RESUMEN
CASE: We report a case of intraneural nodular fasciitis in the forearm initially suspected as a schwannoma, emphasizing the importance of accurate diagnosis. A 40-year-old woman presented with mass on the lateral aspect of her right forearm and radial neuropathy symptoms for 2 months. An excisional biopsy and histopathological examination confirmed nodular fasciitis. Postoperative evaluation at 4.5 years found no pain, paralysis, or recurrence. CONCLUSION: Awareness of nodular fasciitis is crucial to prevent misdiagnosis and unnecessary treatment. Despite its rapid growth, nodular fasciitis generally has an excellent prognosis without long-term consequences.
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Fascitis , Neuropatía Radial , Humanos , Femenino , Adulto , Fascitis/cirugía , Fascitis/patología , Fascitis/diagnóstico por imagen , Neuropatía Radial/etiología , Neuropatía Radial/cirugía , Nervio Radial/patología , Imagen por Resonancia Magnética , Antebrazo/cirugía , Antebrazo/patologíaRESUMEN
Lichen sclerosus (LS) is a chronic inflammatory dermatosis primarily affecting the genitalia, commonly characterized by pearly-white papules and plaques. Although predominantly affecting females, LS can manifest across all age groups, with a bimodal distribution observed in prepubescent girls and postmenopausal women. This case report presents an unusual instance of exclusive extragenital LS in a 10-year-old girl, showcasing hyperpigmented patches and wrinkled plaques resembling lichen planus on her forearms and lower legs. Histopathological analysis confirmed LS, revealing distinctive epidermal changes and lymphocytic infiltrates. The absence of mucosal involvement and unique clinical presentation differentiated this case from typical LS manifestations. Treatment with topical clobetasol propionate demonstrated significant improvement in pruritus. Extragenital LS is infrequent, particularly among children, and its diagnosis necessitates a comprehensive clinicopathological correlation. The reported case contributes valuable insights into this uncommon variant, emphasizing the importance of accurate diagnosis and tailored treatment strategies. Additionally, it highlights the efficacy of high-potency topical corticosteroids in managing this condition.
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Clobetasol , Liquen Plano , Liquen Escleroso y Atrófico , Humanos , Femenino , Niño , Liquen Plano/patología , Liquen Plano/tratamiento farmacológico , Liquen Escleroso y Atrófico/patología , Liquen Escleroso y Atrófico/tratamiento farmacológico , Clobetasol/uso terapéutico , Antebrazo/patología , Pierna/patologíaRESUMEN
INTRODUCTION: Mycetoma is a chronic granulomatous inflammatory disease of the subcutaneous tissue, which affects deep structures and bone. Most cases of actinomycetoma are caused by members of the genus Nocardia. CASE PRESENTATION: Here we report the case of a 43-year-old male who presented a disseminated mycetoma on the forearm, chest and neck, characterized by enlarged and erythematous lesions through which seropurulent material drains, and numerous atrophic scars. Molecular identification was performed by 16S gene amplification and sequencing. Nocardia mexicana was identified with 100% identity. Trimethoprim-sulfamethoxazole, diaminodiphenyl sulfone and amikacin was a successful treatment after 6 months. CONCLUSIONS: Nocardia mexicana is a rare organism that causes mycetoma. We report a case of extensive mycetoma on the forearm with spread to the neck and thorax associated with manipulation of the mouth of a calf.
