A vaginal fibroepithelial stromal polyp: a case report with magnetic resonance images

A fibroepithelial stromal polyp is a benign soft tissue tumour that can occur in the vagina, vulva and uterine cervix. Magnetic resonance imaging (MRI) findings have been reported in patients with vulvar fibroepithelial stromal polyps, not in those with vaginal polyps. We present MRI findings of vaginal fibroepithelial stromal polyp in a postmenopausal female. A 1 to 2 cm firm vaginal mass arising from the left side of the vaginal wall with hypointense signal changes on T1W MRI was identified. A well-defined vaginal mass (1 cm diameter) was detected with inhomogeneous signal intensity on T2W images. However, a major portion had high signal intensity on diffusion-weighted images. A benign vaginal lesion with oedematous changes or myxoid degeneration was suspected. Vaginal resection was performed, and fibroepithelial stromal polyp was pathologically diagnosed. MRI may be a useful non-invasive modality for preoperatively diagnosing vaginal fibroepithelial stromal polyps.

Case Report: Postoperative Recurrence of Adrenal Epithelioid Angiosarcoma Achieved Complete Response by Combination Chemotherapy With Liposomal Doxorubicin and Paclitaxel

BackgroundPrimary adrenal epithelioid angiosarcoma is an extremely rare cancer with a poor prognosis. Because of the rarity of this disease, treatment options have not been well-studied.Case presentationA 51-year-old man was admitted to Zhejiang Cancer Hospital, diagnosed with a recurrence of adrenal epithelioid angiosarcoma. He had undergone a surgical resection seven months earlier. Combination chemotherapy with liposomal doxorubicin and paclitaxel was administered. After two cycles of chemotherapy, his pain was relieved. Computed tomography (CT) suggested that the soft tissue tumour lesions in the surgical area had disappeared, mediastinal and mediastinal-hilar lymph nodes were significantly reduced or had disappeared, and the patient had achieved a partial response (PR). CT after six cycles of chemotherapy indicated that the patient had achieved a complete response (CR).ConclusionCombination chemotherapy with liposomal doxorubicin and paclitaxel may be a preferred therapy for recurrent or advanced adrenal epithelioid angiosarcoma.

MIMICKING SOFT TISSUE TUMOUR- SPINDLE CELL LIPOMA

Spindle cell lipomas (SCL) are slow-growing benign adipocyte tumours that are most commonly seen in (1) the upper back, posterior aspect of the neck, and shoulders . Both genders are affected, but it is more (1) prevalent in males between the ages of 40 and 70 . Spindle cell lipoma is a benign tumour that is frequently confused with (1) liposarcoma. SCLs account for approximately 1.5 percent of all lipomatous tumours reported, making them uncommon . They (2) have a morphology similar to other benign and malignant fatty/spindle cell or myxoid lesions . Microscopically, it is a complex mixture of lipocytes and uniform spindle cells embedded in a mucinous matrix and traversed by (2) a variable number of birefringent collagen bres . Due to the unusual presentation and similar morphology of tumours, early diagnosis is critical; thus, diagnosis is based on clinical examination and conrmed by histopathological ndings. Because SCL has a favourable prognosis, wide local (1) excision is the treatment of choice . This is a case report of a 52-year-old male with a similar presentation in the right upper limb.

Scorbuto: ancora un problema dei nostri giorni?

Scurvy is a condition due to chronic ascorbic acid deficiency responsible for vascular fragility and impaired bone formation. The result is gingival bleeding, petechial lesions and articular and bone pain or limb swelling. Children may also present with irritability, limping or refusal to walk. Because of these symptoms it can be misdiagnosed with osteomyelitis, septic arthritis, bone and soft tissue tumour, leukaemia, bleeding disorders and other rheumatologic conditions. In highly developed countries it is rare, but should be suspected in children with underlying chronic condition characterized by selective eating as in developmental delay or autism spectrum disorders. The paper presents an emblematic case.

