Case Report: An Unusual Osseous Lesion

The intraosseous benign notochordal cell tumor (BNCT) is an intravertebral lesion derived from notochordal tissue. The notochord develops in humans during the third week of embryonic life and persists in adults as the nucleus pulposus of the vertebral disks. The most common locations of such tumors are the saccrococcygeal region and the skull base. Most tumors are asymptomatic and small. Magnetic resonance imaging is useful in their detection and precise localization. Histologically, these lesions consist of sheets of adipocyte-like vacuolated or less vacuolated eosinophilic tumor cells with eccentrically located round nuclei without myxoid matrix. The tumor cells express the epithelial markers, vimentin and S100 protein. Main differential diagnosis is chordoma. Intraosseous BNCT do not require any surgical management and should be recognized by pathologists to prevent unnecessary radical surgery. These lesions should be followed-up with conventional MRI.

Osseous Rosai-Dorfman disease of tibia in children:A case report

BACKGROUND Rosai-Dorfman disease(RDD),or sinus histiocytosis with massive lymphadenopathy,is a benign histiocytic disorder.Extranodal involvement is common,occurring in>40%of patients,but bone involvement occurs in<10%of cases.In addition,primary bone RDD is extremely rare.The majority of patients are adolescents and young adults,and the mean age at onset is 20-years-old.CASE SUMMARY We report an 8-year-old Chinese girl who presented to our hospital with an insidious onset of swelling and pain in the middle shaft of her right tibia for 4 mo.We performed total surgical resection of the right tibia lesion and allograft transplantation.A good prognosis was confirmed at the 6 mo follow-up.Pain and swelling symptoms were totally relieved,range of motion of her right knee and ankle returned to normal,and there was no clinical evidence of lesion recurrence at last follow up.Our case is the second reported case of osseous RDD without lymphadenopathy in the shaft of the tibia of a child.CONCLUSION Extranodal RDD is a rare disease and can be misdiagnosed easily.Lesion resection and allograft transplantation are an option to treat extranodal RDD in children with good short term result.Pediatric orthopedist should be aware of this rare disease,especially extranodal involvement.

Epibulbar osseous choristoma:Two case reports

BACKGROUND Choristoma is a rare,benign,congenital proliferative tumor,with osseous choristoma being the rarest.Although the tumor is benign,effective identification is needed for its diagnosis and treatment.Here,we report the diagnosis and successful surgical treatment of two patients with osseous choristoma.CASE SUMMARY Two patients,a young female and young male patient,were found to have a mass on the ocular surface.The tumor presented on the superior temporal bulbar conjunctiva in the first patient and on the upper eyelid in the second patient.Ultrasound biomicroscopy detected a strong echo with clear boundaries covering the lower echo,and computed tomography examination revealed calcification.Both patients underwent surgery,and histopathological evaluation of the mass showed osseous choristoma.They were treated by excision and subsequently cured.CONCLUSION Osseous choristomas are usually asymptomatic.Our patients were cured immediately after surgery,suggesting that surgical treatment is an effective strategy.

Osseous Dysplasia Secondary Infection: A Case Report

Introduction: Osseous dysplasia is a benign tumor of the jaws predominantly occurring in melanoderm women. The pathogenesis remains unknown. Its often fortuitous discovery usually is in the fourth decade of life. Its treatment involves surgery. Our aim was to report a case of osseous dysplasia secondary infection in Senegal. Observation: The over sixty-year-old patient initially came for recurring old suppuration. A prior history of dental avulsions and self-medication was found out. The clinical features were predominant chronic osteitic manifestations. Its radiologic presentation suggested a florid form. The combination of spiramycin-metronidazole had to be given twice. The isolated sequestrum was enucleated and the anatomopathology confirmed the diagnostics. Discussion: The patient’s age conformed to late discovery due to silent progression and poor access to medical care. The prior iatrogenic avulsions can be explained by the absence of systematic radiological exploration and by the unawareness of the inconspicuous tumor. The clinical and radiological features at this stage of the osseous dysplasia secondary infection were typical. The treatment and the follow-up were dependent on the prevailing work conditions. Conclusion: The chronic osteitic manifestations are indicative of osseous dysplasia in elderly women in Senegal.

