Hoffa's disease: A report on 5 cases

We report the case of five patients referred to our department with Hoffa's disease: three patients were at the initial stage of the disease and the two others had reached the chronic stage. This condition is one of the less well-documented causes of pain in the anterior compartment of the knee. The pathophysiological mechanism is still unclear. It is probably caused by repetitive micro trauma resulting in inflammatory, haemorrhagic and fibrous changes to Hoffa's fat pad. The final outcome of the disease is an osteochondroma. The diagnosis is established by MRI, which demonstrates inflammation of the fat pat. At the chronic stage, a standard X-ray is sufficient to demonstrate ossification of the fat pad.     

Tumor like swellings arising from Hoffa's fat pad: A report of three patients

We report three rare cases of tumor-like conditions arising from Hoffa''s fat pad (HFP). Patients were having persistent knee pain, the cause of which was not diagnosed by the general physician, and then were referred to us for knee pain. Magnetic resonance imaging revealed the lesions to be arising from HFP (ganglion cysts and hemangioma), as was suggested by clinical findings. Anatomy, pathology, and radiological features of the Hoffa''s disease are described here to increase awareness in orthopedic community of this rare but interesting disease which is often misdiagnosed as meniscal pathology. These cases illustrate that increased cognizance can facilitate timely intervention which will prevent morbidity of the patient.     

Glomus tumor of the fat pad

The authors report an exceptional glomus tumor location in Hoffa's ligament in a 65-year-old man. Based on this observation and a literature review, the authors provide the clinical and radiographic diagnostic appearances of this type of tumor. Surgical removal of the tumor achieved immediate disappearance of knee pain. Histological examination of the tumor has established the definitive diagnosis.Arthroscopy 1998 Apr;14(3):325-8     

Hoffa's fracture with ipsilateral fibular fracture in a 16-year-old girl:An approach to a rare injury

Hoffa''s fracture is an uncommon fracture of the femoral condyle with coronal orientation of the fracture line. The mechanism of injury in pediatric Hoffa''s fracture is road traffic accident, sports injury, and trivial injury. Clinical examination and proper imaging is important for diagnosis of pediatric Hoffa''s fracture because of high chances of missing these injuries which can lead to nonunion and malunion at the fracture site. Open reduction and anatomical reduction of intraarticular fragment is the gold standard treatment of these fractures. We present a rare case of Hoffa''s fracture in a 16-year-old girl with associated ipsilateral fibular fracture.     

Mucoid Degeneration of Both ACL and PCL

Unlike meniscal tears and chondral defects, the mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain and there have been no case reports of mucoid degeneration of both the ACL and the posterior cruciate ligament (PCL). A 48-year-old-male patient presented with knee pain and limitation of motion. The patient''s magnetic resonance imaging, arthroscopic findings, and pathologic diagnosis confirmed a clinical diagnosis of mucoid degeneration of both the ACL and the PCL. The symptoms disappeared after arthroscopic partial excision of the ACL and PCL.     

Popliteal glomangioma mimicking baker’s cyst in a 9-year-old child: an unusual location of a glomus tumor

Popliteal cysts (Baker’s cyst) are very common conditions in children. However, in the differential diagnosis of popliteal cysts in childhood, glomus tumor is the most infrequent diagnosis. This is a relatively uncommon soft tissue tumor that can occur at any age and any anatomic site, with a predilection for the subungual region. In the reported series, extradigital glomangiomas involving the knee are located in the patellar ligament, quadriceps tendon, patellar fat pad, and popliteal fossa. In this study, I present a second case of glomus tumor located in the popliteal fossa and misdiagnosed as a Baker’s cyst. I also review the “around-the-knee glomus tumors” that have been discussed in the literature to date.     

Tumeurs glomiques des extrémités de l’enfant,une cause rare de douleur chronique. À propos de deux cas cliniques

Glomus tumor (GT) of limb extremities (finger, toe) is a rare tumor, especially in children. It is formed by hyperplasia of the neuro-myoarterial elements. Chronic pain is often associated. The diagnosis is made by the history and several clinical tests (Hildreth's and Love's tests). This diagnosis must be suspected in a child with chronic extremity pain. Magnetic resonance imaging (MRI) is the most sensitive imaging test. Complete surgical excision of the lesion is curative. We report two clinical cases of glomus tumor of limb extremities (finger and toe) in two children – aged 7 and 12 – causing severe chronic pain; the diagnosis of this condition remains a challenge.     

