Amyloidoma of the neck: Case report and review of the literature

We present a case report of reactive amyloidoma of the neck in a patient with chronic calcaneal osteomyelitis. Localized deposits of amyloid may occur throughout the upper aerodi-gestive tract, but are rarely observed in the soft tissues of the neck. This is the first report in the literature of localized head and neck amyloidosis secondary to a chronic inflammatory or infectious process. A clinicopathologic review of amyloidosis is presented with particular attention to its head and neck manifestations. © 1994 John Wiley & Sons, Inc.     

Primary amyloidoma of the thoracic spine

Focal amyloidosis (amyloidoma) involving the vertebral spine without an underlying systemic disorder is rare. Only six cases been reported in the literature so far, one involving the cervical spine, the rest occurring in the thoracic region. We present a patient with amyloidoma involving the thoracic spine and describe the magnetic resonance imaging features of this condition.     

Amyloidoma of the chest wall: a rare entity

Amyloidoma (tumoral amyloidosis) is defined as a solitary localized tumor-like deposit of amyloid, in the absence of systemic amyloidosis. Amyloidoma is the least common presentation of tissue amyloid deposition, reported in many anatomic sites including the respiratory, genitourinary and gastrointestinal tracts, as well as the central nervous system, skin, breast and soft tissue. Amyloidoma of the chest wall is extremely rare, and to date only one case has been reported in literature. The authors present a case of a chest wall tumor that causes local destruction, being an amyloidoma on histopathologic examination. It was treated with wide local excision, with no recurrence during almost two years of follow-up. A search for occult systemic disease is recommended and was also performed.     

Primary amyloidoma of the axis and acute spinal cord compression: a case report

Background Localized primary amyloidosis is a disease characterized by a single tumor and localized amyloid deposit (amyloidoma) with no evidence of generalized amyloidosis. The occurrence of an amyloidoma in the spine is rare and only three cases affecting the axis have been previously reported. We describe the case of a 79-year-old woman presenting with a mass involving the odontoid process, responsible for an acute tetraparesia. Diagnosis of local primary amyloidosis was made after surgical excision.Results Despite the critical presentation, outcome was excellent after total excision of the mass. This case can be classified as a primary localized amyloidoma. The patient did not exhibit any infection, tumor or inflammatory disease, and continued investigations failed to demonstrate other amyloid deposit after one-year follow-up.Conclusions Amyloidoma must be discussed in presence of a tumor-like mass of the odontoid process and may be responsible, as in our case, for spinal cord compression.     

Primary amyloidoma of the thoracic spine presenting with acute paraplegia

BACKGROUND

Primary solitary amyloidoma of the spine is a rare disease characterized by localized deposition of amyloid. To the best of our knowledge, there have been only 14 cases previously reported in the literature. Patients with focal spinal amyloidoma usually have relatively long symptomatic periods preoperatively, ranging from 3 weeks to 6 years (mean: 12 months). Only two reported patients had acute paraplegia. We add a third case of a thoracic spine amyloidoma presenting with acute paraplegia.

CASE DESCRIPTION

A 65-year-old man presented with a three-day history of progressive paraplegia and urinary retention. He was found to have severe cord compression at T2 on magnetic resonance imaging. He underwent emergent decompressive laminectomy with instrumentation for spinal stabilization. Histopathology revealed abundant amyloid deposits. A systemic work-up was negative for amyloidosis. The patient showed marked neurological improvement with residual mild spastic gait after 1 year.

CONCLUSIONS

Primary spinal amyloidoma with acute paraplegia is rare. One-stage surgery combining prompt decompression and stabilization of the spinal column is mandatory in cases of spinal amyloidoma with acute myelopathy, because primary solitary amyloidoma carries a good prognosis.     

Transdiaphragmatic amyloidoma

The term "amyloidoma" has been used to describe localized pulmonary nodular amyloidosis when it is a solitary lesion. Amyloidoma is an uncommon and infrequently reported cause of benign pulmonary lesions. We report the case of a 45-year-old man with hemoptysis, eosinophilia, and a large mass involving both lobes of the left lung, the chest wall, and, via extension through the diaphragm, the liver. Clinical suspicion of echinococcal cyst led to treatment via en bloc excision rather than attempting tissue biopsy for diagnosis. Complete resection of the isolated pulmonary amyloidoma was achieved with no evidence of recurrence.     

Salmonella ileocecal lymphadenitis masquerading as appendicitis

Salmonella infection requiring surgical intervention is rare. A case of localized ileocecal lymphadenitis due to Salmonella newport is reported. A review of the literature demonstrates that this is one of a spectrum of conditions of tissue infection by Salmonella in the ileocecal region. The outlook is good, and no untoward effects have arisen from surgery so that awareness of this condition should not alter the operative approach to a patient with a clinical diagnosis of acute appendicitis.     