Osseous Metaplasia Leading to Traction Retinal Detachment in the Nonphthisical Eye of Young Boy with Cytomegalovirus Retinitis

Title: Osseous Metaplasia Leading to Traction Retinal Detachment in the nonphthisical eye of Young Boy with Cytomegalovirus Retinitis. Purpose: To report a case of intraocular bone formation in an 11-year-old boy with a history cytomegalovirus (CMV) retinitis secondary to immunosuppression following Bone Marrow Transplantation due to hyper Immunoglobulin G (IgG) syndrome. Methods: An 11-year-old male presented with decreased vision in his better seeing eye. Clinical examination and Bscan ultrasound discovered a tractional retinal detachment with a large subretinal lesion. The patient was taken for surgical intervention. Results: The subretinal lesion was removed during surgery, and histopathologic evaluation revealed mature lamellar bone. Conclusion: This case shows that mature intraocular bone can be associated with tractional retinal detachment in a nonphthisical eye.

Primary Osseous Metaplasia of Right Breast

Osseous metaplasia of the breast is considered to be one of the rare breast conditions. It is characterized by the presence of normal bone tissue within the breast. We report a case of benign osseous metaplasia in a 58-year-old woman presenting with mastalgia and mass in the right breast. A lumpectomy was performed. On the pathological examination, the mass was composed completely of benign bone trabeculae with no epithelial component which was confirmed by negativity of immunohistochemistry.

Ewings Sarcoma-Primitive Neuroectodermal Tumour-Rare Extraosseous Presentation

Introduction: Ewings sarcoma is uncommon in extra osseous locations. They belong to Ewings family of tumours and the primitive neuroectodermal tumour is often diagnosed based on immuno histochemistry and molecular genetic studies. Discussion: A 50-year-old gentleman presented with complaints of a swelling in the right thigh. With a diagnosis of soft tissue sarcoma, the patient underwent a wide local excision of the tumour. We review literature of the small round blue cell tumour. Conclusion: Extraosseous Ewings sarcoma presenting as a thigh swelling is uncommon. The sarcoma was vimentin positive and CD99 membrane positivity.

An unusual biconvex epidural lesion:acutely presenting extraosseous intracranial Ewing's sarcoma

Background:Ewing's sarcoma family of tumors consists of small round cell neoplasms,inclusive of primitive neuroectodermal tumor(PNET),Askin's tumor,and PNET of the bone.Extraosseous Ewing's sarcoma occurs commonly at bones of lower extremities and paravertebral region of the spine.It rarely presents as a primary intracranial lesion.When intracranial,it can be misdiagnosed as central PNET(e.g.,medulloblastoma,pinealoblastoma,or supratentorial PNET),other intracranial lesions,or even as an epidural hematoma.Case presentation:We report the case of a 20-year-old patient who presented to the emergency department with complaints of drowsiness,headache,and fever for 1 day.On initial computed tomography(CT)scan of the brain,a right temporal biconvex epidural lesion involving squamous-temporal bone with periosteal reaction was noted.The patient underwent urgent craniotomy,and a tumor was found and excised.Biopsy report confirmed Ewing's sarcoma.Conclusion:Ewing's sarcoma is a rare intracranial malignancy with only a few cases reported in literature.In a young patient with a biconvex epidural lesion,in the absence of trauma or ongoing infection,the possibility of Ewing's sarcoma should be considered as well.

全身骨显像评价前列腺癌骨转移特点及其临床应用价值

目的:通过99mTc-MDP全身骨显像与MRI、CT及前列腺特异性抗原(PSA)的比较,评价前列腺癌骨转移的特点及其临床应用价值。方法:对60例经病理证实为前列腺癌的患者肘静脉注射99mTc-MDP 925MBq,约3小时后行全身骨显像。在行全身骨显像的前后1周内进行MRI、CT、PSA测定。结果:全身骨显像与MRI在诊断前列腺癌骨转移的阳性率方面无明显差异,且有较高的阳性一致率,均高于CT检查;全身骨显像显示,前列腺癌骨转移的好发部位为骨盆、脊柱;前列腺癌骨转移患者的血清PSA值明显高于无骨转移者。结论:全身骨显像是早期发现前列腺癌骨转移的首选方法,有极高的临床实用价值。

Survival of dental implants in patients with bone dysplasia:A systematic review

Objective:This study used published studies to assess the survival rate of dental implants placed in patients with bone dysplasia of the maxillofacial region.Material and methods:An electronic search without a specified date range was performed using the MEDLINE,PubMed,EMBASE,Web of Science,and Cochrane databases.No gender or age restrictions were applied.Results:Eighteen publications were found that met the study’s criteria,reporting data on 18 patients with bone dysplasia including cleidocranial dysplasia(CDD),fibrous dysplasia(FD),florid cemento-osseous dysplasia(FCOD),and odonto-maxillary segmental dysplasia(SOMD),who received a total of 130 implants,an average of 7.2 implants/patient(range 1 to 16).The mean age of the patients was 36.7 years(range 15 to 70 years).For implants placed in bone dysplasia,the survival rates were 100% for patients with CDD(n=8),FD(n=5),SOMD(n=2),FCOD with implants inserted far from the lesions(n=2)and 0% for dental implants inserted within FCOD(n=1).The mean follow-up was 38.2 months(min 6,max 60).Conclusions:Dental implants placed in patients with dysplastic bone lesions show high survival rates,similar to those in the general population for CDD,FD,and SOMD.For FCOD,the failure rate was 100%.

