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Takamiya A, Ishibashi Y, Makise N, Hirata M, Ushiku T, Tanaka S, Kobayashi H. Imaging characteristics of NTRK-rearranged spindle cell neoplasm of the soft tissue: A case report. J Orthop Sci 2023; 28:1580-1583. [PMID: 35033373 DOI: 10.1016/j.jos.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/17/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Akihiro Takamiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Ishibashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Makise
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Hirata
- Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Di Primio G, Boyd GJ, Fung CI, Hurrell C, Brahm GL, Bird JR, Co SJ, Kirkpatrick IDC. Recommendations for the Management of Incidental Musculoskeletal Findings on MRI and CT. Can Assoc Radiol J 2023; 74:514-525. [PMID: 36710521 DOI: 10.1177/08465371231152151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Incidental Findings Working Group consists of both academic subspeciality and general radiologists tasked with either adapting American College of Radiology (ACR) guidelines to meet the needs of Canadian radiologists or authoring new guidelines where appropriate. In this case, entirely new guidelines to deal with incidental musculoskeletal findings that may be encountered on thoracoabdominal computed tomography or magnetic resonance imaging were drafted, focussing on which findings should prompt recommendations for further workup. These recommendations discuss how to deal with incidental marrow changes, focal bone lesions, abnormalities of the pubic symphysis and sacroiliac joints, fatty soft tissue masses, manifestations of renal osteodystrophy and finally discuss opportunistic osteoporosis evaluation.
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Affiliation(s)
- Gina Di Primio
- McMaster University, Hamilton, ON, Canada
- Department of Radiology, Oakville Trafalgar Memorial Hospital (Halton Health Care), Oakville, ON, Canada
| | - Gordon J Boyd
- Department of Radiology, Dalhousie University, Halifax, NS, Canada
| | - Christopher I Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Gary L Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jeffery R Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - Steven J Co
- University of British Columbia, Vancouver, BC, Canada
| | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, University of Manitoba, Winnipeg, MB, Canada
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Orly J, Bisdorff A, Joly A, Edee AE, Tavernier E, Herbreteau D, Boccara O, Wassef M, Maruani A. Characteristics, Natural Course and Treatment of Intramuscular Capillary-type Haemangioma: A Systematic Literature Review. Acta Derm Venereol 2023; 103:adv00893. [PMID: 36939537 PMCID: PMC10041649 DOI: 10.2340/actadv.v103.4432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/29/2022] [Indexed: 03/21/2023] Open
Abstract
Intramuscular capillary-type haemangiomas (ICTH) are rare vascular anomalies that can easily be misdiagnosed as other entities. A systematic review was performed of all cases of ICTH in the literature since its first description in 1972. An adjudication committee reviewed cases to include only ICTHs. Among 1,143 reports screened, 43 were included, involving 75 patients. The most frequent differential diagnosis was intramuscular venous malformations. The mean age of patients at diagnosis was 21.2 years. ICTH was mainly described as a gradually increasing mass (81.8%), painless (73.9%), that could occur anywhere in the body but most frequently on the head and neck (44.0%). Magnetic resonance imaging (MRI) was mainly used for diagnosis (69.1%) and displayed specific features. The most frequent treatment was complete surgical removal (73.9%), which could be preceded by embolization, and led to complete remission without recurrence in all but 1 case.
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Affiliation(s)
- Jordan Orly
- CHRU Tours, Department of Dermatology, Unit of Pediatric dermatology, Tours, France; Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours.