Pleomorphic hyalinizing angiectatic tumour of the mesorectal soft tissue. A case report and review of the literatre

Pleomorphic hyalinizing angiectatic tumours are rare stromal lesions histologically resembling both neurilemoma and malignant fibrous histiocytoma and occurring in the subcutaneous soft tissue of the lower and upper limbs and, less frequently, in the chest wall. The case reported here is one of 22 cases published in the medical literature and describes a pleomorphic hyalinizing angiectatic tumour which was localized in a body cavity and developed in the pelvis. The present report is the first of its kind to date. A 53-year-old asymptomatic woman was treated via an open laparotomy. The lesion arising from the left mesorectal tissue was entirely resected. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The patient is still disease-free 58 months after the operation. A review of the literature shows that pleomorphic hyalinizing angiectatic tumours are locally aggressive. A 20% recurrence rate has also been observed in long-term follow-up. These patients should therefore be treated by wide local excision and require long-term surveillance.     

Multiple myeloma-associated solitary epidural amyloidoma of C2-C3 without bony connection or myelopathy: case report and review of the literature

BACKGROUND: A large solitary amyloidoma in the cervical epidural space without bony connection and with minimal spinal cord compression and no myelopathy, as a first manifestation of disseminated amyloidosis in a multiple myeloma patient, has not been reported previously; this case is thereby distinct from the seven prior reports in the world literature, of a solitary amyloidoma of the cervical spine. CASE DESCRIPTION: A 72-year-old male, recently diagnosed with multiple myeloma, presented with a neuropathy that prompted a screening MRI of the cervical spine. This disclosed a large mass in the upper cervical epidural area felt to pose a high morbidity/mortality risk, leading to successful surgical removal of the amyloidoma mass. This then led to further testing that showed previously unsuspected widespread amyloidosis, which was subclinical up to that time. CONCLUSIONS: In patients with a newly discovered amyloidoma, whether or not in the setting of known multiple myeloma, further evaluation should be done to detect the presence of amyloidosis. If the mass is discovered de novo, then an investigation should be carried out to determine if multiple myeloma, as well as amyloidosis, is present.     

Extraskeletal osteosarcoma of the forearm: a case report

Extraskeletal osteosarcoma is a rare soft tissue tumor. We report an exceptional case located in the forearm. A 62-year-old woman consulted for a tumor of the right forearm which she had noticed for six months. Physical examination revealed a 10 x 12 cm tumor with an ulcerated center. MRI demonstrated a heterogeneous mass exhibiting no connection with the bone or subjacent periosteum. Wide surgical resection was performed. The pathology study of the operative specimen confirmed the diagnosis of soft tissue osteosarcoma. The patient was given postoperative chemotherapy and was free of local recurrence or metastasis eighteen months after surgery. We discuss the present case and review data reported in the literature.     

Primary amyloidoma of the thoracic spine

Amyloidoma is a nodular mass of amyloid with no evidence of generalized amyloidosis. Primary amyloidoma of the spine is very rare and has a predilection for the thoracic region. The tumor-like appearance and behavior make it difficult to diagnose on imaging studies. Despite its rarity and nonspecific radiologic findings, primary spinal amyloidoma should be included in the differential diagnosis of an osteolytic and calcified mass of the spine. We report the case of a 38-year-old woman with amyloidoma involving the thoracic spine and describe the main characteristics of this condition.     

Primary amyloidoma in epidural and paravertebral space of the lumbar spine

Background context

Localized amyloid deposits result in a mass, that is, so-called amyloidoma; it has been reported in every anatomic site, although systemic amyloid deposition is much more common. However, primary lumbar epidural amyloidoma without bony involvement is extremely rare. To the best of our knowledge, only one case has been reported previously.

Purpose

To report and review the clinical presentations, imaging studies, and treatment of epidural and paravertebral amyloidoma.

Study design

A case report and review of the literature.

Methods

Lumbar epidural and paravertebral amyloidoma in a 75-year-old man with neurologic compromise is presented. Laminectomy with mass resection was performed.

Results

After surgery, almost complete neurologic improvement was observed. Histologically, definite diagnosis was obtained only after the specific staining of tissue. No sign of local recurrence was evident 1 year after surgery.

Conclusions

Primary amyloidoma, although rare, should be included in the differential diagnosis of epidural mass of the spine. Diagnosis before surgery is difficult as there were no characteristic findings in clinical and imaging studies. Special histologic technique and stains are useful to make a definite diagnosis.     

Soft-tissue chondroma of the forefoot mimicking sesamoiditis

First-ray metatarsalgia is commonly attributed to pathologies of the 1st metatarso-phalangeal joint or the sesamoids. A case of a 50-year-old male patient with 1st ray metatarsalgia caused by a rare benign tumour is presented – a soft tissue chondroma located in the subcutaneous tissue plantar to the head of the 1st metatarsus. The tumour was removed with no evidence of recurrence and the patient is symptom-free ever since. A review of the literature regarding this unusual type of tumour is further presented and discussed.     

