Gouty Tophi in Sinus Tarsi of Bilateral Feet Mimicking Synovial Sarcoma:A Case Report

Chronic gout is defined as accumulation of monosodium urate crystals in joints, cartilage, tendons, bursae, bone, and soft tissue. The foot is the most common location for acute gout flares, with the first metatarsophalangeal joint being the most frequent site of tophus formation. However, few studies have reported gouty tophus formation in the subtalar joint. Gout has been termed the “great mimicker” because of its tendency to mimic other pathologic conditions, such as pigmented villonodular synovitis and synovial sarcoma. Herein, we present a rare case of chronic tophaceous gout in the sinus tarsi in both feet in a 23-year-old healthy male, with extensive bony erosions mimicking pigmented villonodular synovitis and synovial sarcoma. We discuss the clinical presentation, distinguishing radiologic characteristics, surgical procedures, and outcome regarding this unique presentation.     

Synovial Osteochondromatosis of the Lisfranc Joint: A Case Report

Synovial osteochondromatosis arising in the foot is a rare condition. We report a 69-year-old woman with synovial osteochondromatosis of the Lisfranc joint. The patient presented with a 10-year history of left foot pain. Imaging studies showed multiple calcified masses around the Lisfranc joint. We performed a synovectomy and removal of the loose bodies in the dorsal, lateral, and plantar aspects of the Lisfranc joint by dislocating the bases of the fourth and fifth metatarsal bones. To our knowledge, this is only the second case report of synovial osteochondromatosis involving the Lisfranc joint.     

颈部巨大复发性滑膜肉瘤1例报告

1临床资料 患者，女．25岁．因左侧颈部肿块术后复发1年余入院，患者曾于1998年在外院行左颈部肿瘤局部切除，3年后复发在外院再次行左颈部肿瘤局部切除，均未做病理诊断。近1年来自觉颈部肿块生长迅速，疼痛，皮肤溃破出血．渐感呼吸和吞咽困难，2004年5月于外院穿刺活检结果为滑膜内瘤，6月7日转入我院。检查：体温37℃，     

Synovial Sarcoma: A Case Report

The case described, of a 40-year-old woman with a 26-year history of a chronic, non-specific knee disorder, is a rather typical example of synovial sarcoma, according to the information given by other authors over the past three to four decades. The diagnostic difficulties and failures are clearly illustrated. It must be emphasized that severe, obscure joint symptoms such as our patient presented over the many years before death should have led to a proper surgical exploration of the knee. Furthermore, it should be unnecessary to stress the importance of performing a histological examination whenever excising abnormal tissue.     

A Giant Thrombosed Aneurysm of the Petrous Carotid Artery Presenting with Cavernous Sinus Syndrome: Case Report

Aneurysms involving the petrous Carotid artery are rare and a review of the literature demonstrates that the mode of clinical presentation depends on the direction of expansion of the aneurysmal sac. The eighth nerve is the most commonly affected, followed by the fifth nerve, sixth nerve and seventh nerve, respectively. There has not been reported to date a lesion presenting with cavernous sinus syndrome. We present the case of a 46-year-old woman who complained of left facial pain and pan-ophthalmoplegia, and was shown to have a giant thrombosed aneurysm of the petrous carotid artery extending into the cavernous sinus. Because preoperative evaluation of the patient revealed good collateral flow, proximal balloon occlusion of the left internal carotid artery was performed. Neurological symptoms of the patient resolved 2 months after surgery except for the size of the left pupil. We conclude that an aneurysm of the petrous carotid artery should be included in the differential diagnosis of cases presenting with a cavernous sinus syndrome. Early diagnosis followed by definitive treatment is important for the alleviation of clinical symptoms associated with this lesion.     

Synovial Osteochondromatosis of the Hip: (Report of 8 Cases Including 2 in Brothers)

One hundred patients with idiopathic scoliosis treated conservatively were reviewed for a mean period of 10.6 years after the end of treatment. The majority of curves had increased; 70% between 16 and 20 years of age and 60% after age 20. The mean progression per year was 3° and 2° for single and double curves, respectively, in the first 4 years after the end of treatment and 1° and 0.5°, respectively, in adulthood. Curves above 40° increased significantly more than smaller curves. It is concluded that curves of more than 40°, especially thoracic single curves, should be treated operatively in adolescence. Conservative treatment of smaller curves should be continued towards 20 years of age, and the patients should be followed up during early adult life.     

