Abhijeet Ashok Salunke

Intramuscular schwannoma: Clinical and magnetic resonance imaging features

INTRODUCTION Schwannomas that arise within the muscle plane are called intramuscular schwannomas. The low incidence of these tumours and the lack of specific clinical features make preoperative diagnosis difficult. Herein, we report our experience with intramuscular schwannomas. We present details of the clinical presentation, radiological diagnosis and management of these tumours. METHODS Between January 2011 and December 2013, 29 patients were diagnosed and treated for histologically proven schwannoma at the National University Hospital, Singapore. Among these 29 patients, eight (five male, three female) had intramuscular schwannomas. RESULTS The mean age of the eight patients was 40 (range 27-57) years. The most common presenting feature was a palpable mass. The mean interval between surgical treatment and the onset of clinical symptoms was 17.1 (range 4-72) months. Six of the eight tumours (75.0%) were located in the lower limb, while 2 (25.0%) were located in the upper limb. None of the patients had any preoperative neurological deficits. Tinels sign was present in one patient. Magnetic resonance (MR) imaging showed that the findings of split-fat sign, low signal margin and fascicular sign were present in all patients. The entry and exit sign was observed in 4 (50.0%) patients, a hyperintense rim was observed in 7 (87.5%) patients and the target sign was observed in 5 (62.5%) patients. All patients underwent microsurgical excision of the tumour and none developed any postoperative neurological deficits. CONCLUSION Intramuscular schwannomas demonstrate the findings of split-fat sign, low signal margin and fascicular sign on MR imaging. These findings are useful for the radiological diagnosis of intramuscular schwannoma.

Surgical management of pelvic bone sarcoma with internal hemipelvectomy: Oncologic and Functional outcomes

INTRODUCTION The management of pelvic sarcoma is challenging and goals of surgery are adequate oncologic local control, maintenance of optimum function with good quality of life. METHODS We have evaluated the results of internal hemipelvecotmy including age, type of resection, reconstruction, radiotherapy or chemotherapy. From 2010 to 2016, 23 patients with pelvic bone tumors (13 with Ewings sarcoma, 9 with Osteosarcoma, 1 with chondrosarcoma) were treated by surgical resection. RESULTS The mean follow-up was 18 months (0.5-5) years. In 12 patients reconstruction was performed and 11 were without reconstruction. A total of 3 patients (13%) had an infection develop at a mean follow up of 1 month. Surgical debridements and antibiotics in three patients led to complete recovery. One patient had sciatic nerve injury.One patient had injury to femoral vein; was treated with femoral vein reconstruction. Two patients (9%) developed a local recurrence and were treated with best supportive treatment. Distal pulmonary metastases were seen in four patients and treated with supportive treatment. Five-year disease-specific survival rates of all patients were 83%. The mean functional MSTS score was 18(14-24). CONCLUSIONS Proper selection of patients, preopertive planning and wide surgical margins with reconstruction provides good functional outcomes following internal hemipelvectomy. The surgical site infection and flap necrosis tend to be minor complication and can be managed leading to optimal outcomes and justifies the need for this complex surgery. The oncological and functional outcome after internal hemipelvectomy suggests that its an effective method for treatment of patients with pelvic sarcomas.

Angiomyofibroblastoma of the Foot: a Rare Soft Tissue Tumor at Unusual Site

Angiomyofibroblastoma is a rare benign soft tissue tumor that arises predominantly in the female genital tract. It occurs less commonly in the scrotum, spermatic cord, and the retroperitoneum. Its diagnosis is based on specific histological and immunopathological features. However, the condition has never been previously described in the extremities. We present the first case report of angiomyofibroblastoma presenting as a slow-growing tumor in the foot of a 48-year-old lady.

Intraosseous Ganglion Cyst of Scaphoid: An Uncommon Cause of Radial Wrist Pain

Intraosseous ganglion cyst is a rare bone tumor and the lesion could often be missed. The diagnosis could be delayed so proper radiologic investigation and index of suspicion is necessary .Differential diagnoses of painful cystic radiolucent carpal lesion are osteoid osteoma, osteoblastoma and intraosseous ganglion. Curettage of the scaphoid lesion and filling of void with bone graft provides good functional outcomes. The cyst contains mucoid viscous material without epithelial or synovial lining. We present a case of 30 years old male with intraosseous ganglion cyst of scaphoid which was treated with curettage and bone grafting. Rarely ganglion cyst is found in small bones of hand and should be considered as differential diagnosis of chronic radial wrist pain.