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Antibacterianos , Antebrazo , Micetoma , Cuello , Nocardiosis , Nocardia , ARN Ribosómico 16S , Tórax , Humanos , Masculino , Adulto , Nocardia/aislamiento & purificación , Nocardia/genética , Micetoma/microbiología , Micetoma/tratamiento farmacológico , Micetoma/diagnóstico , Nocardiosis/microbiología , Nocardiosis/tratamiento farmacológico , Nocardiosis/diagnóstico , Antebrazo/microbiología , Antebrazo/patología , Tórax/diagnóstico por imagen , Tórax/microbiología , Cuello/patología , Antibacterianos/uso terapéutico , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , ADN Bacteriano/genética , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Amicacina/uso terapéutico , ADN Ribosómico/genética , ADN Ribosómico/químicaRESUMEN
A neurofibroma with focal glomus-like body differentiation is an unusual phenomenon recently encountered in an excision specimen from the right lateral distal forearm of a 26-year-old man. Glomus cells are modified smooth muscle cells normally present in glomus-like bodies but can also be found in glomus tumors (GT) or lesions considered in the spectrum of GT, including myopericytoma, myofibroma, and angiolipoma. Neurofibromas are peripheral nerve sheath tumors derived from the neural crest cells. While both GT and its variants and neurofibroma are thought to be derived from different cell types, there is growing evidence that glomus cells have a neural crest origin. This is based on multiple theories, with some overlapping pathways, including neural crest cell differentiation, Schwann cell reprogramming, VEGF expression, and NF1 gene biallelic inactivation. This report adds to the growing evidence of possible neural crest origin for glomus cells and would help explain finding glomus-like bodies scattered through a neurofibroma.
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Tumor Glómico , Neurofibroma , Humanos , Masculino , Adulto , Tumor Glómico/patología , Tumor Glómico/metabolismo , Tumor Glómico/genética , Neurofibroma/patología , Neurofibroma/metabolismo , Cresta Neural/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/metabolismo , Células de Schwann/patología , Células de Schwann/metabolismo , Antebrazo/patologíaRESUMEN
RATIONALE: Acute blockage of forearm supination has been reported in several studies. It is caused by loose bodies in the wrist joint, extensor carpi ulnaris tendon interposition, and distal radioulnar joint (DRUJ) injuries, including forearm bone fractures. Some studies have reported cases of DRUJ injuries caused by triangular fibrocartilage complex (TFCC) tears.We report a case of acute blockage of forearm supination after minor trauma and suggest a possible TFCC tear when a patient complains of forearm supination blocking. In addition, we present a comparison between our case and other reports on etiology, magnetic resonance imaging (MRI) findings, and arthroscopic findings, and show the specific characteristics of our case. PATIENTS CONCERNS: A 22-year-old male presented with left wrist pain as the chief complaint. He was injured 2 months prior to pushing his left hand on the floor during exercise. Physical examination showed a relative limitation of range of motion (ROM) in the left wrist of about 10° in flexion and about 15° in extension compared with the right side. The patient also complained of supination limitation and volar side wrist pain during supination. The patient showed tenderness in the axial compression test. DIAGNOSES: Plain radiographs showing no abnormalities. MRI showed a TFCC tear in the central portion. A torn flap of the TFCC was interposed on the volar side of the DRUJ. INTERVENTIONS: Arthroscopic surgery of the left wrist joint was performed. Arthroscopic examination revealed a tear in the TFCC on the radial side. A torn flap was interposed on the volar side of the DRUJ. We removed the flap from the DRUJ using an arthroscopic grasper and partially resected it. OUTCOMES: Intraoperative tests showed no locking and the forearm was well supinated. Two months after the surgery, the patient had no pain and showed full forearm supination. LESSONS: DRUJ blocking due to a TFCC tear should be suspected when acute blockage of forearm supination occurs after minor trauma. MRI is helpful for diagnosis; however, we suggest that the diagnosis should be confirmed through arthroscopy. Symptoms can be resolved by surgical treatment using arthroscopy.
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Inestabilidad de la Articulación , Lesiones de Menisco Tibial , Fibrocartílago Triangular , Traumatismos de la Muñeca , Masculino , Humanos , Adulto Joven , Adulto , Fibrocartílago Triangular/cirugía , Fibrocartílago Triangular/lesiones , Fibrocartílago Triangular/patología , Antebrazo/patología , Supinación , Lesiones de Menisco Tibial/patología , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/patología , Traumatismos de la Muñeca/diagnóstico , Dolor/patología , Artralgia/patología , Artroscopía/métodos , Inestabilidad de la Articulación/patologíaRESUMEN
A woman in her mid-20s presented to an Indian tertiary care hospital with pain in her left forearm. Extensive initial investigations led to a suspected diagnosis of a peripheral nerve sheath tumour; however, the pathological investigation of the excised tumour mass revealed it to be a case of isolated intramuscular cysticercosis in the forearm. Treatment for cysticercosis was commenced and the patient made a full recovery. Isolated intramuscular cysticercosis without the involvement of other organs is a rare presentation and has only been reported in a handful of case reports. We suggest that isolated intramuscular cysticercosis be considered a differential diagnosis in patients with isolated pain in their muscles and with no other symptoms, in patients with a presentation of solitary swelling and in patients at risk of parasitic infection. In addition, we emphasise the importance of histopathological examination due to the varied presentation of cysts.
