Metastasis to the breast: a rare site for secondary malignancy

Metastases to the breast from extramammary neoplasms are rare. Few cases of melanoma metastatic to the breast have been described in the literature. Correct identification of metastatic breast malignancy is of great significance since this presentation may be confused with primary benign or malignant breast disease.     

Desmoplastic fibroma — a rare tumour in a rare site

Summary We report the occurence of a desmoplastic fibroma in the terminal phalanx of the big toe in a 42-year-old male. The tumour is rare, only 66 cases have been reported in the English language journals. The case history together with review of the literature is presented.

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Résumé Présentation d'un cas de fibrome desmoplastique de la deuxième phalange du premier orteil chez un homme de 42 ans. Cette tumeur est rare, 66 cas seulement ont été rapportés dans la littérature de langue anglaise. Les auteurs présentent l'histoire clinique du malade ainsi qu'une revue de la littérature sur ce sujet.

     

Schwannoma of the penis: a common tumour at a rare site

Schwannoma is a benign tumour arising from neurilemmal cells and is commonly seen along cranial nerves. We describe the case history and histologic findings of a young adult with a schwannoma at a very rare site: the penis. Surgical excision was done and the patient remains disease-free after 2 years.     

Surgical site infection after thyroidectomy: a rare but significant complication

Background

Surgical site infections (SSIs) after thyroidectomy are rare but can have significant consequences. Thyroidectomy is a clean case, and the patterns for use of prophylactic antibiotics vary. We hypothesized that patient and operative characteristics may predict a higher risk of SSI, and that SSI are associated with other complications leading to increased resource utilization.

Methods

Data from the American College of Surgeons National Surgical Quality Improvement Program dataset for patients who underwent thyroidectomy through cervical incisions from 2005–2011 were included. Bivariate analysis using t-tests and chi-square tests were performed, and variables with P < 0.2 were considered for inclusion in a multivariate logistic regression model.

Results

A total of 49,326 patients underwent thyroidectomy from 2005–2011 and 179 (0.36%) had an SSI. On multivariate analysis, the strongest predictors of SSI were operative time (P < 0.001) and wound classification clean-contaminated (odds ratio 6.1; 95% confidence interval, 3.6, 10.3). Preoperative factors associated with SSI on multivariate analysis had lower magnitudes of influence on SSI risk but included obesity, alcohol use, and nonindependent functional status. Patients with SSI were more likely to have a wound dehiscence, renal insufficiency, bleeding requiring transfusion, and return to the operating room on a multivariate model of outcomes.

Conclusions

Although rare, SSI after thyroidectomy are associated with other postoperative complications. We have identified preoperative and intraoperative factors that are associated with SSI, and this may help identify high-risk patients who may benefit from selective use of antibiotics.     

Intracardiac hydatid cyst located in right ventricular outflow tract: a rare site

Intracardiac hydatid cyst is relatively uncommon and involvement of right ventricular outflow tract is extremely rare. We report a rare case of intracardiac hydatid cyst involving the right ventricular outflow tract and do a review of literature.     

Metastasis to a percutaneous gastrostomy site from head and neck cancer: radiobiologic considerations

BACKGROUND: The use of percutaneously placed feeding tubes has increased in recent years in an effort to maintain adequate caloric balance in patients receiving combined therapy for head and neck cancers, particularly concurrent radiotherapy and chemotherapy. METHODS: We report a case of a metastasis to a percutaneous endoscopic gastrostomy site occurring in a patient with an advanced tonsillar squamous cell carcinoma and review the published literature regarding this subject. Radiobiologic principles were examined to explain the most likely cause of such metastases. RESULTS: Six cases of percutaneous endoscopic site metastases occurring in patients with head and neck primary tumors have been reported in the literature. The interval from performance of the procedure to development of the metastases ranged from 3 to 16 months. Tumor kinetics suggest that a significant tumor burden (10(5)-10(6) cells) would need to be present at the site to manifest a metastatic lesion in such a short time interval. CONCLUSIONS: The development of metastases at percutaneous endoscopic gastrostomy sites is a relatively uncommon occurrence. Direct tumor implantation by means of instrumentation at the time of the procedure is most likely explanation for such metastases, although hematogenous seeding cannot be completely discounted. Techniques should be used so as not to disrupt the tumor bed, particularly when gross residual disease is present.     

