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Journal of Bone and Soft Tissue Tumors (JBST) is the official Journal of The Indian Musculo Skeletal Oncology Society
Diagnostic Comparison of F-18 Sodium FluorideNaF, Bone Scintigraphy, and F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Detection of Bone Metastasis
Vol 5 | Issue 1 | Jan-April 2019 | page: 9-12 | Zehra PınarP Koç, Pelin Ö Kara, Emel Sezer, Vehbi Erçolak
Authors: Zehra PınarP Koç [1], Pelin Ö Kara [1], Emel Sezer [2], Vehbi Erçolak [2]
[1] Department of Nuclear Medicine, Mersin University, Mersin/, Turkey.,
[2] Department of Oncology, Mersin University, Mersin, Turkey. Mersin/Turkey.
Address of Correspondence
Dr. Zehra PınarP ınar Koç,
Mersin University Nuclear Medicine Dpt., Mersin – 33343, Turkey.
E-mail: zehrapinarkoc@gmail.com
Abstract
Objective: The aim of this study is to compare the diagnostic efficiency of bone scintigraphy, fluorodeoxyglucose (FDG), and sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) in the evaluation of bone metastasis of the several malignant tumors.
Materials and Methods: A total of Thirteen13 patients (9nine Ffemales and, 4four Mmales; mean 62,.3 ± 7,.1 years) with diagnosis of different malignant tumors were included in the study. The comparison of bone scintigraphy, FDG, and NaF PET/CT results were was performed retrospectively.
Results: The NaF PET/CT demonstrated all the metastatic patients in this series; however, FDG PET/CT missed 7/13 and bone scintigrapyhy 1/13 of the patients with bone metastasis. NaF PET/CT showed significantly higher number of metastatic lesions in all the patients.
Conclusion: The lesion- based analysis showed that NaF PET/CT is significantly superior to FDG PET/CT and bone scintigraphy and patient- based analysis lower detection rate for the FDG PET/CT.
Keywords: Bone, scintigraphy, metastasis, sodium fluorideNaF, fluorodeoxyglucosefdg.
References
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2. Sampath SC, Sampath SC, Mosci C, Lutz AM, Willmann JK, Mittra ES, et al. Detection of osseous metastasis by 18F-NaF/18F-FDG PET/CT versus CT alone. Clin Nucl Med 2015;40:e173-7.
3. Harisankar CN, Agrawal K, Bhattacharya A, Mittal BR. F-18 fluoro-deoxy-glucose and F-18 sodium fluoride cocktail PET/CT scan in patients with breast cancer having equivocal bone SPECT/CT. Indian J Nucl Med 2014;29:81-6.
4. Roop MJ, Singh B, Singh H, Watts A, Kohli PS, Mittal BR, et al. Incremental value of cocktail 18F-FDG and 18F-NaF PET/CT over 18F-FDG PET/CT alone for characterization of skeletal metastasesin breast cancer. Clin Nucl Med 2017;42:335-40.
5. Chan HP, Hu C, Yu CC, Huang TC, Peng NJ. Added value of using a cocktail of F-18 sodium fluoride and F-18 fluorodeoxyglucose in positron emission tomography/computed tomography for detecting bony metastasis: A case report. Medicine (Baltimore) 2015;94:e687.
6. Iagaru A, Mittra E, Mosci C, Dick DW, Sathekge M, Prakash V, et al. Combined 18F-fluoride and 18F-FDG PET/CT scanning for evaluation of malignancy: Results of an international multicenter trial. J Nucl Med 2013;54:176-83.
7. Gradishar WJ, Anderson BO, Balassanian R, Blair SL, Burstein HJ, Cyr A, et al. NCCN Clinical Practice Guidelines in Oncology Breast Cancer Version 2; 2016. Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. [Last accessed on 2016 Oct 19].
8. Yoon SH, Kim KS, Kang SY, Song HS, Jo KS, Choi BH, et al. Usefulness of (18)F-fluoride PET/CT in breast cancer patients with osteosclerotic bone metastases. Nucl Med Mol Imaging 2013;47:27-35.
