RESUMEN
INTRODUCTION AND IMPORTANCE: Aggressive fibromatosis or desmoid tumour is a rare soft tissue tumour that develops from supporting tissues and fascia. Although benign, fibromatosis is a tumour that can be locally invasive, and surgical treatment is often difficult. The interest of this observation is to show the particular characteristics of desmoid tumours: the frequency, the major difficulties of excision and the role of adjuvant treatment in the management of these tumours. CASE PRESENTATION: The patient was 27 years old male, and had a pathological history of a recurrent desmoid tumour on the dorsal surface of the right foot, which had been present for 10 years, had been operated on 5 times and could not be completely removed. A radiological work-up confirmed the nature of the lesion, necessitating a biopsy, which confirmed the diagnosis of a recurrence of the desmoid tumour on the sole of the foot. CLINICAL DISCUSSION: Desmoid tumour is a rare tumour with less than 5 cases per million inhabitants, histologically benign and belonging to the deep fibromatosis group. The average age is 30, with a predominance of women. The most common location for desmoid tumours is the abdominal wall, and they are usually single and unilateral. The treatment of desmoid tumours is primarily surgical, but is fraught with technical difficulties due to the absence of any cleavage plane and the particularly tight adhesions to neighbouring structures. Radiotherapy or hormone therapy has been advocated as an adjunct to tumour resection, but its value is debated, and recurrence occurs in 50-80 % of cases. CONCLUSION: The desmoid tumour is a very rare tumour, with an infiltrating and aggressive benign character, whose surgical treatment is difficult, and whose evolution is marked by recurrences.
RESUMEN
INTRODUCTION: Myxoma, a benign and uncommon tumor, is primarily characterized by undifferentiated spindle cells and a myxoid matrix with muscular infiltration. While the intramuscular form is predominant, the juxta-articular variant is rare, especially in the foot. Juxta-articular myxomas had a heightened risk of recurrence post-surgical excision, emphasizing the need for effective management strategies. CASE PRESENTATION: We report the first description in the literature of a myxoma in the foot with bone invasion in a 59-year-old male with a ten-month history of a progressively enlarging antero-internal swelling near the base of the first metatarsal in the left foot. Clinical examination and imaging revealed erosive changes in the bone, prompting excision-curettage. Histopathological examination confirmed the presence of a juxta-articular myxoma, an exceptionally rare localization. The patient exhibited satisfactory outcomes at the 13-month follow-up. DISCUSSION: Myxomas, primarily occurring around the knee, are infrequently found in the foot, with juxta-articular presentation being exceptionally rare. Traumatic causes and osteoarthritis are debated etiopathogenic factors. Radiologically, bone involvement is atypical, and magnetic resonance imaging aids in diagnosis. Treatment involves surgical excision, often requiring additional procedures. Juxta-articular myxomas, despite sharing characteristics with intramuscular myxomas, are distinguished by location and a higher recurrence rate. CONCLUSION: This case contributes to the limited literature on myxomas localized in the foot, particularly with bone invasion. Histological diagnosis is crucial, and surgery is the mainstay of treatment despite the substantial recurrence risk. This report underscores the importance of vigilance in managing myxomas, especially in rare anatomical presentations, and advocates for ongoing research to enhance understanding and therapeutic approaches.
RESUMEN
Introduction and Significance. Synovial sarcoma, accounting for 7-8 % of malignant sarcomas, typically manifests in adulthood, but it is noteworthy that adolescents and children make up 30 % of reported cases. Contrary to its name, this malignancy often originates from multipotent stem cells rather than the synovium. This report highlights a rare case involving a 23-year-old male with a localized synovial sarcoma in the plantar region, underscoring the importance of recognizing radiological signs for an accurate diagnosis. CASE PRESENTATION: A 23-year-old male, a chronic smoker, presented with a 5-year history of a mass on the plantar region of the right foot. Following an excision biopsy, the tumor recurred after two years, significantly impacting mobility. Radiological imaging revealed a cloud-like soft tissue mass. Surgical biopsy confirmed biphasic synovial sarcoma. A multidisciplinary consultation guided the decision for transtibial amputation and adjuvant chemotherapy. Postoperatively, the patient experienced a superficial infection, effectively treated, with subsequent positive outcomes and successful prosthetic adaptation. DISCUSSION: Synovial sarcoma, a rare and aggressive soft tissue malignancy, predominantly affects young individuals and often develops peri-articularly, presenting diagnostic challenges. Imaging modalities, particularly MRI, play a pivotal role in diagnosis, showcasing characteristic features. The primary treatment involves surgical intervention, with chemotherapy and radiotherapy contributing to local control. Despite advancements, recurrence rates remain significant, necessitating vigilant follow-up. CONCLUSION: Synovial sarcoma of the extremities is characterized by insidious progression and a high metastatic risk. MRI, while nonspecific, is indispensable for diagnostic orientation, later confirmed through histological examination. Surgery remains the mainstay therapy, with radiotherapy and chemotherapy contributing to enhanced local control. The awareness of this rare malignancy and its diagnostic and therapeutic nuances is crucial for optimal patient management and outcomes.
