Atypical Giant Cell Tumor: A Case Report

PURPOSE: Giant cell tumor is the second most common benign neoplasm in upper extremity. Unlike usual chief complaint of painless mass, an atypical case with giant cell tumor presented a distinguishing characteristics of which accompany pain and tenderness and is histologically giant-cell free. METHODS: A 31-year-old male patient complained of a rapid growing painful mass on the proximal phalanx of the left ring finger. Under microscopic operation, a 1.6 x 1.3cm sized mass was found to be surrounded by areolar tissue and attached to a tendon sheath, encircling the digital nerve and artery. Diagnostic confirmation was assisted by positive finding in histologic immunohistochemical stain-CD68. Characteristic pathologic finding is an atypical distribution of spindle cells & histiocytes without giant cells in fascicular pattern. RESULTS: Giant cell tumor was carefully removed under microscopic approach, while preserving digital nerve & artery. In postoperative 13th month, the patient presented with a 6mm of static two-point discrimination test, similar to that of the adjacent fingers. CONCLUSION: We report an atypical case with painful mass on tendon sheath, surrounding the digital nerve and artery that was diagnosed of giant cell tumor, but without giant cells on pathology. This case provides broader understanding of the giant cell tumor that should not only rely its typical findings of the painless mass and positive sign on H&E stain.

Lower Face-Neck Lift by Periauricular Minimal Invasion & Suspension Suture

To reverse the wrinkling & sagging of the skin on lower face and neck, there are various surgical methods such as suspension suture method, classical cervicofacial lift, SMAS-platysmal facelift, deep-plane facelift and composite facelift. Aging of lower face and neck present not only with sagging skin, but also is aggravated due to loss of elasticity of the SMAS and platysmal muscle. Successful surgical outcome is expected when tugging of the SMAS and platysma is performed with proper skin excision of lower face. Practically, deep-plane facelift methods present more satisfying outcome than the subcutaneous dissection, but takes longer recovery period and higher risk of postoperative complication. The authors would like to present a new method of lower face and neck lift, with periauricular minimally invasive suspension suture method, which does not required hospitalization, and gives higher patient satisfaction. In this study, 30 patients(26 females, 4 males) were operated from December of 2004 to February of 2007. Minimal periauricular subcutaneous dissection was performed. While measuring the sagging of the soft tissue on lower face and neck, suspension suture was performed anchoring platysma muscle from the submandibular slit incision site to the fascia of the mastoid process and stretched SMAS of the lower face was suspended to the fascia of the mastoid process with PDS 3-0 sutures. Most of the patients were satisfied without specific problems. The procedure carries advantages of simple operative method, easier access under intravenous sedation, much lesser risk of hematoma formation or facial nerve injury, shorter recovery period, improvement on the cervicomental angle and jaw line, and minimal postoperative scar.

A Case of Ossifying Fibromyxoid Tumor on the Temple Region

Ossifying fibromyxoid tumor of soft parts is a rare soft tissue neoplasm of uncertain histogenesis. It occurs commonly as a subcutaneous or intramuscular mass in the extremities and trunk, but rarely in the head and neck region. Its biologic behavior is generally benign, but a locally aggressive clinical course due to a pseudocapsule containing nests of tumor cells. Herein we report a case of a benign ossifying fibromyxoid tumor which occurred in the right temple in 34-year-old woman. The tumor was located in the temporalis muscle and completely removed with clear margin through bicoronal approach. The lesion was 2.0 x 2.5 x 3.0cm sized white to tan colored, well demarcated, firm mass. The tumor was covered by a fibrous capsule, and there was incomplete shell of lamellar bone at the periphery of the nodule. The tumor cells were uniformly round, ovoid, or spindle-shaped in collagenous and myxoid stroma. During 1 year's postoperative follow-up, the patient had no local recurrence.

The Analysis of Perioperative Photogrammetry in Reduction Malarplasty Patients

Facial contouring surgery is a one of the most common and popular procedure in the field of plastic surgery. The aim of this study is to evaluate the effectiveness of photogrammetric analysis by measuring preoperatively and postoperatively in the patients who were undertaken reduction malarplasty. From January 1995 to May 1999, from thirty patients of reduction malarplasty, Photography of life size - frontal view, lateral view, worm's eye view - were taken. The photograph was analyzed by the same surgeon to reduce an analytic error. The distance between both malar eminences and both zygions was the anatomical landmarks. The differences between pre- and postoperative photographic distance represented the results of the operation. The distance between both malar eminences (ME): preop/postop = 94 - 105 mm/89 - 99 mm. The distance between both zygions(ZY): preop/postop = 125 - 141 mm/ 120 - 135 mm. The reduction values of ME-ME/ZY-ZY are 3 -13 mm / 4 - 12 mm. The photogrammetric analysis of reduction malarplasty was very practical in measuring postoperative changes. We may assume that photogrammetric analysis may be very useful tool on preoperative diagnosis, plan and analysis of result of operation.