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Cisticercosis , Quistes , Femenino , Humanos , Cisticercosis/patología , Antebrazo/patología , Músculos , Dolor , AdultoRESUMEN
In up to 2% of the population, benign tumours called lipomas can develop. When they are more than 5 cm, they are considered giant lipomas. Giant lipomas of the distal forearm and hand may cause compression to the underlying tissues, nerves and muscles, even though they are typically asymptomatic. An older woman with soft tissue swelling in her right wrist and forearm, and numbness and pain in her right hand presented to the general surgery outpatient clinic. Her numb fingers indicated that the median nerve was compressed, and an MRI scan of her wrist and forearm revealed median nerve compression due to a giant lipoma with a dimension of about 9.2×3.4×4 cm. A surgical excision was done with an intraoperative nerve stimulator, and the specimen sent for histopathology confirmed the diagnosis of lipoma. Pain, numbness and motor power improved within 1 week postoperatively, and the patient was discharged.
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Síndrome del Túnel Carpiano , Lipoma , Femenino , Humanos , Anciano , Muñeca/diagnóstico por imagen , Muñeca/patología , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/etiología , Síndrome del Túnel Carpiano/cirugía , Antebrazo/patología , Hipoestesia/etiología , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Dolor/complicacionesRESUMEN
AIM: To determine inter-reader analysis and diagnostic performance on digitally reconstructed virtual flexed, abducted, supinated (FABS) imaging from three-dimensional (3D) isotropic elbow magnetic resonance imaging (MRI). MATERIALS AND METHODS: Six musculoskeletal radiologists independently evaluated elbow MRI images with virtual FABS reconstructions, blinded to clinical findings and final diagnoses. Each radiologist recorded a binary result as to whether the tendon was intact and if both heads were visible, along with a categorical value to the type of tear and extent of retraction in centimetres where applicable. Kappa and interclass correlation (ICC) were reported with 95% confidence intervals. Areas under the receiver operating curve (AUC) were reported. RESULTS: FABS reconstructions were obtained successfully in all 48 cases. With respect to tendon intactness, visibility of both heads, and type of tear, the Kappa values were 0.66 (0.53-0.78), 0.24 (0.12-0.37), and 0.55 (0.43-0.66), respectively. For the extent of retraction, the ICC was 0.85 (0.79-0.91) when including the tendons with and without retraction and 0.78 (0.61-0.91) when only including tendons with retraction. For tear versus no tear, AUC values were 0.82 (0.74-0.89) to 0.96 (0.91-1.01). CONCLUSION: Digital reconstruction of FABS positioning is feasible and allows good assessment of individual tendon head tears and retraction with high diagnostic performance.
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Codo , Traumatismos de los Tendones , Humanos , Codo/diagnóstico por imagen , Codo/patología , Hombro/patología , Antebrazo/diagnóstico por imagen , Antebrazo/patología , Traumatismos de los Tendones/patología , Imagen por Resonancia Magnética/métodosRESUMEN
Congenital infantile fibrosarcoma (CIFS) is a rare malignant soft tissue tumor. The incidence of fibrosarcoma is estimated to be 0.3 per 100 000 population per year, and it accounts for less than 1% of all soft tissue sarcomas. We present a case of a 7-day-old newborn with a large ulcerated and necrotic lesion on the left forearm, which was initially misdiagnosed as rhabdomyosarcoma. Magnetic resonance imaging (MRI) revealed a soft tissue mass with cystic components affecting the forearm and distal humerus muscles. Fine-needle biopsy was performed and initially diagnosed as rhabdomyosarcoma but later confirmed as low-grade fibrosarcoma with positive immunostaining for vimentin. The patient underwent a transhumeral amputation with follow-up chemotherapy at a specialized oncology center. This case underscores the importance of interdisciplinary collaboration and specialized care in managing complex medical conditions in infants. Early detection and appropriate management of these tumors are essential for improving outcomes and reducing morbidity and mortality. Despite the rarity of this case, it serves as a reminder of the importance of considering neoplastic lesions in the differential diagnosis of soft tissue masses in newborns.