Encapsulated pericardial fat necrosis treated by video-assisted thoracic surgery: Report of a case

A 55-year-old moderately obese man who was admitted to a local hospital following a traffic accident reported having experienced an episode of sharp and sudden pleuritic pain in the left anterior lower chest 2 days earlier. A computed tomographic scan on admission demonstrated a nonhomogeneous mass in the anterior left side of the chest, abutting the left cardiac margin, and a left-sided pleural effusion. As a mediastinal tumor was suspected, he was referred to our hospital for investigation and treatment. An exploratory thoracotomy was performed by video-assisted thoracic surgery (VATS) about 3 weeks later, which revealed a firm, yellowish mass on the oral side of the pericardial fat pad, adhering to the anterior chest wall. The mass was easily removed. The resected specimen consisted of a lobulated fragment of adipose tissue measuring 5.0 × 3.5 × 2.0 cm, and the final pathologic diagnosis was pericardial fat necrosis. The patient had an uneventful postoperative recovery and has remained free of symptoms for 10 months since his operation. Pericardial fat necrosis remains a rare clinical entity. Surgical excision by VATS achieves symptomatic cure and probably continues to be the treatment of choice because of the need to exclude a neoplasm in the differential diagnosis. Received: March 15, 1999 / Accepted: March 24, 2000     

Non-chromaffin paraganglioma of the orbit. Case report

The non chromaffin paraganglioma of the orbit is a relatively rare tumor. To our knowledge only 25 cases have been reported in the world literature. We report on the case of a 39-year-old woman who was treated surgically for the removal of an orbital paraganglioma 10 years ago. She had complained of proptosis and her right eyeball was slightly displaced upwards and laterally. A transcranial operation was performed and the tumor, located medically and weighing 9'5 grs., was completely removed; it was encapsulated. 10 years after this total excision there was no evidence of recurrence. From a histological point of view the tumor cells closely resembled those of paragangliomas of the carotid body and glomus jugulare.     

Bicondylar Hoffa's fracture with patellar dislocation – a rare case

Bicondylar Hoffa''s fractures of the femur is very uncommon. Conjoint bicondylar Hoffa fracture with ipsilateral patellar dislocation, Bicondylar Hoffa''s with patellar fracture and extensor mechanism rupture has been described in literature. We report a case of unconjoint bicondylar Hoffa''s fracture with lateral patellar dislocation in 17-year-old male patient treated with open reduction and cancellous screw fixation that subsequently healed well with good functional outcome.     

Primary carcinoid tumor arising in a retroperitoneal mature teratoma in an adult

An extremely rare case of a primary carcinoid tumor arising in a mature retroperitoneal teratoma is reported. A 53-year-old woman was admitted for further examination of an incidental retroperitoneal mass with calcification. Computed tomography scans demonstrated a tumor with fat, soft tissue and bone densities on the left renal hilum. Surgical excision of the tumor was performed with a preoperative diagnosis of retroperitoneal teratoma. The pathological diagnosis was mature teratoma, including all three germ layers. A carcinoid tumor was evident among teratoid tissues and it was thought to be a teratoma with malignant transformation. The patient did not have a carcinoid syndrome and had an uneventful recovery. She has been followed for 31 months with no recurrence. Carcinoid tumors rarely occur in teratomas of the ovary and the testis and, to our knowledge, this is the first case of carcinoid arising in a retroperitoneal mature teratoma.     

Solitary abdominal wall metastasis from a urothelial carcinoma of the urinary bladder

Few cases of abdominal wall metastasis from a urothelial carcinoma were reported in the literature, and those were mostly attributed to iatrogenic implantation after laparoscopic surgery or a percutaneous nephrostomy. An 85-year-old man presented with an infraumbilical mass 6 months after transurethral resection of a bladder tumor (TURBt) for a T4 urinary bladder urothelial carcinoma. Abdominal sonography disclosed a 1.6 cm × 1.5 cm subcutaneous hypoechoic lesion. Wide excision of the mass was performed, and skin flaps were used for skin coverage. A combination of the patient's clinical history, tumor morphology, and immunostaining results were compatible with the pathologic characteristic of his previous bladder urothelial carcinoma. We present this rare case of solitary abdominal wall mass metastasis from a urothelial carcinoma of the urinary bladder.     

Extra digital glomus tumor causing scapulothoracic impingement: A case report

Glomus tumor is a painful benign neoplasm which arises from the glomus body. The glomus body is neuromyoarterial receptor responsible for regulating the peripheral skin blood flow and local temperature. The classical clinical symptoms of the glomus tumor are acute local pain, pin point tenderness and hypersensitivity to cold. The commonest location of the glomus tumor is the subungual region of the distal phalanx of the fingers and toes. We hereby describe a very rare case of extradigital glomus tumor in the interspace between the scapula and the posterior chest wall causing paroxysmal severe pain on the movement of the right shoulder. Being deep in location, the tumor was not clinically palpable or identifiable. The lesion was eventually located on MRI. Surgical resection of the tumor led to complete resolution of patient's symptoms.     

