Hepatoma presenting as a bone tumour: a case report.

Osseous metastases from hepatoma are rare. One patient who had a lesion in the upper humerus is presented.     

Subacute osteomyelitis presenting as a bone tumour

Summary. Twenty-one patients with subacute osteomyelitis who were initially considered to have bone tumours were reviewed, with an average follow up of 3 years. The clinical symptoms were not specific and laboratory investigations were normal. The radiographic findings were limited osteolysis surrounded by bone sclerosis in 14 cases, osteolysis without definite borders in 6, and onion-layer periosteal bone formation in one. The preoperative diagnoses included osteoid osteoma, osteosarcoma, chondroblastoma, Ewing’s sarcoma, giant cell tumour, fibrosarcoma, eosinophilic granuloma, and bone tumour of unknown aetiology. The definitive diagnosis was made by surgical biopsy, histology and cultures which grew staphylococcus in 9 cases. The gross specimens all showed lymphocytes, plasma cells and granulation tissue with osteogenesis. All the patients recovered completely; 17 were treated with antibiotics and immobilisation, and 4 did not need an antibiotic. There was no recurrence of infection after curettage and excision of the infected tissues.

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Résumé. Vingt et un patients atteint d’une ostéomyélite subaigu? , considérée initialement comme une tumeur osseuse, ont été traités à l’h?pital Cochin et revus avec un recul moyen de 3 ans. La douleur, l’apyrexie, la normalité presque constante des résultats biologiques ne permettaient pas d’orienter le diagnostic. La radiographie mettait en évidence 14 fois une ostéolyse au sein d’une ostéocondensation, 6 fois une ostéolyse mal limitée et 1 fois une ossification périostée en “bulbe d’oignon”. Compte tenu de tous ces éléments, le diagnostic retenu avant l’intervention était 8 fois celui d’un ostéome ostéo?de, 3 fois celui d’un ostéosarcome, 5 fois celui d’une autre tumeur (un chondroblastome, un sarcome d’Ewing, une tumeur à cellules géantes, un fibrosarcome et un granulome éosinophile). Cinq fois un diagnostic de présomption tumorale a été retenu sans autre précision. Le diagnostic final a étéétabli par biopsie-curetage et examen bactériologique. Le germe le plus fréquemment retrouvéétait un staphylocoque doré (9 fois). L’examen histologique de la pièce opératoire montrait une infiltration lympho-plasmocytaire avec ostéogenèse. Ces 21 patients ont guéris avec une antibiothérapie adaptée et une immobilisation 17 fois. La guérison a été obtenue en l’absence d’antibiothérapie dans 4 cas.

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Accepted: 21 May 1996     

Large osteoarthritic cyst presenting as soft tissue tumour - a case report

Large osteoarthritic cysts can sometimes be difficult to distinguish from primary osseous and soft tissue tumours. We present such a case involving a cyst arising from the hip joint and eroding the acetabulum which presented as a soft tissue malignancy referred to a tertiary bone and soft tissue tumour centre. We discuss the diagnostic problems it may pose, and present a literature review of the subject.     

Late recurrent adrenocortical carcinoma presenting radiologically as a gastrointestinal stromal tumour: A case report

Introduction

Adrenocortical carcinoma (ACC) is a rare malignancy with an estimated incidence of 1–2 per million people. It may recur, after complete surgical removal by local or distant metastasis.

Hepatic actinomycosis presenting as a liver tumour: case report and literature review

Hepatic actinomycosis poses a difficult problem in both diagnosis and management. We report the management of a patient with isolated hepatic actinomycosis, and review the clinical features and management of patients with hepatic actinomycosis mimicking liver tumour.     

A case of tularemia presenting as a dental abscess: case report.

OBJECTIVE: The purpose of this report is to present a tularemia case accompanied by a neck mass that easily may be confounded with dental abscess. SUMMARY: Francisella tularensis is a potential agent of biologic terrorism. Thirty percent of the symptoms seen in tularemia localize in the head and neck region and are sometimes mistaken for complications of a dental abscess. To our knowledge, reports of the differential diagnostic characteristics of tularemia are lacking in the dental literature and, to date, no dental journal articles have focused on the disease. In this present case, a 51-year-old woman arrived at the public health department with high fever and facial swelling. The findings suggested a dental origin and the patient was directed to dentistry. Radiology and a detailed intraoral and extraoral examination failed to reveal a dental problem. Fortunately, the patient was known to come from a tularemia region; with the suspicion of tularemia the patient was referred to the faculty of medicine. Serologic tests showed that the patient had a Francisella tularensis infection.     

Hypothyroidism presenting as growth retardation. A case report

An unusual case of hypothyroidism presenting as growth retardation is reported. The clinical features of childhood hypothyroidism and the essential laboratory and special investigations needed to make the diagnosis are discussed. The importance of considering hypothyroidism in the differential diagnosis of short stature is emphasized since early treatment can result in normal mental development and growth. Screening programmes to detect hypothyroidism in the newborn are needed.     