| | - Annouk Bisdorff
- 3Reference center for vascular anomalies FAVA-multi, University Hospital of Lariboisière; Coordinator of the constitutive center for superficial arteriovenous malformations in children and adults; AP-HP, Department of Neuroradiology, Paris, France
| | - Aline Joly
- Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France; Reference center for vascular anomalies FAVA-multi, University Hospital of Lariboisière; Coordinator of the constitutive center for superficial arteriovenous malformations in children and adults; AP-HP, Department of Neuroradiology, Paris, France; CHRU Tours, Department of Maxillo-facial surgery, Tours, France
| | - Afi-Emiliène Edee
- Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France; CHRU Tours, Clinical Investigation Center INSERM 1415, Tours, France
| | | | - Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC-Necker), University Hospital Necker-Enfants Malades, Paris, France
| | - Michel Wassef
- Department of Pathology, University Hospital of Lariboisière, AP-HP, Paris, France
| | - Annabel Maruani
- CHRU Tours, Department of Dermatology, Unit of Pediatric dermatology, Tours, France; Reference center for genodermatoses and rare skin diseases (MAGEC-Tours), Tours, France; University of Tours, University of Nantes, INSERM 1246-SPHERE, Tours, France
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Zyluk A. Outcomes of Surgery for intramuscular Haemangiomas in the Extremities. HANDCHIR MIKROCHIR P 2022. [PMID: 35381601 DOI: 10.1055/a-1773-0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The objective of this case-series study was an assessment of outcomes of surgery for intramuscular haemangiomas in the extremities. PATIENTS AND METHODS Three women and one man with a mean age of 28 (23 - 34) years were operated on for intramuscular haemangiomas in the extremities, 3 in the forearms, and 1 in the calf. Three of them, 2 after resection of tumours from the forearm, and one after resection of the tumour in the calf, were available for follow-up assessment at an average of 1.5 (1 - 2) years after surgery. For patients with the tumour in the forearm, preoperative and at the follow-up examination pain was registered with use of the numeric rank scale (NRS), grip strength with the Jamar dynamometer, and function of the extremity with the quickDASH questionnaire. In the patient with the lower limb involvement, pain at the operation site, and efficiency (dexterity) of gait were evaluated. RESULTS All 3 patients with a follow-up examination reported significant reduction of pain. With regard to grip strength and hand function, one patient had significant improvement, whereas in the other, there were no real changes compared to preoperative. The patient with the calf involvement had no symptoms and walked normally. Over the follow-up period, no recurrence was noted. CONCLUSION The results of this small case-series study show that operative treatment of these rare tumours is safe and effective, however, it may be challenging in some cases.
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Pirri C, Pirri N, De Caro R, Stecco C, Özçakar L. Ultrasound imaging as an initial diagnostic method for intramuscular hemangiomas: a narrative review. Postgrad Med 2022; 134:180-186. [PMID: 35076337 DOI: 10.1080/00325481.2022.2033562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Intramuscular hemangiomas are benign vascular lesions, often misdiagnosed due to unfamiliarity. They are rare (but not very rare) causes of musculoskeletal pain and diagnosing these tumors may be challenging because of their pertinent non-specific symptomatology. Herein, as a convenient imaging tool, ultrasound examination appears to an important initial method to scan for these lesions after the clinical examination. To date, there are no studies that examined the state-of-the-art as regards the use of ultrasound imaging in the diagnosis of intramuscular hemangiomas. Accordingly, a literature search was performed using PubMed and Web of Science with the purpose to provide a conceptual understanding and awareness as regards the importance/utility of ultrasound imaging as a first step diagnostic tool for intramuscular hemangiomas at different muscles' locations.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Karapınar M, Atilla Ayyıldız V, Ünal M, Fırat T. Ultrasound imaging of quadriceps muscle in patients with knee osteoarthritis: The test-retest and inter-rater reliability and concurrent validity of echo intensity measurement. Musculoskelet Sci Pract 2021; 56:102453. [PMID: 34507044 DOI: 10.1016/j.msksp.2021.102453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/03/2021] [Accepted: 08/29/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Echo intensity(EI) on ultrasonography images of skeletal muscle reflects muscle composition. OBJECTIVES The primary aim of the study was to investigate the inter-rater and test-retest reliability of EI using grayscale histogram analysis of the cross-sectional area of quadriceps femoris(QF) muscle in patients with knee osteoarthritis(KOA). The secondary aim of the study was to determine the concurrent validity of the Free Hand Tool(FHT) when compared to Rectangular Marquee Tool(RMT) for calculating the region of interest(ROI) in ImageJ. METHODS This study included thirty patients with KOA. Echogenicity of the QF muscle were performed by two different raters. The reliability analysis was applied using intraclass correlation coefficient(ICC), standard error of measurement(SEM) and coefficient of variation(CV). Spearman rank correlation coefficients were calculated for assessing concurrent validity of the FHT to RMT. The Bland-Altman plots was used to show disagreement between tools. Wilcoxon signed-rank test was used for differences in assessments between test/retest sessions, raters, tools. RESULTS The inter-rater and test-retest reliability of the EI using FHT and RMT was found to be excellent (ICCFHT = 0.91-0.95, 0.98-0.99, ICCRMT = 0.91-0.98, 0.91-0.99,respectively). Bland-Altman analysis demonstrated a slight bias when region ROI calculations were collected from RMT or FHT (bias ranging from 2.75 to-2.40 a. u). There were no significant differences between test/retest sessions, raters and tools(p > 0.05). Spearman correlation coefficient showed excellent correlation between tools used for echogenicity assessment of QF muscle(p < 0.001). CONCLUSION EI assessment using ultrasonography in the QF muscle showed excellent reliability. Evaluating muscle echogenicity using both FHT and RMT appears to be reliable and validity for monitoring muscle changes due to KOA.
