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Carpentier E, Ritter P, Viala JF, Dujardin C, Michenet P. [Unusual location of a para-osteal lipoma of the upper limb]. ACTA ACUST UNITED AC 2009; 90:322-3. [PMID: 19421119 DOI: 10.1016/s0221-0363(09)72513-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cekinmez M, Sarica FB, Tufan K, Sener L, Sen O. An unusual cause of low back pain: paravertebral muscle metastases of lung cancer. Neurol Neurochir Pol 2009; 43:83-85. [PMID: 19353448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Paravertebral muscle metastasis is an extremely rare cause of low back pain. Lipomas, haemangiomas, hibernomas and liposarcomas should be considered first in the aetiology of paravertebral muscle masses. Schwannoma, neurofibroma, ganglioneuroma and paraganglioneuromas that show contiguous spread should also be included in the differential diagnosis. Haematogenous metastases are most frequently caused by lung cancers. Lung cancers typically metastasize to liver, brain, bone, kidney, and adrenal glands. They rarely metastasize to skeletal muscles due to metabolism, high tissue pressure and blood flow of muscles. Our case was a 48-year-old male who had been smoking 40 cigarettes per day and presented to our clinic with low back pain and a mass in the lower back region. The mass in his lower back region was excised and histopathological examination confirmed metastasis of a neuroendocrine tumour. Further examinations revealed the lung as the primary source of the metastasis.
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Yasuda H, Inagaki N, Mori T. [Case of pulmonary mycoses associated with malignant lymphoma during chemotherapy]. THE JAPANESE JOURNAL OF ANTIBIOTICS 2008; 61:355-356. [PMID: 19343838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Baena-Ocampo LDC, Encalada-Díaz I, Marín-Arriaga N. [Tendon sheath lipoma associated with quadriceps tendon rupture. Case report]. CIR CIR 2008; 76:265-269. [PMID: 18647563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Tendon sheath lipoma is an uncommon tumor characterized morphologically by mature fatty tissue lobes adherent to the tendon or intersecting its fibers. The association with quadriceps tendon rupture is unusual. Etiologic factors that may condition those ruptures have not yet been fully described. However, several authors suggest the existence of a subjacent pathology such as metabolic or inflammatory diseases. Minimal trauma may lead to such ruptures as well as associated ligamentous or bony injuries. The prognosis regarding quadriceps tendon rupture mainly depends on the lap between injury and time of repair. CLINICAL CASE We present the case of a quadricipital tendinous rupture produced by the presence of a benign neoplasm, which is a very infrequent association. The patient was surgically treated for quadriceps tendon reconstruction via tendinous reinsertion at the patella. Currently, during rehabilitation, the patient is symptom free with an almost-complete flexion/ extension of his left knee. CONCLUSIONS We consider that importance must be given to neoplastic disease as a cause of tendinous rupture, regardless of their infrequency and unusual clinical presentation.
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Bucci T, De Giulio F, Romano A, Insabato L, Califano L. Cavernous haemangioma of the temporalis muscle: case report and review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2008; 28:83-86. [PMID: 18669073 PMCID: PMC2667234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Accepted: 07/26/2007] [Indexed: 05/26/2023]
Abstract
Haemangiomas are benign vascular neoplasms characterized by an abnormal proliferation of blood vessels. They may occur in any vascularized tissue including skin, subcutaneous tissue muscle and bone. These tumours are common in infancy and childhood and commonly involve subcutaneous or mucosal tissues. Intramuscular haemangiomas, a distinctive type of haemangioma occurring within skeletal muscle, account for less than 1% of all haemangiomas. They occur more often in trunk and extremity muscles, whereas involvement of the temporal muscle is extremely rare. Herein, the case is reported of a 38-year-old male who presented with a round, painless mass in the left temporal fossa, which was interpreted as an intramuscular haemangioma after a magnetic resonance imaging scan. In this report, clinico-pathological findings are described in an additional case of haemangioma involving the temporal muscle, and a review is made of the international literature on this subject.