Osteosarcoma of the talus misdiagnosed as ankle arthritis: a case report

We present a 65-year-old man with osteosarcoma of the talus that was misdiagnosed as osteoarthritis. The patient eventually underwent below-knee amputation and adjuvant chemotherapy.

“Banana patella”, fibrous dysplasia of patella: A rare case report

Introduction Patella is a very uncommon site for primary bone tumours and fibrous dysplasia lesion in patella has never been reported. Fibrous dysplasia is a benign fibrosseous lesion of the bone where the fibrous connective tissue replaces the normal bone. Case report We report a case of 23 years female with 7 years history of progressive swelling and anterior knee pain. Radiographs showed enlarged, deformed patella like a shape of banana. The patient underwent patellectomy with extensor mechanism repair and biopsy proved to be fibrous dysplasia. Conclusion Fibrous dysplasia involving patella is very rare and never been reported earlier. Although primary patellar neoplasm are not common but should be kept in mind in chronic anterior knee pain with swelling for early diagnosis and intervention with intralesional therapy otherwise patellectomy has to be done in more advanced, deformed and enlarged lesions.

Giant cell tumor of distal radius treated with ulnar translocation and wrist arthrodesis: What are the functional outcomes?

Introduction: The aim is to analyze the functional outcomes of patients of giant cell tumor (GCT) of distal radius treated with ulnar translocation and wrist arthrodesis. Methods: Study included 25 patients of aggressive GCT of distal radius, resected and reconstructed using ulnar translocation and wrist arthrodesis. The ulna-carpal radius fixation was performed with plate and screws. The patients were followed to bony union and minimum follow-up was 1 year. Result: Twenty-two patients were of Campanacci grade 3 and three patients were of Campanacci grade2. The mean follow-up was of 23 months (12–36). All patients had an excellent range of pronation and supination. The mean Musculoskeletal Tumor Society score was 24 (range 22–28). Grip strength of affected hand compared to the contra lateral hand was found good in 17 cases and average in 7 cases. The mean bone union time at ulna to radius junction was at 6.5 (5–8) months and ulna to carpal junction at 4.5 (4–6) months. The complications were surgical site infection (one case), recurrence (one case) and failure of union (one case), and ulna graft fracture with implant failure in (two cases). Conclusion: Reconstruction of distal end of radius using ulnar translocation and wrist arthrodesis provides excellent functional outcomes with preservation of rotational movement of forearm and hand function. Reconstruction of the distal radius by ulnar translocation without complete detachment from surrounding soft tissues functions like vascularized graft without use of microvascular techniques.

HOFFA’S FRACTURE WITH IRREDUCIBLE PATELLAR DISLOCATION: APPROACH TO AVOID COMPLICATIONS IN A RARE INJURY

Hoffa’s fracture is coronal oriented fracture of distal femur with the fracture line extending through the femoral condyles. Hoffa’s fracture is rarely associated with ipsilateral femur and tibia fractures. Proper clinical examination and radiographic evaluation is necessary to diagnose associated injuries around the knee joint with Hoffa’s fracture. Closed reduction of dislocated patella in emergency room and field triage should be avoided to prevent patellar tendon incarcenation, patellar tendon rupture and osteochondral damage. We report a rare case of Hoffa’s fracture with irreducible patellar dislocation and tibial intercondylar eminence fracture following road traffic accident.

Segmental excision versus intralesional curettage with adjuvant therapy for giant cell tumour of bone

To the Editor: We read with interest the article by Yacob et al. 1 The authors concluded that local recurrence of giant cell tumour (GCT) of bone was not associated with surgical option. Can the authors advise whether any patient had pathological fracture; what the characteristics of the pathological fracture were, for example timing, displacement pattern, and intraarticular extension. Did patients with pathological fracture have a similar outcome to those without? What was the outcome following curettage? In one study, patients with and without a pathological fracture at the time of presentation have a comparable local recurrence rate. 2 The presence of a pathological fracture should not preclude the option of curettage. 2 Was the outcome different in patients with GCT of the ulna or radius? Most such tumours are resected rather than curetted. 3 Was there any adjuvant used following curettage and was burr used to provide extended curettage?

Letter to the Editor: Wrist fusion through centralisation of the ulna for recurrent giant cell tumour of the distal radius.

To the Editor: We read with interest the article by Meena et al.1 It would have been great if the authors had provided data on functional outcome based on the modified Musculoskeletal Tumor Society (MSTS) score, as well as grip strength and range of motion of the metacarpophalangeal joint. In one study, the mean MSTS score was 26 (87%; range, 20–28).2 In another, the grip strength at final follow-up in 25 patients without recurrence or failure was reported to be good in 12, fair in 10, and poor in 3.3