9. Israel O, Goldberg A, Nachtigal A, Militianu D, Bar-Shalom R, Keidar Z, et al. FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging 2006;33:1280-4.
10. Lapa P, Saraiva T, Silva R, Marques M, Costa G, Lima JP. Superiority of 18F-Fna PET/CT for detecting bone metastases in comparison with other diagnostic ımaging modalities. Acta Med Port 2017;30:53-60.
11. Araz M, Aras G, Küçük ÖN. The role of 18F-NaF PET/CT in metastatic bone disease. J Bone Oncol 2015;4:92-7.
12. Schirrmeister H, Glatting G, Hetzel J, Nüssle K, Arslandemir C, Buck AK. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2001;42:1800-4.
13. Piccardo A, Puntoni M, Morbelli S, Massollo M, Bongioanni F, Paparo F, et al. 18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-naF PET/CT. Nuklearmedizin 2015;54:163-72.
14. Iagaru A, Young P, Mittra E, Dick DW, Herfkens R, Gambhir SS. Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clin Nucl Med 2013;38:e290-6.
15. Hillner BE, Siegel BA, Hanna L, Duan F, Quinn B, Shields AF. 18F-fluoride PET used for treatment monitoring of systemic cancer therapy: Results from the national oncologic PET registry. J Nucl Med 2015;56:222-8.
16. Iagaru A, Mittra E, Dick DW, Gambhir SS. Prospective evaluation of (99m)Tc MDP scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CTfor detection of skeletal metastases. Mol Imaging Biol 2012;14:252-9.
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Tumour-like Lesions—- Are We Over Treating Them?
Vol 5 | Issue 1 | Jan-April 2019 | page: 3-8 | Dominic Puthoor, Dijoe Davis
Authors: Dominic Puthoor [1], Dijoe Davis [1].
[1] Department of Orthopedics, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
Address of Correspondence
Dr. Dominic Puthoor,
Orthopedic Oncologist, Amala Institute of Medical Sciences, Thrissur, Kerala, India.
E-mail: dkputhur@gmail.com
Abstract
Introduction: Tumour-like lesions of the bone is area frequently used term but has have not yet been clearly defined. There are no definite guidelines available for their management. The present study was aimed to evaluate the tumour-like lesions and their management.
Case Report: A total of 164 cases of tumour-like lesions managed by the senior author in a Cancer Institute during the past three decades were systematically analyzed. By and large non-aggressive and non-operative treatment was given in all conditions. Outcome of conservative management of tumour-like lesions was very encouraging on long-term follow-up .
Conclusions: Most of the cases with lesser interventions produced better results. They need to be treated only if they are symptomatic or likely to produce a pathological fracture. Even in such situations, one need not take a radical approach.
Keywords: Tumour-like lesions, Cystic lesions, Fibrous lesions.
References
1. Dominic KP, Dijoe D, Manathara LT. Tumour like lesions and their management: A retrospective study. Int J Res Orthop 2018;4:159-65.
2. Puthur DK. Tumour like lesions: Understand the difference. Kerala J Orthopaedics 2013;26:137-41.
3. Mohan H. Text Book of Pathology. 7th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.; 2015. p. 828.
4. Szendröi M, Sim FL. Color Atlas of Clinical Orthopedics. Berlin Heidelberg: Springer Verlag; 2009. p. 209-29.
5. Motamedi K, Seeger LL. Benign bone tumors. Radiol Clin North Am 2011;49:1115-34, 5.
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9. Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R, et al. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up. J Bone Joint Surg Br 2006;88:1212-6.
10. Varshney MK, Rastogi S, Khan SA, Trikha V. Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts? Clin Orthop Relat Res 2010;468:1649-59.
11. Balach T, Stacy GS, Peabody TD. The clinical evaluation of bone tumors. Radiol Clin North Am 2011;49:1079-93, 5.
12. Bhardwaj JR, Deb P. Boyd’s Text Book of Pathology.10th ed. Philadelphia, PA: Williams and Wilkins; 2013. p. 1676.
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19. Donati D, Frisoni T, Dozza B, DeGroot H, Albisinni U, Giannini S, et al. Advance in the treatment of aneurysmal bone cyst of the sacrum. Skeletal Radiol 2011;40:1461-6.
