Rare Lipomatous Neoplasm of The Thigh in A 13 Year Old Male with A Discussion of Imaging Features and Differential Diagnosis of A Fatty Extremity Mass

Lipomatous tumors are among the most common primary musculoskeletal neoplasms affecting both pediatric and adult patient populations. Patient age, tumor location, and imaging features all contribute to the differential diagnosis of musculoskeletal tumors. Tumors identified outside of common patient demographics or in unusual locations may lead to preoperative misdiagnosis. We present an uncommon adipocytic tumor occurring at an uncommon age which was proven at surgery to represent a preoperatively unexpected diagnosis. A 13 year old male presented with a fatty anterior proximal thigh mass; age and magnetic resonance findings suggested lipoblastoma. However, following complete surgical resection, histopathology confirmed hibernoma, a benign lipomatous tumor characterized by the presence of white and multivacuolated brown fat cells, the vast majority of which occur in adult patients.

Comparison of Quality of Life of Patients after Hip Disarticulation and Those after Stump Lengthening with Modular Prosthesis

Background. Disarticulation has been used less and less often in the treatment of musculoskeletal neoplasms; however, in some cases it allows the patient to achieve good oncological and functional outcomes. The aim of this paper is to present the possibilities, surgical technique and treatment outcomes of patients after hip disarticulation and stump lengthening with a modular prosthesis. Material and methods. Three classic hip disarticulation surgeries and 2 hip disarticulation procedures with stump lengthening with a modular prosthesis were performed at the Department of Oncological Orthopaedics in Brzozów in 2013 and 2014. The present paper discusses the indications, surgical technique and outcomes. Pain intensity was assessed in a VAS scale and physical function was measured with the Karnofsky scale. The mental status of the patients was analysed in the Beck Depression Inventory and the ability to perform daily living activities was evaluated according to Katz. The ability to walk after surgery was assessed. Results. Patients after hip disarticulation showed considerably worse functional outcomes. The mean physical function score was 53 points in the Karnofsky scale and 3.33 points in the Katz scale. The patients had difficulty walking and did not ambulate with their prostheses. They reported problems with sitting and using the toilet. Patients with lengthened stumps showed visibly better physical function scores, achieving, on average, 65 points in the Karnofsky scale and 5.5 points in the Katz scale. These patients used their prostheses, ambulated efficiently and were independent. Conclusions. Stump lengthening with a modular prosthesis in patients after hip disarticulation results in significantly better outcomes than the classic procedure.