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Fibrosarcoma , Rabdomiosarcoma , Neoplasias de los Tejidos Blandos , Humanos , Recién Nacido , Diagnóstico Diferencial , Fibrosarcoma/diagnóstico , Fibrosarcoma/congénito , Fibrosarcoma/patología , Antebrazo/patología , Rabdomiosarcoma/diagnóstico , Rabdomiosarcoma/patología , Neoplasias de los Tejidos Blandos/diagnóstico , Neoplasias de los Tejidos Blandos/congénito , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
OBJECTIVE: Lipomas are very common tumors which usually prefer the upper limbs and, depending on their size, may cause nerve compression, or may be asymptomatic. The current cadaveric report describes a giant lipoma in the distal forearm area. CASE REPORT: A large mass (5.1 × 3.2 × 1.6 cm) was identified on the palmar surface of the distal forearm, during dissection of a 63-year-old male cadaver. The mass caused anteromedial displacement and flattening of the median nerve (MN). Despite the lack of information about the subject's medical history, MN compression was assumed on the basis of the lipoma's size, its vicinity to neural structures, and the MN displacement and flattening. CONCLUSION: The enlarged distal forearm lipoma, located adjacent to the carpal tunnel, displaced and flattened the MN. The cadaveric finding described is clinically relevant for both differential diagnosis and surgical treatment of carpal tunnel syndrome.
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Síndrome del Túnel Carpiano , Lipoma , Humanos , Masculino , Persona de Mediana Edad , Cadáver , Antebrazo/patología , Lipoma/complicaciones , Lipoma/patología , Lipoma/cirugía , Nervio Mediano , Muñeca/patología , Muñeca/cirugíaRESUMEN
Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3-7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.
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Neuropatía Radial , Masculino , Humanos , Neuropatía Radial/cirugía , Constricción , Extremidad Superior/patología , Nervio Radial/cirugía , Antebrazo/patología , Constricción Patológica/cirugíaAsunto(s)
Tumores de Células Gigantes , Neoplasias de los Tejidos Blandos , Humanos , Antebrazo/patología , Tumores de Células Gigantes/diagnóstico por imagen , Tumores de Células Gigantes/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/cirugía , Extremidad SuperiorRESUMEN
INTRODUCTION: Acute plastic deformation refers to a traumatic bending or bowing without a detectable cortical defect. CASE PRESENTATION AND DISCUSSION: We describe a rare case from an individual that was exhumed from the Hispano-Mudejar necropolis in Uceda (Guadalajara, Spain) dated between the 13th and 14th centuries AD. The case corresponds to an adult woman, with a bowing involvement of the left ulna and radius. After making the differential diagnosis with various pathologies likely to present with this alteration, we reached the diagnosis of acute plastic deformation of the forearm through external and radiological examination and comparison with the healthy contralateral forearm. CONCLUSIONS: Acute plastic deformation is a rare traumatic injury, not described until the last century and only rarely described in palaeopathological contexts. We contribute a new case, the first being sufficiently documented, contributing to the knowledge and diagnosis of this type of trauma in the ancient bone, while deepening the knowledge of the living conditions of the medieval Mudejar population of Uceda.
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Traumatismos del Antebrazo , Antebrazo , Adulto , Femenino , Humanos , Antebrazo/patología , Traumatismos del Antebrazo/patología , Historia Medieval , Radio (Anatomía)/lesiones , Radio (Anatomía)/patología , Cúbito/lesiones , Cúbito/patologíaRESUMEN
CASE: We present a case of a patient who suffered from wrist swelling and had symptoms of carpal tunnel syndrome. The patient underwent ultrasound and magnetic resonance imaging, in which signs of joint effusion and a fatty synovial lesion were presented. The treatment included open excision of the tumor. In addition, the palmaris longus muscle had an anatomic variation with proximal and distal tendon portions. The histopathological examination disclosed lipoma arborescens of the synovial membranes of the joints. CONCLUSION: The recognition of this entity and its characteristics are important not only for correct diagnosis but also for the appropriate treatment.
