A 66-year-old man underwent computed tomography-guided needle biopsy of a suspicious renal mass. Two months later he underwent partial nephrectomy. Histology revealed a 30-mm clear cell renal cell carcinoma, up to Fuhrman grade 3. An area of the capsule was interrupted, which corresponded to a hemorrhagic area on the cortical surface. Under microscopy, this area showed a tongue of tumor tissue protruding through the renal capsule. A tumor deposit was found in the perinephric fat. These features suggest that tumor seeding may have occurred during the needle biopsy.
Adipose Tissue/*pathology ; Aged ; Biopsy, Needle/*adverse effects ; Carcinoma, Renal Cell/*secondary/surgery ; Humans ; Image-Guided Biopsy/adverse effects ; Kidney/*pathology ; Kidney Neoplasms/*pathology/surgery ; Male ; *Neoplasm Seeding ; Soft Tissue Neoplasms/*secondary

OBJECTIVETo explore the reason, key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation.

METHODSFrom July 2007 to May 2012, clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years, and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating, fervescence, fresh seepage in the wound, and blood inflammatory index increased, etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect.

RESULTSAll patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus, distal part of the wound present local red, swelling and with wave motion at 2 months after operation, staphylococcus aureus infection was confirmed after puncture and bacterial culture, and 1 thrum was found after local incision. The wound healed after change dressings for 1 week, without recurrence after followed up for 13 months.

CONCLUSIONPreventing the risk factors before operation, minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects, and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection, early diagnosis, debridement, VSD negative pressure irrigation and drainage, to choosing sensitive antibiotics according to the results of drug sensitivity, may contribute to wound early healing and decrease complication.

Adipose Tissue ; pathology ; Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Staphylococcal Infections ; pathology ; therapy ; Surgical Wound Infection ; pathology ; therapy ; Time Factors

OBJECTIVETo investigate the blood supply of the pedicle fat grafts with the third lumbar segmental artery and its clinical effects on reoperation for lumbar disc herniation.

METHODSTwelve sides of 6 adult cadaver examples were contributed to investigate the courser of lumbar segmental vessels and the distribution of hypodermic capillary net of the dorsal branch of the third lumbar segmental artery. From January 2000 to January 2007,49 patients needed reoperation to treat lumbar disc herniation,including 26 males and 23 females with an average age of 55.6 years (ranged from 39 to 70 years). Duration between two operations ranged from 8 months to 15 years with an average of 6.9 years. Reoperative reasons included recurrent lumbar disc protrusion(30 cases)postoperative epidural scar formation (17 cases), postoperative epidural cyst formation (2 cases). Of them,9 patients underwent posterior lumbar interbody fusion at the second operation. The pedicle fat grafts with the third lumbar segmental artery were covered on the sites of the laminectomy in these patients. After negative pressure drainage tube were pulled out, 2 ml Chitsan were injected to the sites of the laminectomy and around epidural nerve root through epidural catheter. VAS score and the Oswestry Disability Index (ODI) were used to assess clinical outcomes before and after operation.

RESULTSThe courser of third lumbar segmental vessels were invariant at the lateral face of the lumbar vertebral body. The dorsal branch of the third lumbar segmental artery penetrated thoracolumbar fascia and formed rich hypodermic capillary net in the region. All patients were followed up from 5 to 8 years with an average of 5.6 years. VAS score of low back pain and leg pain decreased respectively from preoperative 7.6 +/- 1.2, 8.9 +/- 0.9 to 3.6 +/- 0.5, 3.0 +/- 0.4 at final follow-up (P < 0.01); and ODI score decreased from preoperative 44.1 +/- 6.2 to 13.9 +/- 3.6 at final follow-up (P < 0.01). According to ODI score to evaluate the clinical outcomes, 29 cases got excellent results, 11 good, 7 fair, 2 poor.

CONCLUSIONThe pedicle fat grafts with the third lumbar segmental artery and Chitsan can reduce epidural scar formation and prevent peridural fibrosis and adhesion and improve clinical effects of reoperation for lumbar disc herniation.

