Primary osteosarcoma of the talus

Osteosarcoma OS of the talus is extremely rare, and few cases have been reported in the literature. We present a case of a 33-year-old male with painful swelling of his left ankle joint. He underwent several radiological diagnostic modalities that showed osteolytic lesion in the posterior aspect of the left talus associated with new bone formation projecting from the posterior-medial aspect of that bone. His chest x-ray showed multiple rounded lung metastases, some of them showed calcifications. Open biopsy was performed. The histopathology confirmed the diagnosis of osteoblastic OS of the talus.     

Intraosseous ganglion of the talus treated with the talonavicular joint approach without exposing the ankle joint

Intraosseous ganglion, which is generally seen in metaphyseal-epiphyseal regions of long bones, is not a rare disorder. It is extremely rare in the talus, however. Differential diagnosis of a cystic talar lesion should include enchondroma, chondroblastoma, giant cell tumor, and unicameral bone cyst. This article presents a case of intraosseous ganglion of the talus in a 38-year-old woman treated with a new surgical approach and technique. The patient had mild ankle pain at the arc of motion in her right ankle that increased with activity. Radiographs and magnetic resonance images showed a cystic lesion in the medial side of the talar dome. It was treated by curettage and autocorticocancellous bone grafting through an opening in the talonavicular joint without disturbing the intact talar dome cartilage. One month after the operation, the patient had an excellent clinical outcome. This approach and technique can be used to treat other lesions of the talus that do not involve the joint space.     

重复癌一例报告

<正> 重复癌(RC),亦称多发性原发癌(MPC)或多原发恶性肿瘤(MPM),系指同一患者一个或多个器官、系统,同时或相继发生两个以上原发癌瘤而言。在肿瘤患者中其发病率不仅高达13.1％,而且近来有上升趋势。作者1985年曾报道过“扁桃体癌自愈一例”,文中曾提及肿瘤的     

Tumour seeding following percutaneous needle biopsy of hepatocellular carcinoma

We report a hepatocellular carcinoma seeding following needle biopsy in a 57-year-old man who first presented with a focal hepatic lesion at another hospital. The patient had been a hepatitis B carrier for 20 years. Initial surveillance ultrasonography showed a lesion in segment IV, in the background of non-cirrhotic liver and normal serum alpha-foetoprotein level (8 ng/ml). A percutaneous needle biopsy was done and histopathology confirmed well-differentiated hepatocellular carcinoma. The patient had refused surgery and preferred to try traditional medicine. He presented to us four months after the initial biopsy with epigastric swelling. This was found to be due to a tumour seeding along the previous biopsy tract. He was given radiofrequency ablation (RFA) of tumour along the needle tract, in addition to the primary tumour. We conclude that the need for percutaneous needle biopsy should be critically evaluated in patients presenting with focal hepatic lesions and the role of RFA in treating tumour seeding needs further evaluation.     

Metastatic endobronchial hypernephroma nine-and-a-half years after nephrectomy.

A patient with an endobronchial nodular lesion, proved to be clear cell carcinoma (hypernephroma) by fibrebronchoscopic biopsy, is described in which the primary tumour had been resected 9 1/2 years before the onset of the present illness. At post-mortem the remaining kidney was found to be normal.     

Mucosal malignant melanoma of the maxillary sinus

Mucosal malignant melanoma (MMM) is an aggressive tumour occurring in the upper respiratory tract. It is rare compared to malignant melanoma of the skin. We report a case of a 53-year-old man with left paranasal swelling. A biopsy showed high-grade spindle cell tumour. Subsequently a subtotal maxillectomy was performed. Histopathological examination revealed a hypercellular tumour composed of mixed spindle and epitheloid cells with very occasional intracytoplasmic melanin pigment. The malignant cells were immunopositive for vimentin, S-100 protein and HMB-45. It was diagnosed as mucosal malignant melanoma (MMM). This article illustrates a rare case of MMM where the diagnosis may be missed or delayed without proper histopathological examination that include meticulous search for melanin pigment and appropriate immunohistochemical stains to confirm the diagnosis. Malignant melanoma can mimic many other types of high-grade malignancy and should be considered as a differential diagnosis in many of these instances.     