Wegener's granulomatosis presenting as otomastoiditis. A case report

A 55-year-old male presented with left-sided otorrhoea, hearing loss and tinnitus of 3 months duration. On clinical examination polypoid tissue was seen prolapsing in the external ear canal. A CT scan of the mastoid cells and middle ear showed otomastoiditis with osteolysis. Oral antibiotic therapy and eardrops were started. When a facial nerve paresis appeared one month later, a mastoidectomy was performed. The mastoid cells and middle ear were filled with a connective tissue-like substance. Postoperative corticosteroids were administered. Despite the therapy the facial nerve problem aggravated and the patient developed severe parietotemporal headache, meningeal irritation and somnolence. The diagnosis of neurosarcoidosis was hypothesised. Blood analysis, including c-ANCA's, culture of the otorrhoea and biopsies of the connective tissue were inconclusive. A CT scan of the brain showed thickening of the left tentorium. A biopsy of the dura indicated a diagnosis of Wegener's granulomatosis. The patient was treated with immunosuppressive medication with satisfactory results.     

Hyperparathyroidism in twin pregnancy. A case report

Primary hyperparathyroidism (PHPT) and associated bony changes are rare in pregnancy; the approach to this condition and its management are discussed. This is probably the first report of PHPT in twin pregnancy and the clinical, radiological and biochemical features are described.     

Extranodal rosai-dorfman disease presenting as incidental bone tumor: a case report

We report a case of primary extranodal Rosai-Dorfman disease presenting as a painless lesion in the left ilium of a 71-year-old African-American man.     

Thoracoscopic segmentectomy for a large previously undiagnosed CPAM presenting as a spontaneous pneumothorax: A case report

IntroductionIncidentally found congenital pulmonary airway malformations (CPAM) in older children are extremely rare and have traditionally been managed with minimally invasive versus open lobectomy of the affected lobe.Presentation of caseIn this report, we present a 11-year-old male who presented with a recurrent spontaneous pneumothorax and was found to have a large symptomatic CPAM confined to a single segment of the right lower lobe. The patient was successfully treated with thoracoscopic segmentectomy without any residual disease seen on follow up imaging.DiscussionMinimally invasive thoracoscopic approach has many advantages over open approach including better pain control, reduced hospital length of stay, and decreased intraoperative blood loss. With increasing use of minimally invasive approaches, lung-sparing surgery has demonstrated to be a viable and an attractive option for definitive resection of CPAM, without compromising resection margins and/or future lung function.ConclusionThis report demonstrates that minimally invasive lung-sparing surgical treatment of a large CPAM is feasible in older children.     

Infundibuloneurohypophysitis presenting a large sellar-juxtasellar mass: case report

BACKGROUND: Infundibuloneurohypophysitis (INH) is reported to be a self-limiting inflammatory disease involving neurohypophysis. The authors experienced a case of INH presenting a large mass compressing the brain stem. CASE PRESENTATION: The patient exhibited polyuria followed by left hemiparesis and dysarthria lasting a year. Magnetic resonance imaging showed a large sellar mass extending into the right cavernous sinus and prepontine cistern and compressing pons. Endocrinologically, diabetes insipidus was diagnosed and anterior pituitary function was almost normal. Microscopic examination of the surgical specimen obtained by a transsphenoidal route demonstrated diffuse infiltration of lymphoid cells with predominance of B cells over T cells and the granulation tissue. The patient underwent 40 Gy local radiation because of initial misinterpretation of histologic findings as malignant lymphoma and short-term corticostertoid administration. CONCLUSION: The mass gradually shrank and the patient has become neurologically intact in 6 months. At this moment, 67 months after the onset, the patient is free from disease and has no other lesion. INH seems to be a clinical entity possessing a wide spectrum from infundibular tumorlet to an aggressive sellar mass trespassing on surrounding structures.     

Infantile fibrosarcoma presenting as shoulder dystocia. A case report

Congenital (infantile) fibrosarcomas are soft-tissue tumours that usually present after birth. In the case described a large tumour of the right arm caused shoulder dystocia and death of the fetus.     

Tibialization of the fibula for a large bone loss. A case report

A 10-centimeter tibial bone loss was treated by inter-tibiofibular bone grafting on each part of the pseudarthrosis, resulting in tibialization of the fibula. The patient was reviewed after 10 years; the clinical result was satisfactory and stable. The tibial forces were deviated on the fibula, which expressed radiologically by important thickening of its cortices. This case illustrates the interest of preserving the fibula for tibial bone loss reconstruction.     

Paraganglioma presenting as a vascular malformation: case report.

Paragangliomas are rare tumours that arise from extra-adrenal chromaffin cells or neuroectodermal chemoreceptor. They are high vascularised and can be functional, secreting catecholamines and other peptides. They occur anywhere from the skull base to the pelvic floor, within the paraganglion system. We present a case of paraganglioma with unusual location, atypical presentation and interesting vascular anatomy.