Distal Ulnar Translocation with Partial Wrist Arthrodesis for Grade III Campanacci Giant Cell Tumors of the Distal Radius – A Case Series

Cases Series | Volume 7 | Issue 1 | JBST January – April 2021 | Page 12-15 | Sivakumar Raju, Prahalad Kumar Singhi, M. Chidambaram, V. Somashekar. DOI: 10.13107/jbst.2021.v0701.43

Author: Sivakumar Raju[1], Prahalad Kumar Singhi[1], M. Chidambaram[1], V. Somashekar[1]

[1]Department of Orthopaedic, Preethi Hospitals Pvt. Ltd., 50 Melur Main Road, Uthangudi, Madurai, Tamil Nadu, India.

Address of Correspondence
Dr. Prahalad Kumar Singhi,
Consultant Arthroscopy and Trauma Surgeon, Preethi Hospitals Pvt. Ltd., Madurai – 625 107, Tamil Nadu, India.
E-mail: docpsin2001@yahoo.co.in

Abstract

Introduction: Campanacci Grade III giant cell tumor of distal radius is an uncommon condition with limited treatments options and ulnar translocation is one.
Materials and Methods: We retrospectively analyzed five cases of Campanacci Grade III tumor in which three were recurrent cases, four female and one male all operated under regional anesthesia (supraclavicular brachial plexus block) with en bloc resection and reconstruction using ulnar translocation with fusion only with proximal carpal row from 2012 to 2018 at our institute. The mean length of tumor resected was 6.74 cm and average follow-up of 60 months. Average union time at radioulnar junction was 4–5 months and ulnocarpal joint was 3–4 months.
Results: Functional outcome was assessed using musculoskeletal tumor society scoring system, 80% had excellent and good outcome, and one patient had extensive recurrence and ended up in below-elbow amputation.
Conclusion: Ulnar translocation with partial wrist arthrodesis is a simple, valid, option with acceptable appearance of forearm, useful wrist function, no donor site morbidity nor need for a microvascular procedure, and no need to achieve complete wrist arthrodesis as compared to other options for reconstruction.
Keywords: Distal radius giant cell tumor, Campanacci Grade III tumor, modified ulnar translocation, partial wrist arthrodesis.

Reference:
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How to Cite this article: Raju S, Singhi PK, Chidambaram M, Somashekar V | Distal Ulnar Translocation with Partial Wrist Arthrodesis for Grade III Campanacci Giant Cell Tumors of the Distal Radius – A Case Series | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2021; 7(1): 12-15.

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A Case Report of Solitary Bone Metastasis from Primary Angiosarcoma of the Bilateral Breasts – A Rare Diagnosis

Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 16-21 | Katrina Ysabel R Naraval, Daniela Kristina D. Carolino, Ma. Lilia Molina P. Jose. DOI: 10.13107/jbst.2021.v07i01.43

Author: Katrina Ysabel R Naraval[1], Daniela Kristina D. Carolino[1], Ma. Lilia Molina P. Jose[1], [2]

[1]Institute of Orthopaedics and Sports Medicine, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Blvd., Quezon city 1112, Philippines,
[2]Orthopaedic Oncology section, Department of Orthopaedics, The Medical City Clark, Pampanga, Philippines.

Address of Correspondence
Dr. Katrina Ysabel R Naraval,
Institute of Orthopaedics and Sports Medicine, St. Luke’s Medical Center, 279 E. Rodriguez Sr. Blvd., Quezon city 1112, Philippines.
E-mail: khayanaraval@gmail.com

Abstract

Introduction: Primary angiosarcoma of the breast is an uncommon subtype of soft-tissue sarcoma known to be aggressive and is associated with distant metastasis and poor prognosis. Solitary bone metastases occurring in these cases are even more rare with the available limited literature based from small retrospective case series.
Case Report: We present a case of a 24-year-old Filipino female previously diagnosed with primary angiosarcoma of the bilateral breasts, initially presenting with a 3-month history of the right hip pain and consulted due to a pathologic fracture of the right proximal femur. Diagnostic tests done confirmed solitary skeletal metastasis to this area, for which she underwent wide resection and application of a proximal femoral endoprosthesis. Postoperatively, the patient was able to independently ambulate, with follow-up radiographs showing stable implant fixation. Further imaging showed that lesion-free bones, however, noted development of distant recurrence manifesting with pulmonary metastases and hemorrhagic subcutaneous lesions 3 months after. Adequate tumor resection and radiotherapy are reported to successfully treat isolated skeletal metastasis in the proximal femur. The presence of the pathologic fracture before definitive treatment may have contributed to its distant recurrence, in addition to an already aggressive nature of the primary malignancy.
Conclusion: In the background of primary breast angiosarcoma, although rare, high suspicion for isolated skeletal metastasis in a symptomatic patient prevents delay in definitive management, which avoids progression to a poorer prognosis.
Keywords: Solitary bone metastasis, angiosarcoma, proximal femur, pathologic fracture.