20. Dicprio M, Enneking W. Current concept review of fibrous dyplasia pathophysiology evolution and treatment. J Bone Joint Surg 2005;87:1848-63.
21. Meredith DS, Healey JH. Twenty-year follow-up of monostotic fibrous dysplasia of the second cervical vertebra a case report and review of the literature. Investigation performed at memorial Sloan-Kettering cancer center. Bone Joint Surg Am 2011;93:e74.
22. Kim SH, Smith SE, Mulligan ME. Hematopoietic tumors and metastases involving bone. Radiol Clin North Am 2011;49:1163-83, 6.
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26. Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 1989;249:256-64.
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Preliminary Results of Curettage and Cementation in the Treatment of Fibrous Dysplasia of the Proximal Radius
Vol 5 | Issue 1 | Jan-April 2019 | page: 13-16 | Ismail Tawfeek Badr, Sanjiv Rampal Ahmed Shahin
Authors: Ismail Tawfeek Badr [1], Sanjiv Rampal [2], Ahmed Shahin [1]
[1] Department of Orthopaedic, Faculty of Medicine, Menoufia University, Faculty of Medicine, Egypt.
[2] Department of Orthopeaedic Department, Faculty of Medicine, Putra University, Faculty of Medicine, Malaysia.
Address of Correspondence
Dr. Ismail Tawfeek Badr,
Department of Orthopaedic, Faculty of Medicine, Menoufia University, Egypt.
E-mail: ismail.tawfeek@yahoo.com
Abstract
Introduction: Fibrous dysplasia (FD)is a benign pathological condition usually observed in the first three decades of life. A single bone may be involved either wholly or partially, or multiple bones may be affected, we aimed to use curettage and cementation as a control method of FDfibrous dysplasia of the proximal radius.
Methods: We describe our finding with the treatment of FDfibrous dysplasia of the proximal radius in five patients(four females and, one male), the mean age of 28.6 years (22 to –39 years). The lesions were in the metaphysis extending to the diaphysis. Persistent pain and pain after pathological fracture were the indications for surgical intervention. We used an extensile approach to expose the lesion then extended curettage using a high-speed burr and filling the cavity with bone cement. Functional outcome and radiological findings were monitored on follow-up visits.
Results: The mean follow-up period was 3.2 years (ranged from 2 years to 5 years).There waswereno recurrences and no patient sustained a fracture at the end of the filling cement. At the time of the last follow-up, all patients have excellent score(mean 27 points) according to the musculoskeletal tumor society scoring system.
Conclusion: Extended curettage and cementation provide a safe and reliable alternative for control of FDfibrous dysplasia of the proximal radius with little morbidity with little risk of recurrence and low incidence of complications.
Keywords: Fibrous dysplasia, Curettage, Cement.
References
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2. Chapurlat RD, Meunier PJ. Fibrous dysplasia of bone. Best Pract Res Clin Rheumatol 2000;14:385-98.
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4. Hart ES, Kelly MH, Brillante B, Chen CC, Ziran N, Lee JS, et al. Onset, progression, and plateau of skeletal lesions in fibrous dysplasia and the relationship to functional outcome. J Bone Miner Res 2007;22:1468-74.
5. Kelly MH, Brillante B, Collins MT. Pain in fibrous dysplasia of bone: Age-related changes and the anatomical distribution of skeletal lesions. Osteoporos Int 2008;19:57-63.
6. Smith SE, Kransdorf MJ. Primary musculoskeletal tumors of fibrous origin. Semin Musculoskelet Radiol 2000;4:73-88.
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8. Guille JT, Kumar SJ, MacEwen GD. Fibrous dysplasia of the proximal part of the femur. Long-term results of curettage and bone-grafting and mechanical realignment. J Bone Joint Surg Am 1998;80:648-58.
9. Leet AI, Boyce AM, Ibrahim KA, Wientroub S, Kushner H, Collins MT, et al. Bone-grafting in polyostotic fibrous dysplasia. J Bone Joint Surg Am 2016;98:211-9.
