Rare localisation of a recurrent desmoid tumour of the foot: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Aggressive fibromatosis or desmoid tumour is a rare soft tissue tumour that develops from supporting tissues and fascia. Although benign, fibromatosis is a tumour that can be locally invasive, and surgical treatment is often difficult. The interest of this observation is to show the particular characteristics of desmoid tumours: the frequency, the major difficulties of excision and the role of adjuvant treatment in the management of these tumours.

CASE PRESENTATION

The patient was 27 years old male, and had a pathological history of a recurrent desmoid tumour on the dorsal surface of the right foot, which had been present for 10 years, had been operated on 5 times and could not be completely removed. A radiological work-up confirmed the nature of the lesion, necessitating a biopsy, which confirmed the diagnosis of a recurrence of the desmoid tumour on the sole of the foot.

CLINICAL DISCUSSION

Desmoid tumour is a rare tumour with less than 5 cases per million inhabitants, histologically benign and belonging to the deep fibromatosis group. The average age is 30, with a predominance of women. The most common location for desmoid tumours is the abdominal wall, and they are usually single and unilateral. The treatment of desmoid tumours is primarily surgical, but is fraught with technical difficulties due to the absence of any cleavage plane and the particularly tight adhesions to neighbouring structures. Radiotherapy or hormone therapy has been advocated as an adjunct to tumour resection, but its value is debated, and recurrence occurs in 50-80 % of cases.

CONCLUSION

The desmoid tumour is a very rare tumour, with an infiltrating and aggressive benign character, whose surgical treatment is difficult, and whose evolution is marked by recurrences.

Synovial sarcoma of the abdominal wall: A case report for a rare entity with a challenging treatment

INTRODUCTION AND IMPORTANCE

Synovial Sarcoma is an intriguing disease, it represents a distinctive subtype of soft tissue sarcoma that does not exceed 10 % of all STS. This tumor can arise from the abdominal wall in very rare cases. Due to its unique presentation (occurring at a young age, various anatomical locations, and slow evolutionary kinetics), diagnosis can be challenging. The mainstay of treatment remains wide surgical excision with negative margins.

CASE PRESENTATION

We herein report a challenging diagnosis of synovial sarcoma with exceptional location, presented as a slowly evolving abdominal mass of the right iliac fossa. Soft tissue MRI confirmed the presence of a sub cutaneous mass without signs of local invasion. Surgical management as indicated. Anatomopathological findings were in favor of a synovial sarcoma of the abdominal wall. The patient was discharged. No complication was observed after 3 months follow up.

CLINICAL DISCUSSION

Patients with synovial sarcoma of the abdominal wall is a very rare entity, therefor positive pre operative diagnosis is hard to achieve, because of the lack of specific clinical and radiological signs. No standard treatment is advised, beside surgical management wish is the main course of management.

CONCLUSION

Synovial sarcoma is an infrequent pathology, with no specific signs in both clinical and radiological findings. The main course of management is surgery with healthy resection margins. Long term follow up is advised because of the high risk of recurrence.

Pilonidal sinus of the cheek: an extremely rare clinical entity-case report and brief review of the literature

Background

Pilonidal sinus is commonly seen at the sacrococcygeal region and few other sites, usually located at the midline, at areas where hairs collect or near protuberances or some adjacent rubbing surfaces. Its presence elsewhere is uncommon. We share an interesting case of a recurrent discharging sinus from the cheek bulge of a male which turned out to be a pilonidal sinus containing tuft of hairs on exploration and wide excision.

Case presentation

A 37 years old hirsute male presents to us with a non-healing discharging sinus at the bulge of the cheek. Exploration after a course of antibiotics showed 2 subcutaneous cavities with tuft of hairs. The area was excised along with a margin, thorough irrigation and curettage was done and the wound was closed primarily; a Z-plasty was incorporated in the central part to break the resultant suture line. Histopathological examination was done to confirm the diagnosis and rule out an off-midline dermoid cyst or an underlying/coexisting malignancy. Post-operative course was uneventful. The patient has been recurrence free for 1.5 years and is satisfied with the nature of the scar.

Conclusions

Pilonidal sinus of the cheek bulge is an extremely rare entity. Complete excision and clinical suspicion are important for cure of this nagging ailment, especially at unexpected areas.

[Cerebral hydatid cyst: Clinical case and review of the literature]

Hydatid disease is an accidental parasitosis, with brain location being rare. The case is reported of a 33year-old male, with no history of note, who was admitted to hospital with intracranial hypertension syndrome and right hemiparesis. Computed tomography showed a cystic lesion in the left frontal-parietal lobule. Surgery was performed by complete excision of the lesion, with a good outcome. Hydatid disease is a rare condition in the brain. Clinical suspicion is important for an early diagnosis. A review is presented on the pathogenesis, diagnosis and treatment of cerebral hydatid disease.