3种方法固定股骨粗隆下骨折的生物力学研究

目的探讨动力髋螺钉(DHS)、股骨近端防旋髓内钉(PFNA)、Inter Tan 3种内固定材料固定股骨粗隆下骨折生物力学性能,为临床选择有效内固定方式提供科学依据。方法采购人工股骨标本18根,按照Seinsheimer分型Ⅲa型予以截骨制作成粗隆下骨折模型,分别用3种内固定材料固定,进行股骨的强度、刚度、稳定性、承载能力测式等生物力学实验,分析比较3种内固定方式固定股骨粗隆下骨折的生物力学性能。结果实验力学结果表明:Inter Tan髓内钉固定强度为(1.84±0.15)MPa,DHS为(1.39±0.11)MPa,PFNA为(1.36±0.12)MPa内固定的强度,Inter Tan组内固定强度大于DHS组和PFNA组,差异有统计学意义(P0.05);Inter Tan组刚度EF为(945.35±82.01)N/mm,DHS为(638.54±78.21)N/mm,PFNA为(755.33±86.32)N/mm,Inter Tan组刚度大于DHS组和PFNA组,差异有统计学意义(P0.05);Inter Tan组的抗剪、抗扭的稳定性、承载能力均明显优于DHS、PFNA组,差异有统计学意义(P0.05);其动态力学性能疲劳寿命也相应比DHS、PFNA组优越。结论 Inter Tan及PFNA均是固定Ⅲa型股骨粗隆下骨折的理想方法,其中Inter Tan整体生物力学性能优于PFNA髓内钉固定,而DHS不适用于此型股骨粗隆下骨折。     

3种内固定治疗老年不稳定股骨粗隆间骨折的疗效比较

目的比较95°髁动力加压钢板(DCS)、股骨近端防旋髓内钉(PFNA)以及第4代髓内钉(Inter Tan)治疗老年不稳定股骨粗隆间骨折的临床疗效。方法 111例股骨粗隆间骨折随机随机采用DCS、PFNA、Inter Tan内固定,每组37例。比较3组手术时间、术中出血量、手术质量、骨折愈合时间及并发症情况,末次随访时疗效采用髋关节功能Harris评分标准评定。结果 3组手术时间差异有统计学意义(F=41.530,P0.001),且PFNA组较DCS组和Inter Tan组短,Inter Tan组较DCS组短。3组术中失血量差异有统计学意义(F=244.890,P0.001);且PFNA组较DCS组和Inter Tan组少,Inter Tan组较DCS组少。3组手术质量比较差异无统计学意义(χ2=1.631,P=0.442)。3组骨折愈合时间差异有统计学意义(F=19.765,P0.001);PFNA组与Inter Tan组骨折愈合时间差异无统计学意义(P0.05),但均明显低于DCS组(P0.05)。3组髋关节功能Harris评分差异有统计学意义(F=3.691,P=0.028);PFNA组与Inter Tan组Harris评分差异无统计学意义(P0.05),但均明显高于DCS组(P0.05)。DCS组并发症发生率明显高于PFNA组及Inter Tan组。结论对于老年不稳定股骨粗隆间骨折,虽然DCS内固定手术质量较髓内钉固定好,但是在术后并发症及功能恢复方面较PFNA和Inter Tan内固定差。PFNA内固定操作简单,手术时间短。Inter Tan内固定抗旋转能力强,退钉率较低。     