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12. Cutler CM, Lee JS, Butman JA, FitzGibbon EJ, Kelly MH, Brillante BA, et al. Long-term outcome of optic nerve encasement and optic nerve decompression in patients with fibrous dysplasia: Risk factors for blindness and safety of observation. Neurosurgery 2006;59:1011-7.
13. Leet AI, Magur E, Lee JS, Wientroub S, Robey PG, Collins MT, et al. Fibrous dysplasia in the spine: Prevalence of lesions and association with scoliosis. J Bone Joint Surg Am 2004;86-A:531-7.
14. Kumta SM, Leung PC, Griffith JF, Kew J, Chow LT. Vascularised bone grafting for fibrous dysplasia of the upper limb. J Bone Joint Surg Br 2000;82:409-12.
15. Plotkin H, Rauch F, Zeitlin L, Munns C, Travers R, Glorieux FH, et al. Effect of pamidronate treatment in children with polyostotic fibrous dysplasia of bone. J Clin Endocrinol Metab 2003;88:4569-75.
16. Leet AI, Collins MT. Current approach to fibrous dysplasia of bone and mcCune-albright syndrome. J Child Orthop 2007;1:3-17.
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18. Keijser LC, Van Tienen TG, Schreuder HW, Lemmens JA, Pruszczynski M, Veth RP, et al. Fibrous dysplasia of bone: Management and outcome of 20 cases. J Surg Oncol 2001;76:157-66.
19. Stanton RP, Ippolito E, Springfield D, Lindaman L, Wientroub S, Leet A. The surgical management of fibrous dysplasia of bone. Orphanet J Rare Dis 2012;7:S1.
20. Bryant DD 3rd, Grant RE, Tang D. Fibular strut grafting for fibrous dysplasia of the femoral neck. J Natl Med Assoc 1992;84:893-7.
21. Shih HN, Chen YJ, Huang TJ, Hsu KY, Hsu RW. Treatment of fibrous dysplasia involving the proximal femur. Orthopedics 1998;21:1263-6.
22. Weiland AJ, Moore JR, Daniel RK. Vascularized bone autografts. Experience with 41 cases. Clin Orthop Relat Res 1983;174:87-95.
23. Errani C, Ruggieri P, Asenzio MA, Toscano A, Colangeli S, Rimondi E, et al. Giant cell tumor of the extremity: A review of 349 cases from a single institution. Cancer Treat Rev 2010;36:1-7.
24. Gitelis S, Mallin BA, Piasecki P, Turner F. Intralesional excision compared with en bloc resection for giant-cell tumors of bone. J Bone Joint Surg Am 1993;75:1648-55.
25. Keçeci B, Küçük L, Isayev A, Sabah D. Effect of adjuvant therapies on recurrence in aneurysmal bone cysts. Acta Orthop Traumatol Turc 2014;48:500-6.
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Unusual presentation of Chordoma in distal radius
Vol 4 | Issue 2 | July-Dec 2018 | Page 33-35 | Subin Sugath, Jayashree, Shrijith MB.
Authors: Subin Sugath [1], Jayashree [1], Shrijith MB [1].
[1] Dept of Regional Cancer Centre , Trivandrum.
Address of Correspondence
Dr. Subin Sugath
Dept of Regional Cancer Centre , Trivandrum,
Email:bhaskarsubin@gmail.com
Abstract
Chordoma is rarely seen in appendicular skeleton. Here we describe a rare case of chordoma occuring in distal radius. Radiograph showed ill defined lytic distal radius, meta diaphyseal lesion. IHC marker for Chordoma Brachyury was done (TMH , Mumbai), which came diffuse strongly positive- confirming the pre op diagnosis of Extra Axial Chordoma. He was treated with Wide resection of the distal radius and one bone forearm wrist arthrodesis
Keywords: Chordoma, extraxial, radius
References
1. Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012 Feb;13(2):e69-76.
2. Nielsen GP, Mangham DC, Grimer RJ, Rosenberg AE. Chordoma periphericum: a case report. Am J Surg Pathol 2001;25:263–7.
