Fibroma of a tendon-sheath presenting as toe deformity

We describe a rare manifestation fibroma in a tendon-sheath in an 83-year-old man. The patient complained initially of a slowly progressive spreading, apart of the right second and third toes. A mass was found in the plantar aspect of the foot. It was completely excised at surgery. Histological examination revealed sparse spindle or stellate cells with slit-like vessels in the dense collagenous matrix. There had been no recurrence at follow-up 17 months after surgery.     

An unusual case of desmoid tumour presenting as haemorrhagic shock

We report the case of a 22-year-old patient who presented to the emergency department with epigastric pain and vomiting. Haematological studies showed a rapid decrease in haemoglobin levels from 13.6 g/dl to 4.9 g/dl. Abdominal ultrasonography revealed the presence of fluid around the spleen and the patient was immediately referred for surgery. An intra-abdominal desmoid tumour presenting as a hemorrhagic shock has not previously been described. Given the relatively benign course of the disease and the young age at presentation, this clinical entity should not be overlooked as it has the potential to invade vessels and therefore be fatal.     

An unusual pleural cyst in a child presenting as a pseudo-pneumothorax. Case report

This case highlights an unusual pleural cyst in a 3-year-old child that simulated a pneumothorax on chest radiograph. The child presented with mild respiratory distress and the 'pneumothorax' failed to respond to pleural intubation. At thoracotomy, a 10 cm air-filled cyst was found attached to the visceral pleura by a narrow pedicle. This was transfixed and divided, with removal of the cyst. Postoperatively, the lung expanded and the child recovered without any sequelae. Histological examination of the cyst showed it to be lined with mesothelial cells. It is suggested that this cyst arose from a mesothelial inclusion cyst or sub-mesothelial pleural tissue, which communicated with the peripheral lung tissue.     

The zero-plus first metatarsal and its relationship to bunion deformity

The relationship between first metatarsal length and hallux valgus (HV) deformity was examined. Retrospectively, 210 randomly selected radiographic files were reviewed between 1988 and 1993. The morbid population consisted of 110 feet with HV deformities. The control population consisted of 100 healthy feet (no deformity). Seventy-seven percent of the patients with HV deformity had a first metatarsal length that was equal to or longer than the second metatarsal. This was defined as a zero-plus first metatarsal. Only 28% of the control population had this same proportion in length. Thus, prevalence of zero-plus first metatarsal was significantly associated with HV formation (χ²₁ = 51.15, P < .001). The mean first metatarsal protrusion distance was significantly higher in the bunion population (+1.58 mm) than in the control patients (−2.05 mm) (P < .001). The distribution of head shape differed significantly between the patients with HV and control patients; patients with HV had predominantly round heads (91%) and the control patients had predominantly square and square with a ridge heads (80%) (χ²₂ = 107.7, P < .001). All zero-plus first metatarsals in the HV population had a round first metatarsal head. Only 7.1% of the control patients had a round head with a zero-plus metatarsal. There was a positive relationship between the protrusion distance of the first metatarsal and the severity of the intermetatarsal angle, particularly in those patients with intermetatarsal angles ranging from 13° to 20° (P < .01). It was concluded that a zero-plus first metatarsal is a significant etiologic factor in the development of bunion deformity and should be part of the preoperative evaluation.     

Pathology of the fifth ray, including the tailor's bunion deformity

Pathology of the fifth ray has been reviewed with emphasis on the tailor's bunion. Based on a thorough radiographic analysis, the bunionette has been grouped into four types, and surgical criteria has been proposed. The goal of this study is to provide guidelines that may enable both podiatric and orthopedic surgeons to recognize the types of tailor's bunions and assist in the selection of an appropriate surgical procedure.     

Turret exostosis of the phalanges presenting as limited motion of the finger

Turret exostosis, or acquired osteochondroma, was first described by Wissinger et al. as a subperiosteal bone formation which develops beneath the extensor apparatus It shares common clinical and radiological features with florid reactive periostitis and bizarre periosteal osteochondromatous proliferation (Nora’s lesion) which belong to the same group of reactive lesions of the bone surface. Turret exostosis is a rare complication of a minor injury to the hand. Its peak incidence is in the third and fourth decades of life, predominantly affecting the proximal and middle phalanges of the hand. Metacarpal involvement has also been reported. It is characterized by pain, soft tissue swelling and a growing mass leading to limitation of motion and cosmetic deformity. This is a report of seven patients in whom lump formation and limitation of motion were the presenting symptoms of turret exostosis. The literature is reviewed and the possible pathogenesis of this disorder is discussed. Received: 30 April 1999 / Accepted: 27 September 1999     

An unusual case of giant cavernous hemangioma presenting as a lytic lesion in manubrium sterni

Primary tumors of the chest wall are uncommon. Cavernous hemangioma is rare. A presternal giant cavernous hemangioma is presented.     

