Hypertrophy of the tensor fascia lata: A pseudotumor due to lumbar radiculopathy

Background: Pseudotumor of the tensor fascia lata (TFL) consists of a rare, benign soft tissue mass/hypertrophy of the TFL that appears on the anterolateral aspect of the proximal thigh. Notably, this condition often mimics a malignant tumor and may be misdiagnosed as a sarcoma. Case Description: A 45-year-old male presented with left hip/groin pain, swelling, and a painful mass on the anterolateral aspect of the left hip/thigh. The symptoms had started 3 months ago following an L1-S1 lumbar laminectomy/fusion. The initial diagnosis was hip disease, and the patient underwent a left MR arthrogram. When this study demonstrated a tear of the left anterosuperior acetabular labrum plus an increased alpha angle causing femoroacetabular impingement, the patient then underwent a left hip arthroscopy. However, as he continued to complain of the hip mass, he was referred to an orthopedic oncologist whose presumptive diagnosis favored a sarcoma. Nevertheless, the pelvic MRI scan and ultrasound (US) confirmed the diagnosis of hypertrophy of the left TFL (US left 33.4 mm vs. right 14.4 mm). The patient was first treated with 50 units of locally injected botulinum. As there was no symptomatic relief, the plan was to repeat the injection within the next few months. Conclusion: Hypertrophy of TFL may mimic a neoplasm such as a sarcoma and contributes to what appears to be a lumbar radiculopathy. However, MR and US imaging should readily identify TFL and rule out malignant lesions such as sarcomas.

Acute dyspnea as a manifestation of Forestier's disease. A case report.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a noninflammatory disease and is characterized by ossification of the anterolateral aspect of vertebral bodies, mostly in thoracic part of the spine. Although, usually, DISH is asymptomatic, in rare cases osteophytes located in the cervical part of the spine can cause otolaryngological manifestations, such as dysphagia (most common), hoarseness and stridor. In differential diagnosis of upper respiratory tract symptoms, we should consider DISH. We present case of 82 years old male patient with acute dyspnea, who was diagnosed with osteophytes of C4-C7 vertebral bodies. In this case conservative therapy was not efficient, therefore successful surgical treatment was performed.

An unusual case of giant multilobulated lipoma over left truncal region

Lipomas can virtually occur anywhere in the human body. They can be of varying sizes. Small lipomas are more frequently found, whereas giant lipomas are comparatively rare. These slow-growing, nearly always benign, tumors usually present as non painful, round, mobile masses with a characteristic soft, doughy feel. They are one of the most common benign tumours found in the body. Difference through histopathology and immunochemistry has to be done to rule out other conditions such as liposarcoma. In this report we present a case of a female with a large swelling with multilobulations over the anterolateral aspect of the left thigh and gluteal region. Incision biopsy revealed a lipoma for which primary excision was done safeguarding vital structures. The lipoma was unusual in its size, its appearance and site of occurrence. Histopathology and immunochemistry revealed it to be a lipoma.

P.140 A new international nomenclature of far and extreme lateral approaches to the craniocervical junction

Background: Far and extreme lateral approaches have become a mainstay treatment for lesions located at the anterolateral aspect of foramen magnum and its vicinity. However, there is a significant discrepancy between authors on what these approaches truly are, which leads to producing papers naming different techniques the same and same techniques differently. Methods: We performed literature search employing PubMed-MEDLINE and Scopus databases. The search terms referred to the nomenclature of far lateral approach (FLA), extreme lateral approach (ELA), and their variants. Finally, important papers on the topic from article references were also included, if deemed contributory. Results: In total, 37 articles were collected. Surprisingly, we found that not a single paper has addressed the confusing nomenclature directly yet. Nine truly separate variants of FLA and ELA were found. We implemented them intraoperatively depending on both patient and lesion characteristics. The essence about each is summarized. Conclusions: In the CNSF meeting, we will shortly discuss causes behind confusion and debate each FLA and ELA variants according to a number of authors and their unique yet sometimes confusing understanding of the approaches. Ultimately, a logical proposal for the unification is provided to stir up discussion