A Rare Pediatric Case of Posttraumatic Pseudoaneurysm: Case Report and Literature Review.

Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thrill, and an audible to-and-fro murmur" (1), which can be confirmed by various imaging techniques. In this report, we describe the case of a 4-year-old boy who presented to the pediatric emergency department 3 weeks after falling and subsequently getting cut by glass. Upon clinical examination, the patient presented with pulsatile, swollen mass in the left wrist. A Doppler ultrasound of the left wrist demonstrated that the area of clinical concern in the left wrist showed a pseudoaneurysm, and prominent arterial blood flow was seen within the pseudoaneurysm. Because pseudoaneurysms, particularly posttraumatic pseudoaneurysms, are extremely rare in the pediatric population, it may be easy to miss these cases during clinical examination. Misdiagnosis of the pseudoaneurysm can cause delayed treatment, a longer recovery period, and complications such as infection, rupture, and hemorrhage. It is important for physicians to consider this entity when evaluating patients with symptoms of asymptomatic bulges to painful pulsatile masses after trauma.

Adamantinoma of bone: Long-term follow-up of 46 consecutive patients.

BACKGROUND: Adamantinomas are rare bone tumors, commonly affecting the tibia. Due to the rare nature of disease, previous studies are small or from multiple centers. The purpose of this study is to investigate outcomes of patients with adamantinoma treated in a single institution. METHODS: Forty-six histological confirmed adamantinomas of the extremities were reviewed at our institution between 1939 and 2012. Follow-up data included clinical and radiographical information focusing on complications, local recurrence, metastasis, and overall survival after the treatment. The mean follow-up was 16 years (range 2-42 years). RESULTS: The most common location was the tibia (n = 31). Patients commonly presented with pain and swelling. The mean age was 24 years (7-79 years). Thirty-seven patients were treated with limb salvage. The 39% of patients required a reoperation. The 10-year disease specific- and recurrence free survival was 92% and 72%, with three patients having a recurrence over 15 years postoperative. Older (> 20 years) patients and males were at increased risk of local recurrence (P < 0.05). CONCLUSION: Treatment of adamantinoma of the long bone consists of limb-salvage surgery. Male patients should be cautioned on their increased risk of disease recurrence, and advocate for continued surveillance of patients even greater than 15-years postoperatively due to late tumor recurrence.

[Post-traumatic acral melanoma: an underestimated reality?]. / Mélanome acral post-traumatique : une réalité sous-estimée ?

BACKGROUND: The role of trauma in the physiopathology of malignant melanoma remains controversial. We report a case of acral melanoma in which a characterized trauma seems implicated in tumour progression; we performed a review of the literature. PATIENTS AND METHODS: A 73-year-old male consulted for a lesion of his right big toe. Physical examination revealed a dystrophic and hyperkeratotic nail destroyed by a growing lesion. Histological study showed an ulcerated superficial spreading melanoma with a Breslow thickness of 4mm. He had previously had this same toe broken, leaving gradually worsening dystrophy of the nail; the toe was injured again spontaneously and by partial removal of the nail tablet. DISCUSSION: A number of cases of "post-traumatic" melanomas have been reported. This hypothesis, though widely admitted for other tumours, remains debated for melanomas mainly because of possible recall bias. In this patient, there was a clear continuum of the lesion as well as topographic correspondence between the initial trauma, the remaining dystrophy and the appearance of the melanoma. Case-control studies have identified trauma as an independent risk factor for acral melanoma with a high relative risk; such risk is multiplied for repeated trauma, suggesting a "dose-effect" relationship. Trauma could act as the promotional stage of melanoma mediated by cytokines released during wound healing or it could cause direct activation of micro-vascular tumour cell transport. CONCLUSION: Our observation and literature research provide convincing arguments for a role of trauma in the development of acral melanomas. Dermatologists must pay attention to any unusual changes in an old scar.

Marjolin's ulcer--a diagnostic dilemma.

Marjolin's ulcer is malignant change in a long-standing ulcer and or scar tissue. Commonly these lesions are treated as chronic ulcers and suspicion of malignancy should be raised with crusting, increase in pain or size of the ulcer and bleeding. We report a case of Marjolin's ulcer arising in a post-traumatic chronic ulcer of sole in a 60-year-old female.

Resection and reconstruction of an osteochondroma of the hallux: a review of benign bone tumors and a description of an unusual case.

UNLABELLED: Osteochondroma, which is also known as exostosis, is the most common benign bone tumor. Although foot and hand surgeons frequently encounter the subungual exostosis, exostoses commonly localize to other areas of the skeleton as well. In this review, we describe the clinical and diagnostic imaging characteristics of benign bone tumors and, in particular, the osteochondroma and its surgical management. We also report the case of a patient who experienced an unusual pedal digital osteochondroma-like lesion. LEVEL OF CLINICAL EVIDENCE: 4.

Traumatic neuroma of the lower lip.

Traumatic neuroma is a rare disorder that represents a reactive proliferation of neural tissue following damage to an adjacent nerve. Clinically, oral lesions usually appear as a nodule of normal or grayish white smooth surface colouration, and patients may complain of pain as a frequent symptom. We report a case of a painless lower lip traumatic neuroma, clinically misdiagnosed as lipoma, in a 24-year-old Caucasian woman. On intraoral examination, a yellowish and smooth sessile, well-delimited, painless, nodular lesion measuring 10 mm x 7 mm x 4 mm in size was observed on the mucosal lower lip. An excisional biopsy was performed and the final diagnosis was traumatic neuroma. After 18 months of follow-up, the patient is asymptomatic and there are no signs of recurrence.

Marjolin ulcer of the scalp: intruder of a burn scar.

