Intramuscular desmoid tumor of the leg leading to external popliteal sciatic neuropathy: A case study and literature review.

INTRODUCTION AND IMPORTANCE: Desmoid tumors (DT), rare benign neoplasms of soft tissues, exhibit local aggressiveness and high recurrence rates. Originating from myofibroblast proliferation, complete surgical intervention is the preferred treatment. Despite their benign nature, these tumors are infrequent, predominantly affecting women between 15 and 60, with a higher incidence in adolescence. CASE PRESENTATION: A 44-year-old woman with a DT in the leg mimicking external popliteal sciatic neuropathy. Diagnosis confirmed by biopsy, surgery performed with preservation of the external popliteal nerve, ensuring optimal nerve function. Two-year follow-up with no recurrence, demonstrating the success of the surgical intervention. CLINICAL DISCUSSION: DTs, although rare, exhibit three distinct genomic mutations, with the 45F genotype associated with the highest risk of recurrence. Generally sporadic, these tumors can be linked to familial adenomatous polyposis (FAP) and influenced by states of hyperestrogenism. DTs typically present as deep-seated masses, with frequent local recurrence despite complete resection. CONCLUSION: DTs pose diagnostic and therapeutic challenges, often requiring complete surgical intervention. Management depends on symptomatology, with careful monitoring for small asymptomatic tumors and adjuvant radiotherapy in case of incomplete resection. Despite surgical success, frequent recurrence underscores the need for in-depth research to enhance therapeutic approaches.

Compression of the posterior interosseous nerve secondary to a synovial cyst: Case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Posterior interosseous nerve syndrome secondary to compression by a synovial cyst at the elbow is a rare and often unrecognized pathology. Early management relies on complete neurolysis to achieve satisfactory functional recovery. Increasing awareness among the orthopedics will help in the early diagnosis of the disease and in the initiation of early and proper treatment. CASE PRESENTATION: In this article, we report the case of a 32-year-old patient with posterior interosseous nerve syndrome secondary to compression by a synovial cyst of the elbow. Surgical management combined with post-operative rehabilitation resulted in indolence with good functional recovery. CLINICAL DISCUSSION: Posterior interosseous nerve syndrome secondary to compression by a synovial cyst at the elbow is a rare entity. Anatomically, the deep branch of the radial nerve or posterior interosseous nerve passes through the Fröhse's arch or arch of the supinator muscle at the elbow, then travels between the two heads of this muscle. Several anatomical structures may compress the NIOP. Clinically, it presents as paralysis or paresis of the extensor muscles of the fingers and the abductor muscle of the thumb. Limitation of the ulnar extensor carpi may be responsible for radial deviation of the carpus in some cases. MRI is the radiological examination of choice. Electromyography plays a contributory role in diagnosis prior to surgical exploration. Surgical excision is the treatment of choice. It may be combined with radial neurolysis for better recovery. Progression after surgical treatment is generally favourable. CONCLUSION: Ignorance of posterior interosseous nerve palsy syndrome frequently leads to misdiagnosis. Early management relies on complete neurolysis to achieve satisfactory functional recovery.

Actinomycosis of the sole of the foot (Madura foot): A rare case report and literature review.

INTRODUCTION AND IMPORTANCE: Actinomycosis of the foot is a rare, chronic, granulomatous infectious ailment affecting the skin, dermis, and subcutaneous tissues. It is caused by a fungal or actinomycotic agent, resulting in a pseudotumoral appearance. This pathology typically progresses slowly, leading to delayed diagnosis. The primary objective of this report is to emphasize the rarity and clinical significance of this highly uncommon medical condition. CASE PRESENTATION: We present the case of a 45-year-old woman with a mass on the sole of her right foot. The condition was treated through excisional biopsy along with combined antibiotic therapy. Histopathology of the excised mass confirmed the presence of actinomycosis, ultimately confirming the diagnosis. The patient's progress was satisfactory, with no recurrence observed over a 2-year follow-up period. CLINICAL DISCUSSION: Actinomycosis of the foot is a common pathology in tropical and subtropical regions where climatic conditions promote its emergence. It is a chronic, granulomatous infection of exogenous origin, caused by either fungal (eumycetoma) or bacterial (actinomycetoma) agents. When left unrecognized, these infections can lead to complications, including osteoarticular lesions, with a severe impact on the functional prognosis. The presence of foot swelling should raise suspicion of mycetoma as a diagnosis, with confirmation relying on histological analysis. Management typically involves the aggressive control of invasive soft-tissue masses, often followed by prolonged antibiotic treatment. Skin grafting is a standard method for closing Madura foot defects, and continuous surveillance is necessary due to the potential for actinomycosis recurrence. CONCLUSION: In the context of Morocco, actinomycosis of the foot remains sporadic. Identifying these conditions presents significant diagnostic challenges, leading to unfortunate treatment delays. These largely unrecognized conditions have the potential to become more complex by causing osteoarticular damage and lesions, ultimately worsening the functional outlook. Early vigilance is advisable upon observing foot swelling, considering the possibility of actinomycosis of the foot. A definitive diagnosis requires histological analysis, a critical step.