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Puchała M, Kruczyński J, Szukalski J. Problems with diagnostic work-up of musculoskeletal pain due to glomus tumour. Four case reports. Ortop Traumatol Rehabil 2008; 10:82-89. [PMID: 18391909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Glomus tumours are rare benign neoplasms of myoepithelial origin. Due to characteristic and painful symptoms, glomus tumours are a major clinical problem. MATERIAL Four histologically confirmed cases of glomangioma treated at the Orthopaedics & Traumatology Department between 1999 and 2007. RESULTS The most significant symptom was extreme pain causing a decrease in the quality of life. Regardless of the location of the tumour, the correct diagnosis was delayed by 1.5 to 3 years. CONCLUSIONS Due to its rare occurrence, glomus tumours are often missed out in the differential diagnosis of musculoskeletal pain. The agonising pain makes glomus tumours a significant clinical problem that should be remembered about, especially as surgery brings about spectacular improvement.
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Eley HL, Russell ST, Baxter JH, Mukerji P, Tisdale MJ. Signaling pathways initiated by beta-hydroxy-beta-methylbutyrate to attenuate the depression of protein synthesis in skeletal muscle in response to cachectic stimuli. Am J Physiol Endocrinol Metab 2007; 293:E923-31. [PMID: 17609254 DOI: 10.1152/ajpendo.00314.2007] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To investigate the mechanism by which beta-hydroxy-beta-methylbutyrate (HMB) attenuates the depression of protein synthesis in the skeletal muscle of cachectic mice, a study has been carried out in murine myotubes in the presence of proteolysis-inducing factor (PIF). PIF inhibited protein synthesis by 50% within 4 h, and this was effectively attenuated by HMB (25-50 muM). HMB (50 muM) alone stimulated protein synthesis, and this was attenuated by rapamycin (27 nM), an inhibitor of mammalian target of rapamycin (mTOR). Further evidence for an involvement of this pathway was shown by an increased phosphorylation of mTOR, the 70-kDa ribosomal S6 kinase (p70(S6k)), and initiation factor 4E-binding protein (4E-BP1) and an increased association of eukaryotic initiation factor 2 (eIF4E) with eIF4G. PIF alone induced a transient (1-2 h) stimulation of phosphorylation of mTOR and p70(S6k). However, in the presence of HMB, phosphorylation of mTOR, p70(S6k), and 4E-BP1 was increased, and inactive 4E-BP1-eIF4E complex was reduced, whereas the active eIF4G.eIF4E complex was increased, suggesting continual stimulation of protein synthesis. HMB alone reduced phosphorylation of elongation factor 2, but this effect was not seen in the presence of PIF. PIF induced autophosphorylation of the double-strand RNA-dependent protein kinase (PKR), leading to phosphorylation of eIF2 on the alpha-subunit, which would inhibit protein synthesis. However, in the presence of HMB, phosphorylation of PKR and eIF2alpha was attenuated, and this was also observed in skeletal muscle of cachectic mice administered HMB (0.25 g/kg). These results suggest that HMB attenuates the depression of protein synthesis by PIF in myotubes through multiple mechanisms.
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Bien E, Stachowicz-Stencel T, Sierota D, Polczynska K, Szolkiewicz A, Stefanowicz J, Adamkiewicz-Drozynska E, Czauderna P, Kosiak W, Dubaniewicz-Wybieralska M, Izycka-Swieszewska E, Balcerska A. Sarcomas in children with neurofibromatosis type 1-poor prognosis despite aggressive combined therapy in four patients treated in a single oncological institution. Childs Nerv Syst 2007; 23:1147-53. [PMID: 17628808 DOI: 10.1007/s00381-007-0392-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Revised: 03/23/2007] [Indexed: 10/23/2022]
Abstract
OBJECTS Patients with neurofibromatosis type 1 (NF1) are predisposed to developing soft tissue sarcomas (STS). MATERIALS AND METHODS We report on four cases of STS diagnosed in locally advanced, unresectable stages in children with NF1 (three girls, one boy; age = 8 months-14 years). All patients received protocols for STS: Cooperative Weichteilsarkomstudie 91, 96 and 2002. One patient with limb rhabdomyosarcoma entered complete remission but developed late metastatic relapse and died of progression despite complete excision and autologous bone marrow transplantation. The other patient with bladder rhabdomyosarcoma died of neutropenia-related sepsis without remission. Patients with malignant peripheral nerve sheet tumour and malignant triton tumour located in the pelvis did not respond to therapy. One of them died of disease progression, while the other is disease-free 6 years post-therapy after mutilating tumour resection. CONCLUSION STS in NF1 seem to display poor prognosis in spite of combined therapy; thus, children with NF1 should remain under detailed control of the oncologist.
