Giant cell tumor of the sternum.

A primary giant cell tumor (GCT) originating from the sternum is extremely rare. We report a case of a GCT originating from the sternum in a 45-year-old man who was referred to us for a mass in the anterior chest wall that had been growing slowly. Computed tomography revealed a soft tissue mass involving a large osteolytic and destructive lesion of the sternum body. Subtotal sternectomy and reconstruction with methylmethacrylate were performed. The tumor was 8.5 x 4.5 x 2.5cm, and the histopathological examination confirmed GCT. Radical wide resection of primary sternum tumors and reconstruction with an appropriately rigid prosthetic material are necessary to minimize local recurrence.     

Giant cell tumors that originated in the sternum

Giant cell tumors originating from the sternum are rare. We report a case of a giant cell tumor of the sternum with radiological evidence of aggressiveness. A 34 year-old woman noted a mass in the anterior chest wall that had been slowly growing over 1 year. After incision biopsy revealed a diagnosis of a giant cell tumor she was treated by surgical resection (subtotal sternectomy) and reconstruction with methylmethacrylate. The tumor was 14 × 9 × 8 cm, and histological study confirmed that it was a giant cell tumor. Although giant cell tumors are benign, they are locally aggressive lesions and must be considered in the differential diagnosis in patients with a sternal mass.     

Giant cell tumor of the sternum: a case report

We report a rare case of giant cell tumor (GCT) of the sternum in a 55-year-old man. He presented with a bony mass in the body of the sternum that had been slowly growing over 6 months. The patient was treated by surgical curettage and cementation. Histological study showed typical GCT findings with cytogenetic abnormalities of many telomeric associations of chromosomes, predominantly the 19q arm.     

Primary malignant fibrous histiocytoma of the ascending colon: Report of a case

We report herein an unusual case of primary malignant fibrous histiocytoma (MFH) of the ascending colon. A 47-year-old man was admitted to our hospital for further investigations following the discovery of a mass in the right lower quadrant of the abdomen during a medical checkup. Abdominal ultrasonography (US) and computed tomography (CT) demonstrated a mass extending to the right lateral side from the ascending colon. At laparotomy, a tumor was found originating in the ascending colon and infiltrating the right lateral peritoneum. A right hemicolectomy and partial peritoneal dissection were performed followed by an ileotransverse colostomy reconstruction. The resected specimen contained a tumor measuring 7×5×4 cm, the cut surface of which was yellowish white, and the mucosa of the colon was intact. Based on histological and immunohistochemical inspection, the tumor was diagnosed as MFH of the ascending colon. We reviewed the total 18 known cases of colorectal MFH documented in the literature including our case. After surgery, 4 of 17 patients died of local recurrence, all within 42 months, indicating that early and complete excision of tumor is essential to achieve cure.     

Anterior chest wall giant cell tumor

Giant cell tumors (GCTs) of bone are rare primary neoplasms that usually originate from the epiphysis of long bones. Even when the tumor occurs in a rib, it is usually in the posterior aspect. We report a case of a GCT originating from the anterior arc of the rib in a 22-year-old woman presenting with a progressively growing thoracic mass in the right anterior chest wall. Through this case the authors emphasize not only the rarity of a bone GCT but also its unusual costal localization.     

Gastrointestinal stromal tumor of the lesser omentum in a young adult patient with a history of hepatoblastoma: Report of a case

A gastrointestinal stromal tumor (GIST) of the lesser omentum is extremely rare. This report presents a case of GIST of the lesser omentum in a 22-year-old man with a history of hepatoblastoma. Computed tomography showed an abdominal mass about 30 mm in diameter adjacent to the lesser wall of the stomach. A laparotomy showed a mass of about 27 × 24 × 20 mm in diameter originating from the lesser omentum but isolated from the stomach and the liver. Histopathology showed that the tumor was composed of spindle-shaped tumor cells with high cellularity. Immunohistochemically, the tumor was positive for KIT and CD34. An in-frame deletion was observed in the c-kit gene exon 11. Therefore, the tumor was diagnosed as a GIST originating from the lesser omentum.     