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Variación Anatómica , Lipoma , Codo/patología , Antebrazo/patología , Humanos , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Músculo Esquelético/patologíaRESUMEN
Parosteal lipoma is a rare benign soft tissue mesenchymal tumour that may impair limb motor function when located adjacent to neurovascular structures. We report a case of a woman in her 80s with a long-standing lesion in the forearm and consequent sensory and motor function changes. She was admitted for an elective excision of the lipoma. Postoperative evolution was favourable, with marked improvement of limb function. Our aim in sharing this case is to create awareness of these rare deep-seated lipomas that might originate nerve palsy and should therefore be excised as soon as possible to avoid neurological damage.
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Neoplasias Óseas , Lipoma , Neoplasias de los Tejidos Blandos , Neoplasias Óseas/patología , Femenino , Antebrazo/patología , Humanos , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Parálisis/etiología , Radio (Anatomía)/patología , Neoplasias de los Tejidos Blandos/cirugíaRESUMEN
Inclusion body myositis (IBM) is a slowly progressive muscle weakness of distal and proximal muscles, which is diagnosed by clinical and histopathological criteria. Imaging biomarkers are inconsistently used and do not follow international standardized criteria. We conducted a systematic review and meta-analysis to investigate the diagnostic value of muscle ultrasound (US) in IBM compared to healthy controls. A systematic search of PubMed/MEDLINE, Scopus and Web of Science was performed. Articles reporting the use of muscle ultrasound in IBM, and published in peer-reviewed journals until 11 September 2021, were included in our study. Seven studies were included, with a total of 108 IBM and 171 healthy controls. Echogenicity between IBM and healthy controls, which was assessed by three studies, demonstrated a significant mean difference in the flexor digitorum profundus (FDP) muscle, which had a grey scale value (GSV) of 36.55 (95% CI, 28.65-44.45, p < 0.001), and in the gastrocnemius (GC), which had a GSV of 27.90 (95% CI 16.32-39.48, p < 0.001). Muscle thickness in the FDP showed no significant difference between the groups. The pooled sensitivity and specificity of US in the differentiation between IBM and the controls were 82% and 98%, respectively, and the area under the curve was 0.612. IBM is a rare disease, which is reflected in the low numbers of patients included in each of the studies and thus there was high heterogeneity in the results. Nevertheless, the selected studies conclusively demonstrated significant differences in echogenicity of the FDP and GC in IBM, compared to controls. Further high-quality studies, using standardized operating procedures, are needed to implement muscle ultrasound in the diagnostic criteria.
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Miositis por Cuerpos de Inclusión , Antebrazo/diagnóstico por imagen , Antebrazo/patología , Humanos , Debilidad Muscular , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Miositis por Cuerpos de Inclusión/diagnóstico por imagen , Ultrasonografía/métodosRESUMEN
Recently, the number of survivors that had oral cancer has increased, but deterioration in the quality of life of patients concerning oral function and cosmetic appearance has become problematic. Prosthodontic dentures usefully treat jaw defects after maxillary resection for cancer, but advances in microsurgery have rendered the possibility to reconstruct maxillary defect and oral cavity using a microvascular flap. Here, we describe 2-stage treatment after 35 years postoperatively. We restored the maxillofacial function using microvascular flaps and partial denture. The patient was a 59-year-old woman who underwent left lateral maxillectomy 35 years previously to treat an advanced left maxilla gingival carcinoma. A maxillary prosthesis was applied, requiring repeated adjustments and refabrications. The patient visited to obtain improvements for oral and maxillofacial functions and long-term quality of life. The left maxillary bone defect was 45×50 mm in area. Collaborating with the Department of Plastic and Reconstructive Surgery, the patient underwent reconstructive treatment using a microvascular forearm flap and partial denture. The patient's progress was excellent; eating, swallowing, and articulation improved. For 1 year postoperatively, the patient was satisfied with the results.