髓内固定系统治疗老年股骨转子间骨折

目的分析髓内固定系统对老年股骨转子间骨折的疗效。方法采用股骨近端抗旋髓内钉(PFNA)、股骨近端髓内钉(PFN)、联合加压交锁髓内钉(Inter Tan)及亚洲型股骨近端抗旋髓内钉(PFNA-Ⅱ)4种髓内固定系统治疗95例老年股骨转子间骨折患者。比较4种方法的手术时间、术中出血量、透视次数、骨折愈合时间及末次随访Harris评分。结果 95例均获得随访,时间7~20个月。骨折愈合时间6~9个月。PFNA组1例术后5个月发生外伤后股骨颈骨折;PFNA-Ⅱ组1例术后3个月发生螺旋刀片切出;PFN组2例术后1周时发生深静脉血栓。手术时间:PFN组长于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P0.05),与Inter Tan组比较差异无统计学意义(P0.05);Inter Tan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P0.05);PFNA组与PFNA-Ⅱ组比较差异有统计学意义(P0.05)。术中出血量:PFN组多于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P0.05),与Inter Tan组比较差异无统计学意义(P0.05);Inter Tan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P0.05);PFNA组与PFNA-Ⅱ组比较差异无统计学意义(P0.05)。C臂机透视次数:PFN组多于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P0.05),与Inter Tan组比较差异无统计学意义(P0.05);Inter Tan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P0.05);PFNA组与PFNA-Ⅱ组比较差异无统计学意义(P0.05)。4组骨折愈合时间和末次随访Harris评分比较差异无统计学意义(P0.05)。结论股骨转子间骨折选择合适的髓内固定系统治疗都可以获得良好疗效,而PFNA-Ⅱ和PFNA损伤更小。     

PFNA与InterTan内固定治疗股骨粗隆间骨折的回顾性分析

目的比较股骨近端防旋髓内钉(PFNA)和Inter Tan内固定治疗股骨粗隆间骨折的临床疗效。方法笔者自2014-01—2016-03诊治87例股骨粗隆间骨折,比较PFNA与Inter Tan内固定2种固定方式在手术时间、术中出血量、术后输血量、术后下地时间、术后并发症发生率、术后Harris评分的差异。结果 87例均获得随访3~24个月,平均17.6个月。PFNA组出现内固定松动3例,肺部感染5例,尿路感染1例,Inter Tan组术后出现1例股骨远端骨折,差异有统计学意义(P0.05);PFNA组手术时间(43.8±10.5)min,术中出血量(205.9±99.3)ml,术后下地时间(30.2±6.4)d;Inter Tan组手术时间(55.9±13.9)min,Inter Tan组术中出血量为(278.5±116.1)ml,术后下地时间(7±3.1)d,PFNA组手术时间、术中出血量较Inter Tan组少,术后下地时间较Inter Tan组晚,差异有统计学意义(P0.05)。2组骨折愈合时间、Harris评分比较差异无统计学意义(P0.05)。结论 PFNA术中操作相对于Inter Tan较简单,手术时间及术中出血量较Inter Tan少;Inter Tan在术后下地时间较PFNA组早,并发症低;2种髓内固定治疗股骨粗隆骨折的骨折愈合时间及术后活动功能相似,均可取得较为满意的效果。     

ALCP、PFNA-Ⅱ、InterTan内固定治疗股骨粗隆间骨折的疗效比较

目的比较股骨近端解剖型锁定钢板(ALCP)、亚洲型股骨近端防旋髓内钉(PFNA-Ⅱ)与新型股骨近端髓内钉(Inter Tan)3种内固定方法治疗股骨粗隆间骨折的临床疗效。方法自2011-07—2014-07采用ALCP、PFNA-Ⅱ、InterTan内固定手术治疗股骨粗隆间骨折88例,33例采用ALCP内固定(ALCP组),29例采用PFNA-Ⅱ内固定(PFNA-Ⅱ组),26例采用Inter Tan内固定(Inter Tan组),对3种内固定方式在手术时间、术中失血量、术后24 h引流量、住院时间、负重时间、骨折愈合时间、Harris评分进行比较。结果在手术时间、术中失血量、术后24h引流量方面,Inter Tan组优于PFNA-Ⅱ组及ALCP组,PFNA-Ⅱ组优于ALCP组,差异均有统计学意义(P0.05);在负重时间、骨折愈合时间方面,Inter Tan组及PFNA-Ⅱ组优于ALCP组,差异有统计学意义(P0.05),Inter Tan组与PFNA-Ⅱ组差异无统计学意义(P0.05);3组在住院时间、Harris评分方面差异无统计学意义(P0.05)。结论 Inter Tan内固定治疗股骨粗隆间骨折疗效优于PFNA-Ⅱ及ALCP,PFNA-Ⅱ内固定优于ALCP。     