A management strategy for giant cell tumor of the metacarpal: A single-center series of 11 cases

BackgroundPrimary giant cell tumor (GCT) arising from bones of hand are rare to occur. Metacarpals are often the most common site of involvement among hand bones. There are no uniform guidelines for treatment of GCT involving metacarpals due to lack of relevant literature.ObjectiveTo suggest a management strategy for GCT involving metacarpals.MethodsRetrospective review of cases of GCT involving metacarpals over a period of 15 years from 2005 to 2019 managed at department of Orthopaedics, All India Institute of Medical Sciences, New Delhi.ResultsA total of 12 cases of GCT involving metacarpal were included, out of which one was lost to follow-up. Four cases were recurrent, and seven were primary at the time of surgery. All the patients were operated with wide excision of the tumor. In seven patients reconstruction of the metacarpal and MCPJ was done using fibular strut graft and silastic artificial joint, while in two patients, MCPJ arthrodesis was performed using fibula and/or iliac crest bone graft. In another two patients, the MCPJ was reconstructed using reversed vascularised toe transfer. Mean follow up of the patients was 3.22 ± 2.07 years. Mean Quick DASH score at latest follow-up of patients operated with silastic joint reconstruction, reversed vascularised toe transfer and arthrodesis of MCP joints were 30.5 ± 9.5, 25 ± 2.3 and 39.8 ± 3.4 respectively. Local recurrence occurred only in one patient at one year after surgery. All the patients were pain free at latest follow-up with quite functional and cosmetically acceptable hand.ConclusionReversed vascularised metatarsal transfer has obtained better functional results compared to reconstruction with fibular grafting and silicone joint replacement but due to technical difficulties, vascularised joint transfer may not be performed in every setting and there is risk of donor site morbidities with this technique. Our strategy for the treatment of GCT involving metacarpal was to do vascularised joint transfer or arthrodesis for border digits and reconstruction with silicone joint for central digits.     

Surgical resection and reconstruction for a giant cell tumor of the anterior rib

Giant cell tumors (GCTs) are rare neoplasms, most commonly arising in the metaphysis/epiphysis of long bones. They consist of multinucleated giant cells with surrounding spindle-shaped mononuclear stromal cells. GCTs rarely appear in the ribs. We report a case of a GCT originating from the anterior arc of the fourth rib in a 31-year-old man who presented with a progressively growing thoracic mass in the left anterior chest wall. Thoracotomy involving en bloc resection of the chest wall and tumor and a reconstruction of the chest wall were performed.     

病灶切刮骨水泥填充治疗肢体骨巨细胞瘤125例

目的 探讨病灶切刮骨水泥填充治疗肢体骨巨细胞瘤（ＧＣＴ）的临床应用价值,方法 对１９８０年３月～１９９７年１２月１２５例ＧＣＴ的治疗情况进行回顾分析。患者男６２例,女６３例,年龄１２－７１岁,平均年龄３１．５岁,其中原发ＧＣＴ１０１例,复发ＧＣＴ２４例。发病部位在膝关节周围者１００例（占８０％）。结果 １２５例患者均获随访,随访时间１３－１９４个月,平均９６个月。原发ＧＣＴＦ得,１３例复发,复发率     

Adult granulosa cell tumor with minor foci of juvenile granulosa cell tumor in postmenopausal woman: A rare case report

IntroductionGranulosa cell tumor (GCT) is a rare neoplasm that is divided into adult GCT (AGCT) and juvenile GCT (JGCT). Generally, a patient will only have the AGCT or JGCT subtypes. Here, we presented the first case of AGTC accompanied by focal JGTC in a postmenopausal woman.Presentation of caseA 63-year-old postmenopausal woman came with distended abdomen accompanied by postmenopausal bleeding. CT scan shows a solid mass with cystic degeneration. Laparotomy found a solid mass from the right ovary measuring 18 × 15 × 14 cm. The pathological results showed a diffuse tumor representing AGCT, accompanied by Call-Exner bodies and nuclear groove. In addition, minor foci were also found, which consist of well-defined margins tumor and follicular-like structures that resemble JGCT. The patient underwent bilateral salpingo-oophorectomy with a total hysterectomy and no recurrence in three months follow-up.DiscussionAge and clinical symptoms cannot be used as specific differentiators between AGTC and JGTC. Radiological imaging also shows a similar appearance of solid masses tumors with hemorrhagic or fibrotic changes, multilocular cystic lesions, or completely cystic tumors. The concomitant findings of JGCT and AGCT could be distinguished very carefully by anatomical pathology examination. It is crucial to differentiate AGCT from JGCT, especially to see the prognosis.ConclusionThe role of pathologists is needed in differentiating AGCT and JGCT, primarily when found simultaneously.     

Primitive neuroectodermal tumor of the sternum in a child: resection and reconstruction

Pediatric primary malignancies of the sternum are rare. They represent less than 1% of all bone tumors. Primitive neuroectodermal tumor of the chest wall or Askin's tumor is more often seen in the ribs than in the sternum. Surgical treatment involves resection of the tumor followed by primary reconstruction. We report the case of a 16-year-old adolescent boy who was diagnosed to have primitive neuroectodermal tumor of the sternum and underwent resection with primary reconstruction of the anterior chest wall. We describe for the first time the use of a 2-mm Gore-Tex Dualmesh plus biomaterial (W.L. Gore and Associates, Flagstaff, Ariz) and locking mandibular multiperforated titanium plates with screws (Stryker-Leibinger, Freiburg, Germany) for primary sternal reconstruction in a child. Despite having a wide resection, he did not require postoperative ventilation and had an uncomplicated recovery. The reconstructed chest wall has a normal contour with normal pulmonary physiology.     

