Giant solitary hydatid cyst of spleen—A case report

INTRODUCTIONPrimary hydatid disease of the spleen is very rare and even rarer to cause (any complication … pancreatitis.). Usually, splenic hydatid cysts are secondary, either resulting from spontaneous spread of cysts or occurring after operations involving hydatidosis in other regions. Here, we report a case of a primary isolated splenic hydatid cyst treated with a classical surgical approach. This case report and literature review describes the management of hydatid splenic invasion.PRESENTATION OF CASEWe report the case of a 28-year-old female who presented with left hypochondriac non tender swelling/(mass). Abdominal ultrasonography and computed tomography (CT) revealed a cyst located in the spleen. The diagnosis was confirmed by a serological test. Surgical treatment involved a radical en bloc splenic resection (together with resection of the diaphragm and subcutaneous tissue.) The postoperative course was uneventful with three weeks of albendazole treatment. CT follow-up at six months demonstrated the absence of recurrence. Histopathologic examination revealed a hydatid cyst.DISCUSSIONComplete aggressive surgical en bloc resection resection is the gold standard treatment of patients with hydatid cysts with the aim to remove all parasitic and pericystic tissues.CONCLUSIONThe infrequency with which it is encountered makes splenic hydatid disease a formidable early diagnostic challenge especially in nonendemic areas. Hydatid disease should be considered in the differential diagnosis of all cystic masses in the spleen/(abdomen), especially in the geographical regions where the disease is endemic.     

Aneurysmal bone cyst of fourth metacarpal bone in a child: excision and reconstruction with fibular strut graft��a case report and review of literature

Aneurysmal bone cysts of small bones of hands are rare and pose diagnostic and therapeutic challenge. We report a case of aneurysmal bone cyst of fourth metacarpal bone in a 14-year-old boy who presented with history of pain and swelling for 6 months duration. Radiograph and magnetic resonance imaging revealed a fusiform swelling involving the diaphysis and the distal metaphysis of the fourth metacarpal bone without any cortical breach. The physeal plate was not involved. Histopathological finding confirmed the diagnosis to be aneurysmal bone cyst. The patient was treated with marginal resection of the tumour preserving the articular surface by retaining the epiphysis and the bony defect was reconstructed with autologous fibular strut graft. One-year follow-up revealed an excellent incorporation of the graft with no evidence of local recurrence and also excellent range of motion of the hand. Nonvascularized fibular strut graft is easy to harvest and provide an excellent functional outcome when used as intercalary autograft after excision of aneurysmal bone cyst of hand.     

Calcaneal cyst: a classical simple bone cyst?

INTRODUCTION: In the calcaneus differentiation between a solitary cyst and intraosseus lipoma is difficult. Radiologists frequently diagnose an intraosseus lipoma, whereas histology shows the classical signs of a solitary bone cyst. We present 12 cases of a solitary cyst of the calcaneus. MATERIAL AND METHODS: Between 1993 and 2001 we operated on 12 patients (8 men, 4 women, median age 28 +/- 14 years) with calcaneal cysts. 9 patients received a curretage and an autologous, one patient a homologous, one patient a mixed autologous-homologous bone-grafting and one patient only a curretage (due to the small diameter of the cyst) of their cysts. RESULTS: No case revealed the histological picture of a fatty formation, which appears to be typical for an intraosseus lipoma. All of the microscopic findings resembled the characteristics seen in cysts of the long bones. A pathological fracture has not been observed. CONCLUSION: The histologically confirmed calcaneal cysts showed the radiological signs that are supposed to be typical for an intraosseous lipoma. It cannot be decided whether the histologically diagnosed calcaneal lipomas described by others can be interpreted as fatty degeneration of a calcaneal cyst, or whether fatty areas of the bone marrow have given a wrong impression. Since the literature only describes single isolated cases of a pathological fracture of the calcaneal cyst or lipoma, asymptomatic patients should be treated non-operatively.     

Precoccygeal epidermoid cyst in a child — A unique case report

Introduction

Epidermoid cyst is a benign tumour frequently observed throughout the body. It can grow in size and may get infected over a period of time.