Bone formation in a rectal inflammatory polyp

Heterotopic bone formation(osseous metaplasia) is rarely detected in the gastrointestinal tract.Most of reported cases are associated with malignant lesions.We herein report a case of osseous metaplasia in a rectal inflammatory polyp and a review of the literature on suggested mechanisms for its aetiology.A 39-year-old man visited our hospital with a chief complaint of melena.Total colonoscopy revealed a slightly reddish subpedunculated polyp,about 12 mm in diameter,in the lower rectum.Endoscopic resection was performed.Histologically,several foci of heterotopic bone formation were found.From the review of the literature,all of the polyps described were larger than 10mm in diameter,55.6% showed inflammatory changes,and 62.5% were detected in the rectum.Osteogenic stimulation was considered to be a result of the inflammatory process.As our inflammatory polyp was located in the rectum,the pathogenesis could be a reactive change stimulated by the repeated local trauma,or be on a peculiar characteristic of the rectal mucosa itself.

Recalcitrant distal humeral non-union following previous Leiomyosarcoma excision treated with retainment of a radiated non-angiogenic segment augmented with 20 cm free fibula composite graft: A case report

BACKGROUND Leiomyosacromas in the Extremities are rare malignant smooth muscle tumors.Adjuvant radiation therapy, in combination with wide surgical excision allows the best chance of treatment. During the follow up pathological fractures are common complications that can be accompanied by Implant failure and defect situations that are most challenging in their management.CASE SUMMARY We present a case of a 52-year-old female suffering from a pathological fracture of the humeral shaft 10 yr after resection of a Leiomyosarcoma and postoperative radiotherapy. She developed implant failure after retrograde nailing and another failure after revision to double plate fixation. In a two-stage revision, the implants were removed and the huge segmental defect created after debridement was bridged by a compound osteosynthesis with nancy nails and bone cement for formation of the induced membrane. Due to the previous radiotherapy treatment,20 cm of the humeral shaft were declared devascularized but were left in situ as a scaffold. In the second stage, a vascularized fibula graft was used in combination with a double plate fixation and autologous spongiosa grafts for final reconstruction.CONCLUSION This combinatory treatment approach led to a successful clinical outcome and can be considered in similar challenging cases.

Unusual Presentation of Endometrial Cancer: A Clinicopathological Study of One Case

Endometrial carcinoma is the most frequent genital tract malignancy. The first symptom (guide-symptom) is usually metrorrhagia;however, in around 10% of cases it is not. In contrast, osseous metastases are infrequent in endometrial cancer. The bones of the pelvis and lower extremities are those most frequently involved in disseminated metastatic diseases. In these cases, endometrial cancer is usually high grade (Grade III). Case report: 56-year-old woman who presented right inguinal pain. The X-ray showed a lithic lesion in the right ischium. A histopathological study demonstrated a metastatic lesion, suspected to be endometrial cancer. The computer tomography scan revealed a uterine mass and a second lithic lesion in the right tibia. The patient received chemotherapy (carboplatin and paclitaxel), and the bone lesions were irradiated. The patient is still alive 18 months after the diagnosis. This case emphasizes the importance of considering an endometrial primary tumor when evaluating bone metastasis of unknown primary cancer.

Bilateral Long Bone Fractures in a Patient with Sarcoid: A Case Report

Although there have been many reports of small bone and vertebral involvement in sarcoidosis, long bone pathology is rare. We report a case of almost identical bilateral fractures of the proximal femoral diaphysis during separated in time through a low-energy mode of injury, and explore the difficulties encountered when seeking radiological and tissue diagnosis.

Treatment of Craniomaxillofacial Fibrous Dysplasia

Fibrous dysplasia is a benign osseous disease, although radical resection is commonly recommended because of the possibility of recurrence or malignant change. However, radical resection is undesirable, particularly in the maxillofacial region, because facial bones are difficult to replace in an aesthetically-pleasing manner after radical excision. In our department, conservative shaving, as reported by Chen and Noordhoff, is used to reduce tumor volume while maintaining facial aesthetics that are as normal as possible. We have experienced eight cases of craniomaxillofacial fibrous dysplasia and successfully applied conservative shaving to the maxillofacial lesions. These cases have exhibited no recurrence, and their facial contours have improved remarkably.