Osteochondromas are common and typically arise from the metaphyseal ends of long bones. An osteochondral neoplasm of the soft tissue, which is a lesion of uncertain pathogenesis, is uncommon and usually arises from the synovial tissue in joints and tendon sheaths. Rarely, extraskeletal osteochondromas also arise outside of synovial compartments. Most of the reported cases were presented in the hands and feet, especially in the fingers. Here we describe a 44-yr-old female patient who presented with a pain in the left buttock. A well-defined osseous mass was detected in the buttock. It consisted of sharply demarcated, mature hyaline cartilage that was covered with a fibrous capsule, which changed gradually into cancellous bone, more pronouncedly at the center. The diagnosis of an extraskeletal osteochondroma should be considered when a discrete, ossified mass is localized in the soft tissues. A case of pathologically proven extraskeletal osteochondroma of the buttock is presented with a literature review, magnetic resonance imaging, and radiological findings.
Accidental Falls ; Adult ; Buttocks* ; Diagnosis, Differential ; Female ; Human ; Myositis Ossificans/diagnosis ; Osteochondroma/complications ; Osteochondroma/diagnosis* ; Osteochondroma/radiography ; Osteochondroma/surgery ; Pain/etiology ; Sarcoma/diagnosis ; Soft Tissue Neoplasms/complications ; Soft Tissue Neoplasms/diagnosis* ; Soft Tissue Neoplasms/radiography ; Soft Tissue Neoplasms/surgery

Here, we describe a popliteal mass that was initially misdiagnosed as a simple popliteal cyst, which finally turned out to be osteochondrolipoma. A 63-year-old housewife presented with sustained knee pain in association with a palpable mass on the popliteal fossa. The mass was in the posteromedial area and soft, non-tender, non-movable in the posteromedial area. Using plain radiography, the mass appeared as a round, soft tissue density lesion containing bony fragments. We performed an ultrasound-guided needle biopsy in conjunction with magnetic resonance imaging, followed by an open excisional biopsy. Microscopically, histological sections showed a lipoma with cartilaginous and osseous differentiation, finally diagnosed as osteochondrolipoma. In conclusion, popliteal masses are not always simple cysts, and the evaluation of masses in the popliteal fossa is always necessary.
Female ; Humans ; Lipoma/complications/*diagnosis ; Middle Aged ; Osteochondroma/complications/*diagnosis ; Popliteal Cyst/etiology ; Soft Tissue Neoplasms/complications/*diagnosis

OBJECTIVETo study the clinicopathologic features of osteomalacia or rickets-associated mesenchymal tumors.

METHODSThe clinical and pathologic findings of 10 cases of osteomalacia or rickets-associated mesenchymal tumors were evaluated. Hematoxylin and eosin stain, immunohistochemistry and histochemistry were performed on the archival paraffin sections.

RESULTSAmongst the 10 patients studied, 6 were males and 4 were females. Their age at the time of operation ranged from 28 to 69 years ( mean = 45.6 years). A history of long-standing bone pain, arthralgia, limitation in movement, hypophosphatemia and hyperphosphaturia was present in all cases. The duration of symptoms ranged from 2 to 27 years (mean = 9.6 years). The tumor size ranged from 1 to 7 cm (mean size = 3.52 cm). Microscopically, the tumors were composed of various mesenchymal cells, including spindled fibroblast-like cells, adipocytes, chondroid cells and mucinous cells. The background was rich in blood vessels. In 8 of the 10 cases, there was also dystrophic calcification in an unusual flocculent or "grungy" pattern. Peripheral woven bone shell formation was noted in 2 cases and non-urate crystal deposition in 2 cases. Mitotic figures were rare in 9 cases. In 1 of the 10 cases however, mitotic figures and bizarre cells were commonly encountered. On immunohistochemical study, the tumor cells were all positive for vimentin. There was focal positivity for smooth muscle actin and CD34 in 5 and 3 cases respectively. The staining for desmin, S-100 and AE1/AE3 was negative. Ki-67 proliferation index was less than 4% in 8 cases and 30% in 1 case. Alcian blue-positive mucinous matrix and mucinous degeneration around vessels were noted in 8 cases.

