Uncommon causes of nerve compression in the distal forearm

IntroductionNerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition. They may compress underlying structures in the carpal tunnel region, causing pain and paresthesias, which leads to the wrong diagnosis of carpal tunnel syndrome.Clinical casesWe present three cases of patients with symptomatology and clinical tests compatible with compression of the median nerve in the carpal tunnel but whose physical examination showed a soft mass in the distal region of the forearm which was compressing the median nerve, as demonstrated by ultrasound evaluation.DiscussionThe reported cases of accessory muscles or lipomas described in the literature as causes of median nerve compression clinic are mainly described only after the surgical decompression of the carpal tunnel, due to the maintenance of residual symptoms.ConclusionCareful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment.     

髓/囊比值对儿童复杂脊髓脂肪瘤手术后再拴系的影响

目的探讨髓/囊比值对儿童复杂脊髓脂肪瘤手术后远期再拴系的影响。方法回顾性分析2009年1月至2014年6月深圳市儿童医院神经外科采用手术治疗的复杂脊髓脂肪瘤患儿的临床资料,共56例。采用神经电生理监测下显微手术切除脂肪瘤+重塑神经基板+硬膜囊成型的方法。术后应用MRI评估髓/囊比值,分析髓/囊比值对术后远期脊髓再拴系的影响。结果56例患儿均顺利完成手术。术后MRI显示髓/囊比值<30%者10例,30%~50%者31例,>50%者15例。患儿均未发生术后严重并发症。术后中位随访时间为8.9年(5.0~10.5年),失访4例。6例(11.5%,6/52)发生脊髓再拴系需要再次行手术治疗(再拴系组),其中术后髓/囊比值为30%~50%者2例,>50%者4例。无再拴系组的46例患儿髓/囊比值<30%10例,30%~50%27例,>50%9例。两组髓/囊比值差异有统计学意义(P=0.039)。结论髓/囊比值是影响儿童复杂脊髓脂肪瘤术后再拴系的重要因素,髓/囊比值越小,再拴系的概率越小。     

Lipoma of the Floor of the Mouth: Report of an Unusually Large Lesion

Lipomas are among the most common benign tumors affecting the human body. However, they are relatively uncommon in the oral cavity. Oral lipomas are likely to affect cheek, tongue, lips, gingiva and rarely the floor of the mouth. We report a case of huge lipoma of the floor of the mouth, associated with difficulty in speech and mastication in a 72-year-old male. The tumor was completely excised and sent for histopathological examination, which confirmed the tumor to be a simple classical lipoma.     

脂肪瘤与脂肪肉瘤的影像学诊断(附十例分析)

笔者分析了脂肪瘤(7例)和脂肪肉瘤(3例)的平片及CT表现。脂肪瘤肿块平片和CT显示低密度,内见条状纤维分隔,钙化或骨化征。脂肪肉瘤肿块密度不均匀和溶骨性骨质破坏。并讨论了影像学征象的病理学基础。     

Colo-colonic intusussception secondary to a lipoma

We present a case of subacute obstruction in a 49 years old lady due to colo-colonic intussusception secondary to a lipoma. We describe the difficulties in diagnosis and management of this rare cause of bowel obstruction and review the literature on adult intussusceptions.     

单发脉络丛脂肪瘤1例

患者女,76岁.头痛5天,右眼肿4天.心肺腹查体未见异常.神经系统:神志尚清,定向力、记忆力均正常.颅神经正常,双下肢肌力正常.头颅MR:平扫双侧基底节区及额叶脑白质内见多发片状长T1,长T2信号,FLAIR像为高信号,病变边界清楚.右侧脑室后角脉络丛内见小圆形短T1,长T2信号影,约0.6 cm×0.6 cm,信号均匀,边界清晰(图1A、B).T1和T2抑脂序列病变均示病变信号明显减低(图1C、D).MR诊断:双侧基底节区及额叶多发腔隙性脑梗死,右侧脑室脉络丛脂肪瘤.     

超声吸引装置在脂肪瘤型脊髓拴系综合征中的应用研究

目的探讨超声吸引装置(Cavitron ultrasonic surgical aspirator,CUSA)在脂肪瘤型脊髓拴系综合征中的应用价值。方法收集2016年5月至2018年11月于湖南省儿童医院神经外科收治的62例脂肪瘤型脊髓拴系综合征患儿作为研究对象,按是否采用CUSA技术分为常规组(n=47)和CUSA组(n=15),对比两组患儿手术时间、术后并发症及预后情况。结果 CUSA组手术时间为(120±43)min,常规组为(220±40)min,差异有统计学意义(t=8.281,P<0.05)。CUSA组并发症发生率为0 (0/15),常规组并发症发生率为12.7%(6/47),差异无统计学意义(X^2=2.12,P=0.321)。常规组中症状加重4例,分别为大小便功能障碍和双下肢畸形,改善10例,稳定33例。CUSA组无一例症状加重;需间歇导尿1例,3个月随访时排尿功能恢复;改善4例;稳定11例。结论通过采用显微外科技术,术中使用CUSA切除脂肪瘤组织等综合措施,可缩短手术时间,减少脂肪瘤型脊髓拴系患儿术后并发症。     

Giant intramuscular thigh lipoma: A case report and review of literature

IntroductionLipomas are the most common soft tissue tumor. Giant lipomas are defined by measuring at least 10 cm in diameter in one dimension or by a minimum of 1000 g. They often are asymptomatic; however, they can cause compression syndromes due to nerve damage and difficulties in walking.Presentation of caseWe described the case of a 25-year-old female with no significant medical history who began her condition two years before her consultation. The patient referred to the appearance of a non-painful mass on her right thigh with progressive growth that hinders daily activities. A simple CT scan reported a 10.3 × 8.1 × 19.6 cm adipose mass with infiltration towards the semitendinosus muscle and the biceps femoris muscle. A free margin resection of the tumor was performed, and the involved muscles were preserved. The patient had a satisfactory postoperative outcome.DiscussionLipomas are common benign soft tissue tumors that arise from fatty tissue and may challenge surgical management due to their extension and dimensions; they often require delicate surgical intervention due to their potential risk of malignant transformation. We believe surgical pathologists and radiologists must draw attention to muscle involvement and the infiltrative pattern.ConclusionGiant lipomas should always raise awareness of malignant transformation. Radiological guidance should provide enough evidence to decide whether to do a biopsy or not; hence, saving the patient an extra invasive procedure. We recommend taking at least 1 cm of border margin while removing these tumors to avoid local recurrence.     

Axillary Giant Lipoma: a Case Report

Lipoma are the most frequent mesenchymal soft tissue tumours but rarely present huge sizes in their cutaneous localization. Some cases of so-called “giant lipomas” have been reported in the literature and here is presented a giant lipoma of the axillary area which is, to our best knowledge, the second report of such a giant lipoma in this localization.