ABSTRACT
BACKGROUND: Synovial cell sarcomas are usually seen in a juxta-articular location. However, they occur rarely in the head and neck region. CASE PRESENTATION: We report a rare case of brachial plexus synovial sarcoma in a 24-year old South Asian man treated successfully with surgical excision followed by radiotherapy. CONCLUSIONS: Synovial sarcoma arising from the brachial plexus is rare. The treatment is multimodal with complete excision (often challenging owing to the proximity of the neurovascular structures) and adjuvant therapy.
Subject(s)
Brachial Plexus/surgery , Radiotherapy, Adjuvant/methods , Sarcoma, Synovial/radiotherapy , Sarcoma, Synovial/surgery , Soft Tissue Neoplasms/radiotherapy , Soft Tissue Neoplasms/surgery , Adolescent , Adult , Asian People , Brachial Plexus/physiopathology , Child , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Rare Diseases/diagnosis , Rare Diseases/radiotherapy , Sarcoma, Synovial/diagnosis , Soft Tissue Neoplasms/diagnosis , Soft Tissue Neoplasms/therapy , Treatment Outcome , Young AdultABSTRACT
PURPOSE: Benign aggressive expansile osteolytic lesions such as giant cell tumors and aneurysmal bone cysts involving the metacarpal head pose problems in management. Unacceptably high rates of recurrence are reported after curettage and bone grafting. An en bloc excision of such tumors ideally requires osteoarticular replacement of the excised metacarpal heads to retain mobility and function. We used nonvascularized metatarsal head and shaft harvested from the foot to replace the metacarpal defect after en bloc resection to retain movement and function of metacarpophalangeal (MCP) joint. The purpose of this study was to evaluate results of patients who underwent this procedure. METHOD: Nine patients treated with metatarsal transfer for osteoarticular reconstruction after en bloc excision of benign aggressive osteolytic metacarpal head tumors were reviewed retrospectively. The postoperative evaluation included examination of radiographs, joint mobility, and patient rated return of function using the Michigan Hand Questionnaire. RESULTS: Of 9 patients, 4 had aneurysmal bone cyst, 4 had giant cell tumor, and 1 an atypical cartilaginous lesion. Patients were aged between 14 and 45 years at the time of surgery. After an average of 44 months of follow-up (minimum follow-up of 24 months; range, 24-104 months), all patients had good postoperative function, satisfactory results, and no recurrence of tumor. The mean active range of motion at the reconstructed MCP joint was 75° (range, 0° to 90°). The Michigan Hand Questionnaire score averaged 80 (range, 69-92). No patient complained of donor site morbidity. One patient underwent MCP joint fusion after a pin tract infection. CONCLUSIONS: Use of a matched metatarsal graft for osteoarticular reconstruction after en bloc excision of benign aggressive tumors involving the metacarpal head is a potential treatment option. In this limited series, consistent results with respect to functional range of motion at MCP joint, and without recurrence of tumor or notable donor site morbidity were obtained. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Subject(s)
Bone Cysts, Aneurysmal/surgery , Bone Neoplasms/surgery , Giant Cell Tumor of Bone/surgery , Metacarpal Bones/surgery , Metatarsal Bones/transplantation , Adolescent , Adult , Autografts , Bone Cysts, Aneurysmal/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Male , Metacarpal Bones/diagnostic imaging , Metacarpal Bones/pathology , Middle Aged , Radiography , Young AdultABSTRACT
We report a case of a 17-year-old boy who presented with botryoid lesions of both hands. These lesions resembled those of cutaneous botryomycosis. We treated him with surgical debridement and were unable to isolate infective agents initially. However, 3 months later Mycobacterium tuberculosis grew in the culture. One year of antituberculous drug therapy resulted in healing of the lesions.