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Ming YC, Wong KS, Wang CJ, Lai JY. Successful management of a bilateral diaphragmatic lymphangioma. Pediatr Surg Int 2007; 23:591-3. [PMID: 17043877 DOI: 10.1007/s00383-006-1811-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2006] [Indexed: 10/24/2022]
Abstract
A 5-year-old boy developed two episodes of massive chylothorax due to a huge bilateral diaphragmatic lymphangioma. Two episodes of chylothorax were well controlled only after parenternal octreotide. The lymphangioma showed more than 90% shrinkage after intralesional sclerotherapy with bleomycin.
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Nishinari K, Wolosker N, Yazbek G, Zerati AE, Nishimoto IN. Venous reconstructions in lower limbs associated with resection of malignancies. J Vasc Surg 2006; 44:1046-50. [PMID: 17098540 DOI: 10.1016/j.jvs.2006.07.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 07/13/2006] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with tumors in the limbs who undergo surgical treatment may have involvement of major vessels. Major arteries are always reconstructed for limb salvage. Major veins may be reconstructed to avoid the onset of venous hypertension signs and symptoms. The objective of this study was to analyze the results from surgical treatment of a sample of patients who underwent lower limb venous reconstructions associated with the resection of malignant tumors. METHODS Follow-up was performed of 17 patients with malignant tumors involving major vessels in the lower limbs. The median length of follow-up was 22 months. Venous reconstruction concomitant to arterial reconstruction was performed in 15 patients, and an isolated venous reconstruction was performed in 2 patients. The venous substitutes used were the contralateral long saphenous vein (n = 12), expanded polytetrafluoroethylene prosthesis (n = 3), and Dacron prosthesis (n = 2). RESULTS Vascular complications occurred in seven patients: three occlusions of the venous graft, edema in seven patients, and one rupture of the arterial graft. The primary 2- and 5-year patency rates of venous reconstructions were 79.3% and 79.3%, respectively. Nonvascular complications occurred in six patients: neurological deficit (n = 3), partial necrosis of the flap (n = 2), wound infection (n = 1), hematoma (n = 1), and enteric fistula (n = 1). Eight patients were still alive and disease free, although one of them underwent above-knee amputation as a result of local disease recurrence. One patient experienced regional disease recurrence and is undergoing chemotherapy. Eight patients died due to pulmonary metastases. The 2- and 5-year overall survival rates were 58.6% and 42.4%, respectively. The 2- and 5-year thrombosis-free survival rates were 51.9% and 35.2%, respectively. CONCLUSIONS Lower limb venous reconstructions associated with tumor resection in this study gave good functional results, although the prognosis for these patients had been unfavorable. The saphenous vein is a suitable substitute.
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Kim SH, Shin HH, Rho BK, Lee ES, Baek SH. A case of intramuscular hemangioma presenting with large-angle hypertropia. KOREAN JOURNAL OF OPHTHALMOLOGY 2006; 20:195-8. [PMID: 17004637 PMCID: PMC2908847 DOI: 10.3341/kjo.2006.20.3.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the case of a patient with large-angle hypertropia of an intramuscular hemangioma of the right superior rectus muscle (SR). Methods A 63-year-old man with progressive vertical deviation of the right eye for the past 6 months visited our strabismus department; his condition was not painful. An examination indicated that he had 60PD of right hypertropia at distance and near in primary gaze. Additionally, a significant limitation of his downgaze was noted. The right eye appeared mildly proptotic, and the upper and lower eyelids were slightly edematous. Corrected vision was 20/20 in both eyes. Results Orbital magnetic resonance imaging (MRI) studies revealed fusiform enlargement of the right superior rectus muscle, with prominent but irregular enhancement following gadolinium administration. Incisional biopsy revealed an intramuscular hemangioma in the superior rectus muscle with cavernous-type vessels. Conclusions This case demonstrates that intramuscular hemangioma should be considered in the differential diagnosis of isolated extraocular muscle enlargement and unusual strabismus.