Cystic Lymphangioma of the Gallbladder: Report of a Case

Abdominal lymphangioma is usually diagnosed within the first 2 years of life and is extremely rare in adults. The most common location of abdominal lymphangioma is the mesentery, but there are sporadic reports of its development in the gallbladder. A 66-year-old woman was found to have a cystic lesion near the gallbladder. Preoperative studies, including endoscopic ultrasonography, computed tomography, and magnetic resonance imaging, showed a tumor with multilocular cystic structure, originating in the gallbladder fossa. The patient underwent exploratory laparotomy, and the mass was resected en bloc with the gallbladder, as there was no evidence of malignancy on intraoperative ultrasonography. Macroscopically, the tumor was a multilocular cystic mass, 6 × 3 × 2 cm in size, with a rough, sponge-like appearance. Histologically, the cystic tumor was diagnosed as a lymphangioma, originating in the gallbladder. To our knowledge, only three other cases of a cystic lymphangioma originating in the gallbladder have been reported in the medical literature of the world.     

Large benign schwannoma of the greater omentum with synchronous cervical cancer: A case report

Introduction and importanceSchwannomas are uncommon tumors of the omentum with only 16 reported cases originating from the greater omentum in the literature. We report for the first time a synchronous presentation of an omental schwannoma and cervical cancer.Case presentationA 37-year-old female presented with an abdominal mass and heavy vaginal bleeding. An 11.5 × 14.6 × 16.6 cm complex omental mass and 5.4 × 6.2 × 4.4 cm lobulated heterogeneous cervical mass were noted on CT-scan. Wide excision of the complex mass and radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection was performed. The final biopsy revealed benign omental schwannoma and poorly differentiated cervical adenocarcinoma.Clinical discussionSchwannomas originating from the greater omentum are less common than in the lesser omentum due to the paucity of nervous tissue in the former. They can undergo malignant transformation and the most common presentation is abdominal pain/discomfort. Larger tumors may cause catastrophic bleeding. Prompt surgery should be offered and wide local excision with sufficient margins be performed when there is suspicion of malignancy. Schwannomas presenting with multiple or synchronous lesions are commonly associated with neurofibromatosis type 2, schwannomatosis, and Carney's complex. Whether this co-occurrence is simply incidental or has a causal relationship remains to be established.ConclusionBenign schwannoma of the greater omentum is rare and only requires complete tumor excision. However, surgeons should be aware that synchronous presentation of cervical cancer is possible and that thorough examination of both sites should be undertaken when either primary tumor presents.     

Giant cell tumor of the rib

We experienced a rare case of giant cell tumor (GCT) arising in the 5^th rib involving the 5^th vertebral body and transverse process. A 57-year-old man presented with a well-defined mass in the left thoracic cavity on chest x ray examination. Chest computed tomography showed a heterogeneous 7cm-diameter mass originating in the posterior segment of the left 5^th rib. The tumor had spread to the 5^th thoracic vertebra destroying the left half of the body and transverse process. Magnetic resonance imaging showed a heterogeneous-intensity mass involving the 4^th to 6^th ribs. A radical excision of the tumor followed by a 50 Gy radiotherapy was performed after embolization of the feeding arteries. The pathological diagnosis was a GCT. The patient remains well without evidence of recurrence for 6 years following surgery. The present case is only the 14^th case of GCT arising in the rib to have been reported in Japan.     

A case of angiomyolipoma of the renal sinus

The case of a 63-year-old woman with a relatively rapidly growing angiomyolipoma (AML) originating from the right renal sinus is presented. The tumor had enlarged to more than fivefold in volume (7.4 × 6.7 × 10.1 cm) in the 7 years following its detection (5.6 × 3.4 × 4.6 cm) and had significantly pushed aside the duodenum and the inferior vena cava. The tumor was surgically resected together with the right kidney, and pathological examination revealed AML originating from the renal sinus. An AML involving or originating from the renal sinus is exceedingly rare; only 14 cases have been reported. Rapidly growing AMLs of the renal sinus are difficult to differentiate from liposarcoma because of similar findings in imaging studies. It should be noted that AML of the renal sinus can be a differential diagnosis of retroperitoneal fatty mass. Furthermore, an enlarged AML in the renal sinus may push aside other organs, such as the ileum, pancreas, and major vessels. Clinicians should determine whether these patients should be placed under active surveillance or be treated with invasive measures, such as radical nephrectomy.     

