verified the number and perforating points of all perforators around the LD lateral border using the results of dynamic contrast-enhanced magnetic resonance imaging of patients with breast cancer. Following the anatomical evaluation, we performed large muscle-preserving flap transfer that contained all of the perforators around the LD lateral border in an actual clinical setting. Results A total of 175 latissimus dorsi from 98 patients were included. The mean number of perforators (TDAP-sc + TDAP-mp + LTAP) per side was 4.51±1.44 (2–9); TDAP-sc was present in 57.1% (100/175) of cases, and TDAP-mp in 76.6% (134/175); the TDAP total prevalence rate (TDAP-sc + TDAP-mp) was 96.0% (168/175). The LTAP existence rate was 94.3% (165/175). Distance from the axillary artery to the TDAP-sc was 148.7±56.3 mm, which was significantly proximal to the TDAP-mp (183.8±54.2 mm) and LTAP (172.2±81.3 mm). Conclusion The lateral thoracic region has an abundant cutaneous perforator system derived from the descending branch of the thoracodorsal and lateral thoracic arteries. Clinical application of the lateral thoracic WPS flap is promising, with a large survival area even with muscle-preserving procedures and requiring a relatively simple procedure.

592 A Large Lipoma: An Unusual Presentation of the Tongue

Background Lipomas are commonly identified tumours of the body however they are rarely found in the oral cavity. Rarer still is it to report a case of a lipoma in the tongue as they are more commonly located in the buccal mucosa. Objectives To diagnose and explore the pathogenesis of a soft-tissue swelling of unknown origin Method A thorough patient history and clinical examination was undertaken followed by magnetic resonance imaging (MRI) which revealed an alarming report at first glance. An incisional biopsy of the lesion was then carried out to aid in diagnosing the lesion. Results The swelling caused the patient no pain however the mere size of the lesion affected the patient’s tongue movement and function which therefore affected the patient’s quality of life. The imaging and the biopsy of the lesion led to a diagnosis of a large lipoma on the lateral border of the tongue. Conclusions To the authors’ best knowledge, we present a rare case of a patient whom we diagnosed with a large lipoma on the lateral border of the tongue. This case report discusses the stages of patient management from initial presenting complaint, up to the maintenance of the patient following the diagnosis of this lesion.

Incidental finding of hereditary multiple osteochondroma causing ischiofemoral impingement

Ischiofemoral impingement (IFI) has been described in the medical literature as a cause of hip pain. IFI occurs due to an abnormal contact or reduced space between the lesser trochanter and the lateral border of the ischium and is an often unrecognised cause of pain and snapping in the hip. Association of multiple exostoses and a skeletal dysplasia characterised by an abnormal modelling of bone metaphysis and osseous deformities is highly characteristic of this disease. Consequently, multiple exostoses may narrow the ischiofemoral space and cause impingement and pain, even in the absence of malignant transformation. Surgical excision of exostosis of the lesser trochanter is a safe and effective method of treatment for patients with IFI. We present a case of left hip pain with incidental finding of hereditary multiple osteochondroma causing IFI and discuss the predisposing factors and review of literature.