En-bloc excision of Giant Cell Tumors of the distal radius and arthrodesis of the translocated ipsilateral ulna: A report of two cases

The distal radius is the third most common site of giant cell tumor of bone (GCTB). The local aggressive invasion of this rare neoplasm requires reconstructive solutions after wide excision. The authors present two cases of patients diagnosed with Campanacci grade III GCTB of the distal radius successfully treated with en-bloc excision and translocation of the ipsilateral ulna. Pre-operative application of denosumab was given for one year to both patients. At one year of follow-up, both patients are disease-free and reported satisfactory results on Quick - Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire and modified Musculoskeletal Tumor Society (MSTS) score. Although a challenge, the reported procedure offers good oncological and functional outcomes. Keywords: Giant cell tumor of bone; distal radius; en-bloc excision; translocation; ipsilateral ulna; wrist arthrodesis

Hemangioma of the Rib Mimicking Chondrosarcoma: A Report of Two Cases and Literature Review

Cases. Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone. Conclusion. We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.

Primary malignant bone tumours of spine and pelvis in children

Purpose Axial malignant bone tumours are rare in children and adolescents, and their prognosis is still relatively poor due to non-specific symptoms, such as back or groin pain, which may result in late hospital presentation. Therefore, it is very important to raise awareness regarding this pathology. Methods We performed a narrative review, including scientific publications published in English. We searched Medline and Google Scholar databases for information on the incidence and prognosis of axial malignant bone tumours in children and adolescents (< 18 years). Outcomes of different surgical management strategies and reconstruction options were assessed. Results The incidence of primary malignant bone tumours before the age of 18 years is approximately five per one million population; around 25% of these tumours are located in the axial skeleton. With a five-year survival rate of 50%, tumours in an axial location (chest cage, spine, pelvis) are associated with a poorer prognosis than tumours in more peripheral locations. En bloc excision with clear margins has been shown to improve local control and overall survival, even though obtaining adequate surgical margins is difficult due to the close location of large neurovascular structures and other major organs. Spinal reconstruction options include instrumented fusion with allograft or expandable cage. Pelvic reconstruction is needed in internal hemipelvectomy, and the options include biological, endoprosthetic reconstructions, hip transposition, arthrodesis or creation of pseudoarthrosis and lumbopelvic instrumentation. Conclusion Early diagnosis, a timely adequate multidisciplinary management, appropriate en bloc excision, and reconstruction improve survival and quality of life in these patients. Level of Evidence V

Disease presentation and surgical treatment of patients with foreign-body granulomas and ASIA syndrome: case series

Background The result of illicit polymer injection is chronic inflammation with foreign-body granuloma (FBG) formation. Treatment can be divided into medical and surgical. Some patients develop severe complications with need surgical treatment. This study aims to describe patients who underwent surgical removal of the FBGs and autoimmune/inflammatory syndrome induced by adjuvants (ASIA); additionally, we evaluated the quality of life after surgery.Methods In this retrospective single-center study, the authors examined data of patients who underwent surgical removal of FBG caused by illicit polymer injection for cosmetic purposes and confirmed ASIA from 2015 to 2020 by three different surgical approaches. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, treatment strategies, histopathology reports and quality of life.Results The cohort included 11 female patients with FBGs and ASIA. The most affected anatomical zones were the combination of gluteal region, thighs and legs (40%); and thighs with legs (20%). Main presentation was: skin hyperpigmentation (90.9%), skin induration (63.6%), chronic fatigue (63.6%), and ulcers (36.4%). Surgical modalities consisted of: ultrasonic-assisted liposuction in four patients (36.4%); open en bloc excision and primary closure in four patients (36.4%); and open en bloc excision and microsurgical reconstruction in three patients (27.2%). The postoperative quality of life visual analog scale score was 83.9.Conclusions ASIA treatment represents a challenge for the plastic surgeon. Adequate surgical treatment emphasizing, when possible, the total or near-total resection of the FBG must be performed to improve ASIA evolution.

Perforated High-Grade Mixed Neuroendocrine Nonneuroendocrine Neoplasm of Cecum: Unusual Presentation of Rare Disease

Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) are rare neoplasms of the gastrointestinal tract, where the neuroendocrine as well as the nonneuroendocrine components each comprise at least 30% of the tumor. Of all cases of colorectal malignancies, MiNENs constitute around 3–9.6%, with only a few cases reported to be arising in the cecum. Since majority present with nonspecific clinical and radiological findings, its diagnosis preoperatively is almost impossible and these are usually diagnosed after histopathological examination of the resected specimen. Owing to the rarity of these tumors as well as lack of complete molecular characterization, optimal treatment remains unestablished. We, here, report a rare case of MiNENs of the cecum infiltrating the right psoas muscle and presenting with perforation for which right hemicolectomy and en bloc excision of the involved psoas muscle was done followed by adjuvant chemotherapy.

Outcomes and Complications of Surgical Removal of Foreign Body Granulomas Due to Illicit Polymer Injection for Cosmetic Purposes

Background There are several local complications associated with subcutaneous injection of illicit polymers, including: injection-site deformity, granulomas, and skin changes. Objectives To compare the postoperative complications and symptom flare in patients undergoing surgical excision of foreign-body granulomas. Methods We retrospectively examined data of patients who underwent surgical removal of foreign-body granulomas caused by polymer injection for cosmetic purposes with UAL, en bloc excision with primary closure, skin grafts, or free flaps during 2014–2020. Data collected included demographic and operative parameters. Postoperative complications, symptom flare, and time to flare were reported. Relationship between type of surgery and complications, symptom flare, and time to flare was determined through statistical analysis. Results The final cohort included 49 surgeries (42 primary and 7 secondary) in 35 patients. Overall complication rate was 28.9%, with no significant intergroup differences (30.8%, 20%, 66.7%, and 40%; p = 0.328). Wound dehiscence and skin burns were the main complications. An overall symptom flare of 35.1% in surgical treated areas over a mean period of 28.49 months was reported. Chi-squared test indicated statistical significance between type of surgery and symptom flare (p = 0.004) and between complications and flare (p = 0.013). Kaplan–Meier test for flare was statistically significant (p = 0.006) after comparison of the four groups. Conclusions Rate of postoperative complications was similar for each type of surgery. However, en bloc excision and reconstruction by either primary closure or free flap was associated with a significantly decreased rate of symptom flare and a longer symptom-free period.