Severe hypercalcaemia in B-cell lymphoma: combined effects of PTH-rP, IL-6 and TNF

Hypercalcaemia as the only manifestation of B-cell lymphoma is seen very rarely. Its pathophysiology is heterogenous and not well understood. We report a 73-year-old man who presented with severe hypercalcaemia before any signs of malignancy became evident. He was diagnosed with a B-cell lymphoma on bone marrow trephine biopsy. The hypercalcaemia was associated with high plasma concentrations of parathyroid-hormone-related protein, interleukin-6 and tumour necrosis factor. Our patient had markedly increased osteoclast and osteoblast activity as a result of synergistic effects between these factors, with consequent severe hypercalcaemia. This is the first reported example of such combined effects of these factors in humans.     

前列腺基底细胞癌一例报告并文献复习

目的探讨前列腺基底细胞癌的临床特点及其诊治方法。方法分析1例前列腺基底细胞癌患者的临床资料,并结合文献对前列腺基底细胞癌的临床病理特征、诊断治疗及预后进行分析。结果肿瘤位于前列腺左侧叶,切面实性,灰白色。组织学检查：癌细胞排列成实性团块状或筛网状,瘤细胞体积较小,细胞核大并呈卵圆形,大小一致,胞浆少,可见核分裂象。肿瘤呈浸润性生长,肿瘤边缘部分见前列腺基底细胞增生,病理诊断为前列腺基底细胞癌。肿瘤组织中前列腺基底细胞特异抗体（34E12）、p53和p63基因阳性表达,PAP、PSA和S100蛋白阴性表达。术后患者恢复良好,无尿失禁及血尿。随访27个月未见肿瘤复发及转移。结论前列腺基底细胞癌是一种罕见的前列腺恶性肿瘤,虽然具有惰性生物学行为,但常与前列腺腺癌伴发,且肿瘤有侵袭和转移的潜能,根治性前列腺切除术应作为治疗的第一选择。     

Primary merkel cell carcinoma clinically presenting as deep oedematous mass of the groin

Merkel cell carcinoma (MCC) is a relatively rare, polyomavirus associated, primary neuroendocrine carcinoma of the skin which is usually arising from dermal skin layers. However, the origin of MCC in the subcutaneous tissue is debatable. We report a 58-yearold female patient with an oedematous mass on her left groin that was firm in consistency and had no discoloration or other visible abnormality of the overlying skin. On histology and immunohistology the tumour was consistent with the diagnosis of MCC showing a predominant subcutanous growth pattern. Pelvic magnetic resonance tomography revealed a tumour conglomerate reaching from the subcutis of the left groin to the left paraaortal and parailiacal region indicating widespread lymphogenic metastisation. Despite complete medical work-up no other MCC primary could be detected. In conclusion, predominant subcutaneous growth pattern as well as tumour localization in the groin are uncommon features of MCC. MCC showing the aforementioned features may be associated with significant delay of diagnosis and therefore represents an unfavourable prognostic factor.     

图像法DNA分析在骨肿瘤穿刺活检的应用

应用图像分析仪测定35例骨肿瘤穿刺组织的肿瘤细胞核DNA含量。结果表明恶性骨肿瘤DNA含量高于良性,良恶性之间差异非常显著。骨巨细胞瘤DNA指数广泛分布在良恶性之间,显示出“中间性肿瘤”的特征。骨巨细胞瘤复发组含量显著高于无复发组,提示DNA含量与肿瘤生物学行为有密切关系。术前穿刺DNA含量分析,有助于对肿瘤增殖能力的了解,作为术式选择,良、恶性肿瘤的鉴别和预后估计的参考。穿刺DNA图像分析法的开展是可行的,具有一定的临床价值。     