Adipose Tissue ; pathology ; Adult ; Aged ; Arteries ; pathology ; physiopathology ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; pathology ; physiopathology ; surgery ; Lumbar Vertebrae ; blood supply ; pathology ; surgery ; Male ; Middle Aged ; Reoperation ; Transplantation ; Treatment Outcome

OBJECTIVETo report our therapeutic effect of double adipofascial turnover flaps in repairing stage IV ischial pressure scores.

METHODSDuring the period of May 2009 to February 2013, we treated 11 cases of stage IV ischial pressure scores with double adipofascial turnover flaps and proper drainage. Based on the conditions of pressure scores and abundant blood supply of adipofascial flaps, we designed two adipofascial flaps on each side of lesion. The two flaps were overlaped to cover the pressure score, following with negative pressure drainage.

RESULTSAll pressure scores healed primarily. The follow-up period ranged from 11 to 36 months with satisfactory results and no recurrence.

CONCLUSIONSDouble adipofascial turnover flaps and proper drainage is a safe and simple method for the treatment of stage IV ischial pressure scores with satisfactory results.

Adipose Tissue ; transplantation ; Drainage ; methods ; Fascia ; transplantation ; Female ; Follow-Up Studies ; Humans ; Ischium ; Male ; Negative-Pressure Wound Therapy ; Pressure ; Pressure Ulcer ; pathology ; surgery ; Recurrence ; Surgical Flaps ; blood supply ; transplantation ; Wound Healing

We present a rare case of glomus tumor of Hoffa's fat pad in a 42-year-old woman. Magnetic resonance imaging findings along with the characteristic clinical picture led us to suspect a glomus tumor as the possible etiology. An ischemia test was found to be positive and this further substantiated our diagnosis. An arthroscopic excision was performed and the histology confirmed the diagnosis of glomus tumor of Hoffa's fat pad. The patient responded well to the excision with immediate complete resolution of pain and she remains asymptomatic at the last follow-up after 15 months. To our knowledge, this is the second reported case of glomus tumor of Hoffa's fat pad and the first ever to be managed by simple arthroscopic excision. The tumor poses a great challenge to an orthopedic surgeon. However, knowledge of its characteristic clinical presentation and the recognition of such a rare entity can help achieve an early diagnosis and timely management.
Adipose Tissue/pathology/*surgery ; Adult ; Arthroscopy ; Female ; Glomus Tumor/*secondary ; Humans ; Knee/pathology/*surgery ; Magnetic Resonance Imaging ; Soft Tissue Neoplasms/*surgery

OBJECTIVETo study the nature of the residue hard tissue after liposuction in lipoma and its role in lipoma recurrence.

METHODSThe residue hard tissue after liposuction was collected for histologic study, including HE-staining and immunohistochemistry with antibody of stem cell marker (CD29 and CD44). The average density and area of positive cells were analyzed statistically.

RESULTSThe residue hard tissue had a medium hardness. The center tissue was light yellow surrounding by soft, loose, irregular and cord-like tissue. The normal fat tissue is light yellow with a soft and unanimous texture. HE-staining showed abundant stromas in residue hard tissue, with lots of fibroblast-like cells locating among adipocytes. The cytoplasm was less with large and blue-staining nucleus. In normal fat tissue, the fat cells were uniform which were round or polygon. The stromas was less and the fibroblast-like cells were comparatively less. The slices were stained with antibody (CD29, CD44) of stem cell marker. The density and area of positive cells were much more in residue hard tissue than those in normal adipose tissue. Two Independence Samples T test were as follows: (t'CD29 = 9.931, P = 0.000; (t'CD44 =10.171, P = 0.000 for density; and (t'CD29 = 7.761, P = 0.000; tt'CDRR = 6.639, P = 0.000 for area. The difference was significant.

CONCLUSIONSAbundant fibroblast-like cells that are signed by the marker of stem cells exist in residue hard tissue. Those cells are proven to be lipoma derived stem cells (LDSCs) which may play an role in lipoma recurrence after lipoma liposuction.

