Granular cell tumour: malignant or benign?

<p><b>INTRODUCTION</b>Granular cell tumours (GrCTs) are uncommon soft tissue tumours that are usually benign (approximately 0.5%-2.0% have been reported as malignant). They are very rarely found at the extremities. Differentiating a malignant GrCT from a benign one is important as the former is aggressive and has a poor prognosis, whereas the latter, after surgical resection, has excellent outcomes. A malignant lesion can be suspected on clinical presentation and confirmed via histopathological examination using the Fanburg-Smith criteria.</p><p><b>METHODS</b>This was a retrospective review of all cases of GrCT of the extremities that presented to the Orthopaedic Oncology Unit of University Malaya Medical Centre, Malaysia, from September 2006 to March 2013.</p><p><b>RESULTS</b>There were a total of five cases, all of which involved female patients aged 13-40 (mean age 24) years. Three cases involved the upper limbs and two involved the lower limbs. Using the Fanburg-Smith criteria, three cases were classified as benign, one as atypical and one as malignant. Wide local excision was performed in all five cases and the outcomes were excellent except for the patient with a malignant tumour. That patient presented with lung metastasis about three months after surgery.</p><p><b>CONCLUSION</b>Malignant and benign GrCTs can be differentiated on clinical presentation and by using the Fanburg-Smith criteria. We believe that wide local excision is the best treatment for both benign and malignant tumours. The role of adjuvant chemotherapy and radiotherapy in malignant GrCTs should be studied. All patients with GrCTs should receive follow-up to check for recurrence and metastasis.</p>

Cannulated Screw Fixation For Femoral Neck Fractures: A 5-year Experience In A Single Institution

Cannulated screw fixation is a widely accepted surgical method for management of fractures of the neck of femur especially in patients with poor premorbid conditions, minimally displaced fractures and those from a younger age group. A five year retrospective study was carried out in 53 consecutive patients between 2006 to 2010 to determine the pattern of injuries, management, outcomes and the associated predictive factors.All the patients underwent cannulated screw fixation, with 37 (69.8%) having had surgery within 24 hours and the remaining 16 (30.2%) 24 hours after the initial injury. All patients were followed up to union of fractures and complications thereafter if any. Good outcome was observed in 43 (81.1%) patients leaving only 10 (18.9%) patients with a poor outcome, of whom nine developed avascular necrosis (90%) and one non-union (10%). We found no significant relationship between the incidence of avascular necrosis and age of patient, fracture displacement, numbers of cannulated screws used, fracture reduction acceptability and anatomical location of the fracture. The time interval from injury to surgery and the presence of posterior comminution did seem to influence the rate of avascular necrosis but due to the small number of patients, was not statistically significant.We conclude that cannulated screw fixation is a viable option of treatment for fractures of the neck of femur.

Incidence and outcome of bone metastatic disease at University Malaya Medical Centre

<p><b>INTRODUCTION</b>Morbidity and mortality from malignant diseases are usually the result of metastasis. The bone is the third most common site of metastasis.</p><p><b>METHODS</b>This is a retrospective study of patients with metastatic bone disease who were referred to the Orthopaedic Department of University Malaya Medical Centre, Malaysia, between January 2004 and October 2009.</p><p><b>RESULTS</b>A total of 151 patients (51.0% men, 49.0% women) had metastatic bone disease, with the highest incidence at the age range of 50-59 years. The commonest primary cancer was breast (23.3%), followed by lung (21.2%), prostate (9.3%), thyroid (7.3%) and renal cell carcinoma (5.3%); unknown primary cancer was 6.6%. There was long bone involvement in 52.7% of cases, axial bone in 44.5%, and both long and axial bones in 2.8%. The majority (90.1%) were symptomatic, with pain as the commonest symptom. 106 (70.2%) patients had pathological fractures. Neurological deficit was reported in 90.7% of patients, with 41.1% having extraskeletal metastases. 67.8% of the lesions were osteolytic, 24.3% were sclerotic, and 7.9%, mixed. Palliative and therapeutic interventions were undertaken for 62.0% of patients. The mean survival times were: breast 21.0; thyroid 20.7; prostate 20.3; lung 16.0; and unknown primary cancer 32.6 months.</p><p><b>CONCLUSION</b>In our study, breast and lung cancers were the commonest primary cancers in metastatic bone disease. Most patients had more than one site of involvement, pain at presentation and pathological fractures. Surgery is beneficial to relieve pain and improve function and neurology. Duration of survival depends on the type of primary cancer and whether systemic metastasis is present.</p>

Intra-articular haemangioma of the knee in the skeletally immature

Intra-articular haemangioma is a rare and uncommon condition that sometimes presents in infants. The lesion can be a diagnostic challenge, with misdiagnosis often leading to delayed diagnosis and treatment. It is essential to establish and treat the condition early, as intra-articular haemangioma can lead to destruction of the joint and secondary arthrosis. Herein, we report the case of a five-year-old boy who presented with intra-articular haemangioma and discuss the management of his condition.

Malignant Melanoma of the Foot in Patients with Diabetes Mellitus – A Trap for the Unwary

Melanomas on the foot are difficult to differentiate from diabetic foot ulcers (DFU). In particular, acral lentiginous and amelanotic melanomas have a high chance of being misdiagnosed. We present two patients with diabetes mellitus and malignant melanomas of the foot initially diagnosed as DFU. Both cases were treated with wide excision amputation and local dissection, without adjuvant chemotherapy or radiotherapy. Both patients remain disease-free up to the last follow-up visit. It is important to maintain a high index of suspicion and a skin biopsy should be done in any DFU with atypical features.