An unusual intracranial tumour presenting in pregnancy

We describe a patient who presented in late pregnancy with deteriorating neurological status due to an intracranial capillary haemangioma causing mass effect and raised intracranial pressure. She became confused and uncooperative leading to practical difficulties in performing adequate radiological imaging. Decision regarding timing of delivery and craniotomy was not straightforward and required discussion between the neurosurgeon, obstetrician and anaesthetist based on assessment of fetal maturity and the need to perform a craniotomy to excise what was initially thought to be a meningioma. Caesarean section was performed under general anaesthesia. The tumour was resected three weeks later. Management of obstetric patients with brain tumours is complex, requiring knowledge of the physiological effects of pregnancy on tumour size and labour on intracranial pressure. Both of these may influence the choice of labour analgesia or anaesthesia for caesarean section. Anaesthetists must be aware of the difficulties of radiological imaging during pregnancy, particularly in confused patients. The conflicting requirements of general anaesthesia for craniotomy and caesarean section should be considered.     

Metastasis from scapular Ewing's sarcoma presenting as sutural diastasis: An unusual presentation

Ewing's sarcoma is a malignant non-osteogenic primary tumor of the bone. It is one of the most common primary malignant tumors of bone. Peak incidence is noticed in second decade of life with male preponderance of 1.6:1. It occurs most frequently in long bones and flat bones of pelvic girdles. In 30% cases, Ewing's sarcoma is multicentric in origin. In 14-50%, multiple metastases are present at the time of diagnosis. CNS spread is rare and isolated CNS involvement is not seen. Skull metastasis of Ewing's sarcoma is not rare compared to primary Ewing's sarcoma of the skull, but the actual frequency is unknown. We wish to report a case of "Primary Ewing's sarcoma of scapula with metastasis to Skull Vault in a Child resulting in sutural diastasis" diagnosed by clinicoradiological examination and confirmed by histopathology.     

Hemothorax: an unusual complication of costal exostosis

We report a case of a spontaneous hemothorax in a 15-year-old girl because of costal exostosis. This possibly may have been provoked by a nontraumatic rupture of markedly dilated pleural vessels because of long-standing friction between the exostosis and the pleura. The authors conclude that exostosis of the rib is a rare cause of hemothorax in children and should be considered among possible etiologies in diagnosis.     

Surgical treatment of a canal of Nuck cyst presenting as a femoral hernia: An unusual case report

Introduction and importanceA canal of Nuck cyst forms because of a patent peritoneal fold evaginating through the inguinal canal in a female patient. It is a rare diagnosis because the canal often obliterates within the first year of a female patient's life. A persistent canal of Nuck may cause indirect inguinal hernias, or form hydroceles, termed canal of Nuck cysts. Here we report the first case of a canal of Nuck cyst discovered to be evaginating through the femoral canal.Case presentationA 70-year-old female patient initially presented with a symptomatic groin mass, and a suspected inguinal hernia on pre-operative ultrasound. Intraoperatively, she was found to have a canal of Nuck cyst terminating within the femoral canal. This was successfully repaired using a modified McVay approach, and approximation of the internal inguinal ring. She performed well post-operatively with no signs of recurrence at her six-month follow-up.Clinical discussionThis case report serves to highlight the canal of Nuck cyst, a rare embryologic remnant, and the first literature-reported femoral canal of Nuck cyst. We re-affirm the diagnostic unreliability of ultrasound imaging in the workup of groin hernias. Furthermore, we describe surgical techniques to repair a canal of Nuck cyst found within the femoral canal.ConclusionTo the best of our knowledge, no prior literature reports a canal of Nuck cyst presenting as a femoral hernia. This rare diagnosis may be encountered in common operations and is amenable to definitive repair using traditional hernia repair techniques.     

An unusual cause of hiccup: costal exostosis. Treatment by video-assisted thoracic surgery

The described case is of a 15-year-old boy who presented with a persistent hiccup and repeated episodes of left-sided chest pain. At computed tomography scan an exostosis originating from the costo-chondral junction of the left 4th rib was seen. The tip of the exostosis reached the external surface of the pericardium. Removal of a 2 cm rib segment including the implantation basis of the exostosis was achieved by video-assisted thoracic surgery. Symptoms disappeared after surgery. This report shows an exceptional symptom of costal exostosis.