Inguinal site infection as a rare cause of secondary peritonitis: report of a case

BACKGROUND: Many rare conditions may cause secondary peritonitis. Injection site infection as a primary source of peritonitis has not been reported. METHODS: Case report and review of the pertinent English-language literature. RESULTS: We describe a 39-year-old intravenous drug user who presented with peritonitis. During the surgical exploration, all abdominal organs were intact, but there was an orifice in the pelvic peritoneum that was related to an inguinal site infection. Cultures of both the inguinal area and the peritoneal cavity discharge revealed Staphylococcus aureus. CONCLUSIONS: Physicians should be aware of secondary peritonitis induced by self-injection of illicit substances in proximity to the peritoneal envelope.     

The management of superior dislocation of the patella with interlocking osteophytes--an update on a rare problem

The superior dislocation of the patella with interlocking osteophytes is a rare condition. A review of the English literature revealed only 12 reported cases. The purpose of reviewing these case reports is to highlight the unusual presentation and the injury mechanism in 2 of our patients, and to present our treatment algorithm. Closed reduction with manipulation of the patella, with or without anaesthesia, was performed without difficulty. We recommend an intermediate step of trying a regional nerve block before proceeding to general anaesthesia. Our patients had full range-of-motion after reduction and they were symptom-free after 3 years of follow-up. There were no recurrent dislocations in our patients.     

Post burn Marjolin's ulcer in the natal cleft mimicking anal canal carcinoma: a rare site

Marjolin's ulcer is a recognised complication of burn scars, chronic sinuses, and at sites of chronic irritation. The majority of these wounds occur at either venous ulcer or burn sites, usually in the extremities or the trunk. The only current method for confirming diagnosis is biopsy, which if positive will be followed by wide local excision and skin coverage. This paper reports an unusual case, in which a Marjolin's ulcer presented in the natal cleft 45 years after the initial burn injury. Its presentation mimicked that of an anal canal carcinoma, although detailed workup, which included computed tomography (CT) scan revealed this growth to be separate from the anal canal, albeit in close association. This is an extremely rare site and the study illustrates that squamous cell carcinoma can mimic anal carcinoma unless carefully examined.     

Metastasis development at the site of cervical spine arthrodesis

Biologically, the site of arthrodesis provides a microenvironment replete of growth factors and active remodeling, which is propitious for bone regrowth. There is a theoretical possibility though that this microenvironment would also provide a fertile site for metastatic deposits to occur. Although spinal fusion with various types of instrumentation is commonly used to treat various disorders, development of tumors at the site of spinal arthrodesis has not been previously reported. We present the clinical, radiographic, and pathological features of a case of previously undiagnosed metastatic adenocarcinoma, occurring 1 year following anterior arthrodesis and fusion for cervical spondylotic myelopathy at the C3–C4 level. The patient’s initial radiologic presentation suggested an epidural abscess with osteomyelitic destruction of C3 and C4. Our report alerts surgeons to the possibility that metastasis may occur at the site of a previous spinal arthrodesis.     

Isolated metastatic primary peritoneal carcinoma to the breast: a rare site of disease recurrence

Primary breast carcinoma is a common pathology in the UK. It can present with metastatic deposits but it is rare that lesions in the breast are the sole primary or secondary presentation for metastatic cancer from other sources. We present a case of a primary peritoneal cancer recurring after optimal treatment with a new breast lesion and the diagnostic difficulties that this can cause.     