PFNA、APFLP及InterTan髓内钉治疗高龄不稳定性转子间骨折临床效果比较

目的比较股骨近端防旋髓内钉(PFNA)、股骨近端解剖锁定钢板(APFLP)及联合拉力交锁髓内钉(Inter Tan)治疗高龄不稳定性转子间骨折的临床效果。方法 2009年4月~2015年4月我院收治高龄不稳定性转子间骨折患者90例,根据内固定方式的不同分为三组,各30例,分别采用PFNA、Inter Tan及APFLP内固定。比较三组患者术中出血量、手术时间、切口长度、术中透视次数、住院时间、骨折愈合时间、髋关节功能优良率、髋关节功能评分(Harris评分)及术后并发症情况。结果两组患者均获得1年以上随访。PFNA组患者术中出血量最小、手术时间最短,Inter Tan组次之,APFLP组术中出血最多、手术时间最长(P0.05);PFNA组与Inter Tan组切口长度、术中透视次数均小(/少)于APFLP组(P0.05)。三组患者住院时间、骨折愈合时间、髋关节功能优良率、Harris评分差异均无统计学意义(P0.05);而APFLP组总并发症率明显高于其他两组(P0.05),而PFNA组和Inter Tan组并发症率比较无统计学差异(P0.05)。结论 PFNA、APFLP及Inter Tan髓内钉内固定均适用于高龄不稳定性转子间骨折,但PFNA具有手术操作简单、术中创伤较小、术后并发症较少等优点,成为不稳定性转子间骨折治疗的首选。     

髓内、外内固定方式治疗高龄股骨粗隆间骨折患者失血量及相关因素分析

目的分析高龄股骨粗隆间骨折运用髓内髓外固定方式治疗时的失血量差异并探讨相关因素的影响。方法回顾性分析自2011-01—2015-01诊治的157例高龄股骨粗隆间骨折,患者分别采用股骨近端防旋髓内钉(PFNA)和动力髋螺钉(DHS)内固定治疗,分析2组显性失血量、隐性失血量及总失血量的差异,以及年龄、性别和体重指数对2种术式中隐性失血量的影响。建立隐性失血量与术后第3天血红蛋白之间的线性方程式。结果 PFNA组显性出血量(140.3±31.6)ml,隐性出血量(409.7±191.3)ml,总出血量(550.0±192.5)ml,DHS组显性出血量(174.3±39.0)ml,隐性出血量(295.0±134.3)ml,总出血量(469.3±144.1)ml,2组显性失血量(t=6.01,P0.001)、隐性失血量(t=-4.33,P0.001)、总失血量(t=-2.96,P=0.036)比较差异有统计学意义。PFNA组中高龄组与超高龄组中隐性出血量比较差异有统计学意义(P0.05);性别(F=0.97,P=0.326)与BMI(F=0.00,P=0.976)对2组的隐性出血量差异无统计学意义。手术方案、术后3 d Hb及隐性出血量三者之间呈线性关系。结论髓内固定方式治疗高龄股骨粗隆间骨折的隐性出血量显著大于髓外固定方式,但显性出血量相反;年龄是影响隐性出血量的因素;隐性失血量与术后血红蛋白水平呈负相关。     

不同内固定治疗老年股骨转子间骨折的比较

目的对比三种不同内固定治疗老年股骨转子间骨折的临床疗效。方法将101例EvansⅢ-Ⅳ型老年股骨转子间骨折患者按照随机数字表法分为股骨近端解剖锁定钢板(proximal femoral locking plate,PF-LCP)组34例、股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)组34例及股骨近端顺行联合拉力交锁髓内钉系统(Inter Tan)组33例,按照各自的分组进行相应的手术治疗,对比分析三种治疗方法在手术时间、术中出血量、负重时间、临床愈合时间、Harris评分及并发症方面的差异。结果三组患者在手术时间、术中出血量、负重时间、临床愈合时间及卧床时间方面比较,差异均无统计学意义(P0.05)。Inter Tan组的优良率高于PF-LCP组及PFNA组,差异无统计学意义(P0.05)。Inter Tan组并发症的发生率为3.03%,明显低于PF-LCP组(20.59%)及PFNA组(23.53%),其差异均有统计学意义(P0.05)。而PF-LCP组及PFNA组之间比较,差异无统计学意义(P0.05)。结论 Inter Tan系统治疗老年转子间骨折在保证疗效的情况下可明显减少并发症的发生,是老年股骨转子间骨折较为理想的治疗方法。     