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Affiliation(s)
- Merve Karapınar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey.
| | - Veysel Atilla Ayyıldız
- Department of Radiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Meriç Ünal
- Sports Medicine Department, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Tüzün Fırat
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Lee HS, Hong YC, Jung KJ, Yeo ED, Won SH, Jang SH, Ji JY, Lee DW, Yoon SJ, Kim WJ. A Huge Plantar Intramuscular Hemangioma in the Plantar Area Treated Surgically: A Case Report and Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179088. [PMID: 34501676 PMCID: PMC8431436 DOI: 10.3390/ijerph18179088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Intramuscular hemangioma (IH) is rare, accounting for only 0.8% of all hemangioma cases. In particular, IH of the foot has only been reported a few times. In such cases, the symptoms typically include tenderness and swelling, often in relation to physical activity, but tingling or impaired function may also be present. Here, we report a patient who presented with a significant IH in the plantar area treated surgically. A 25-year-old female visited our hospital with pain in the plantar aspect of the right foot. She had noticed a mass about 10 years prior. She had previously experienced pain only when pressing the mass, but the pain subsequently became more regular pain and was exacerbated by exercise. In fact, the pain became so intense that she could not sleep well. Upon physical examination, mild swelling and tenderness of the plantar area were noted in the second to the fourth metatarsal. Sensation and motor reflexes were normal and the results of Tinel’s test were negative. Plain radiographs of the right foot revealed phleboliths scattered throughout the first to third intermetatarsal spaces. Magnetic resonance imaging revealed a space-occupying multilobulated mass (5.6 × 2.8 × 2.5 cm) located in the flexor digitorum brevis (FDB) muscle, which penetrated the plantar fascia and spread to the subcutaneous layer. In T2-weighted images, the lesion displayed a hyperintense signal compared to the surrounding skeletal muscle. Based on radiological findings, we suspected IH. The mass surrounded by the FDB muscle was exposed and completely removed via wide excision. IH consisting of cavernous-like vascular structures was diagnosed on pathology. At 1-year follow-up, the patient was almost asymptomatic and had recovered almost full range of motion in the plantar area. Histological analysis and surgery are recommended to remove intramuscular hemangiomas in the plantar area, but if the patient is not suitable for surgery, sclerotherapy or combination treatment should also be considered.
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Affiliation(s)
- Hong Seop Lee
- Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Hangeulbiseok-ro, Nowon-gu, Seoul 01830, Korea;
| | - Yong Cheol Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
| | - Eui Dong Yeo
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul 05368, Korea;
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea;
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Jae Young Ji
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea;
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea;
| | - Sung Joon Yoon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Korea; (Y.C.H.); (K.J.J.); (S.J.Y.)