Primary cervical amyloidoma: a case report and review of the literature

Background context

Primary solitary amyloidosis or amyloidoma is a disease process characterized by the focal deposition of amyloid in the absence of a plasma cell dyscrasia with normal serum protein measurements. Solitary amyloidomas affecting the vertebrae are very uncommon but typically affect the thoracic spine. Primary cervical amyloidosis is an exceedingly rare entity with exceptionally good prognosis, but requires diligence of the treating physician to establish the diagnosis and implement the appropriate surgical intervention.

Purpose

This study aimed to present a rare case of primary cervical amyloidosis with long-term follow-up and review the clinical presentation, characteristic imaging findings, diagnostic pathology, differential diagnosis, treatment algorithm, and prognosis of the disease entity. This case demonstrates the progressive resorption of the amyloidoma over time after surgical stabilization. Previous reported cases of primary cervical amyloidosis will also be reviewed.

Study design

This study is a report and review of the literature.

Methods

A 77-year-old woman presented with a several-week history of gradual progressive weakness in her upper and lower extremities. Computed tomography and magnetic resonance imaging demonstrated a retro-odontoid nonenhancing soft-tissue mass, with erosive bony changes and severe mass effect on the upper cervical cord. The patient was taken to the operating room for decompression and posterior spinal stabilization.

Results

Intraoperative tissue specimens demonstrated amyloidosis and extensive systemic workup did not reveal any inflammatory processes, systemic amyloidosis, or plasma cell dyscrasia. Postoperatively, the patient regained full strength and ambulatory status. The patient remains asymptomatic at a 2-year follow-up. A postoperative follow-up magnetic resonance imaging demonstrated complete resorption of the residual amyloidoma.

Conclusions

Primary solitary amyloidosis is a rare form of amyloidosis that is important to differentiate given its excellent prognosis with surgical management. Treatment should include surgical decompression and spinal stabilization. This is the first case report to clinically and radiographically demonstrate the progressive resorption of a primary amyloidoma over time after surgical stabilization in the upper cervical spine. It is imperative that surgeons encountering such lesions maintain a high suspicion for this rare disease entity and advise their pathologists accordingly to establish the correct diagnosis.     

Soft tissue echinococcosis: a report of two cases and review of the literature

Echinococcosis (hydatid cyst disease) is a zoonotic infection caused by the parasitic tapeworm Echinococcus. The larval stage of this parasite can implant in many organs of the body, most commonly the liver, and create internal budding cystic masses. Echinococcal cysts also can implant in soft tissues; however, a review of the literature revealed no published case with the patient initially presenting with a soft tissue mass. Two such cases are reported in the current study. Physicians who evaluate soft tissue masses, particularly in patients from Echinococcus-endemic areas, need to include echinococcosis in their differential diagnoses. The current treatment of choice for soft tissue echinococcosis is wide resection combined with perioperative medical therapy.     

Masked urinary bladder injury with a bullet expulsed spontaneously during voiding

We report a case with gunshot to the pelvis. The injury site was the soft tissue between the rectum and urinary bladder. Several days later, the bullet was expulsed spontaneously during voiding. In the literature, only a few case reports have described spontaneous expulsion of an intravesical bullet. A 19-year-old male was wounded on the left hip by gunshot. Radiographic examinations showed a bullet in the pelvis, which was localized in the soft tissue between the rectum and urinary bladder, with no accompanying visceral injury on abdominopelvic computerized tomography. Macroscopic hematuria was noticed after urethral catheterization. Rectosigmoidoscopy and retrograde cystoscopic examinations were both negative. The patient was monitored closely and treated conservatively with no surgical intervention. The urinary catheter was removed on the fifth postoperative day, and the bullet was expulsed spontaneously via the urethra during normal voiding three hours after catheter removal. Thereafter, a retrograde urethrography was performed, which showed no evidence of urinary tract or bladder injury.     

Scoliosis in Gordon's syndrome

Gordon's Syndrome is described as an autosomal dominant condition with the characteristics of short stature, a stiff spine, camptodactyly (89%), cleft palate (27%) and club feet (73%). The authors present a case report of a patient with this rare entity complicated by an unusual complex spinal deformity. There are no prior reports in the literature concerning operative or nonoperative management of deformity in this patient population. Scoliosis in Gordon's Syndrome shares the characteristics of an arthrogrypotic neuromuscular curve and demands extensive soft tissue release for optimal correction.     

Banking a fillet flap to aid in reconstruction following a hindquarter amputation

A hindquarter amputation and hemipelvectomy for recurrent malignancy presents a reconstructive challenge to the plastic surgeon. Tumour resection leaves a considerable defect, with exposure of bone, neurovascular structures, pelvic and abdominal organs. A free lower leg fillet flap is a recognised method of providing soft tissue coverage, but ischaemic time is often lengthy as described in the literature. We present a unique method of providing soft tissue coverage using a free lower leg fillet flap, and minimising ischaemic time by banking the flap on the ulnar artery during the hindquarter amputation and tumour resection.Level of Evidence: Level V, therapeutic study.