Enlarging lymphoepithelial cyst of the pancreas during 12 months of observation: report of a case

Pancreatic lymphoepithelial cysts (LECs) are rare benign pancreatic cystic lesions, the etiology of which is unknown. We report a case of a pancreatic LEC, discovered incidentally in a 63-year-old man during a follow-up clinic visit for an abdominal aneurysm. Computed tomography showed a multilocular cyst, 60-mm diameter in the body of the pancreas. This cyst increased from 6.0 to 6.5 cm during 12 months of observation. Part of the cyst was also visualized on positron emission tomography imaging. Since a pancreatic cystic neoplasm could not be ruled out, we performed distal pancreatectomy and postoperative pathological examination confirmed that the lesion was an LEC of the pancreas. Despite the conclusive postoperative findings, resection is unavoidable when a true pancreatic neoplasm cannot be excluded.     

A case report of Turner syndrome associated with Rathke cleft cyst

It has not been reported that Turner syndromecould be associated with Rathke cleft cyst yet,nowwe report such a case found in our hospital.Clinical data:The patient,social sex female,15.3ys,was a junior high school student.Chief com-plaints:She had short stature for 10~ years and no pu-berche.She was a first full term fetus with cephalicpresentation.The delivery was accomplished by episi-otomy and vacuum extracter with a history of neonatal     

Traumatic hyoid bone fracture �C a case report and review of the literature

Objective:

To present a case of traumatic hyoid bone fracture and a review of the literature

Rationale:

Traumatic hyoid bone fractures are rare, however with the increasing popularity of martial arts the incidence of traumatic hyoid bone fracture may increase in prevalence.

Clinical Features:

A thirteen year old taekwondo athlete collapsed after receiving a kick to the anterior neck. Following first aid emergency care the athlete reported pain with speaking and swallowing and was suffering from dyspnea. Ecchymosis and tenderness were noted over the hyoid bone.

Intervention and Outcome:

Lateral radiographs revealed fracture of the hyoid. Patient was sent home with analgesics and instructed to rest. The athlete was cleared for sport at 4 weeks post injury.

Conclusion:

Ensuring airway integrity and screening for signs of laryngeal laceration are essential in the management of suspected hyoid bone fractures. Observation for 48–72 hours is highly recommended.     

Spontaneous resolution of symptoms associated with a facet synovial cyst in an adult female – a case report

Background:

Facet cysts are implicated in neural compression in the lumbar spine. Surgery is the definitive treatment for symptomatic facet cysts since the failure rate for conservative treatment is quite high; however, the role of physical/manual medicine practitioners in the management of symptomatic facet cysts has not been well explored. This case report will add to the body of evidence of spontaneous resolution of symptoms associated with facet cysts in the chiropractic literature.

Case:

A 58 year old female presented with acute low back and right leg pain which she attributed to a series of exercise classes that involved frequent foot stomping. Physical examination did not elicit any objective evidence of radiculopathy but MRI and CT scans revealed a facet cyst impinging on the right L5 nerve root. Injections and surgery were recommended; however, the patient’s radicular symptoms completely resolved after three months without surgical intervention.

Summary:

There is currently a paucity of data in the literature regarding the chiropractor’s role in the management of symptomatic facet cysts. The case presented here has added to this literature and possible areas for future research have been explored.     

Revision shoulder arthroplasty with morselized bone allograft—a case report

Background and purpose Several studies have shown that nicotine has a detrimental effect on the development of rotator cuff tear. However, little is known about its mechanism. We evaluated the effect of nicotine on the maximum tensile load, the maximum tensile stress, and the elastic modulus of the supraspinatus tendon in a rat model.

Methods 27 rats were randomly assigned to 3 groups. Subcutaneously implanted osmotic pumps delivered two different concentrations of nicotine solution (high dose: 45 ng/mL; low dose: 22.5 ng/mL) or saline solution (controls) over a 12-week period. The level of serum cotinine, a breakdown product of nicotine, was evaluated. We performed tensile testing using the left supraspinatus tendon in each rat. The maximum load of the supraspinatus tendon was measured, and the maximum tensile stress and elastic modulus were calculated.