- Correspondence:
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8
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Two Cases of Intramuscular Hemangiomas in the Upper Limbs: From Sonography to Pathology. Am J Phys Med Rehabil 2021; 100:e82-e84. [PMID: 33048488 DOI: 10.1097/phm.0000000000001561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Intramuscular hemangiomas are benign soft tissue tumors that are rarely found in the upper limbs. Diagnosing these tumors may be challenging owing to their pertinent nonspecific symptoms-often leading to misdiagnoses like tendinitis or muscle strain. In this article, two cases of intramuscular hemangiomas are presented-one in flexor pollicis brevis muscle and the other one in flexor digitorum superficialis muscle. Both subjects had nonspecific clinical symptoms whereby ultrasound imaging led to prompt diagnosis. To this end, the authors strongly advocate sonographic examination as an extension of physical examination in the daily clinical practice of musculoskeletal physicians.
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Pattamapaspong N, Peh WC, Shek TW. Imaging of intramuscular haemangiomas of the extremities. Singapore Med J 2021; 61:122-128. [PMID: 32488279 DOI: 10.11622/smedj.2020030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intramuscular haemangiomas are benign soft tissue tumours that are more frequently seen in children and young adults. As they may be difficult to diagnose clinically, imaging has an important role in the detection, diagnosis and preoperative planning of these lesions. Haemangiomas of the extremities may be classified into capillary, cavernous, venous and mixed types, with or without an arteriovenous shunt, depending on the predominant vascular channels. Nonvascular components such as fat, smooth muscle, fibrous tissue and thrombus may also be present. This pictorial essay highlights the imaging features of intramuscular haemangiomas, with an emphasis on magnetic resonance imaging.
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Affiliation(s)
| | - Wilfred Cg Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Tony Wh Shek
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
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Blum AG, Gillet R, Athlani L, Prestat A, Zuily S, Wahl D, Dautel G, Gondim Teixeira P. CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings. Insights Imaging 2021; 12:16. [PMID: 33576888 PMCID: PMC7881081 DOI: 10.1186/s13244-020-00958-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.
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Affiliation(s)
- Alain G Blum
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France.
| | - Romain Gillet
- Service D'imagerie Guilloz, CHRU Nancy, 54 000, Nancy, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
| | | | - Stéphane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases and Vascular Medicine Division, CHRU Nancy, INSERM UMR-S 1116 University of Lorraine, 54 000, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHRU de Nancy, 54 000, Nancy, France
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Intramuscular haemangioma of abductor hallucis muscle - A rare case report. Int J Surg Case Rep 2021; 77:682-685. [PMID: 33395873 PMCID: PMC7711174 DOI: 10.1016/j.ijscr.2020.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Haemangioma is a slow growing benign soft tissue tumor and its presentation in the foot is rare. Intramuscular haemangioma (IH) are usually found before 30 years of age, with gender predominance is still inconclusive. PRESENTATION OF CASE An 18-year-old woman came with pain and mass in the left foot for the past 3 years. Magnetic Resonance Imaging (MRI) of the left foot shown a heterogenous multilobulated mass, with previously thought originated from flexor digitorum brevis (FDB) muscle. Wide excision was performed and intraoperative findings showed that the mass actually originated from abductor hallucis muscle. Post-operative histopathological findings confirmed the diagnosis of cavernous-type of intramuscular haemangioma. DISCUSSION The rare occurrence of intramuscular haemangioma of the foot can cause a delayed diagnosis and treatment to the patient. The differential diagnosis include lipoma, fibroma, enlargement of the lymph nodes, compartment syndrome, hematoma, hernia, and soft-tissue sarcoma. Anytime a soft tissue mass is identified in the skeletal muscle of a young adult, haemangioma should be considered. CONCLUSION Literature research identified very few cases of intramuscular haemangioma of the foot. Wide excision of the muscle is a feasible surgical treatment option.
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12
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Savvidou OD, Koutsouradis P, Bolia IK, Kaspiris A, Chloros GD, Papagelopoulos PJ. Soft tissue tumours of the elbow: current concepts. EFORT Open Rev 2020; 4:668-677. [PMID: 32010455 PMCID: PMC6986393 DOI: 10.1302/2058-5241.4.190002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Soft tissue tumours of the elbow are mostly benign. Malignant tumours in this area, although uncommon, often present unique clinical and histopathological characteristics that are helpful for diagnosis.Management of soft tissue tumours around the elbow may be challenging because of their rarity and the proximity to neurovascular structures. Careful staging, histological diagnosis and treatment are essential to optimize clinical outcome. A missed or delayed diagnosis or an improperly executed biopsy may have devastating consequences for the patient.This article reviews the most common benign and malignant soft tissue tumours of the elbow and discusses the clinicopathological findings, imaging features and current therapeutic concepts. Cite this article: EFORT Open Rev 2019;4:668-677. DOI: 10.1302/2058-5241.4.190002.
