Hepatocellular Carcinoma with Cervical Spine and Pelvic Bone Metastases Presenting as Unknown Primary Neoplasm / 대한소화기학회지

The occurrence of hepatocellular carcinoma (HCC) is closely associated with viral hepatitis or alcoholic hepatitis. Although active surveillance is ongoing in Korea, advanced or metastatic HCC is found at initial presentation in many patients. Metastatic HCC presents with a hypervascular intrahepatic tumor and extrahepatic lesions such as lung or lymph node metastases. Cases of HCC presenting as carcinoma of unknown primary have been rarely reported. The authors experienced a case of metastatic HCC in a patient who presented with a metastatic bone lesion but no primary intrahepatic tumor. This case suggests that HCC should be considered as a differential diagnosis when evaluating the primary origin of metastatic carcinoma.

A case of isolated metastatic hepatocellular carcinoma arising from the pelvic bone / 대한간학회지

Reports of metastatic hepatocellular carcinoma (HCC) without a primary liver tumor are rare. Here we present a case of isolated HCC that had metastasized to the pelvic bone without a primary focus. A 73-year-old man presented with severe back and right-leg pain. Radiological examinations, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed a huge mass on the pelvic bone (13x10 cm). He underwent an incisional biopsy, and the results of the subsequent histological examination were consistent with metastatic hepatocellular carcinoma. The tumor cells were positive for cytokeratin (AE1/AE3), hepatocyte paraffin 1, and glypican-3, and negative for CD56, chromogranin A, and synaptophysin on immunohistochemical staining. Examination of the liver by CT, MRI, positron-emission tomography scan, and angiography produced no evidence of a primary tumor. Radiotherapy and transarterial chemoembolization were performed on the pelvic bone, followed by systemic chemotherapy. These combination treatments resulted in tumor regression with necrotic changes. However, multiple lung metastases developed 1 year after the treatment, and the patient was treated with additional systemic chemotherapy.

[Functional impairment in patients with rheumatoid pelvispondilyte]

To assess functional impairment in patients with rheumatoid pelvispondylite. cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]. metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index [BASFI], and likert scale assessing social, economic arid physical disability. 30 patients [22 men], the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50%are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100: the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social economic and physical disability was felt among 67%of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index. This impact on the quality of life is increased by the low level of education and poor professional integration

Manejo de tumores de la pelvis / Treatment of primary pelvic tumors

Pelvic resection surgeries due to primary bone tumors are infrequent. According to the compromised area we can divide it in three zones, being those who affect the acetabulum the ones with the major functional alterations, pelvic stability and leg length discrepancy. The aim of this study is to present our experience in the surgical management of this type of lesions. From series of 17 patients, eight (47 percent) presented complications, the most frequents was surgical wound infection (23 percent) and deep venous thrombosis (18 percent). 4 patients died (23 percent). The other 13 patients answered the Musculo Skeletal Tumor Society (MSTS) scale being the average score 22,3. One local recurrence appeared in this group. The acceptance of the patients in this kind of surgeries is very good. These surgeries are complex, there is a high rate of complications. They must be performed in centers with a suitable professional and technical equipment.

Las cirugías de resecciones pélvicas por tumores óseos primarios son infrecuentes. Según el área comprometida se divide principalmente en 3 zonas, siendo las que afectan al acetábulo las que producen mayor alteración (funcional, en la estabilidad pélvica y la longitud de las extremidades inferiores). El objetivo de este trabajo es presentar la experiencia del equipo de tumores del Instituto Traumatológico y la Clínica Santa María en el manejo quirúrgico de este tipo de lesiones. Con un total de 17 pacientes, 8 presentaron complicaciones (47 por ciento), la más frecuente fue la infección de herida operatoria (4 pacientes 23 por ciento) y la trombosis venosa profunda (3 pacientes 18 por ciento). Cuatro pacientes (24 por ciento) fallecieron, los 13 restantes respondieron la escala Musculo Skeletal Tumor Society (MSTS) siendo el puntaje promedio de 22,3. Se presentó una recidiva local en este grupo. El grado de aceptación de los pacientes es muy bueno. Deben realizarse en centros con el equipamiento profesional y técnico adecuado para las exigentes y complejas cirugías a realizar.

Acute hematogenous osteomyelitis of the ischio pubic ramus. A case report

Pelvic osteomyelitis is rare. We report the case of a 10-year-old boy presented with a five-day history of pyrexia and left painful lameness. Passive range of hip was normal. Initial biological investigations revealed an inflammatory syndrome. Plain radiographs of the pelvis and ultrasound scan of the left hip joint were normal. Bone scintigraphy showed a tracer uptake in the left obturator ring. The blood cultures were positive for methicillin-sensitive staphylococcus aureus. The diagnosis of pelvic osteomyelitis was held. Magnetic Resonance Imaging [MRI] showed a left ischio-pubic ramus osteomyelitis with a subperiostal abscess decompressing into the surrounding tissues. This case history draw attention to the distinctive clinical and bacteriological features of this rare focus of acute hematogenous osteomyelitis and emphasize the MRI interest in the investigation of deep localizations. It may facilitate early recognition of pelvic osteomyelitis in child

Vanishing bone disease involving the pelvis.