Results Serum cotinine levels showed controlled systemic release of nicotine. The maximum tensile load and stress were similar in the three groups. The elastic modulus was, however, higher in the nicotine groups than in the control group.

Interpretation In a rat model, ncotine caused a change in the material properties of the supraspinatus tendon. This change may predispose to a tear in the supraspinatus tendon.     

Intrahepatic cholangiocarcinoma arising 28 years after excision of a type IV-A congenital choledochal cyst: report of a case

This report presents a rare case of intrahepatic cholangiocarcinoma (IHCC) arising 28 years after excision of a type IV-A congenital choledochal cyst. The patient underwent excision of a congenital choledochal cyst (Todani’s type IV-A) at 12 years of age, with Roux-en-Y hepaticojejunostomy reconstruction. She received a pancreaticoduodenectomy (PD) using the modified Child method for an infection of a residual congenital choledochal cyst in the pancreatic head at the age of 18. She was referred to this department with a liver tumor 22 years later. Left hemihepatectomy with left-side caudate lobectomy was performed and the tumor was pathologically diagnosed to be IHCC. The cause of the current carcinogenesis was presumed to be reflux of pancreatic juice into the residual intrahepatic bile duct during surgery. This case suggests that a careful long-term follow-up is important for patients with congenital choledochal cysts, even if a separation-operation was performed at a young age, and especially after PD.     

Spontaneous epiphyseal injury as a complication of a simple bone cyst of the femoral neck? Case report and review of the literature

A case of a spontaneous epiphyseal injury of the femoral neck in an 8-year-old boy is reported. The same boy had been seen 8 months before for a pathological fracture caused by a simple bone cyst of the femoral neck on the same side. At the second visit the boy showed spontaneous severe pain of the hip, and radiography was performed under the presumed diagnosis of a slipped capital femoral epiphysis. However, it demonstrated a separation through the growth plate cranially and a fracture through the metaphysis inferiorly, leading to the differential diagnosis of a Salter-Harris type II fracture despite a nontraumatic patient history.A review of the literature failed to reveal a similar report of simultaneous occurrence of a simple bone cyst and epiphyseal injury of the femur. However, slipping of the proximal humeral epiphysis in connection with a simple bone cyst has been described by some authors. We propose a pathophysiological model for the simultaneous occurrence of epiphyseal injury and a simple bone cyst. Physeal involvement by a simple bone cyst and varus deformity of the femoral neck could cause weakening of the growth plate and predispose for epiphyseal injury.Based on these findings, we suggest that a simple bone cyst of the proximal femoral metaphysis can develop into a severe condition. Children presenting with this clinical picture should be treated vigorously and monitored for the development of complications leading to epiphyseal injury.     

Giant sublingual epidermoid cyst — An unusual case report

Epidermoid cysts of the floor of the mouth represent <0.01% of all oral cysts. Only few cases have been reported so far. We report a case of a 24 years man with a large sublingual swelling for 17 years, unable to take solid meals. The swelling was approximately 13 × 13 cm, non-tender, non-transilluminant, with doughy consistency and with patent visible Wharton’s duct openings on both the sides. Initial decompression of the lesion was done to facilitate nasotracheal intubation followed by partial excision of the cyst with marsupialization. Histopathological examination revealed a thick wall cyst lined with pseudostratified squamous epithelium without any evidence of dermal appendages suggestive of epidermoid cyst. Postoperative care included extraction of the loose infected dentures and physiotherapy of the ankylosed temporomandibular joints. Clinical progress was uneventful and cosmetic appearance was acceptable on 6 month and 2 years follow up with normal mastication function.     

Are bone bruises a possible cause of osteochondritis dissecans of the capitellum? a case report and review of the literature

A 17-year old soccer-player sustained a fracture and dislocation of the ulnar epicondyle combined with a bone bruises at the radial head and the capitellum. An open reduction and internal fixation was performed using two K-wires. Initial recovery was uneventful. After the operation he was discharged home and reviewed on a regular basis. When bony union had occurred the two K-wires were removed. However, on follow up he continued to complain of pain on the radial aspect of the joint and did not regain his normal range of movement. A further MRI was performed. Now a grade II osteochondritis dissecans not visible on the previous MRI taken 12 weeks earlier was clearly visualised. Treatment was continued conservatively with physiotherapy but avoiding aggressive mobilisation. On final review 6 months later he was able to move painfree with residual limitation of movement (ROM 0–5–130°). Another MRI taken now was assessed as normal.This study was carried out at the Dept of MRI, Klinik für Radiologische Diagnostik, Klinikum Saarbrücken, Winterberg 1, D- 66119 Saarbrücken.     