Synovial Osteochondromatosis: Clinical Characteristics Unique to the Shoulder

BackgroundSynovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints.MethodsThe characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24–154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs.ResultsThe average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs. Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT.ConclusionsPain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.     

滑膜骨软骨瘤病与骨性关节炎影像学分析

目的探讨滑膜骨软骨瘤病与骨性关节炎的影像学改变特点。方法 16例滑膜骨软骨瘤病合并骨性关节炎患者（A组）,影像改变均得到病理证实,另16例为单纯性骨性关节炎患者（B组）,观察两组骨关节炎影像学改变特征,并比较两组患者患侧及对侧影像学改变程度。结果 A组患侧骨性关节炎影像学改变与对侧比较无明显差异（P〉0.05）,B组患侧影像学改变程度与对侧比较有显著性差异（P〈0.01）;组间比较,A、B两组患侧比较无显著性差异（P〉0.05）,对侧关节炎程度相比具有统计学差异（P〈0.05）。结论滑膜骨软骨瘤病可导致骨性关节炎程度加重,并加速骨性关节炎进程。     

Giant Malignant Cystic Pheochromocytoma: A Case Report

Cystic malignant pheochromocytomas are uncommon. Differing from solid pheochromocytomas, which produce catecholamines and present adrenergic syndrome, cystic pheochromocytomas, may not produce these. Preoperative diagnosis may be difficult. Ct scan is useful for preoperative management. In this report, we describe a case of a giant malignant cystic pheochromocytoma in a young woman (17 years old) which presented as giant abdominal mass. The malignancy was confirmed by the presence of liver metastasis. Two years after curative resection, the patient is in good health with no recurrence.     

Giant Prostatic Hyperplasia: Case Report

The giant hyperplasia of the prostate is extremely rare pathology of prostate gland. Here, we report the successful removal of the 9th heaviest prostate ever reported in the literature.     

Synovial Sarcoma of the Mediastinum: Report of a Case

We report a case of synovial sarcoma of the mediastinum, a very rare tumor, in a 50-year-old man hos-pitalized with anterior chest pain. Chest X-ray and computed tomography (CT) on admission showed a 10 × 8-cm mass in the right anterior mediastinal space, compressing the superior vena cava. A diagnosis of sarcoma was established by a CT-guided percutaneous needle biopsy. Systemic examination revealed no metastasis to the contralateral pleural cavity or other distant organs, and we resected the mediastinal sarcoma. Pathological and immunohistochemical analyses confirmed a diagnosis of monophasic synovial sarcoma. The patient is alive with recurrence 9 months after his operation, and is receiving chemotherapy with ifosfamide.     

Synovial Sarcoma of the Digits: A Case Report of an Unplanned Excision

Synovial sarcoma is a rare occurrence in the lower extremity, although the presenting symptoms can mimic those of other more common and benign musculoskeletal pathologies. We present the case of a patient who was originally thought to have a Morton's neuroma or ganglionic cyst. The correct diagnosis, synovial sarcoma, was determined only after an unplanned excision. Despite the patient presenting with symptoms similar to those of a compressive neuropathy, a high index of suspicion should be present when a patient presents with any soft tissue mass, especially if it has an unusual clinical appearance to avoid an unplanned excision.     

A Giant Adrenal Pseudocyst: Case Report and Review of the Literature

A 45-year-old woman whose MR images revealed a lobulated, complicated cyst with septations on the superior pole of left kidney underwent retroperitoneoscopic cyst marsupialization. In pathologic examination beneath the atrophic adrenal gland, hyalinized, calcification foci cyst wall without any surrounding epithelium was seen microscopically. It was reported to be “adrenal pseudocyst”.     

Maxillary Sinus Myxofibrosarcoma Mimicking Nodular Fasciitis: A Rare Case Report

Myxofibrosarcoma (MFS) is a fibroblastic soft tissue sarcoma that is extremely rare in the maxillofacial region. Due to its non-specific clinicoradiographic findings and challenging histopathological features, the diagnosis is difficult. Here, we present a case of MFS which was first diagnosed as nodular fasciitis. The initial examination of the incisional biopsy showed a benign-appearing proliferation of fibroblasts without features of malignancy. The patient returned with recurrence four months after surgical excision of the primary lesion. The second histologic study revealed a high-grade spindle cell sarcoma with myxoid features most compatible with MFS. Definitive diagnosis of MFS was confirmed by these histopathologic features and supportive immunohistochemical stains. Unfortunately, the patient died of disease 3 months later.     

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.