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Affiliation(s)
- Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
| | | | - Ioanna K Bolia
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
| | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology/Sector for Bone Research, School of Health Sciences, University of Patras, Patras 26504, Greece
| | - George D Chloros
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 'ATTIKON' Hospital, Athens, Greece
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Ledoux P, Kind M, Le Loarer F, Stoeckle E, Italiano A, Tirode F, Buy X, Crombé A. Abnormal vascularization of soft-tissue sarcomas on conventional MRI: Diagnostic and prognostic values. Eur J Radiol 2019; 117:112-119. [PMID: 31307635 DOI: 10.1016/j.ejrad.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/27/2019] [Accepted: 06/10/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To assess the prevalence of abnormal vessels inside and surrounding soft-tissue sarcomas (STS) on conventional MRIs so as to evaluate their correlations with particular histotypes, histological grades, and prognosis. METHOD This single-center retrospective study included 157 adult patients (median age: 61) with histologically-proven non-metastatic STS. All had pre-treatment conventional contrast-enhanced MRI. Two radiologists reported: presence of abnormal flow-voids, number and distribution (peri-tumoral and/or intra-tumoral), percentage of tumor circumference it covered, maximal diameter. The radiological findings were correlated with histopathology. Associations were evaluated with Chi-2 or t-tests. Survival analysis (for metastasis-free survival (MFS) and overall survival (OS)) included log-rank tests and multivariate Cox-model. RESULTS Twenty-nine of 157 (18.5%) STS showed abnormal flow-voids that were peri-tumoral (9/157, 5.7%), intra-tumoral (5/157, 3.2%) or both intra- and peri-tumoral (15/157, 9.6%). Ten STS had more than 5 flow-voids, all being grade II-III, namely: 4 undifferentiated sarcomas, 2 solitary fibrous tumors, 1 alveolar soft-part sarcoma (ASPS), 2 leiomyosarcomas and 1 pleomorphic liposarcoma. The distribution of flow-voids was associated with survivals in the univariate analysis: patients with abnormal peritumoral flow-voids (APTFV) showed poorer OS and MFS (p = 0.039 and 0.014, respectively). These associations did not remain significant in multivariate analysis. Radio-pathological correlations revealed large tortuous tumoral neo-vessels with intra-vascular thrombi of tumor cells in ASPS and in one case of undifferentiated sarcoma displaying enrichment in genes involved in neo-angiogenesis at transcriptional level. CONCLUSIONS APTFV on conventional MRIs may be associated with a higher risk of metastatic relapse and poorer OS in STS patients.
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Affiliation(s)
- Pauline Ledoux
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France
| | - Michèle Kind
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France
| | - François Le Loarer
- Department of Pathology, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France; University of Bordeaux, F-33000, Bordeaux, France; INSERM U1218, Action, Institut Bergonié, Bordeaux, France
| | - Eberhard Stoeckle
- Department of Surgery, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France
| | - Antoine Italiano
- University of Bordeaux, F-33000, Bordeaux, France; INSERM U1218, Action, Institut Bergonié, Bordeaux, France; Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France
| | - Franck Tirode
- Cancer Research Center of Lyon, University of Lyon, Université Claude Bernard Lyon 1, CNRS 5286, INSERM U1052, Lyon France
| | - Xavier Buy
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France
| | - Amandine Crombé
- Department of Radiology, Institut Bergonié, Comprehensive Cancer Center, F-33076, Bordeaux, France; University of Bordeaux, F-33000, Bordeaux, France; INSERM U1218, Action, Institut Bergonié, Bordeaux, France.
