ABSTRACT
Perivascular epithelioïd cell tumor (PEComa) is a mesenchymal neoplasm with epithelioïd or spindled morphology with numerous thin-walled capillaries between tumor cells. They co-express markers of both melanocytic and smooth muscle differentiation. PEComas are rare, presenting in numerous anatomic sites including lung, kidney, liver, genitourinary tract, soft tissue, and skin. Primary cutaneous PEComas are very rare entity, and malignant ones are even more uncommon. Herein, we report the case of a 92-year-old female which was presenting with 7 cm exophytic, ulcerated, hemorrhagic nodular tumor, and rapidly growing for 8 months over the right thigh. On histologic examination, we found a dermal neoplasm formed by an atypical clear cell tumor with numerous branching capillaries between tumor cells. The mitotic count was found 6 mitotic figures/10 HPF. On immunohistochemistry, tumor cells co-expressed smooth muscle and melanocytic markers, CD10, and CD68. Based on these findings, the diagnosis of primary cutaneous malignant perivascular epithelioïd cell tumor (PEComa) was made. The large size (7 cm), the count of mitoses (6 mitotic figures/10 HPF), and the nuclear pleomorphism argued for malignancy. The absence of soft tissue or visceral localization argued for the cutaneous primitive origin. Adjuvant radiotherapy and targeted therapy with mTOR inhibitor (nab-sirolimus) was indicated. To the best of our knowledge, this is only the eighth case of a primary cutaneous malignant PEComa reported in the literature to date.
ABSTRACT
OBJECTIVE: The objective of this study was to evaluate the clinical and radiological results of the treatment of aseptic nonunion of the tibia by plating and bone grafting. MATERIAL AND METHODS: This retrospective study included 40 patients with aseptic nonunion of the tibia, treated in the Trauma-Orthopedic department B4 of CHU Hassan II in Fez-Morocco. The average age was 41 years (range 25-60 years). The initial fractures were in the middle third of the tibia for the majority of our patients. We used the ASAMI criteria to assess the results. RESULTS: We found 45 patients with aseptic nonunion of the tibia who were treated by the same surgical team and followed in postoperative consultation for a fixed period of 10 months. Three patients lost to follow-up and two patients refused the treatment. In 37 patients (92.5%), union was obtained after a mean delay of 4.3 months (range 3-7 months). The average time from initial treatment to treatment for nonunion was eight months (range 6-10 months). According to the ASAMI classification, bone results were excellent in 26, good in 8, fair in 3 and poor in 3; functional results were excellent in 10, good in 16, fair in 11 and poor in 3. CONCLUSIONS: Our study suggests that the combination of screwed plate and autograft in the treatment of aseptic nonunion of the tibia has provided satisfactory results. A well-codified management of the initial fracture remains the gold key to prevent the occurrence of pseudarthrosis.
Subject(s)
Bone Plates , Bone Transplantation , Tibial Fractures , Adult , Bone Transplantation/methods , Fracture Fixation, Internal/methods , Fracture Healing , Fractures, Ununited/diagnostic imaging , Fractures, Ununited/surgery , Humans , Middle Aged , Retrospective Studies , Tibia/diagnostic imaging , Tibia/surgery , Tibial Fractures/diagnostic imaging , Tibial Fractures/surgery , Treatment OutcomeABSTRACT
Coverage of loss of skin substances on the lower third of the leg is a challenging problem. This is due to adjacent soft tissues impairment, shortage of local vascularization and bone exposure. We conducted a retrospective study of a series of 9 cases of skin coverage of the lower third of the leg treated at the University Hospital Hassan II of Fez from 2016 to 2018. This study aims to highlight the characteristic of the loss of skin substances on the lower third of the leg, while emphasizing the difficulty of management.
Subject(s)
Leg Injuries/surgery , Plastic Surgery Procedures/methods , Soft Tissue Injuries/surgery , Surgical Flaps , Adolescent , Adult , Female , Humans , Leg Injuries/pathology , Male , Middle Aged , Retrospective Studies , Skin/pathology , Soft Tissue Injuries/pathology , Young AdultABSTRACT
MASSON described glomus tumour as a benign neuromyoarterial proliferation. It represents approximately 1% -5% of all tumors of the hand. Pain is the main clinical sign. Definitive diagnosis is based on a body of evidence: clinical and radiological but only histology will allow confirmation. We conducted a retrospective study of 11 patient whose average age was of 36, 27 years (range 8-48 years), with a mean follow-up period of 34,40 months. All patients underwent surgical excision. This strategy allowed us to achieve satisfactory results.
Subject(s)
Glomus Tumor/pathology , Hand/pathology , Adolescent , Adult , Child , Female , Follow-Up Studies , Glomus Tumor/surgery , Hand/surgery , Humans , Male , Middle Aged , Retrospective Studies , Young AdultSubject(s)
Clavicle/surgery , Fracture Fixation, Internal/methods , Fractures, Bone/surgery , Adolescent , Adult , Bone Nails , Bone Plates , Clavicle/injuries , Female , Follow-Up Studies , Fracture Fixation, Internal/instrumentation , Humans , Male , Middle Aged , Operative Time , Prospective Studies , Young AdultSubject(s)
Achilles Tendon/injuries , Achilles Tendon/surgery , Orthopedic Procedures/methods , Adolescent , Adult , Athletic Injuries/epidemiology , Athletic Injuries/surgery , Female , Humans , Male , Middle Aged , Orthopedic Procedures/adverse effects , Postoperative Complications/epidemiology , Retrospective Studies , Rupture/surgery , Young AdultSubject(s)
Patellar Ligament/injuries , Tendon Injuries , Adolescent , Adult , Female , Humans , Male , Orthopedic Procedures/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prognosis , Retrospective Studies , Tendon Injuries/diagnosis , Tendon Injuries/epidemiology , Tendon Injuries/therapy , Young AdultSubject(s)
Hallux Valgus/surgery , Osteotomy/methods , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Stress fracture of the clavicle is a rare entity. It can manifest itself with an atypical shoulder pain. The clavicle is vulnerable to pathological fractures from several causes such as neoplasm, infection and rarely metabolic bone disease. CASE PRESENTATION: We report a case of a bone insufficiency fracture of the clavicle, in a 67-year-old Moroccan woman patient with several risk factors of bone insufficiency including osteoporosis, osteomalacia and primary hyperparathyroidism. CONCLUSION: The diagnosis of bone insufficiency-related fracture of the clavicle can be challenging. It should be considered in the differential diagnosis of shoulder or clavicle pain.