两种不同髓内固定治疗股骨转子骨折的疗效比较

目的比较股骨近端防旋髓内钉(PFNA)和InterTan两种不同髓内固定方式治疗股骨转子骨折的临床疗效。方法将92例不稳定股骨转子骨折患者按治疗方法分为PFNA组(54例)和InterTan组(38例),比较两组患者的手术相关指标、术后6个月Harris评分及术后并发症情况。结果所有患者均获得6个月以上随访。两组患者术后卧床、负重时间比较差异无统计学意义(P0.05);Inter Tan组的手术时间、住院费用高于PFNA组(P0.01),但术中失血量低于PFNA组(P0.01);两组术后6个月优良率比较差异无统计学意义(P0.05)。结论 PFNA及InterTan治疗股骨转子间骨折疗效均较可靠,可有效改善髋关节功能,在手术时间及住院费用方面PFNA有一定优势,而InterTan术中失血量更低。     

PFNA与DHS内固定治疗老年股骨转子间骨折的疗效比较

目的比较防旋股骨近端髓内钉(PFNA)与动力髋螺钉(DHS)内固定治疗老年股骨转子间骨折的疗效差异。方法选取2013年1月至2015年1月在云浮市新兴县人民医院行股骨转子间骨折治疗的90例老年患者,按照随机表法随机分为PFNA组和DHS组,每组各45例,分别采用PFNA和DHS内固定手术进行治疗。记录两组切口长度、手术时间、显性失血量和隐性失血量、术后血红蛋白减少量、术后患肢肿胀情况、住院时间、骨折愈合时间、髋关节功能Harris评分及术后并发症发生情况。结果 PFNA组在切口长度、手术时间、显性失血量和术后血红蛋白减少量、术后肢体消肿时间、住院时间、术后并发症发生率方面均低于DHS组,术后1年Harris评分优良率高于DHS组,两组比较,差异均有统计学意义(P0.05);两组隐性失血量和骨折愈合时间比较,差异无统计学意义(P0.05)。结论对于老年股骨转子间骨折,PFNA内固定较之DHS内固定具有手术损伤小、手术时间短、出血少、住院时间短、术后肢体功能恢复快、术后并发症少等优势。     

Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture,a meta-analysis

Objective

The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures.

髓内、外内固定与人工关节置换术治疗高龄股骨粗隆间骨折疗效对比研究

目的比较髓内、外内固定与人工关节置换术治疗高龄股骨粗隆间骨折的临床疗效。方法回顾分析自2012-09—2015-01诊治的107例高龄粗隆间骨折的临床资料,根据手术方式不同分为髓内固定(PFNA组)、髓外固定(PFLCP组)和人工关节置换(BHR组),比较3组出血量、时间和并发症发生率、切口大小、术中透视次数、术后患肢完全负重时间、卧床和住院时间、术后髋关节Harris评分。结果 3组均顺利完成手术。所有患者均获随访3~36个月,平均12个月。BHR组与另外2组比较,手术时间短、切口大、出血多、透视少、卧床和住院时间短、术后负重时间早、髋关节功能更好,差异有统计学意义(P0.05),3组并发症发生率比较差异无统计学意义(P0.05)。术后9个月3组均获得良好的关节功能,Harris评分两两比较差异无统计学意义(P0.05)。结论双极人工股骨头置换术治疗高龄股骨粗隆间骨折术后可获得良好的关节功能,患肢完全负重早,是一种安全的治疗方法。     

Intramedullary versus extramedullary fixation in the treatment of subtrochanteric femur fractures: A comprehensive systematic review and meta-analysis