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Cada M, Gerstle JT, Traubici J, Ngan BY, Capra ML. Approach to diagnosis and treatment of pediatric primary tumors of the diaphragm. J Pediatr Surg 2006; 41:1722-6. [PMID: 17011277 DOI: 10.1016/j.jpedsurg.2006.05.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND/PURPOSE Tumors of the diaphragm in the pediatric population are extremely rare. We present 5 cases diagnosed at the Hospital for Sick Children, Toronto, and together with a review of the world literature, provide an approach to the diagnosis and management of these tumors. METHODS A clinical retrospective review of patients diagnosed as having primary diaphragmatic tumor (PDT) at the Hospital for Sick Children as well as a review of the world literature. RESULTS Forty-one cases of PDT in the pediatric population have been described from 1868 to 2005 inclusive. There is an equal incidence in boys and girls, they are found with the same frequency on the left as on the right, and 78% are malignant. Rhabdomyosarcoma is the most commonly occurring malignant tumor. The mean age at diagnosis is 10 years. "Chest-associated" symptoms are more common than "abdomen-associated" symptoms. Imaging often fails to identify the site of origin as the diaphragm. Surgery is the cornerstone of therapy for PDT. CONCLUSION A multidisciplinary team approach is needed for successful treatment and management of PDT.
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Dormand EL, Prabhu-Desai A, Rice AJ, Rosin RD. Not all pain in the left iliac fossa is diverticular disease: A case study of a psoas myxoma and review. Surgeon 2006; 4:239-43. [PMID: 16892842 DOI: 10.1016/s1479-666x(06)80066-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Intramuscular myxomas are rare, benign, mesenchymal tumours that may present to a wide variety of specialties. We present a case study of an intramuscular myxoma in the psoas muscle, followed by a review of the literature regarding the diagnosis and treatment of intramuscular myxomas
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Radke H, Spreng D, Sigrist N, Lang J, Bornand V, Schawalder P. Acute compartment syndrome complicating an intramuscular haemangiosarcoma in a dog. J Small Anim Pract 2006; 47:281-4. [PMID: 16674724 DOI: 10.1111/j.1748-5827.2006.00092.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acute compartment syndrome in dogs is a rare complication of muscle trauma, but it has not been previously reported as a consequence of neoplasia in dogs. This case report describes the occurrence of a compartment syndrome of the femoral compartment in an 11-year-old, male, mixed-breed dog caused by acute bleeding of an intramuscular haemangiosarcoma. The compartment syndrome was relieved by immediate fasciotomy. The dog was euthanased following acute recurrence of clinical signs seven weeks after surgery.
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Bar-Am Y, Anug AM, Shahar R. Femoral compartment syndrome due to haemangiosarcoma in the semimembranosus muscle in a dog. J Small Anim Pract 2006; 47:286-9. [PMID: 16674725 DOI: 10.1111/j.1748-5827.2006.00076.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A five-year-old, entire male German shepherd dog was presented to the Veterinary Teaching Hospital-Koret School of Veterinary Medicine because of an acute, painful swelling of the right thigh and severe lameness of two-weeks duration. On physical examination, a firm and painful mass was detected in the hamstring region. Radiography and ultrasonography revealed a soft tissue mass, with a 250 cc fluid accumulation craniomedial to it. Intracompartmental pressure measurement with a Wick catheter demonstrated significantly elevated pressure within the right caudal femoral compartment (25 to 28 mmHg compared with 5 to 7 mmHg in the unaffected leg). Surgical exploration of the area was undertaken, fasciotomy and mass excision were performed, and resolution of the clinical signs was achieved. The mass was identified by histopathology results as haemangiosarcoma. Two and a half months after surgery, which was followed by adjunct chemotherapy (doxorubicin), the dog was readmitted with a subcutaneous mass in the same area, although he was not lame at this time. Radiographs of the thoracic cavity demonstrated widely disseminated metastases in the lungs. At that point, the owner elected to have the dog euthanased.
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Hurreiz H, Hussain I, Barkeji M. Post-traumatic haematoma: a red herring to something more sinister. THE NEW ZEALAND MEDICAL JOURNAL 2005; 118:U1776. [PMID: 16372026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Abstract
Cancer metastasis can affect any part of the nervous system. When the peripheral nervous system is involved, the usual targets are cranial nerves, nerve roots and plexi. However, peripheral nerves and muscles can also be affected by compression or infiltration of neoplastic cells. This review focuses in the diagnosis and treatment of metastatic complications of cancer involving plexi, peripheral nerves and muscles.