Marjolin's ulcer of the suprapubic cystostomy site infiltrating the urinary bladder: a rare occurrence

We report a case of a 40-year-old man who had presented with a spontaneous suprapubic urinary leak from a well-healed suprapubic cystostomy tract scar, 20 years following a successful scrotal tube substitution urethroplasty done for a post-traumatic urethral stricture. Preoperative contrast studies suggested a recurrent bulbomembranous urethral stricture. Excision biopsy of the suprapubic fistulous tract revealed scar cancer infiltrating the bladder wall. Of 3 similar cases reported in the past, only 1 had bladder involvement. Ours is the second such case with bladder involvement.     

全膝关节置换术中髌骨置换与髌骨截骨疗效的病例对照研究

目的：比较人工全膝关节置换术髌骨截骨和髌骨置换的疗效,为临床治疗提供参考.方法：2004年4月至2011年4月行人工全膝关节置换术52例（54膝）,分为髌骨置换组和髌骨截骨组.髌骨置换组24例24膝,其中男13例,女11例,年龄53～78岁;髌骨截骨组28例30膝,男16例,女12例,年龄55～79岁.术后对其进行临床评价,包括膝关节评分（HSS评分系统）,髌骨评分（Feller评分标准）,膝关节活动度（ROM）,患者满意度,髌骨相关并发症.结果：术后随访20～80个月,平均56个月.髌骨置换组HSS评分由术前38.4±8.2提高为末次随访时的91.2±8.6,Feller评分由13.6±6.2提高为25.2±4.2,膝前痛分数由3.9±3.2提高为11.2±3.7,ROM由（78±26）°提高为（108±18）°.髌骨截骨组HSS评分由术前39.5±8.4提高为末次随访时的91.0±8.5,Feller评分由13.4±6.5提高为25.6±4.0,膝前痛分数由3.7±3.1提高为11.3±3.6,ROM由（76±27）°提高为（110±19）°.术后满意度髌骨置换组91％,髌骨截骨组89％;髌骨相关并发症髌骨置换组16.7％,髌骨截骨组10.0％.两组术后HSS评分、Feller评分、膝前痛分数及ROM比较差异无统计学意义,患者满意度比较差异无统计学意义,两组髌骨相关并发症比较差异有统计学意义,髌骨截骨组低于髌骨置换组.结论：全膝关节置换术中髌骨置换与髌骨截骨均能明显改善膝关节功能和减轻疼痛,髌骨相关并发症与髌骨的处理方式有关,但术后膝前痛及患者满意度与髌骨的处理方式无关.     

髌骨软骨母细胞瘤1例

患者,男,17岁。1年前无明显诱因出现右膝酸痛,右侧股四头肌萎缩,并伴有行走乏力,曾在当地医院就诊,行右下肢股四头肌肌电图检查,考虑为股神经损害,给予药物"弥可保"营养神经治疗,但症状改善不明显,为求进一步诊治于2011年3月4日就诊并入院。患者无明确外伤史。查体:双下肢等长,右侧股四头肌萎缩,右侧髌骨上10cm处周径较左侧短缩5cm,右膝关节无内、外翻畸形,未见明显肿胀,触之皮温略高,右膝关节浮髌试验阴性,髌骨摩擦试验阴性,髌骨压痛阳性,无半月板及韧带损伤体征。实验室检查结果未见明显异     

Ewings sarcoma of patella: A rare entity treated with a novel technique of extensor mechanism reconstruction using tendoachilles auto graft

We report a case of Ewings sarcoma (ES) involving the patella in a young female. ES of patella is a rare entity. The patient was presented with anterior knee pain and swelling arising from the patella. She was treated with neoadjuvant chemotherapy followed by wide excision of the patella and reconstruction of the extensor mechanism using split tendoachilles auto graft. The patella is an uncommon site for primary or metastatic tumors of the bone. ES, though rare, should be included in the differential diagnosis of swellings arising from the patella. Auto graft from the tendoachilles is a good alternative for reconstructing the extensor mechanism of the knee.