Adipocytes ; cytology ; pathology ; Adipose Tissue ; pathology ; Humans ; Lipectomy ; Lipoma ; pathology ; surgery ; Recurrence ; Stem Cells ; pathology

Renal angiomyolipomas are benign neoplasms composed of varying amounts of adipose tissue, smooth muscles and blood vessels. They typically contain macroscopic fat, which is seen as negative attenuation on computed tomography. Calcification and scarring is rarely seen in renal angiomyolipomas. We report the case of a 40-year-old man who was found to have a renal angiomyolipoma with a central stellate scar and focal calcification. The lesion was initially misdiagnosed as a calyceal calculus.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Angiomyolipoma ; diagnosis ; surgery ; Biopsy, Needle ; Calcinosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Kidney Calculi ; diagnosis ; surgery ; Kidney Calices ; diagnostic imaging ; pathology ; Kidney Neoplasms ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Male ; Risk Assessment ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Urography ; methods

Human adipose tissue-derived mesenchymal stem cell (hATMSC) have emerged as a potentially powerful tool for bone repair, but an appropriate evaluation system has not been established. The purpose of this study was to establish a preclinical assessment system to evaluate the efficacy and safety of cell therapies in a nude rat bone defect model. Segmental defects (5 mm) were created in the femoral diaphyses and transplanted with cell media (control), hydroxyapatite/tricalcium phosphate scaffolds (HA/TCP, Group I), hATMSCs (Group II), or three cell-loading density of hATMSC-loaded HA/TCP (Group III-V). Healing response was evaluated by serial radiography, micro-computed tomography and histology at 16 weeks. To address safety-concerns, we conducted a GLP-compliant toxicity study. Scanning electron microscopy studies showed that hATMSCs filled the pores/surfaces of scaffolds in a cell-loading density-dependent manner. We detected significant increases in bone formation in the hATMSC-loaded HA/TCP groups compared with other groups. The amount of new bone formation increased with increases in loaded cell number. In a toxicity study, no significant hATMSC-related changes were found in body weights, clinical signs, hematological/biochemical values, organ weights, or histopathological findings. In conclusion, hATMSCs loaded on HA/TCP enhance the repair of bone defects and was found to be safe under our preclinical efficacy/safety hybrid assessment system.
Adipose Tissue/*cytology ; Animals ; Biocompatible Materials/therapeutic use ; Bone Diseases/pathology/radiography/*therapy ; Bone Regeneration/physiology ; Calcium Phosphates/therapeutic use ; Diaphyses/radiography/surgery/ultrastructure ; Disease Models, Animal ; Durapatite/therapeutic use ; Femur/*pathology/radiography/surgery ; Humans ; Male ; *Mesenchymal Stem Cell Transplantation ; Mesenchymal Stem Cells/*cytology ; Rats ; Rats, Nude ; Tissue Engineering ; Tomography, X-Ray Computed ; Transplantation, Heterologous

Adipose Tissue ; pathology ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Joint Diseases ; diagnosis ; pathology ; surgery ; Knee Joint ; pathology ; Male ; Middle Aged

We report a rare case of giant mesenteric lipoma presenting with colicky abdominal pain. A 29-yr-old woman underwent laparoscopic resection for a giant mesenteric lipoma causing compression of the ileal loop. The resected ileal segment was encased by a giant fatty tissue, and normal mucosal fold patterns of the resected ileum were effaced by the mass. Microscopically, the mass was characterized by homogenous mature adipose tissue without cellular atypia, which was compatible with the diagnosis of a mesenteric lipoma. Despite the benign nature of this tumor, total excision with or without the affected intestinal loop should be considered if intestinal symptoms such as abdominal pain are present.
Abdominal Pain/*etiology ; Adipose Tissue/pathology ; Adult ; Diagnosis, Differential ; Female ; Humans ; Ileal Diseases/etiology ; Laparoscopy ; Lipoma/complications/*diagnosis/surgery ; *Mesentery/pathology ; Peritoneal Neoplasms/complications/*diagnosis/surgery ; Tomography, X-Ray Computed