CONCLUSIONSMost of the osteomalacia or rickets-associated tumors are either benign or low-grade malignant mesenchymal tumors. They can be mistaken as other neoplasms due to the morphologic heterogeneity present. Thorough understanding of the associated clinical features and laboratory investigation results is helpful in arriving at the correct diagnosis.

Actins ; metabolism ; Adult ; Aged ; Antigens, CD34 ; metabolism ; Bone Neoplasms ; complications ; metabolism ; pathology ; Female ; Femoral Neoplasms ; complications ; metabolism ; pathology ; Humans ; Male ; Mesenchymoma ; complications ; metabolism ; pathology ; Middle Aged ; Osteomalacia ; complications ; Rickets ; complications ; Soft Tissue Neoplasms ; complications ; metabolism ; pathology ; Vimentin ; metabolism

OBJECTIVETo analyze the results and the indications of free flaps in the skull base reconstruction.

METHODSA retrospective review was performed of 25 free flaps reconstructions for skull base tumor ablation defects between March of 1999 and March of 2009. There were 9 latissimus dorsi flaps, 6 rectus abdominis flaps, 4 deep inferior epigastric artery perforator flaps, 3 anterolateral thigh flaps, 2 radial forearm flaps and 1 fibular flap. The defects were classified as cranial bone (100%), dura (40%), brain (12%), sino-nasal cavity (52%), mucosa (56%) and skin (80%).

RESULTSTwenty-three of 25(92%) free flaps survived. One total flap failure and 1 partial flap failure occurred. Five patients (20%) had central nervous system related postoperative complications which including 1 mortality, 2 central nerve system infection and 2 cerebrospinal fluid fistula.

CONCLUSIONSFree flaps transfer is a reliable reconstruction technique for cranial base surgery. This provides a solution to the select advances disease otherwise surgical contraindications. Free flap is the choice for reconstruction of advanced oncological defects, especially when skin and mucosa are violated.

Adult ; Aged ; Aged, 80 and over ; Female ; Free Tissue Flaps ; Humans ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skull Base Neoplasms ; surgery ; Soft Tissue Injuries ; surgery ; Young Adult

OBJECTIVETo study the relation of the sex, age, location and chemotherapy with recurrence of the tumor.

METHODSFrom January 2000 to August 2010, 47 patients with giant cell tumor of tendon sheath in upper extremity were retrospectively analyzed. Statistical analysis of sex, age at presentation, lesion location, chemical inactivation, surgical complications, tumor recurrence and pathological findings were explored. There were 28 females and 19 males, ranging in age from 17 to 78 years, with an average of 38.15 years. All the patients underwent surgical excision. Fourteen patients received intraoperative chemically inactive treatment. All the patients had routine follow-up to observe the wound healing, pathological findings,tumor recurrence, and received necessary imaging examinations.

RESULTSAll the patients were followed up, and the duration ranged from 22 to 129 months, with a mean time of 53.89 months. Four patients who received intraoperative alcohol inactivation appeared wound complications such as wound swelling, discharge of necrotic tissue, delayed wound healing. Fifteen patients had active growth of tumor tissue, 1 patient had low-grade malignant giant cell tumor of tendon sheath. The recurrence rate was significantly higher in the group which preoperative X-ray was found to have bone destruction (P = 0.003); patients receiving chemically inactivation had lower risk of recurrence after surgery than patients not receiving chemically inactivation (P = 0.042).

CONCLUSIONThe recurrence rate of giant cell tumor of tendon sheath in upper limb was closely related to tumor growth site, bone destruction and chemical inactivation. Local excision of giant cell tumor of tendon sheath was the effective treatment. How to identify the patients at high risk of recurrence, how to reduce the recurrence rate and the functional restoration after wide resection are the priorities and difficulties of future researches.