Vanishing bone disease is a rare condition characterized by progressive osteolysis of the bony structures by vascular tissue and their replacement by fibrous, vascular connective tissue. A 38-year-old lady who had a previous history of angioma of the left iliac bone presented with vague symptoms of a limping gait and pain during walking since 2 years duration. The radiologic findings were suggestive of degenerative changes. A possibility of metastatic disease was also considered. However the biopsy and Positron emission tomography (PET) scan ruled out any active disease. Like in most other cases this was possibly a self-limited disease where bone resorption had spontaneously arrested.

pattern of pelvic Fractures in Asir Region of Saudi Arabia

The aim of this study is to review two hundred cases of pelvic ring fractures, acetabular fractures and dislocation of hips seen in Asir Central Hospital over a six-year period from 1409H [1989] to 1415H [1995] and to see how it correlates the with pattern seen in other parts of the world. In the review emphasis is laid on associated injuries, causes of the injury, the most common type of pelvic ring fractures and the most common type of acetabular fractures seen. Data were gathered from the case notes of all admissions and transfers to this hospital of all patients with pelvic fractures during the period of study. All the relevant roentgenograms were retrieved and re-studied for the purpose of classification of the pelvic ring and the acetabular fractures. Male-female ratio was 5.1:1. The average age was 30.7 years. The most common associated injuries were fractures of bones of the lower extremities and head injury. Road traffic accident was the most common cause of pelvic fracture followed by fall from height. Most common type of pelvic fracture was pelvic ring injuries without acetabular fractures followed by type A injuries [stable ring injuries]. The most common acetabular fracture was type A followed by type B injuries. With the exception of one case, all the hip dislocations were posterior dislocations. Road traffic accident is the most common cause of pelvic fractures in Asir region of Saudi Arabia. The most common associated injury is the fracture of bones of the lower extremities. The most common type of pelvic ring fractures seen is stable type A, and the most acetabular fracture seen is type B

Tumores musculoesqueléticos de la pelvis y la cadera / Soft tissue and bone tumores of the hip and pelvis

El tratamiento actual de los tumores musculoesqueléticos cuya filosofía es la reducción de la magnitud de la cirugía con reservación de los miembros y de ser posible de la función, ha provocado una gran demanda de los métodos del diagnóstico por imágenes. Cuando las lesiones asientan en la pelvis al tema etiológico se suma la dificultad en su detección debido a la particular anatomía del área. Con el objeto de analizar la incidencia de los tumores musculoesqueléticos y el aporte de divesos métodos diagnósticos se estudió una población constituída por 214 pacientes con tumores o lesiones seudotumorales pelvianas comprobados histológicamente. Se detectaron 19 lesiones seudotumorales, 27 tumores benignos, 6 tumores o células gigantes y 162 tumores malignos. Dos tercios de las lesiones seudotumorales y de los tumores benignos ocurrieron por debajo de los 30 años de edad. Los tumores malignos fueron mayoría (75 por ciento) destacándose las metástasis (70 por ciento de todos los tumores malignos). El tumor primario más frecuente fue el condrosarcoma. El diagnóstico por imágenes juega en la actualidad un rol significativo en el diagnóstico y estadificación de los tumores muescoesqueléticos. Junto con la clínica y la anatomía patológica constituyen el trípode indispensable para arribar al diagnóstico definitivo e instituir la terapéutica adecuada

Total innominatectomy for chondrosarcoma innominate.

Internal hemipelvectomy or innominatectomy is a preferred alternative to hindquarter amputation for malignant tumours of the pelvis. Various segments of the pelvis have been removed surgically leaving the lower limb with residual segments of the pelvis in treatment of such tumours. We herewith present a case of total innominatectomy, i.e. dis-articulation at the pubic symphysis and sacroiliac joint for surgical clearance and treatment of a chondrosarcoma of the Innominate bone. The tumour extended from just in front of the sacroiliac joint to the ischium and warranted such a complete resection.

Pelvis oblicua en la paralisis cerebral / Pelvic obliquity in cerebral palsy

Se enuncian las distintas enfermedades neuromiopaticas donde puede hallarse presente la oblicuidad pelviana. Se describen sus causas y se las clasifica en supra e infrapelvica: se exponen los elementos a tener en cuenta para su examen clínico. Se basan sus conclusiones en el analisis de 115 pacientes con paralisis cerebral, 21 de los cuales presentaban oblicuidad pelviana, a quienes efectua distintos tratamientos