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14
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Crombé A, Brisse HJ, Ledoux P, Haddag-Miliani L, Bouhamama A, Taieb S, Le Loarer F, Kind M. Alveolar soft-part sarcoma: can MRI help discriminating from other soft-tissue tumors? A study of the French sarcoma group. Eur Radiol 2018; 29:3170-3182. [DOI: 10.1007/s00330-018-5903-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/25/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023]
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15
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Öztürk E, Yılmaz E, Öztürk İE, Polat B, Orhan KS. Posttraumatic Intramuscular Hemangioma Arising from Scalene Muscles in Supraclavicular Region. Turk Arch Otorhinolaryngol 2017; 55:87-90. [PMID: 29392062 DOI: 10.5152/tao.2017.2138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/28/2017] [Indexed: 11/22/2022] Open
Abstract
Intramuscular hemangiomas (IMH) account for <%1 of all hemangiomas and are rarely located in the head and neck region. The most common site of origin in the head and neck is the masseter muscle, whereas IMH originating from the scalene muscles are rarely seen. Surgical excision of intramuscular hemangioma is considered the main treatment modality. Here we present the case of a male patient aged 17 with IMH that occured after blunt trauma in the supraclavicular region, fed by the thyrocervical and costocervical trunks, and with an arteriovenous shunt.
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Affiliation(s)
- Erkan Öztürk
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Eren Yılmaz
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - İlker Erdinç Öztürk
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Beldan Polat
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Kadir Serkan Orhan
- Department of Otorhinolaryngology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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16
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Rizer M, Singer AD, Edgar M, Jose J, Subhawong TK. The histological variants of liposarcoma: predictive MRI findings with prognostic implications, management, follow-up, and differential diagnosis. Skeletal Radiol 2016; 45:1193-204. [PMID: 27209201 DOI: 10.1007/s00256-016-2409-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/01/2016] [Accepted: 05/05/2016] [Indexed: 02/07/2023]
Abstract
Liposarcoma is the single most common soft tissue sarcoma accounting for up to 35 % of sarcomas. It represents a histologically diverse group of soft tissue tumors that demonstrate a wide range of imaging appearances with varied behavior patterns. Correspondingly, more aggressive histological subtypes often require management that includes a combination of surgery, chemotherapy, and radiation therapy. Distinguishing among liposarcoma subtypes has important therapeutic and prognostic implications. In this manuscript, we review the liposarcoma subtypes and their histologic and MRI findings, prognostic implications, and differential diagnostic considerations.
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Affiliation(s)
- Magda Rizer
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory Healthcare, Atlanta, GA, USA
| | - Mark Edgar
- Bone and Soft Tissue Pathology, Department of Pathology, Emory Healthcare, Atlanta, GA, USA
| | - Jean Jose
- Section of Musculoskeletal Imaging, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ty K Subhawong
- Section of Musculoskeletal Imaging, Miller School of Medicine, University of Miami, Miami, FL, USA
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17
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Yu X, Nie T, Zhang B, Dai M, Liu H, Zou F. Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report. Oncol Lett 2016; 12:195-198. [PMID: 27347124 DOI: 10.3892/ol.2016.4610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/01/2016] [Indexed: 11/06/2022] Open
Abstract
Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature.
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Affiliation(s)
- Xiaolong Yu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Tao Nie
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Bin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Min Dai
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
| | - Hucheng Liu
- Multidisciplinary Therapy Center of Musculoskeletal Tumor, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Fan Zou
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi 330006, P.R. China
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18
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Lee KW, Lee HI, Kim CH, Kim TK. Large Cavernous Hemangioma of the Subscapularis Muscle - A Case Report. Clin Shoulder Elb 2014. [DOI: 10.5397/cise.2014.17.4.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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19
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Uslu M, Beşir H, Turan H, Bozkaya H, Erdem H. Two different treatment options for intramuscular plantar hemangioma: surgery versus percutaneous sclerotherapy. J Foot Ankle Surg 2014; 53:759-62. [PMID: 25128310 DOI: 10.1053/j.jfas.2014.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Indexed: 02/03/2023]
Abstract
Intramuscular hemangiomas are benign neoplasms usually seen in children and adolescents. They tend to occur in the deep fascia and muscle and more often in the lower extremity, although they are rarely encountered in the plantar musculature. Surgical excision, ultrasound- or fluoroscopic-guided percutaneous sclerotherapy, and angiographic embolization are all treatment options. Surgical excision is the most prevalent form of therapy, although this can be difficult in the hands and feet. For this reason, ultrasound- and fluoroscopic-guided percutaneous sclerotherapy is a useful treatment option for pedal intramuscular hemangioma. In the present report, we describe 2 cases of intramuscular hemangioma in children, 1 treated by excision and 1 by percutaneous sclerosis.