Adult ; Female ; Giant Cell Tumors ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; epidemiology ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Soft Tissue Neoplasms ; pathology ; surgery ; Tendons ; pathology ; Upper Extremity

Aged ; Carcinoma, Renal Cell ; pathology ; Carcinosarcoma ; pathology ; Chondroma ; pathology ; Chondrosarcoma ; complications ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Female ; Humans ; Kidney Neoplasms ; complications ; metabolism ; pathology ; secondary ; surgery ; Lung Neoplasms ; secondary ; Nephrectomy ; Pleural Effusion, Malignant ; etiology ; S100 Proteins ; metabolism ; Soft Tissue Neoplasms ; pathology ; Vimentin ; metabolism

No abstract available.
Adult ; Biopsy ; Disease Progression ; Fatal Outcome ; Humans ; Lung Neoplasms/*complications/diagnostic imaging/secondary/surgery ; Lymphatic Metastasis ; Male ; Pleural Effusion, Malignant/diagnostic imaging/*etiology/therapy ; Pneumothorax/diagnostic imaging/*etiology/therapy ; Sarcoma/*complications/diagnostic imaging/secondary/surgery ; Soft Tissue Neoplasms/*pathology ; Tomography, X-Ray Computed ; Treatment Outcome

Transcatheter arterial chemoembolization (TACE) has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.
Antiviral Agents/therapeutic use ; Bone Neoplasms/radiography/secondary ; Carcinoma, Hepatocellular/diagnosis/pathology/*therapy ; Catheter Ablation ; Chemoembolization, Therapeutic/*adverse effects ; Hepatitis B/complications/drug therapy ; Humans ; Liver Cirrhosis/etiology ; Liver Neoplasms/diagnosis/pathology/*therapy ; Male ; Middle Aged ; Positron-Emission Tomography ; Soft Tissue Neoplasms/secondary ; Spinal Cord Injuries/*etiology ; Tomography, X-Ray Computed

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.
Adult ; Aneurysm, False ; diagnosis ; Biopsy ; Bone Diseases ; diagnosis ; Bone Diseases, Metabolic ; diagnosis ; Bone Neoplasms ; diagnosis ; Cell Proliferation ; Diagnosis, Differential ; Diagnostic Errors ; prevention & control ; Female ; Giant Cell Tumors ; diagnosis ; Humans ; Hyperparathyroidism ; complications ; Leukocytosis ; diagnosis ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Neoplasms ; diagnosis ; microbiology ; Osteomyelitis ; diagnosis ; microbiology ; Osteosarcoma ; diagnosis ; Sarcoma ; diagnosis ; Soft Tissue Neoplasms ; diagnosis ; Tibia ; pathology

OBJECTIVETo review the outcomes and complications of 21 consecutive patients with soft tissue sarcomas of the adductor compartment treated in our hospital from July 2006 to March 2012.

METHODSMedical records of 21 patients who underwent resection of soft tissue sarcomas of the adductor compartment were reviewed. Eight of the patients had primary operation, other eight had secondary radical excision, and five were admitted for tumor recurrence after operation in local hospitals. Six cases used gracilis or sartorius muscle to fill the cavity after removal of adductor muscle group. Fifteen patients underwent adjuvant treatment including radiotherapy and/or chemotherapy.

RESULTSSeven patients (33.3%) developed wound complications. Five required further surgery and two received dressing changes. All the patients were followed up for 3 to 60 months. During the follow-up period, no tumor recurrence was found in all the patients, only one case had multiple bone and pulmonary metastases, and two cases died (one for pulmonary metastasis at 11 months after surgery, and the other died of heart disease at 36 months post operation).

CONCLUSIONSGood local control rate can be achieved in patients with soft tissue sarcomas of the adductor compartment by using adductor muscle group resection, but it carries a relatively high rate of wound complications requiring proper management.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; secondary ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Muscles ; surgery ; Postoperative Complications ; Radiotherapy, Adjuvant ; Sarcoma ; drug therapy ; radiotherapy ; secondary ; surgery ; Soft Tissue Neoplasms ; drug therapy ; radiotherapy ; surgery ; Survival Rate ; Thigh ; Young Adult