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Bruel BM, Dajoyag-Mejia MA. Shoulder mass and pain in a patient with C5 American spinal injury association grade a tetraplegia. Am J Phys Med Rehabil 2005; 84:725. [PMID: 16141754 DOI: 10.1097/01.phm.0000176417.96898.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eroğlu A, Kürkçüoğlu IC, Karaoğlanoğlu N, Alper F, Gündoğdu C. Extraskeletal Ewing sarcoma of the diaphragm presenting with hemothorax. Ann Thorac Surg 2005; 78:715-7. [PMID: 15276562 DOI: 10.1016/s0003-4975(03)01418-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2003] [Indexed: 11/28/2022]
Abstract
Ewing sarcoma is a relatively uncommon malignant bone neoplasm that usually occurs in children and young adults and involves the major long bones, pelvis, and ribs. Primary diaphragmatic Ewing sarcoma is extremely rare. To the best of our knowledge, only three cases of primary Ewing sarcoma of the diaphragm have been reported. A 12-year-old girl presented spontaneous occurrences of the right hemothorax. After drainage, a roentgenogram film, computed tomography, ultrasonography, and magnetic resonance image showed a giant mass on the right diaphragm. Primary diaphragmatic tumor was resected totally by right posterolateral thoracotomy, and histologically, an extraskeletal Ewing sarcoma was identified. The patient received adjuvant radio-chemotherapy, and there was no evidence of disease 10 months after the operation. Although extremely rare, extraskeletal Ewing sarcoma should be kept in mind in the differential diagnosis of diaphragmatic soft tissue tumors.
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Erol O, Ozçakar L, Inanici F. Cystic hygroma in the quadriceps muscle: a sanguine diagnosis for knee pain. Joint Bone Spine 2005; 72:267-9. [PMID: 15851001 DOI: 10.1016/j.jbspin.2004.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 05/12/2004] [Indexed: 10/26/2022]
Abstract
Reported here is a 28-year-old female who presented with severe right knee pain and swelling nearby the joint. Ultrasonography, magnetic resonance imaging and eventually surgery were performed. She was diagnosed to have a cystic hygroma in the vastus lateralis muscle. This is the first patient of a cystic hygroma in the quadriceps muscle.
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Moustafa M, Verma K, Beynon DWG. Vulval carcinoma associated with myxoma of iliopsoas muscle. J OBSTET GYNAECOL 2005; 24:831-2. [PMID: 15763809 DOI: 10.1080/01443610400009691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Spitzer SG, Bersani TA, Mejico LJ. Multiple Bilateral Extraocular Muscle Metastases as the Initial Manifestation of Breast Cancer. J Neuroophthalmol 2005; 25:37-9. [PMID: 15756132 DOI: 10.1097/00041327-200503000-00010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 75-year-old woman had gradually progressive binocular diplopia and 2 months later had breast cancer diagnosed. Examination showed bilateral external ophthalmoplegia with lid retraction and lag and no pupillary abnormalities. Orbital magnetic resonance imaging showed enlargement and enhancement of all extraocular muscles bilaterally. A right orbital biopsy was consistent with metastatic breast carcinoma. Positron emission tomography, bone scan, and computed tomography of the chest, abdomen, and pelvis failed to disclose other evidence of breast cancer metastases. It is unusual to encounter metastatic breast cancer affecting every extraocular muscle before the diagnosis of the primary carcinoma.
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Shimoyama N, Akizuki A, Takahashi H, Shimoyama M. [Palliative medicine for advanced gynecological malignancy]. NIHON RINSHO. JAPANESE JOURNAL OF CLINICAL MEDICINE 2004; 62 Suppl 10:627-31. [PMID: 15535321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Agar M, Broadbent A, Chye R. The management of malignant psoas syndrome: case reports and literature review. J Pain Symptom Manage 2004; 28:282-93. [PMID: 15336342 DOI: 10.1016/j.jpainsymman.2003.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2003] [Indexed: 01/02/2023]
Abstract
Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. We review the relevant clinical features and the subsequent multidisciplinary pain management in relation to four new cases of malignant involvement of the psoas muscle, and the 23 case reports in the literature. We propose that MPS comprises a continuum of symptoms and signs related to the degree of anatomical destruction with associated inflammatory reaction and muscle spasm, and also the degree of lumbosacral plexopathy causing neuropathic pain. A protocol is presented for the management of the complex pain issues of MPS directed at likely mechanisms. The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.
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