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INTRODUCTION: Bilateral forms of quadricipital tendon rupture are rare. They are usually associated with predisposing factors, such as secondary hyperparathyroidism due to chronic renal failure, which need to be treated to avoid recurrence. PRESENTATION OF CASE: A 38-year-old man with a medical history of chronic kidney failure was presented to the hospital for bilateral quadricipital tendon ruptures after a low-energy trauma. Ruptures were in the midportion of the tendon on the right side and in the level of patellar insertion on the left side. We performed a surgical reparation. One year after surgery, he consulted for a recurrence of the left quadricipital tendon rupture after an impeded extension movement. Biology showed secondary hyperparathyroidism due to chronic renal failure. Surgical reparation and reconstruction by a graft tendon were performed. As for his secondary hyperparathyroidism, he got a sub-parathyroidectomy after medical treatment failure. Recovery was remarkably uneventful. DISCUSSION: Despite the early diagnosis and treatment of a bilateral quadricipital tendons rupture, our patient had an iterative rupture. His secondary hyperparathyroidism due to chronic renal failure may weaken the tendon system through physiological and histological modifications, as it is reported in the literature. As a result, treating a bilateral rupture as a banal post-traumatic lesion without management of the predisposing factors may lead to recurrences. CONCLUSION: A non or low-traumatic tendon rupture in a patient with a history of chronic renal failure needs to identify secondary hyperparathyroidism, which must be treated to avoid recurrences.
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INTRODUCTION AND IMPORTANCE: Desmoid tumour is a rare neoplasm that develops from the fascia and musculoaponeurotic tissue. These tumours tend to local invasion. Desmoid tumours are usually solitary. We present the first case of two synchronous desmoid tumours of the chest wall. CASE PRESENTATION: A 56-year-old male with no medical history presented a painless chest wall mass. CT scan showed a deep soft tissue mass infiltrating the pectoralis major and minor muscles with an invasion of the subclavian and axillary pedicles and a second tumour infiltrating the latissimus dorsi muscle. MRI has allowed for a better study of these two masses, and a surgical biopsy confirmed the diagnosis of a desmoid tumour. The surgical resection was intra-tumoural for the anterior mass to preserve the axillary and subclavian pedicles, and the tumour resection was marginal for the posterior tumour. The postoperative course was uneventful, and an adjuvant therapy based on Imatinib was performed. The tumour residue was stabilized for two years follow-up. CLINICAL DISCUSSION: Desmoid tumours are considered a locally aggressive disease. Ultrasound, CT scan, and MRI have different roles in their diagnosis. But pathological diagnosis is the "golden standard" diagnosis of desmoid tumours. The treatment of desmoid tumours is still not standardized. Surgery is the best primary treatment, but sometimes oncological resection may not be possible because of extension to the vital structure. Adjuvant therapy, like Imatinib, had demonstrated encouraging results. CONCLUSION: For desmoid tumours with vital or noble structure invasion, intra-tumoural resection associated with adjuvant therapy demonstrated encouraging results.
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Malignant transformation of chronic osteomyelitis is a rare and late complication which mainly occurs at the level of the edges of a fistulous tract with extension and infiltration to the surrounding soft tissues and more rarely to bones. We here report the case of Mr N.J. aged 67 years, followed up for chronic osteomyelitis of the right femur fistulized to the skin and evolving since the age of 16 years. He presented with secerning fistulas. Imaging examination showed pathologic fracture due to osteolytic lesion of the lower extremity of the right femur associated with poorly defined intra-medullary collection of fluid measuring 8 cm along its longer axis. The patient underwent surgical resection of the fistulas with complete evacuation and curettage of the bone cavity. Pathological examination showed differentiated keratinising squamous cell carcinoma, infiltrating the fistulous tract and extending to the soft parts and to the lower extremity of the right femur. Staging was negative. Disarticulation of the HIP was performed. At two-years follow-up the patient was doing well without local recurrence or distant metastasis. Initial treatment of chronic osteomyelitis is essential to prevent alarming complications. Amputation is the treatment of choice in patients with malignant transformation of chronic osteomyelitis in particular to squamous cell carcinoma, as in the case of our patient, in order to to prevent secondary involvement.