3. O’donnell P, Tirabosco R, Vujovic S, Bartlett W, Briggs TW, Henderson S, et al. Diagnosing an extraaxial chordoma of the proximal tibia with the help of brachyury, a molecule required for notochordal differentiation. Skeletal Radiol 2007;36:59–65.
4. Tirabosco R, Mangham DC, Rosenberg AE, Vujovic S, Bousdras K, Pizzolitto S, et al. Brachyury expression in extra-axial skeletal and soft tissue chordomas: a marker that distinguishes chordoma from mixed tumour/myoepithelioma/parachordoma in soft tissue. Am J Surg Pathol 2008;32:572–80.
5. van Akkooi AC, van Geel AN, Bessems JH, den Bakker MA. Extra-axial chordoma. J Bone Joint Surg Br 2006;88:1232–4.
6. DiFrancesco LM, Davanzo Castillo CA, Temple WJ. Extra-axial chordoma. Arch Pathol Lab Med 2006; 130:1871–4.
7. Lantos JE, Agaram NP, Healey JH, Hwang S. Recurrent skeletal extra-axial chordoma confirmed with brachyury: imaging features and review of the literature. Skeletal Radiol 2013;42:1451–9
8. Rekhi B. Primary, large extra-axial chordoma in proximal tibia: a rare case report with literature review and diagnostic implications. APMIS. 2016
Mar;124(3):238-42
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Clear Cell Sarcoma: A Rare Aggressive Tumor with Potential Diagnostic Challenge
Vol 4 | Issue 2 | July-Dec 2018 | Page 30-32 | Yash B Rabari, Nikhil Suri, D.V. Prasad, Siddharth Shah.
Authors: Yash B Rabari [1], Nikhil Suri [1], D.V. Prasad [1], Siddharth Shah [1].
[1] Department of Orthopaedics, Rural Medical Collage, LoniBk, Maharashtra, India.
Address of Correspondence
Dr. Yash B. Rabari.
107, NRI Hostel, PMT Campus, LoniBk, Tal.-Rahta, Dist.- Ahmadnagar Maharastra 413736
Email: dryash.rabari@gmail.com
Abstract
Clear cell sarcoma (CCS) is an exceedingly rare tumor of young adults with melanocytic differentiation. The exact incidence is largely unknown, although occasional case series mention CCS comprising less than 1% of all soft tissue sarcoma. CCS is a deep-seated tumor, typically involving tendons and aponeuroses. It has a predilection for lower extremities, particularly around the foot and ankle region, accounting for nearly 40% of cases. A primary dermal origin is rarer. We report a case of primary cutaneous CCS of 42 year old female located on the left popliteal fossa. Complete excision led to relief of symptoms
Keywords: Clear cell Sarcoma, Tumor, CCS
References
1. Dim DC, Cooley LD, Miranda RN. Clear cell sarcoma of tendons and aponeuroses: A review. Arch Pathol Lab Med. 2007;131:152–6.
2. Deenik W, Mooi WJ, Rutgers EJ, Peterse JL, Hart AA, Kroon BB. Clear cell sarcoma (malignant melanoma) of soft parts: A clinicopathological study of 30 cases. Cancer. 1999;86:969–75.
3. Kazakos CJ, Galanis VG, Giatromanolaki A, Verettas DA, Sivridis E. Clear cell sarcoma of the scapula. A case report and review of literature. World J SurgOncol. 2006;4:48–53. [PMC free article]
4. Hantschke M, Mentzel T, Rutten A, Palmedo G, Calonje E, Lazar AJ, et al. Cutaneous clear cell sarcoma: A clinicopathological, immunohistochemical, and molecular analysis of 12 cases emphasizing its distinction form dermal melanoma. Am J SurgPathol. 2010;34:216–22.
5. Hisaoka M, Ishida T, Kuo TT, Matsuyama A, Imamura T, Nishida K, et al. Clear cell sarcoma of soft tissue: A clinicopathological, immunohistochemical, and molecular analysis of 33 cases. Am J SurgPathol. 2008;32:452–60.
