Lipoma subdeltoídeo como causa de síndrome do impacto no ombro – um relato de caso / Subdeltoid lipoma causing shoulder impingement syndrome – a case report

A síndrome do impacto é definida pela colisão dos tendões dos músculos que formam o manguito rotador contra o arco coracoacromial. Vários fatores concorrem para essa doença e são classificados como estruturais ou funcionais. Os primeiros são alterações do arco coracoacromial, úmero, bursa e manguito rotador; os fatores funcionais estão relacionados com o mecanismo de elevação do membro superior, por meio da atividade sincronizada e equilibrada entre o manguito rotador e os músculos da cintura escapular. Os autores relatam aqui, o caso de um lipoma parosteal do úmero proximal, situado entre os ventres musculares do deltoide, redondo menor e infraespinhal ocasionando os sinais clínicos da síndrome do impacto. Trata-se de uma ocorrência rara, caracterizada como uma causa estrutural para o desencadeamento dessa sintomatologia.

The impingement syndrome is defined by the compression of the rotator cuff tendons against the coracoacromial arch. Several factors contribute to this condition and they are classified as structural or functional factors. The former are changes in the coracoacromial arch, proximal humerus, bursa and rotator cuff, and the latter are related to the mechanism of the upper limb by means of synchronized activity and balanced between the rotator cuff and scapular girdle muscles. The authors report here a case of parosteal lipoma of the proximal humerus, located between the muscles deltoid, teres minor and infraspinatus causing clinical signs of impingement. It is a rare occurrence, characterized as a structural cause for the onset of this symptom.

Mixoma intramuscular: A propósito de tres casos / Intramuscular myxoma: Report of three cases

El mixoma intramuscular es un raro tumor benigno de tejidos blandos, de origen mesenquimal, que se presenta como masa de crecimiento lento, indolora, habitualmente en el muslo. El diagnóstico histológico es necesario antes de la resección, siendo la exéresis su tratamiento. No existen casos de malignización y su recurrencia se debe a resección incompleta. Presentamos tres casos de mixoma intramuscular tratados en nuestro centro entre los años 2004 y 2011. De este modo aprovechamos para realizar una revisión de la presentación clínica, diagnóstico, tratamiento y resultados funcionales de los mismos. En todos los casos se llevó a cabo el mismo protocolo diagnóstico y terapéutico, comenzando con la exploración física del paciente y realizando una ecografía y RMN como pruebas complementarias. Posteriormente una biopsia incisional del tumor para estudio anatomopatológico y finalmente la exéresis íntegra.

Intramuscular myxoma is a rare soft tissue benign tumor, arising from the mesenchyma; it presents as a slow-growing painless mass located usually in the thigh. Histologic diagnosis is necessary before resection and treatment consists of exeresis. There are no cases of malignization and recurrence results from incomplete resection. We report herein three cases of intramuscular myxoma treated at our center from 2004 to 2011. At the same time, we conducted a review of the clinical presentation, diagnosis, treatment and functional results. The same diagnostic and therapeutic protocol was used in all cases. It began with the patient’s physical exam, and ultrasound and MRI as complementary tests. An incisional biopsy of the tumor was taken for anatomopathological studies and, finally, complete exeresis was performed.

Histiocitoma fibroso maligno primario del músculo temporal: presentación de un caso / Primary malignant fibrous histiocytoma temporalis muscle: case report

El Histiocitoma fibroso maligno (HFM) fue descrito por Obrien y Stout en 1964 representando al 1-3 por ciento de los sarcomas del tejido blando de cabeza y cuello. Su histogénesis es incierta y el comportamiento biológico es propenso a la recidiva local y a las metástasis a distancia, preferentemente a ganglios linfáticos regionales, pulmón, hígado y huesos. Se presenta una paciente de 38 años de edad, con una lesión tumoral epicraneal recidivante, de consistencia blanda, fluctuante, no dolorosa, de aproximadamente 5 por 3 cm en región temporal derecha, se le realiza Tomografía computarizada de cráneo e Imagen por resonancia magnética, es intervenida quirúrgicamente resecándose totalmente una tumoración predominantemente quística en intima relación con el músculo temporal y reintervenida quince días después, el Rx de tórax, el ultrasonido abdominal y el survey óseo fueron negativos, el estudio histopatológico arrojó un Histiocitoma fibroso maligno pleomorfico por lo que es enviada al servicio de oncología para tratamiento adyuvante (radioterapia). Actualmente pasado un año se encuentra libre de enfermedad. Concluimos que el HFM primario del músculo temporal es una rara localización entre los sarcomas de partes blandas y aun más entre los de cabeza y cuello, donde el aumento de volumen no doloroso fue la forma clínica de presentación, la tomografía computarizada y principalmente las imágenes por resonancia magnética mostraron la relación músculo tumor, lográndose con el empleo de la cirugía y la radioterapia adyuvante alcanzar buenos resultados.

Lipoma de la vaina tendinosa asociado a ruptura de tendón del cuadríceps: informe de un caso / Tendon sheath lipoma associated with quadriceps tendon rupture: case report

BACKGROUND: Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair. CLINICAL CASE: We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee. CONCLUSIONS: We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.

Tenosynovial giant cell tumor of finger, localized type: a case report

The authors report a typical case of tenosynovial giant cell tumor of the right middle finger of a 31-year-old man. Histologically, this tumor is characterized by a discrete proliferation of rounded synovial-like cells accompanied by a variable number of multinucleated giant cells, inflammatory cells, and xanthoma cells. Clinicopathologically, this tumor is a benign lesion that nonetheless possesses a capacity for local recurrence. Local excision with a small cuff of normal tissue is the treatment of choice in this tumor.