Giant cell tumor of the rib

We experienced a rare case of giant cell tumor (GCT) arising in the 5^th rib involving the 5^th vertebral body and transverse process. A 57-year-old man presented with a well-defined mass in the left thoracic cavity on chest x ray examination. Chest computed tomography showed a heterogeneous 7cm-diameter mass originating in the posterior segment of the left 5^th rib. The tumor had spread to the 5^th thoracic vertebra destroying the left half of the body and transverse process. Magnetic resonance imaging showed a heterogeneous-intensity mass involving the 4^th to 6^th ribs. A radical excision of the tumor followed by a 50 Gy radiotherapy was performed after embolization of the feeding arteries. The pathological diagnosis was a GCT. The patient remains well without evidence of recurrence for 6 years following surgery. The present case is only the 14^th case of GCT arising in the rib to have been reported in Japan.     

Flow‐through omental flap to free anterolateral thigh flap for complex chest wall reconstruction: Case report and review of the literature

Despite the options currently available for chest wall reconstruction, patients with complex composite defects may still pose a significant challenge for the reconstructive surgeon when only using conventional methods. In particular, prior radiotherapy and/or large en bloc resection may leave inadequate regional flaps and recipient vessels for free tissue transfer. Here, we describe a case in which we reconstruct a 14 cm × 18 cm complex chest wall defect, secondary to tumor resection and infected sternum debridement, with a pedicled flow‐through omental flap to a 14 cm × 22 cm free anterolateral thigh flap using the omental gastroepiploic vessels as recipient vessels. Reconstruction was successful with excellent flap viability, and no complications at recipient or donor sites. We review the literature on complex chest wall reconstruction and introduce this valuable option of utilizing a pedicled omental flap as a flow‐through flap to a free flap for patients without viable recipient vessels or local flaps. © 2015 Wiley Periodicals, Inc. Microsurgery 36:70–76, 2016.     

Intrathoracic ganglioneuroma in an elderly patient over 70 years of age

We herein present an exceedingly rare case of intrathoracic ganglioneuroma that was surgically resected in an elderly patient over 70 years of age. A 74-year-old woman was asymptomatic, but a computed tomography (CT) scan of the thorax indicated the presence of a posterior mediastinal mass paravertebrally. A thoracotomy was thus performed under a strongly suggested diagnosis of a neurogenic tumor because of the appearance and position of the mass on the chest CT and magnetic resonance imaging findings, and measuring 6.9 × 5.8 × 1.6 cm. Not only tumors originating from the nerve sheath, but also neurogenic tumors occurring in young patients such as ganglioneuroma, should be included in the different diagnosis of posterior mediastinal tumor occurring in elderly patients.     

An abdominal desmoid tumor involving the xyphoid and costal chondrium associated with pregnancy: Report of a case

We report herein the case of a 27-year-old woman found to have an abdominal desmoid tumor involving the xyphoid and costal chondrium associated with pregnancy. The patient was referred to our department on the third day after delivery for investigation of a fist-sized, firm tumor in the infrasternal angle, first noticed during the eighth month of gestation. Computed tomography and magnetic resonance imaging revealed a well-defined mass, 9×7.5 cm in size, invading the xyphoid. The tumor could be radically excised with the xyphoid, a lower part of sternum, and the chondrium of the bilateral sixth and seventh ribs, including 1.5 cm of free margin. The resected specimen measured 10×11.5×11.5 cm and weighed 395 g. Histological examination revealed the lesion to be a desmoid tumor consisting of spindle cells with small, elongated nuclei infiltrating dense collagenous fibers. The patient had an uneventful postoperative course and was discharged on the 11th postoperative day. There has been no evidence of recurrence in the 6 months since her operation. This case is of interest with regard to the possible contribution of sex hormones, especially estrogen, to desmoid tumor development.     

A large Guyon’s canal lipoma without neuropathy in a child

Lipomas originating from Guyon’s canal are uncommon tumors. There are rare reports of adult cases, often with nerve compression findings. However, so far, no report had described this tumor in the pediatric age group. This article presents an 8-year-old boy who presented with a 3-year history of slowly growing hypothenar mass. Exploration yielded a large lipoma (35×55×44 mm) originating from the proximal Guyon’s canal, which resides within the hypothenar musculature. The lesion was excised totally, and histological evaluation confirmed the diagnosis. The follow-up period was uneventful, and complete cure was attained. To the best of our knowledge, this is the first report of a lipoma deriving from the Guyon’s canal in a child. Despite its huge mass, no signs of nerve compression were detected. This inconsistency between children and adult patients may be due to anatomical and physiological differences of the Guyon’s canal and attending nerves and muscles. In children, the structures forming the canal may be more expandable to let such a bulk grow without neuropathy.