RESUMEN
INTRODUCTION AND IMPORTANCE: Aneurysmal bone cysts (ABCs) are relatively uncommon tumor-like lesions that require careful management. Reporting such cases is crucial to highlight the importance of understanding the physiopathology and treatment options associated with ABCs. Literature-based writing emphasizes the significance of reporting cases like the one presented here. The aneurysmal bone cyst, classified as a Tumor Rich in Giant Cells according to the latest World Health Organization (WHO) classification of soft tissue and bone tumors, has posed several hypotheses and challenge. This aggressive form and rare localization of this lesion necessitates thorough discussions regarding its management. CASE PRESENTATION: We present a compelling case of a 37-year-old patient, without any specific pathological history, with a giant diaphyseal aneurysmal bone cyst located in the right femur. Remarkably, the lesion had been progressing for a decade, leading to extensive destruction of the entire femoral diaphysis despite undergoing previous surgical interventions. The patient's unique circumstances highlight the unpredictable behavior and destructive potential of aneurysmal bone cysts in rare anatomical locations. DISCUSSION AND CONCLUSION: This case underscores the need for a comprehensive understanding of aneurysmal bone cysts and their management. The utilization of denosumab, an inhibitor of the RANK/RANKL system, as a medical treatment in conjunction with surgery resulted in a favorable therapeutic response, including a reduction in tumor mass. The current WHO classification, recognizing ABCs as Tumors Rich in Giant Cells, consolidates previous hypotheses and enables the development of new therapeutic protocols. The integration of surgery and medical treatment holds promise for improving outcomes in patients with aneurysmal bone cysts. In conclusion, advancements in understanding the physiopathology and treatment options are crucial for developing effective therapeutic protocols to these aggressive forms of ABCs.
RESUMEN
Ollier disease is a rare genetic disorder characterized by the development of multiple enchondromas. The clinical manifestations of the disease vary widely, but patients often present with bone deformities and an increased risk of developing chondrosarcoma. Here, the authors present a case report of a 25-year-old male patient with a devastating and historic evolution of Ollier disease. Case presentation: At the age of 10, the patient developed a sub-centimeter mass in the first phalanx of the left middle finger, which subsequently grew in size. A biopsy was performed at the age of 14, which confirmed the diagnosis of chondroma. At the age of 14, the patient developed multiple large masses on the left hand, resulting in the amputation of his left hand. At 25 years old, the patient developed new masses in his contralateral hand and left foot. Discussion: Ollier disease is caused by somatic mutations in the PTH/PTHrP receptor gene, leading to the formation of multiple enchondromas. Patients with Ollier disease are at an increased risk of developing chondrosarcoma, which can be life-threatening. The diagnosis of Ollier disease is usually made based on clinical and radiographic findings, and genetic testing can confirm the diagnosis. Treatment is typically focused on managing the symptoms and preventing the development of chondrosarcoma. Conclusion: The authors presented a case report of a patient with a devastating and historic evolution of Ollier disease. This case highlights the importance of early diagnosis and management of this disease to prevent the development of chondrosarcoma and minimize the risk of complications. Further research is needed to better understand the underlying mechanisms of the disease and develop effective treatments.
RESUMEN
INTRODUCTION: Synovial sarcoma is a rare and aggressive soft tissue tumor that affects the para-articular regions of the large joints. It originates from mesenchymal cells with synovial differentiation. Its management remains surgical with wide excision. CASE PRESENTATION: We report a case of synovial sarcoma with rare localization that occurred in a 37-year-old man on the inner side of the right ankle, and we recall the clinical, radiological, and histological signs that allowed us to suggest the diagnosis as well as multidisciplinary management. DISCUSSION: Synovial sarcoma is a highly aggressive soft tissue tumor with a high risk of spreading. It is a deceptive tumor in some clinical and morphological aspects that may indicate benignity. Although non-specific, MRI is critical for guiding diagnosis, identifying prognostic criteria, and ensuring post-treatment follow-up. CONCLUSION: This rare case underlines the importance of evoking a synovial sarcoma in front of a mass of soft parts of the benign aspect of the ankle, as well as adapting the treatment in order to prevent possible metastases, especially in the lungs.
RESUMEN
Pure anterior bilateral shoulder dislocations are rare clinical features, especially in traumatic forms. They are most often posterior, occurring during an epileptic seizure. Few cases are described in the literature, and the mechanism varies from case to case. We report a specific case of pure bilateral anterior shoulder dislocation in a 29-year-old judo player following an accident during his training and discuss the circumstances, mechanism, treatment, and prognosis.