References:

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18. Sarahrudi K, Hora K, Heinz T, Millington S, Vécsei V. Treatment results of pathological fractures of the long bones: A retrospective analysis of 88 patients. Int Orthop 2006;30:519-24.

How to Cite this article: Naraval KYR, Carolino DKD, Jose MLMP | A Case Report of Solitary Bone Metastasis from Primary Angiosarcoma of the Bilateral Breasts – A Rare Diagnosis | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2021; 7(1): 16-21.

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Treatment of GCT of Distal Radius Bone with Pre-operative Denosumab Plus Replacement by Distal Ulna and Ulnocarpal Arthrodesis: A Case Report

Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 9-11 | Francisco de Assis Serra Baima Filho. DOI: 10.13107/jbst.2021.v07i01.42

Author: Francisco de Assis Serra Baima Filho[1]

[1]Department of Orthopedics, Aldenora Bello Maranhao Institute of Oncology (IMOAB), São Luís, Brazil.

Address of Correspondence
Dr. Francisco de Assis Serra Baima Filho,
Department of Orthopedics, Aldenora Bello Maranhao Institute of Oncology (IMOAB), São Luís, Brazil.
E-mail: assisbaima@gmail.com

Introduction: Giant-cell tumor (GCT) of bone is a benign tumor, however locally aggressive with a tendency for local recurrence and potential for metastasis. The distal radio is the third most frequent location, after the distal femur and proximal tibia. In Campanacci grade Grade III tumors, multiple reconstruction techniques after resection of the distal radius have been described, such as bone graft plus wrist arthrodesis. The use of the drug denosumab in the pre-operative period helps a surgery with less comorbidity, and limb preservation and reduces the chance of function loss. The objective is to report a case of a patient who underwent treatment of Campanacci grade Grade III distal radius bone GCT, with pre-operative denosumab application and resection surgery, replacement by bone graft (distal ulna), and ulnocarpal arthrodesis.
Methodology: Quantitative, descriptive, retrospective study by analyzing the medical record of a case report, plus literature study.
Conclusion: The use of pre-operative denosumab favors surgery with less comorbidity, ; however, more studies are needed in order to define the ideal dosage. Ulnar translocation with ulnar carpal arthrodesis has also proved to be a successful technique and further studies are needed to evaluate its effectiveness.
Keywords: Giant -cell tumors of bone (MeSH ID: D018212), denosumab (MeSH ID: D000069448), arthrodesis (MeSH ID: D001174), case report (MeSH ID: D002363).

Reference:
1. Qi DW, Wang P, Ye ZM, Yu XC, Hu YC, Zhang GC, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg 2016;8:196-204.
2. Yang YF, Wang JW, Huang P, Xu ZH. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord 2016;17:1-6.
3. Barik S, Jain A, Ahmad S, Singh V. Functional outcome in giant cell tumor of distal radius treated with excision and fibular arthroplasty: A case series. Eur J Orthop Surg Traumatol 2020;30:1109-17.
4. Meena DK. Re: Wrist fusion through centralisation of the ulna for recurrent giant cell tumour of the distal radius. J Orthop Surg 2016;24:280.
5. McCarthy CL, Gibbons CL, Bradley KM, Hassan AB, Giele H, Athanasou NA. Giant cell tumour of the distal radius/ulna: Response to pre-operative treatment with short-term denosumab. Clin Sarcoma Res 2017;7:1-11.
6. Gulia A, Puri A, Prajapati A, Kurisunkal V. Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma 2019;10:1033-7.
7. Bianchi G, Sambri A, Marini E, Piana R, Campanacci DA, Donati DM. Wrist arthrodesis and osteoarticular reconstruction in giant cell tumor of the distal radius. J Hand Surg Am 2020;2020:1-6.

How to Cite this article: de Assis Serra Baima Filho F. | Treatment of GCT of Distal Radius Bone with Pre-operative Denosumab Plus Replacement by Distal Ulna and Ulnocarpal Arthrodesis: A Case Report | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2021; 7(1): 9-11.