Sarcoidois and pulmonary hypertension--a case report

We report a case of severe pulmonary hypertension associated with sarcoidosis with a unique histopathological presentation. This 43-year old obese patient first presented eight years ago with complaint of dyspnea on exertion for four years and was diagnosed as primary pulmonary hypertension. Six years later, a skin biopsy performed on her left cheek to rule out squamous cell carcinoma revealed sarcoidosis. The patient was then put on steroid therapy and subsequently, the oxygen saturation improved transiently, although the mean pulmonary arterial pressure did not show improvement. The patient was then started on prostacyclin infusion and was hemodynamically stable, but the pulmonary artery pressures worsened. The patient died from complications subsequent to a diagnostic procedure. An autopsy limited to the lungs was performed and routinely prepared hematoxylin and eosin stained sections were examined. Immunohistochemical stains for CD31, factor VIII-related antigen and muscle-specific actin were performed on selected sections. The diagnosis of sarcoidosis was confirmed. However, pulmonary fibrosis was not seen. The granulomas surrounded medium- and small-sized pulmonary arteries, but did not destroy the vessel wall. Plexiform lesions indicating severe pulmonary hypertension were identified in pulmonary arteries, which were not involved by granulomas.     

Solitary neurilemmoma in postaural region

Neurilemmoma in postaural region arising from great auricular nerve is an extremely rare tumour. An 11 years boy presented with pain and swelling behind his left ear for last 3-4 years. The clinical examination revealed the swelling appeared to be diffuse with the margin being ill defined. On radiological examination a diffuse homogeneous mass was seen in the postaural region of the left side. The tumour was completely removed by an incision through postaural route. Histopathological study revealed neurilemmoma. Postoperative period was uneventful.     

Malignant rhabdoid tumour of the brain

Rhabdoid tumour is a rare childhood tumour with poor prognosis. We report a 13-month-old Malay girl suffering from this tumour that was located at the left fronto-temporo-parietal region of the brain. Computed tomography showed a large irregular enhancing mass that caused obstructive hydrocephalus. The tumour did not reduce in size after three operations and finally the patient succumbed to the disease four months after diagnosis.     

An unusual case of recurrent left atrial myxoma.

In a patient who had a calcified left atrial myxoma resected, recurrence developed 31 months later. Although complete radical resection of the recurrent tumour presented a special problem, the patient survived the second operation. The tumour recurred again and the patient had two episodes of cerebral embolism 1 1/2 and 2 years later, respectively, and died 3 1/2 years after the second operation. The erythrocyte sedimentation rate correlated with the size of the tumor, and the recurrent tumour seemed to grow more rapidly than the primary tumour. Experience with this case and a review of the nine reported cases of recurrent left atrial myxoma suggest that a radical approach is necessary at the primary operation.     

肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤一例

肺黏膜相关淋巴组织型边缘区B细胞淋巴瘤(marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type,MALT-MZL)是一种较为罕见的肺部原发性恶性肿瘤.本例患者采用纤维支气管镜检查,经组织病理和免疫组化确诊,具有完整的病例资料,并结合国内相关资料进行文献分析,以探讨其临床、病理特点及诊断、治疗方法.患者主要表现为周期性发热、咳嗽、胸痛,用正规的抗生素治疗无效.胸部CT显示右肺中叶和左肺下叶实变,伴有支气管充气征和CT血管造影征,肺实变内可见扩张的支气管.左侧少量胸腔积液,是单核细胞为主的渗出液.血清蛋白电泳发现M蛋白.支气管镜下可见左肺下叶、右肺中叶支气管狭窄,用支气管镜进行透壁肺活检,病理为小淋巴细胞弥漫浸润,可见淋巴上皮病变;免疫组化CD20阳性,CD3,CD5,CD10,CD21,CD23,Bcl2和Bcl6阴性.肺MALT-MZL是肺原发性淋巴瘤中最常见的一种类型,大多数临床表现不典型,易误诊,及时行有创检查取得病理标本有助于早期诊断.某些临床表现(如周期性发热,肺实变及其内扩张的支气管, 血浆或支气管肺泡灌洗液中出现M蛋白等)具有一定的特征性.治疗方法主要为手术、放疗和化疗.肺MALT-MZL属于惰性淋巴瘤,预后相对良好.     