Aneurysmal bone cyst: a hereditary disease?

Recent genetic and immunohistochemical studies propose that the primary aneurysmal bone cyst is a tumour and not a reactive tumour-simulating lesion. Based on a familial case of aneurysmal bone cyst the authors contacted 135 patients with this disease. Sixty-eight females and 67 males (median age 14 years; range 2-73 years) were asked if other family members had bone lesions. One hundred and seven patients (79%) denied having other family members with lesions, 23 patients (17%) did not answer, and five patients (4%) gave evidence of other bone lesions in the family. These data indicate that a predisposing genetic defect could be part of a multifactorial pathogenesis in the development of some aneurysmal bone cysts.     

Successful management of an aortoesophageal fistula caused by a fish bone – case report and review of literature

We report a case of aortoesophageal fistula (AEF) caused by a fish bone that had a successful outcome. Aortoesophageal fistula is a rare complication of foreign body ingestion from which few patients survive. Over one hundred cases of AEF secondary to foreign body ingestion have been documented but only seven, including our case, have survived over 12 months. Treatment involved stabilising the patient with a Sengstaken-Blakemore tube and insertion of a thoracic aortic endovascular stent-graft. Unfortunately the stent became infected and definitive open surgical repair involved removing the stent, replacing the aorta with a homograft and coverage with a left trapezius flap while under deep hypothermic arrest.     

Arthroscopic management of Juxta-articular chondroblastoma with bone substitutes – A case report

Chondroblastoma, a rare benign bone tumour arising from the epiphysis, accounts for approximately 1% of all primary bone tumours and is known to be locally aggressive with potential for metastases and local recurrence. Open surgical curettage is associated with high risk of recurrence and potential for damage to the physis resulting in growth disturbances. We report a 14-year-old girl with chondroblastoma involving the distal femoral epiphysis in whom an arthroscopic approach was employed for thorough curettage of the lesion under direct vision followed by cavity management using bone graft substitute. At seven years follow-up she is asymptomatic, has normal knee function and her radiographs have shown good osteointegration of the synthetic graft with no evidence of recurrence. By combining the principles of intra-articular and endosteal arthroscopy in select patients, both tumour excision and cavity management can be done arthroscopically.     

Meckel’s diverticulum perforation by a fish bone: A case report

IntroductionMeckel’s diverticulum is the most common congenital abnormality of the gastrointestinal tract. The perforation of a Meckel’s diverticulum by a foreign body is a very rare complication.Case presentationA 61-year-old male presented to the Emergency Department with complaints with abdominal pain and fever, and abdominal rebound tenderness on physical examination. An intestinal perforation by a foreign body was diagnosed by CT scan. The patient was submitted to a diagnostic laparoscopy and a perforation of a Meckel’s diverticulum by a foreign body was identified. The foreign body was removed and a stapled diverticulectomy was performed.DiscussionMeckel’s diverticulum is asymptomatic in most of the affected individuals, with a 4.2–16.9% probability of symptomatic presentations. The clinical presentation ranges from intestinal obstruction, to bleeding, inflammation and perforation. While children with Meckel’s diverticulum present more often with gastrointestinal bleeding, intestinal obstruction is the most common presentation in adults. Foreign body perforation of a Meckel’s diverticulum is an extremely rare event. There is general agreement that a symptomatic Meckel’s diverticulum should be resected. Laparoscopy is a safe diagnostic and therapeutic tool that can decrease diagnostic time and theoretically avoids the morbidity and mortality of a delayed diagnosis.ConclusionThe perforation of a Meckel diverticulum by a foreign body is an extremely rare event and may have a bad prognosis in case of a delayed diagnosis.