ObjectiveThis meta-analysis aimed to compare the clinical outcomes of intramedullary fixation with the extramedullary fixation in the surgical management of subtrochanteric fractures by analyzing relevant randomized controlled trials (RCTs) and retrospective cohort studies (RCSs).MethodsThe PubMed, Embase, Cochrane Library, Wanfang database, and Chinese National Knowledge Infrastructure (CNKI) were searched from their inception till June 29, 2020. Two reviewers extracted the data, including operation time, intraoperative blood loss, fluoroscopy time, length of stay, union time, nonunion rate, infection rate, implant failure rate, reoperation rate, Harris hip score, and mortality rate. The Cochrane risk-of-bias tool and the Newcastle-Ottawa quality assessment scale were used to evaluate the methodological quality of RCTs and RCSs, respectively. Statistical heterogeneity was quantitatively evaluated with the I2 statistic.ResultsThere were no significant differences in operation time, intraoperative blood loss, average length of stay in hospital, infection rate, implant failure rate, Harris hip scores, and mortality rate. Intramedullary nail could achieve shorter union time (MD=−1.77, 95% CI −3.40~−0.14, p=0.03), lower nonunion rate (RR=0.36, 95%CI 0.14~0.97, p=0.04), and reoperation rate (RR=0.46, 95% CI 0.24~0.89, p=0.02) than extramedullary fixations. The subgroup analysis indicated that intramedullary nail was superior than extramedullary fixations in operation time, reoperation rate, and Harris hip scores in the ≥60-year subgroup. However, the intraoperative blood loss in intramedullary nail group was significantly higher than that of extramedullary fixation group in the <60-year subgroup.ConclusionThe results of this study have revealed that intramedullary fixation can confer shorter union time, lower nonunion, and reoperation rates compared with extramedullary fixations. Therefore, intramedullary fixation should be considered as the first selection for the treatment of patients with subtrochanteric fractures.Level of EvidenceLevel II, Therapeutic study     

Secondary extramedullary plasmacytoma involving the pancreas

Extramedullary plasmacytoma is a rare variant of plasma cell tumor involving organs outside the bone marrow. The vast majority of extramedullary plasmacytomas present as a secondary tumor of systemic myelomatosis of the bone marrow. We experienced a patient with extramedullary plasmacytomas of the head and tail of the pancreas presenting as secondary masses from extramedullary plasmacytoma of the maxillary sinus that had been treated 5 years previously. A 38-year-old Japanese man had undergone radiation therapy for an extramedullary plasmacytoma of the maxillary sinus 5 years before the current presentation. He experienced severe upper abdominal pain in November 1999, when laboratory data showed elevation of the serum amylase level. Computed tomography showed two isodensity masses, in the head and tail of the pancreas. Angiography showed two hypervascular masses, one in the head and the other in the tail of the pancreas, and encasement of the portal vein trunk junction. Laparotomy was performed, with the tentative diagnosis of extramedullary plasmacytoma of the pancreas, in order to obtain a definite diagnosis. Intraoperative biopsy revealed that the two pancreatic masses were extramedullary plasmacytomas. External radiation therapy was performed after the operation. When a pancreatic mass is noticed in patients with a history of plasmacytoma, secondary extramedullary plasmacytoma of the pancreas should be considered as a differential diagnosis. Received: April 13, 2001 / Accepted: November 16, 2001     

Surgical Results of Intradural Extramedullary Tumors

Background

To report the treatment results of 12 patients who underwent a total excision of intradural extramedullary tumors.

Methods

Twelve cases of histopathologically confirmed intradural extramedullary tumors were treated surgically between February 2002 and March 2005. There were 8 males and 4 females with an average age of 42.6 years. The mean postoperative follow-up period was 24.2 months. The histopathological findings, locations of the tumors, and clinical results were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel classification.

Results

The histopathological results are as follows: 4 cases of a meningioma, 4 cases of a schwannoma, 2 cases of an epidermoid cyst, 1 case of an arachnoid cyst, and 1 case of an ependymoma. The locations of the tumors were as follows: 7 cases in the thoracic region, 4 cases in the lumbar region, and 1 case in the cervical region. At the final follow-up, a 2-grade and 1-grade improvement was observed in 1 and 7 cases, respectively. There were no changes in the Frankel grade in 4 cases. The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Postoperatively, there were 2 cases of cerebrospinal fluid leakage and 2 cases of paresthesia.