Synovial Sarcoma of the Cervical Spine: Case Report

PurposeTo describe a very rare case of Synovial Sarcoma affecting cervical spine vertebra.SS is a rare malignant and aggressive soft tissue tumour arising from mesenchymal cells. Primary bone origin SS is a much rarer entity that affects more commonly long bones. Ideal therapeutic strategy is yet to be defined due to very small number of cases reported so far.Case reportA 55-year-old male, construction worker, with no other relevant medical history presented with a progressive tetraparesis after recurring several times during a 4-week period to assistant physician and emergency department complaining about bilateral shoulder pain. Image studies revealed an osteolytic lesion centred on C4 vertebra with intracanalar and intraforaminal extension, causing neurologic compression. Patient was submitted to urgent surgical decompression intervention. C3 and C4 corpectomy and excisional biopsy followed by stabilization with C2-C5 arthrodesis.OutcomesNeurological deficits did not improve after surgery. Histopathological and immunohistochemical analysis revealed phenotypical characteristics of a biphasic Synovial Sarcoma. Patient died 4 weeks after surgery due to a respiratory tract infection.DiscussionSS is a malignant rare and aggressive soft tissue tumour that usually affects young adults. Very few cases of primary bone SS affecting the spine are described in literature. Imaging studies may suggest the diagnosis of synovial sarcoma but definitive diagnosis can only be confirmed by histological and immunohistochemical analysis.The rarity of these lesions demands high clinical suspicion for the diagnosis and due to the low number of cases reported ideal therapeutic strategy is yet to be defined.

972 Investigating the Modified Glasgow Prognostic Score as A Tool in Patients Undergoing Surgery for Sarcoma - A Newcastle Cohort Study

Aim Sarcomas are an aggressive group of cancers with a poor prognosis. The modified Glasgow Prognostic Score (mGPS) uses CRP and albumin levels to generate a score from 0 to 2. A higher mGPS is associated with worse outcomes and is validated in various carcinomas. However, less evidence exists for its usefulness in sarcoma and this study aims to further investigate this area. Method All patients with a bone or soft tissue sarcoma diagnosis presenting to the North of England Bone and Soft Tissue Tumour Service between 2010 – 2014 were analysed. A retrospective review of clinical notes, pre-operative biochemistry results and oncological outcome was performed. Primary outcome measures were local recurrence or metastasis and overall survival (OS). Results 80 patients met the inclusion criteria (28 females and 52 males). 64% of patients were aged >50 at diagnosis. 78% of tumours were high grade (Trojani Grade 2/3) and 71% were >5cm in size. 51 patients had a calculated mGPS=0, 19 patients had mGPS=1 and 10 patients had mGPS=2. In the mGPS=0 group, 22% developed recurrence or metastases and median OS was 42.2 months. For an mGPS of 1 and 2, the rate of recurrence or metastasis was 58% and 60% respectively, and median OS was 41.6 and 39.9 months. Conclusions Pre-surgical CRP and albumin levels (mGPS) may be important in predicting outcome and aiding the management of sarcoma patients. In this cohort, a higher mGPS (1/2) was associated with increased frequency of recurrence or metastasis, however further data is required to determine statistical significance.

Anatomy, physiology, and pathology of body fat

Subcutaneous body fat is a distinct anatomical entity with unique physiology, metabolism, and disease. The main roles of fat are energy storage, hormone production, and insulation. Free fatty acids and glycerol can be assembled into triglycerides, and conversely triglycerides can undergo lipolysis. Insulin is the key hormone that controls this fine balance. Pregnancy is associated with increased truncal body fat and breast ptosis. Cellulite is the padded appearance of fat and there is currently no single proven treatment. Lipomas are the most common soft tissue tumour and can be treated with excision or liposuction. Lipodystrophies are disorders characterized by the selective loss of body fat and lipofilling is a useful treatment modality. Panniculitis is the inflammation of subcutaneous fat and treatment involves dealing with the precipitating cause. The plastic surgeon should be familiar with the anatomy, physiology, and pathology of fat in order to treat this wide array of adipose-related conditions.