手部血管球瘤的诊断与显微切除术

目的 探讨手部血管球瘤诊治的临床经验。方法 1994年以来，我院共收治手部血管球瘤患者72例，确诊后全部行显微手术切除，术后病理证实。结果 术后效果良好，随访3个月～10年，无1例复发。结论 诊治的成功关键在于：血管球瘤的临床三联症表现，手术采用显微技术完整切除瘤体，是防止复发的关键。     

Glomus tumor associated with pacinian hyperplasia--case report

Features of the glomus tumor and the relatively recently described pacinian hyperplasia are described including signs and symptoms, differential diagnosis and treatment. The role of trauma as an etiology is proposed. A case is reported and discussed in which the patient had a glomus tumor and pacinian hyperplasia in an index finger, and a glomus tumor in the small finger of one hand. Treatment of both entities was surgical excision.     

Lipoma of the temporal region: a rare case series

Lipomas are common benign tumours that can occur in most parts of the body. Lipomas arising from the deep temporal fat pad, found between the two layers of the deep temporal fascia, are rare, however; there has been only one documented case report to our knowledge. We describe a second case arising from the temporal fat pad in a patient treated at our unit, having previously reported the first one, and discuss the relevant anatomy and management.     

Rare glomus tumor formation following trauma to the first digit

IntroductionGlomus tumors are rare and few cases are reported in the literature. They typically occur in females on the digits of the hands.Case presentationWe report a case of a 30 year-old woman who presented with a mass that developed on the distal tip of her right thumb after traumatic injury. Magnetic resonance imaging (MRI) was conducted and mass resection was performed. Histopathology confirmed that the mass was a glomus tumor.Clinical discussionClinical presentations of glomus tumors are typically non-specific, mainly consisting of a small mass with chronic pain, with a lengthy time to diagnosis and potentially improper management. MRI is the preferred diagnostic step, followed by curative surgical excision and pathological confirmation.ConclusionGlomus tumors can cause significant discomfort for patients, and clinicians should be aware of the rare diagnosis when treating painful masses on the extremities, as surgical excision is often curative.     

Multiple glomus tumor: a case report and review of the literature.

Multiple glomus tumors are extremely rare and differ from the more common solitary glomus tumors in their clinical presentation and histological features. The authors report a case of multiple glomus tumors of the right hand in a 65-year-old man, its treatment, and a review of the features of this uncommon tumor. The tumor usually presents as a painful, firm, purplish, solitary nodule of the extremities, especially in the nail bed. Multiple glomus tumors are described as softer, more compressible, bluish nodules and they occur with less frequency than solitary tumors. They are often inherited in an autosomal dominant pattern. The authors present a case of multiple glomus tumors of the right hand, in which many small, painful, red papules were grouped in the right hypothenar region. The patient was treated by wide excision of the lesion and coverage of the defect with an ulnar artery forearm flap.     

Complete excision of the infrapatellar fat pad is associated with patellar tendon shortening after primary total knee arthroplasty

Background

Patella baja is a potentially disabling and difficult-to-treat complication following total knee arthroplasty (TKA). We investigated whether complete or partial excision of the fat pad has an effect on the length of the patellar tendon following TKA.

Methods

A retrospective review of patient radiographs was performed. One hundred and eleven consecutive patients who underwent primary TKA for osteoarthritis using the same components by two consultants were selected. Seventy-two patients underwent complete excision of the fat pad, whilst 39 had partial excision as per consultant practice. Patellar height was measured using the Caton–Deschamps Index (CDI) on immediate postoperative radiographs and at a minimum follow-up of 1 year.

Results

In the complete excision group, the mean CDI changed from 0.54 immediately postoperatively to 0.45 at a minimum follow-up of 1 year (p < 0.0001) indicating shortening of the patellar tendon, and eight patients reported anterior knee pain. The partial excision group’s mean CDI changed from 0.76 to 0.75 (p = 0.231). An analysis of variance showed that the effect of complete fat pad excision on patella tendon length was significant, F(1, 109) = 15.273, p < 0.001.

Conclusion

At a minimum follow-up of 1 year, the patellar tendon length shortened significantly in the group of patients with complete fat pad excision. With partial excision, there was no significant change in tendon length. Complete excision of the fat pad should therefore be avoided wherever possible in an attempt to avoid patella baja.

Level of evidence

II.

     

32例甲外血管球瘤的临床分析

目的 总结甲外血管球瘤的临床特点及诊治方法 .方法 2000年1月至2008年4月对32例甲外血管球瘤进行诊治,其中30例单发,2例为两处病灶.均行局部病灶切除术.结果 术后随访2～98个月,平均46个月.所有患者术前症状全部消失,无复发病例.结论 甲外血管球瘤具有特征性的临床表现,即疼痛、压痛、冷激惹的三联征,因病变隐匿,诊断较困难,肿瘤切除术是唯一有效的治疗方法 .