Conclusions

Intradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgically. Therefore, more active surgical approaches by orthopedic surgeons are recommended to decrease morbidity.     

Biclonal Extramedullary Plasmacytoma Arising in the Peritoneal Cavity: Report of a Case

We report a rare case of extramedullary plasmacytoma, which arose either in the ileum or the ileal mesentery. A 70-year-old woman presented with a high fever and symptoms of bowel obstruction. Computed tomography and magnetic resonance imaging showed a large heterogeneous tumor in the peritoneal cavity. Serum immunoelectrophoresis revealed a biclonal increase of IgA- and IgG-. At surgery, we found that the parenchyma of the fragile tumor had firm communication with the ileal mesentery, and the cavity of the tumor communicated with the ileal lumen. After a temporary regression following surgery and chemotherapy, the tumor grew rapidly. Although there was no evidence of progression to multiple myeloma, the patient died of cachexia less than 4 months after surgery.     

Adrenal extramedullary hematopoiesis: Report on a pediatric case and update of the literature

The authors report on a rare pediatric case of adrenal extramedullary hematopoiesis in a patient with beta-thalassemia disease. The lesion was clinically discovered as incidentaloma of the right adrenal gland and treated by surgery. Adrenal extramedullary hematopoiesis may clinically be detected as incidentaloma. Adrenal incidentalomas presenting with hematologic disorders, such as agnogenic myeloid aplasia and beta-thalassemia, need careful imaging as well as adrenal hormonal investigation in order to exclude malignancy and sublinical hypersecretory syndromes. Ultrasound or CT-FNA of the lesion are effective in finding out the disease.     

Extramedullary Plasmacytoma of the Trachea

Extramedullary plasmacytomas are plasma cell tumors that occur outside the bone marrow. They constitute around 4 % of all plasma cell neoplasms. The most common site of extramedullary plasmacytoma is the upper aerodigestive tract—nasal cavity, paranasal sinuses and oronasopharynx. We are presenting a case of extramedullary plasmacytoma of the trachea. Trachea is an extremely rare site of plasmacytoma. When extraosseous plasmacytoma occur in uncommon sites, the distinction from B cell lymphomas showing extensive plasmacytic differentiation can be difficult and diagnostically challenging.     

Presacral extramedullary haematopoiesis: A diagnostic update and case report of a late diagnosis

INTRODUCTIONWe report a rare case of presacral extramedullary haematopoiesis, which manifested as a tumoural mass on a routine ultrasonography in a patient presenting with symptoms of cholecystitis. Since Ask-Upmark in 1945 reported 3 cases of pelvic extramedullary haematopoiesis, we are aware of only published 14 additional cases.PRESENTATION OF CASEA 73-year-old female patient presented with abdominal pain in the right hypochondrium. An abdominal ultrasonography revealed cholecystitis with cholecystolithiasis and a coincidental hyperreflective mass of 9.5 cm was visualised behind the bladder. A clinical examination identified a mass in the pelvis that could be palpated vaginally. A computerised tomography scan showed a large presacral, inhomogeneous, multilobular and nodular tumour. The patient was admitted for laparoscopic resection of the gall bladder and laparoscopic exploration of the presacral mass. An anatomopathological examination of the tissue revealed the presence of extramedullary haematopoietic tissue. A postoperative haematological investigation indicated that the extramedullary haematopoiesis was idiopathic.DISCUSSIONPresacral EMH may occasionally present with symptoms of nerve compression. Symptoms of haematologic disorders may accompany EMH.Barium enema, abdominal ultrasound, CT scan, MRI and radionuclide bone marrow imaging have all been used by previous authors in establishing the diagnosis. Tissue samples may be misdiagnosed when atypical megakaryocytes are misinterpreted as malignant cells, which occurred in this case. Misdiagnosis can occur even more often when EMH is not considered in the differential diagnosis due to its rare occurrence. In this case, the final diagnosis was made tissue sampling after surgery.Treatment of EMH is only necessary when it is symptomatic.CONCLUSIONThis case report shows that extramedullary haematopoiesis is very rare and that it is a difficult diagnostic challenge when its location is unusual and when it is not associated with a haematologic disorder. Together with this case report, we present an update of the available diagnostic methods.