Angioleiomyoma (Vascular Leiomyoma) Presenting as a Pseudoaneurysm of the Tibialis Posterior Artery

Reported here is the case of a 55-year-old woman presenting to a podiatry clinic with a chief complaint of left heel and ankle pain, who ultimately underwent operative excision of an angioleiomyoma adjacent to the tibialis posterior artery at the level of the medial malleolus. Accompanying this case are images from three modalities through which the defining characteristics of an angioleiomyoma can be appreciated. This case advocates for the inclusion of angioleiomyoma in the preoperative differential diagnosis of a mass presenting as a pseudoaneurysm in the lower extremity, particularly among women in the fourth to sixth decades of life.

Case Report: Multiple hemorrhagic metastases to the brain from primary lung choriocarcinoma

Herein we report a very rare entity of multiple hemorrhagic metastases to the brain from a primary lung choriocarcinoma in a young woman. The patient presented with recent onset of progressive headache, decreased level of consciousness and multiple episodes of vomiting. CT of the head revealed multiple hemorrhagic lesions within the brain. The patient’s serum B-human chorionic gonadotrophin was increased. A chest X-ray revealed a right lung mass. The patient urgently underwent operative excision of the lesion in the posterior fossa, so as to prevent impending tonsillar herniation. The histology from the lesion provided the diagnosis of choriocarcinoma. After surgery, ultrasonography of the abdomen and pelvis was normal, and a chest CT revealed an enhanced and highly vascular right apical lung lesion, suggestive of lung primary choriocarcinoma, with regard to the clinical background. The patient was then started on chemotherapy, following which her serum B-HCG level decreased rapidly. This case highlights the importance of keeping this entity in the differential diagnosis of hemorrhagic lesions in any patients of a child bearing age. Early diagnosis and rapid initiation of multimodal therapy is prudent for ensuring a good outcome from an otherwise rapidly metastasizing and highly vascular lesion.

Three Cycles of Radiofrequency Ablation Are More Efficacious Than Two in the Management of Morton’s Neuroma

Background. Morton’s neuroma is a common cause of forefoot pain. Outcomes of conservative therapy are mixed and many patients undergo operative intervention. Radiofrequency ablation has recently gained favor as a treatment option, although the optimal regime is unknown. This study investigates the effectiveness of 2 versus 3 cycles of radiofrequency ablation for the treatment of Morton’s neuroma. Methods. We surveyed a cohort of patients with Morton’s neuroma who had progressed to radiofrequency ablation after failed conservative treatment. Patients received either 2 or 3 cycles of radiofrequency ablation by a single surgeon. We assessed patients based on their change in numerical pain rating scale, symptom improvement, complications, and progression to surgical excision through a series of telephone interviews. Outcomes between the 2 treatment arms were compared by parametric tests. Results. Twenty-eight patients were included in the study. Eighteen patients with 21 neuromas received 2 cycles and 10 patients with 11 neuromas received 3 cycles. Mean time of follow-up was 12.9 months. Overall, 88% of patients were either very or moderately satisfied with their outcome. In patients who received 2 cycles mean numerical pain scores decreased from 7.9 ± 1.1 to 3.4 ± 2.4 postprocedure. Three patients progressed to operative excision. In patients who received 3 cycles, numerical pain scores decreased from 8.0 ± 1.0 to 1.5 ± 2.0 postprocedure. One patient progressed to operative excision. Patients who received 3 cycles had reduced medium-term pain postoperatively compared with 2 cycles (3.4 ± 2.4 vs 1.5 ± 2.0, P = .011). Conclusion. Radiofrequency ablation provides a high rate of patient satisfaction in the treatment of Morton’s neuroma with few side effects. It appears that 3 cycles may be superior to 2 cycles but a randomized controlled trial will be required to confirm these results. Levels of Evidence: Intervention, Level III: Comparative study without concurrent controls

Occurrence of second primary cancer after curative resection of cholangiocarcinoma: a report of 5 cases

The second primary cancer, a new cancer subsequent to the initial cancer, usually occurs in a person who has a history of cancer or the patient treated with curative resection. Although the pathogenesis of second primary cancer is unclear, it is always found that occurrence of second primary cancer is related to the age and family history. In our 5 cases’ reports, second primary cancer occurs after curative resection of cholangiocarcinoma. And most of the second primary cancers belong to well differentiated adenocarcinomas which grow slowly and never metastasize distally in early stage. Therefore, operative excision is the most effective treatment. At the same time, conventional examination after operation could improve early diagnosis and timely surgical treatment.

Posterior Ankle Impingement

Thirty cases of posterior ankle impingement in 28 patients were treated over a 10-year period (1982–1992). All conditions were caused by forced plantar flexion. An os trigonum or posterior process fracture was demonstrated radiographically in 63% of these cases, and an intact posterior process was demonstrated in 33%. Ten cases were lost to follow-up. Of the remaining 20 cases, in 18 patients 12 (60%) improved with nonoperative treatment; 8 (40%) required operative excision. The results were good to excellent in 7 patients and fair in 1 patient. Operative excision for the treatment of recalcitrant posterior ankle impingement can relieve symptoms and allow a return to full preinjury activities.

Excision of the Fractured Os Peroneum: A Report on Five Patients and Review of the Literature

Five patients sustained fractures of the os peroneum after supination and plantarflexion injuries. Two of the injuries involved the knee in hyperflexion and the foot under the buttock. Four of the five were treated with immobilization for 6 weeks. All five required operative excision of the fractured sesamoid 8 months to 8 years after the initial injury. Three fractures were bipartite and there were two multipartite fractures. At 12- to 28-month follow-up, all patients were pain-free over the lateral midfoot and four patients returned to preinjury activity levels.