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Schwannoma in the Bifurcation of the Sciatic Nerve: A Case Report and Literature Review

Case Report | Volume 7 | Issue 1 | JBST January – April 2021 | Page 4-8 | Daniela Kristina D. Carolino, Ai E. Gamboa, Edwin Joseph R. Guerzon. DOI: 10.13107/jbst.2021.v07i01.41

Author: Daniela Kristina D. Carolino[1], Ai E. Gamboa[1], Edwin Joseph R. Guerzon[1]

[1]Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Philippines.

Address of Correspondence
Dr. Daniela Kristina D. Carolino,
Department of Orthopaedics, Institute of Orthopedics and Sports Medicine, St. Luke’s Medical Center, Quezon City, Philippines.
E-mail: dkdcarolino@gmail.com

 

Abstract

Purpose: The schwannoma is a benign tumor and is known to be the most common type of tumor of the peripheral nerve sheath. They are known to arise from the nerves of the head and neck; however, outside this region, it is found more often in the upper extremity, and if occurring in the lower extremity, is likely found in the posterior tibial nerve. Schwannoma of the sciatic nerve is considered a very rare entity, accounting for only 1% of all schwannomas, with an estimated incidence of about 6 cases per million individuals.
Methods: In our literature search, it is noted that they are more likely to arise from the proximal aspect of the nerve, as it exits the sciatic notch, presenting as a mass in the proximal thigh. This case reports tackles an even more unusual presentation of this tumor, occurring adjacent to the bifurcation of the sciatic nerve.
Results: A 46-year- old male presented with sharp, shooting pain from the back of his thigh to the plantar aspect of his left foot of 2 years duration. Patient was initially diagnosed as a case of plantar fasciitis and hamstring tightness that was managed conservatively. However, due to persistence as well as appearance of a small mass on the posterior thigh and positive Tinel’s sign over the mass, patient underwent work-up and subsequent surgery.
Conclusion: Due to its presentation that closely mimics sciatica of a lumbosacral discal pathology and other musculoskeletal disorders, these are often diagnosed and managed late. Despite its rarity, it should be suspected in patients with history of radicular pain without any neurologic deficits, which is poorly controlled by analgesics and supportive therapy, with physical examination pointing to a localized neural pathology.
Keywords: Schwannoma, sciatic nerve, bifurcation.

References:
1. Omezzine SJ, Zaara B, Ali MB, Abid F, Sassi N, Hamza HA. A rare cause of non discal sciatica: Schwannoma of the sciatic nerve. Orthop Traumatol Surg Res 2009;95:543-6.
2. Rhanim A, El Zanati R, Mahfoud M, Berrada MS, El Yaacoubi M. A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve. J Clin Orthop Trauma 2013;4:89-92.
3. Nahar S, Goyal A. A large schwannoma of sciatic nerve-a case report. J Peripher Nerve Surg 2018;2:86-9.
4. Godkin O, Ellanti P, O’Toole G. Large schwannoma of the sciatic nerve. BMJ Case Rep 2016;2016:bcr201617717.
5. As-Sultany M, Ben-Ghashir N, Mistry A, Chandrasekar C. Giant schwannomas of the sciatic nerve. BMJ Case Rep 2017;2017:bcr2016218466.
6. Wu WT, Chang KV, Hsu YC, Yang YC, Hsu PC. Ultrasound imaging for a rare cause of sciatica: A schwannoma of the sciatic nerve. Cureus 2020;12:e8214.
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8. Naik H, Velho V. Sciatic nerve schwannoma: A rare case. Neurol India 2019;67:151-3.
9. Rosario MS, Yamamoto N, Hayashi K, Takeuchi A, Miwa S, Inatani H, et al. A case of infected schwannoma mimicking malignant tumor. World J Surg Oncol 2016;14:302.
10. Eroglu U, Bozkurt M, Ozates O, Akturk S, Tuna H. Sciatic nerve schwannoma: Case report. Turk Neurosurg 2014;24:120-2.
11. Cavalcante JB, Cembraneli PN, Cavalcante RB, Valente VF, Cavalcante JE. Unusual presentation of giant schwannoma in the sciatic nerve. Case Rep Int 2020;9:100081Z06JC2020.
12. Haspolat Y, Ozkan FU, Turkmen I, Kemah B, Turhan Y, Sarar S, et al. Sciatica due to schwannoma at the sciatic notch. Case Rep Orthop 2013;2013:510901.
13. Gorgan M, Sandu AM, Bucur N, Neacsu A, Pruna V, Voina A, et al. Sciatic nerve schwannoma: A case report. Rom Neurosurg 2008;15:27-31.
14. Rekha A, Ravi A. Sciatic nerve schwannoma. Int J Low Extrem Wounds 2004;3:165-7.
15. Hamdi MF, Aloui I, Ennouri K. Sciatica secondary to sciatic nerve schwannoma. Neurol India 2009;57:685-6.
16. Mansukhani SA, Butala RR, Shetty SH, Khedekar RG. Sciatic nerve schwannoma: A case report. J Orthop Surg (Hong Kong) 2015;23:259-61.
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How to Cite this article: Carolino DK, Gamboa AE, Guerzon EJ. | Schwannoma in the Bifurcation of the Sciatic Nerve: A Case Report and Literature Review | Journal of Bone and Soft Tissue Tumors | Jan-Apr 2021; 7(1): 4-8.