6. Patel RM, Downs-Kelly E, Weiss SW, Folpe AL, Tubbs RR, Tuthill RJ, et al. Dual-color, break-apart fluorescence in situ hybridization for EWS gene rearrangement distinguishes clear cell sarcoma of soft tissue from malignant melanoma. Mod Pathol. 2005;18:1585–90.
7. Rodriguez-Martin M, Saez- Rodriguez M, Esquivel B, Gonzalez RS, Cabrera AN, Herrera AM. Clear cell sarcoma: A case mimicking primary cutaneous malignant melanoma. Indian J Dermatol. 2009;54:168–72.
8. Enzinger FM. Clear cell sarcoma of tendons and aponeuroses: An analysis of 21 cases. Cancer. 1965;18:1163–74.
9. Chung EB, Enzinger FM. Malignant melanoma of soft parts.A reassessment of clear cell sarcoma. Am J SurgPathol. 1983;7:405–13.
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Inter-Osseous Epidermoid Inclusion Cyst Of The Sacrum: A Case Report
Vol 4 | Issue 2 | July-Dec 2018 | Page 27-29 | Mike Parry, Anish Patel, Rajesh Botchu, Vaiyapuri S, Desai, Jeys Lee.
Authors: Mike Parry [1], Anish Patel [2], Rajesh Botchu [2], Vaiyapuri S [3], Desai [4], Jeys Lee [1].
[1] Department of Orthopedic Oncology.
[2] Department of Musculoskeletal Radiology,
[3] Department of pathology,The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
[4] Department of Surgery, The Queen Elizabeth Hospital, Birmingham, UK
Address of Correspondence
Dr. Rajesh Botchu
Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
Email: drbrajesh@yahoo.com
Abstract
Whilst common in subcutaneous locations, inclusion epidermoid cysts arising from the pelvic bones are extremely rare. We report the case of a patient presenting with coccydynia and altered bowel habit who, following investigation was found to have a large cystic lesion of the sacrum with extending anteriorly into the presacral tissue resulting in compression of the rectum. The lesion was treated by surgical resection, sacrificing the lower sacral nerve roots. Histology confirmed an epidermoid cyst. Whilst a rare presenting symptom, careful assessment of the patient presenting with coccydynia and altered bowel function must raise the suspicion of a sacral pathology that demands further investigation.
Keywords: sacral epidermoid cyst, rare presentation
References
1. Handa U, Kumar S, Mohan H. Aspiration cytology of epidermoid cyst of terminal phalanx. Diagn Cytopathol. 2002;26(4):266–7.
2. Adachi H, Yoshida H, Yumoto T, Naniwa S, Okuno M, Morimoto K, et al. Intraosseous epidermal cyst of the sacrum. A case report. Acta Pathol Jpn. 1988;38(12):1561–4.
3. Muellner T, Nicolic A, Lang S, Schabus R, Kwasny O. Epidermoid cyst after arthroscopic knee surgery. Arthroscopy. 1998;14(3):331–4.
4. Ettinger RL, Manderson RD. Implantation keratinizing epidermoid cysts. A review and case history. Oral Surg Oral Med Oral Pathol. 1973;36(2):225–30.
5. Musharrafieh RS, Tawil AN, Saghieh SS, Macari G, Atiyeh BS. Epidermoid cyst of the thumb. Orthopedics. 2002;25(8):862–3.
6. Zadek I, Cohen HG. Epidermoid cyst of the terminal phalanx of a finger; with a review of the literature. Am J Surg. 1953;85(6):771–4.
7. Vion-Dury J, Vincentelli F, Jiddane M, Van Bunnen Y, Rumeau C, Grisoli F, et al. MR imaging of epidermoid cysts. Neuroradiology. 1987;29(4):333–8.
8. Epstein WL, Kligman AM. Epithelial cysts in buried human skin. AMA Arch Derm. 1957;76(4):437–45.
9. Jaiswal A, Shetty AP, Rajasekaran S. Precoccygeal epidermal inclusion cyst presenting as coccygodynia. Singapore Med J. 2008;49(8):e212–4.
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