先天性马蹄内翻足矫形后距、舟骨畸形的病理及三维有限元分析

目的：探索先天性马蹄内翻足（CCF）经矫形后距、舟骨畸形的病理成因与生物力学基础。方法：在动物模型的基础上建立足内侧纵弓和外侧纵弓的三维模型，用有限元方法建立正常足与CCF内侧纵弓的生物力学模型。结果：距骨在胚胎阶段即出现发育不良，距骨、跟骨间重叠不良和跟骨内翻；正常足与异常足第2序列的应力主要集中于第2跖骨与足底腱膜。足弓结构异常、跖筋膜切断都将加剧应力集中程度、增加足弓背屈变形，应力传导导致舟骨、距骨变形。结论：CCF在胚胎发育期即有足的马蹄内翻且畸形程度随生长发育而逐步加重，距骨在胚胎阶段即出现发育不良。距、舟骨继发畸形与经矫形后应力集中、足弓背屈变形有关。     

Bladder leiomyoma: a case report

A case of bladder leiomyoma is reported. A female patient of 35 years old presented with lower abdominal pain, urinary symptoms and episodes of haematuria. USG and CT scan showed a large homogeneous globular mass arising from posterior wall of the urinary bladder occupying a considerable portion of its cavity. Cystoscopy and transurethral resection biopsy confirmed that protruding mass from the bladder wall was leiomyoma. Surgery is the definitive treatment for this rare bladder tumour. Here the tumour was managed successfully by transvesical enucleation.     

Primary ovarian lymphoma in a child

Ovarian tumour is rarely seen in paediatric age group and primary ovarian non-Hodgkin's lymphoma is very uncommon. A child presenting with acute abdomen was detected to have bilateral solid ovarian tumours. Because of torsion of the right ovarian tumour and complete replacement of the ovarian tissue by the tumour on left side, bilateral salpingo-oophorectomy was done. Bilateral primary ovarian lymphoma was diagnosed on histopathological examination. Immunohistochemistry was suggestive of B-cell lineage. She had eight cycles of chemotherapy and at 28 months follow-up doing well without any sign of any recurrence or any evidence of metastasis.     

Rectal carcinoma in a nine-year-old Nigerian male child: case report

Carcinoma of the colon and rectum are rare in children and under the age of 40 years. A case of coro-rectal carcinoma in a nine-year-old Nigerian male child is reported. Family history was significant in the patient, it revealed that his father died three years earlier because of chronic diarrhoea and mucoid stool with associated on and off constipation and one of his elder brothers died eight years ago of colonic cancer at the age of twenty years. Exploratory laparotomy was done for the patient which revealed fixed rectosigmoid tumour with metastases to the liver, omentum and small intestine and ascites was also found. Hartmann's procedure with sigmoid colostomy was performed and the tumour was resected. Histological report of the biopsy specimen was consistent with poorly differentiated adeno-carcinoma. To the best of our knowledge, the youngest patient recorded in the literature is seven years old, which is younger than our patient, but this is still the youngest in our records.     

Primary squamous cell carcinoma of the breast: a case report

Primary squamous cell carcinoma of the breast is a rare entity. We treated a 55-year old woman who came to us with bleeding from the left breast tumor. The tumor was 7 x 8 x 10 cm in size with ulceration and surgical biopsy results showed it to be squamous cell carcinoma of the breast, while metastatic work-up findings ruled out other sources of primary tumor. She also complained of nausea and vomiting, and brain CT disclosed cerebellar metastasis. The metastatic brain tumor was surgically removed, however, the symptoms became gradually exacerbated. The patient died 67 days after admission.