Childhood burn accidents are still a problem all over the world. Besides the contractures and hypertrophic scar conditions, malignant transformation in the burn scar is one of the primary concerns later in adulthood. Marjolin ulcer, commonly seen after burn scar, is a neoplastic change in the scar tissue. The scalp region necessitates additional attention because of the inevitable structures it protects. The long-standing ulcers with malignant transformation may cause invasion of different layers of the scalp. As the cranium is invaded, reconstruction after wide excision of these tumors becomes more difficult to deal with. Scalp invasion of Marjolin ulcers with different levels is presented in the following study. Consistent with the literature, histopathology of the tumors was squamous cell carcinoma in most patients. Although rare, mesenchymal tumor is involved in 2 of 9 patients. The latent period of the tumor is inversely proportional to the age at the time of burn injury. As the patient is younger at the time of injury, the occurrence of the ulcer is longer than expected. Lag period as long as 81 years is detected in the study. The delayed diagnosis due to social considerations such as financial limitations increases the likelihood of cranial invasion. A single huge scalp flap is often sufficient for soft tissue defects, and cranioplasty with methyl methacrylate is an appropriate option for reconstruction.

A great Marjolin's ulcer of the scalp invading outer calvarial bone and its different treatment with support of Medpor.

A Marjolin's ulcer arising in a chronic scalp burn scar is reported. Malignant transformation occurred after 1 decade. The tumor had invaded the skull, but not dura mater and its underlined brain tissue. This case illustrates the importance of appropriate and expeditious initial wound management of scar ulcers with high malignant potential to prevent this devastating outcome and also the role of reconstructive surgical techniques in radical surgery for scalp cancers.

Telomerase activity with concurrent loss of cell cycle regulation in feline post-traumatic ocular sarcomas.

Paraffin wax-embedded ocular globes of cats with post-traumatic ocular sarcomas were examined for the presence of TERT, the active subunit of telomerase. The latter is a ribonucleoprotein complex essential for immortalization and expressed by most malignant tumours, germ line cells, lens epithelial cells, and some stem cells. Due to the frequent loss of cell cycle control with the increased expression of telomerase activity, post-traumatic ocular sarcomas were also examined for loss of p16 expression and alterations in p53, the findings being related to mitotic score, tumour grade, and proliferating cell nuclear antigen. These sarcomas expressed telomerase at a high frequency (62.5%); in addition, the majority showed alterations in cell cycle control, as evaluated by lack of p16 immunolabelling (66.7%). Alterations in p53 were the sole mechanism by which cell cycle control was dysregulated in only two tumours expressing TERT (13%). These findings suggest that p16, and not p53, represents the primary mechanism by which post-traumatic ocular sarcomas that express telomerase activity escape cell cycle control.

Marjolin's ulcer on the nose.

Malignancies in scars are generally known as Marjolin's ulcer. The majority of these arise from burn injuries. Although Marjolin's ulcer consists of all kinds of skin cancer, squamous cell carcinoma is the main cancer type reported in the literature. The pathogenesis of this tumor is due to chronic irritation of the effected area and mostly involves the extremities and scalp area. This report presents an unusually located and rare type of Marjolin's ulcer: on the nose and baso-squamotic in type. A 54-year-old man, 33 years after burn, presented with an unhealed ulcer on his nose which had been present for 2 years. The case was managed by tumor excision and a naso-labial transposition flap. To our knowledge, this is the first report of Marjolin's ulcer developing on post-burned skin of the nose.

Metastatic adenocarcinoma in a recent burn scar.

Neoplastic lesions arising in recent burn scars are apparently quite rare and we could find no report of such an occurrence in the literature. Nevertheless we recently treated a patient with a metastatic adenocarcinoma from the lung in a 3-month-old burn scar.

Postburn scar carcinomas in Kashmiris.

Seventy-two Kashmiri patients with postburn scar carcinomas seen over a period of 12 years have been reviewed. The incidence of this cancer in the valley appears to be comparatively high (10.4 percent of squamous cell cancers and 7.6 percent of all cutaneous cancers). A Kangri burn was the commonest aetiological agent (44.4 percent). The mean age at presentation was 41.5 years, with a mean latent period of 35.4 years. None of the patients had metastases and all tumours were well differentiated squamous cell carcinomas. Sixty-four patients underwent excisional surgery and six had amputations, with a 5-year survival rate of 68.7 percent, which is better than reported by many other series.

Malignant schwannoma in a burn scar.

The malignant potential of a burn scar is well recognized. Epidermal malignancies predominate and sarcomas are a rare finding. The first case of a malignant schwannoma developing in a burn scar is reported, and the management discussed.

Acute squamous cell carcinoma arising within a recent burn scar in a 14-year-old boy.

We have described the case of a 14-year-old boy who developed an acute squamous cell carcinoma within a healed burn scar 6 weeks after thermal injury. This is a rare condition necessitating early excision and histopathologic confirmation of clearance. The authors recommend early skin grafting of deep partial- and full-thickness burns to prevent future malignant transformation and a low index of suspicion of any nodules or ulceration appearing within a healed burn.

[A recurrent desmoid tumor of the popliteal fossa with vascular compromise]. / Tumor desmoide recidivante de hueco poplíteo con compromiso vascular.

We report a case of a 18-year-old male patient with his fourth relapse of a desmoid tumour of the left popliteal hollow after a traumatism in this area. Arterial displacement and extrinsic compression were showed by arteriography. Tumoration was extirpated including popliteal artery, in this way a terminal by-pass from distal femoral to peroneo-tibial trunks with contralateral great saphena was made. Diagnosis of intestinal polyposis and of the little osseous malformations, was discarded these pathologies frequently are related with these tumours. The research for 8 years and 4 months doesn't show any relapse, nor local neither multicentral. Furthermore, some considerations about this theme are reported.