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Affiliation(s)
- Mustafa Uslu
- Assistant Professor, Department of Orthopaedics and Traumatology, Düzce University School of Medicine, Düzce, Turkey.
| | - Halit Beşir
- Department of Radiology, Düzce University School of Medicine, Düzce, Turkey
| | - Hakan Turan
- Department of Dermatology, Düzce University School of Medicine, Düzce, Turkey
| | - Halil Bozkaya
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Havva Erdem
- Department of Pathology, Düzce University School of Medicine, Düzce, Turkey
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20
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Intramuscular capillary-type hemangioma: radiologic-pathologic correlation. Pediatr Radiol 2014; 44:558-65. [PMID: 24487677 DOI: 10.1007/s00247-014-2876-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/08/2013] [Accepted: 01/06/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Infantile hemangiomas demonstrate a pattern of proliferative growth in infancy followed by a slow phase of involution. In contrast a rare type of vascular tumor, intramuscular capillary-type hemangioma, usually presents beyond the period of infancy with nonspecific symptoms and no evidence of involution. OBJECTIVE The purpose of this study was to characterize the clinical, imaging, histopathological characteristics and management of intramuscular capillary-type hemangioma. MATERIALS AND METHODS We performed a retrospective review of a 20-year period to identify children diagnosed with intramuscular capillary-type hemangioma. Patient demographics, imaging and histopathological findings were recorded. RESULTS We included 18 children (10 boys, 8 girls) with histologically proven intramuscular capillary-type hemangioma - and adequate imaging. The mean age at presentation was 8.1 years (range 1 day to 19 years). Twelve lesions involved muscles of the extremities, 4 were located in the trunk and 2 were in the head and neck. MRI had been performed in all children and demonstrated a soft-tissue mass with flow voids, consistent with fast flow. The lesion was well-circumscribed in 16 children and intralesional fat was seen in 14. Doppler US demonstrated a heterogeneous lesion, predominantly isoechoic to surrounding muscle, with enlarged arterial feeders. Enlarged feeding arteries, inhomogeneous blush and lack of arteriovenous shunting were noted on angiography (n = 5). The most common histopathological findings were lobules of capillaries with plump endothelium and at least some adipose tissue. The lesions were excised in six children. Two children were lost to follow-up. In the remaining 10, follow-up MRI studies ranging from 3 months to 10 years showed that the lesion enlarged in proportion to the child (n = 7), demonstrated slow growth (n = 2) or remained stable (n = 1). There was no change in imaging characteristics on follow-up. CONCLUSION Intramuscular capillary-type hemangioma is a rare benign vascular tumor of skeletal muscle. The most typical imaging features show a heterogeneous intramuscular mass with fast flow, and intralesional fat. Although the lesion is relatively stable in appearance over time, imaging does not obviate the need for a biopsy to rule out sarcoma. The diagnosis can usually be established by typical findings on histopathology.
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21
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Skeletal Muscle Haemangioma: A Cause for Chronic Pain about the Knee: A Case Report. Case Rep Orthop 2012; 2012:452651. [PMID: 23259123 PMCID: PMC3504282 DOI: 10.1155/2012/452651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/31/2012] [Indexed: 11/17/2022] Open
Abstract
Skeletal muscle haemangiomas are uncommon soft tissue tumors; more than 90% are misdiagnosed initially. They present as chronic pain and swelling in a muscle with or without a history of trauma. Plain X-rays, bone scans, computerized tomography (CT) studies, and angiography studies may not always be specific for this tumor. Diagnostic ultrasound is an appropriate initial imaging modality for suspected haemangioma, although magnetic resonance imaging is the investigation of choice. Many treatment modalities for the symptomatic haemangiomas are available of which surgical excision is the most preferred. We present an unusual case of pain, swelling, and restriction of movements in the right knee following an episode of trauma in a 12-year-old boy who was being followed for 1 year by a general practioner and later referred to us. The patient was diagnosed to have intramuscular cavernous haemangioma in the vastus medialis by us for which he was treated by surgical excision and followed for 1 year and found to have no recurrence. The clinical features, radiological picture, pathological histology, diagnostic tools, and treatment options have been discussed.