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A Giant Gluteal Mass in a One1-Year-Old: A Case Report on Pediatric Lipoblastoma

Case Report | Volume 7 | Issue 1 | JBST January-April 2021 | Page 1-2 | Abigail Rivera Tud, Albert Jerome C Quintos. DOI: 10.13107/jbst.2021.v07i01.40

Author: Abigail Rivera Tud[1], Albert Jerome C Quintos[1]

[1]Department of Orthopedics, The Medical City, Pasig City, Philippines.

Address of Correspondence
Dr. Abigail Rivera Tud,
Department of Orthopedics, The Medical City, Pasig City, Philippines.
E-mail: abitud@gmail.com

Abstract

Introduction: Lipoblastomas are a rare type of benign neoplasm arising from embryonal fat, found primarily among young children. Predominantly small tumors of the head and neck, trunk, and extremities, less than twenty 20 cases of gluteal lipoblastoma have been reported in the English literature. Complete surgical resection is recommended, with recurrence rates at 14–-46%.
Case Report: A one1-year-old female presented with a large, painless gluteal mass of one 1 year. Growth was consistent since shortly after birth, with no history of manipulation, constitutional symptoms or trauma. Magnetic resonance imaging showed a heterogenous, encapsulated, lobulated mass without bone or vascular invasion, and marginal excision was completed without need for soft soft-tissue reconstruction. At five 5 years post-surgery, the outcome has been uneventful, without evidence of recurrence.
Conclusion: Lipoblastomas present with characteristic features on clinical examination, diagnostic imaging, and histology. While benign, they may share features with more aggressive soft tissue tumors, emphasizing the need for careful assessment prior to before surgery.
Keywords: Gluteal, lipoblastoma, pediatric.

Reference:
1. Coffin CM. Adipose and myxoid tumors. In: Pediatric Soft Tissue Tumors: A Clinical, Pathological, and Therapeutic Approach. Ch. 8. New Salt Lake City, Utah. JA Majors Company; 1997. p. 254-76.
2. Bruyeer, E, Lemmerling M, Poorten VV, Sciot R, Hermans R. Paediatric lipoblastoma in the head and neck: Three cases and review of literature. Cancer Imaging 2012;12:484-7.
3. Gisselsson, D, Hibbard MK, Dal Cin P, Sciot R, His BL, Kozakewich HP, et al. PLAG1 alterations in lipoblastoma: Involvement in varied mesenchymal cell types and evidence for alternative oncogenic mechanisms. J Pathol 2001;159:955-62.
4. Hicks J, Dilley A, Patel D, Barrish J. Lipoblastoma and lipoblastomatosis in infancy and childhood: Histopathologic, ultrastructural, and cytogenetic features. Ultrastruct Pathol 2009;25:321-33.
5. Jung SH, Chang PY, Luo CC, Huang CS, Lai JY, Hsueh C. Lipoblastoma/ lipoblastomatosis: A clinicopathologic study of 16 cases in Taiwan. Pediatr Surg Int 2005;21:809-12.
6. Kok KY, Telishinghe PU. Lipoblastoma: Clinical features, treatment, and outcome. World J Surg 2010;34:1517-22.
7. Nakib GL, Calcaterra V, Avolio L, Guazzotti M, Goruppi I, Viglio A, et al. Intrascrotal lipoblastoma in a ten-year-old: Case report and review of literature. Rare Tumors 2013;5:e11.
8. Kerkeni Y, Sahnoun L, Ksia A, Hidouri S, Chahed J, Krichen I, et al. Lipoblastoma in childhood: About 10 cases. Afr J Paediatr Surg 2014;11:32-4.

How to Cite this article: Tud AR, Quintos AJ| A Giant Gluteal Mass in a 1-Year-Old: A Case Report on Pediatric Lipoblastoma| Journal of Bone and Soft Tissues Tumors 2021;Jan-Apr 2021; 7(1): 1-3.

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