Giant Cell Tumor of Flexor Pollicis Longus Tendon Sheath: An Uncommon Case Report and Literature Review.

Introduction: Giant cell tumors of tendon sheath are benign, rarely malignant, soft-tissue tumors arising from tenosynovial sheath and periarticular soft tissue. They usually present as painless masses with some restriction of movement. Histopathological diagnosis is gold standard although pre-operative fine-needle aspiration cytology (FNAC), plain radiographs, and MRI help in narrowing down the differentials. Giant cell tumor of the tendon sheath (GCTTS) although benign is notorious for having a high rate of recurrences, with most important risk factors being adjacency to joint and incomplete excision. Adequate marginal excision forms the mainstay for managing these tumors. Adjuvant radiotherapy has found some role in treating and decreasing the chances of recurrences. Case Report: A 55-year-old lady was brought to the outpatient department with a history of painless, gradually progressive swelling on volar aspect of thumb. Swelling was well defined with a smooth surface. Overlying skin showed no signs of local inflammation or adherence. Pain radiographs showed soft-tissue shadow with some articular bony erosions. A ultrasound-guided FNAC and MRI showed a picture of GCTTS. An excisional biopsy was done and confirmed the diagnosis. Conclusion: GCTTS is a benign entity with a slow course of evolution, although uncommon, and should be kept as differential for swellings of hand and feet. Complete excision with no evidence residual tumor is diagnostic as well as curative. A regular follow-up is essential on account of high rates of recurrences.

Dilemmas in Diagnosing Popliteal Swellings: Nodular Fasciitis Masquerading as Baker's Cyst.

Introduction: This is a case of a popliteal swelling which was clinically misdiagnosed as a simple popliteal cyst, which turned out to be a benign fibroblastic tumor featuring nodular fasciitis (NF). A swelling in the popliteal fossa by and large is considered to be a Baker's cyst. However, an array of other lesions which can be encountered such as fibroma featuring NF, meniscal cysts, lipoma, aneurysms, bursitis of the biceps femoris tendon, and schwannoma should also be borne in mind since clinical and radiological evaluation may not always be conclusive. This case report presents fibroma featuring NF masquerading as Baker's cyst, which has not been described in any literature that the authors could find hitherto, making it a unique case. Case Report: A 20-year-old male man presented to the outpatient department with a solitary palpable mass on the posterior aspect of his right knee for the past 3 years associated with difficulty in squatting for the past 3 months. The mass gradually was well defined and increased gradually in size to the current size of 10*9 cm, irregular soft to firm in consistency, spherical, non-tender, and non-reducible on the posterior aspect of the popliteal fossa. Local ultrasonography showed evidence of heterogeneous hypoechoic lesion with signs of inflammation; underlying bony cortices appeared to be normal. A clinical diagnosis of Baker's cyst was made and an excisional biopsy was performed. Microscopically, histologic sections showed fibroblasts arranged in loose fascicular patterns intermixed with small amount of collagen and myxoid stroma. Conclusion: Popliteal masses need not always be simple Baker's cyst, and careful evaluation of the mass in the popliteal fossa is always mandatory. Radiologic investigations may not always be conclusive and biopsy is the gold standard for diagnosis.

An Uncommon Case Report: Pathologic Fracture in a Proximal Femur Aneurysmal Bone Cyst in a Child.

Introduction: Aneurysmal bone cysts (ABCs) are a group of benign, expansile, locally aggressive lesion characterized by fluid-filled cysts usually in the metaphyseal end of long bones. They usually affect children and young adults, with an atypical etiology and uncommon presentation. Treatment modalities include en bloc resection and curettage with or without bone graft or bone substitute augmentation with instrumentation, sclerosing agents, arterial embolization, and adjuvant radiotherapy. Case Report: We report a rare case of ABC with pathological fracture in the proximal femur of a 13-year-old male patient, who presented to the emergency department with severe pain in the right hip and inability to walk following trivial fall while playing. Curettage with open biopsy was performed followed by implantation with modified hydroxyapatite granules and internal fixation for the subtrochanteric fracture with pediatric dynamic hip screw and four hole plate, with a favorable outcome. Conclusion: There is a lack of a standard guideline for the management on account of uniqueness of these cases; curettage with bone graft or bone substitutes in conjunction with internal fixation of associated pathologic fracture yields bony union with adequate clinical results.