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22
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Yamada H, Mishima K, Kawaguchi K, Horiuchi T, Nakaoka K, Iino M, Saito I, Hamada Y. A nodular buccal mass. ACTA ACUST UNITED AC 2010; 110:140-4. [PMID: 20659696 DOI: 10.1016/j.tripleo.2010.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 04/01/2010] [Accepted: 04/06/2010] [Indexed: 01/08/2023]
Affiliation(s)
- Hiroyuki Yamada
- Department of Oral and Maxillofacial Surgery, Tsurumi University School of Dental Medicine, Yokohama, Tokyo, Japan.
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23
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Fnini S, Messoudi A, Benjeddi Y, Elandaloussi Y, Hassoun J, Garche A, Ouarab M, Largab A. [Intramuscular hemangioma of the forearm: seven cases]. ANN CHIR PLAST ESTH 2010; 58:243-7. [PMID: 20880625 DOI: 10.1016/j.anplas.2010.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 08/13/2010] [Indexed: 11/17/2022]
Abstract
The authors reexamined the files of seven patients dealt with for intramuscular hemangioma of forearm. It concerns five women and two men, between 16 and 39 years old. The average time of consultation was 13 months. The clinical signs were dominated by the development of a generally painless soft mass over the anterior compartment of the forearm and/or the elbow. Two patients presented nervous lesions signs of the ulnar or median nerves. The feeder pedicle was the ulnar artery in five cases and radial artery in two cases. The excision was incomplete in two cases because of the invasion of the ulnar nerve by the hemangioma. With four years average follow-up, the five patients having undergone a complete excision do not present a recurrence and the hand function is excellent. The authors insist on the interest of a preoperative diagnosis with the IRM, which permits to envisage surgical difficulties due to the proximity of vascular and nervous pedicles.
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Affiliation(s)
- S Fnini
- Service de chirurgie orthopédique et traumatologique, pavillon 32, CHU Ibn Rochd, Casablanca, Morocco.
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24
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Mitsionis GI, Pakos EE, Kosta P, Batistatou A, Beris A. Intramuscular hemangioma of the foot: A case report and review of the literature. Foot Ankle Surg 2010; 16:e27-9. [PMID: 20483123 DOI: 10.1016/j.fas.2009.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 05/17/2009] [Accepted: 05/23/2009] [Indexed: 02/04/2023]
Abstract
Intramuscular hemangiomas (IHs) are rare benign neoplasms usually seen in children, adolescents and young adults. Although lower extremities are the commonest localization, the localization at the foot is extremely rare since only a few cases have been reported. We report a case of mixed type IH of the flexor digitorum brevis muscle in a 12-year-old boy who was treated with surgical excision, with wide surgical margins.
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Affiliation(s)
- Gregory I Mitsionis
- The Department of Orthopaedic Surgery, University Hospital of Ioannina, University of Ioannina, School of Medicine, Ioannina, Greece.
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25
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Harzallah-Hizem W, Mnif H, Njim L, Salem R, Zrig M, Jellali MA, Zakama A, Hafsa C, Abid A, Golli M. [A rare etiology of painful knee in child]. Arch Pediatr 2009; 16:1584-6, 1569-70. [PMID: 19854033 DOI: 10.1016/j.arcped.2009.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 08/08/2009] [Accepted: 09/06/2009] [Indexed: 10/20/2022]
Affiliation(s)
- W Harzallah-Hizem
- Service d'Imagerie Médicale, CHU Fattouma Bourguiba, Rue 1 Juin, 5000 Monastir, Tunisie
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