RESUMEN
SummaryGiant cell tumours of bone are benign and locally aggressive tumours that usually occur in young adults and at the epiphysial locations after physeal closure. Occurrence outside of epiphysial locations and appearance in geriatric patients is rare. We report a case of a woman in her late 60s with a giant cell tumour of the mid-shaft of the right tibia. Extended curettage and biological reconstruction were performed with autologous double-barrel fibular struts and tri-cortical iliac crest bone grafting. At the 28-month follow-up examination, we noted full bony union at both ends with successful consolidation of the fibular struts, and importantly, no evidence of recurrence or other complications was observed.
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Neoplasias Óseas , Tumor Óseo de Células Gigantes , Tibia , Humanos , Femenino , Tibia/diagnóstico por imagen , Tibia/cirugía , Tibia/patología , Neoplasias Óseas/cirugía , Neoplasias Óseas/patología , Neoplasias Óseas/diagnóstico por imagen , Tumor Óseo de Células Gigantes/cirugía , Tumor Óseo de Células Gigantes/patología , Tumor Óseo de Células Gigantes/diagnóstico por imagen , Legrado , Trasplante Óseo/métodos , Persona de Mediana Edad , Ilion/diagnóstico por imagen , Peroné/diagnóstico por imagen , Peroné/patología , Peroné/cirugía , Diáfisis/cirugía , Resultado del TratamientoRESUMEN
In reconstructive surgery, complications post-fibula free flap (FFF) reconstruction, notably peri-implant hyperplasia, are significant yet understudied. This study analyzed peri-implant hyperplastic tissue surrounding FFF, alongside peri-implantitis and foreign body granulation (FBG) tissues from patients treated at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Using light microscopy, pseudoepitheliomatous hyperplasia, anucleate and pyknotic prickle cells, and excessive collagen deposition were observed in FFF hyperplastic tissue. Ultrastructural analyses revealed abnormal structures, including hemidesmosome dilation, bacterial invasion, and endoplasmic reticulum (ER) swelling. In immunohistochemical analysis, unfolded protein-response markers ATF6, PERK, XBP1, inflammatory marker NFκB, necroptosis marker MLKL, apoptosis marker GADD153, autophagy marker LC3, epithelial-mesenchymal transition, and angiogenesis markers were expressed variably in hyperplastic tissue surrounding FFF implants, peri-implantitis, and FBG tissues. NFκB expression was higher in peri-implantitis and FBG tissues compared to hyperplastic tissue surrounding FFF implants. PERK expression exceeded XBP1 significantly in FFF hyperplastic tissue, while expression levels of PERK, XBP1, and ATF6 were not significantly different in peri-implantitis and FBG tissues. These findings provide valuable insights into the interconnected roles of ER stress, necroptosis, apoptosis, and angiogenesis in the pathogenesis of oral pathologies, offering a foundation for innovative strategies in dental implant rehabilitation management and prevention.
Asunto(s)
Implantes Dentales , Hiperplasia , Humanos , Femenino , Implantes Dentales/efectos adversos , Masculino , Persona de Mediana Edad , Hiperplasia/patología , Hiperplasia/metabolismo , Adulto , Anciano , Inmunohistoquímica , Periimplantitis/metabolismo , Periimplantitis/patología , Periimplantitis/etiología , Peroné/patología , Peroné/metabolismoRESUMEN
BACKGROUND: Desmoplastic fibroma is an extremely rare primary bone tumor. Its characteristic features include bone destruction accompanied by the formation of soft tissue masses. This condition predominantly affects individuals under the age of 30. Since its histology is similar to desmoid-type fibromatosis, an accurate diagnosis before operation is difficult. Desmoplastic fibroma is resistant to chemotherapy, and the efficacy of radiotherapy is uncertain. Surgical excision is preferred for treatment, but it entails high recurrence. Further, skeletal reconstruction post-surgery is challenging, especially in pediatric cases. CASE PRESENTATION: Nine years ago, a 14-year-old male patient presented with a 4-year history of progressive pain in his left wrist. Initially diagnosed as fibrous dysplasia by needle biopsy, the patient underwent tumor resection followed by free vascularized fibular proximal epiphyseal transfer for wrist reconstruction. However, a histological examination confirmed a diagnosis of desmoplastic fibroma. The patient achieved bone union and experienced a recurrence in the ipsilateral ulna 5 years later, accompanied by a wrist deformity. He underwent a second tumor resection and wrist arthrodesis in a single stage. The most recent annual follow-up was in September 2023; the patient had no recurrence and was satisfied with the surgery. CONCLUSIONS: Desmoplastic fibroma is difficult to diagnose and treat, and reconstruction surgery after tumor resection is challenging. Close follow-up by experienced surgeons may be beneficial for prognosis.
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Neoplasias Óseas , Fibroma Desmoplásico , Fibroma , Adolescente , Humanos , Masculino , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Fibroma Desmoplásico/diagnóstico por imagen , Fibroma Desmoplásico/cirugía , Peroné/patología , Estudios de Seguimiento , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Familial Adenomatous Polyposis (FAP) is a colorectal cancer (CRC) predisposition syndrome caused by germline APC mutations and characterised by an increased risk of CRC and colonic polyps and, in certain forms, of specific prominent extraintestinal manifestations, namely osteomas, soft tissue tumours and dental anomalies. Pachydysostosis of the fibula is a rare clinical entity defined by unilateral bowing of the distal portion of the fibula and elongation of the entire bone, without affectation of the tibia. CLINICAL REPORT: We report a 17-year-old male, who presented with a non-progressive bowing of the right leg detected at 18 months of age caused by a fibula malformation (later characterized as pachydysostosis) and a large exophytic osteoma of the left radius, noticed at the age of 15 years, without gastrointestinal symptoms. There was no relevant family history. Detailed characterisation revealed multiple osteomas, skin lesions and dental abnormalities, raising the hypothesis of FAP. This diagnosis was confirmed by genetic testing [c.4406_4409dup p.(Ala1471Serfs*17) de novo mutation in the APC gene] and endoscopic investigation (multiple adenomas throughout the colon, ileum and stomach). DISCUSSION: This case report draws attention to the phenotypic spectrum of skeletal manifestations of FAP: this patient has a congenital fibula malformation, not previously associated with this syndrome, but which is likely to have been its first manifestation in this patient. This clinical case also illustrates the challenges in the early diagnosis of FAP, especially without family history, and highlights the importance of a multidisciplinary approach and the adequate study of rare skeletal abnormalities.
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Poliposis Adenomatosa del Colon , Osteoma , Masculino , Humanos , Adolescente , Proteína de la Poliposis Adenomatosa del Colon/genética , Peroné/diagnóstico por imagen , Peroné/patología , Poliposis Adenomatosa del Colon/genética , Poliposis Adenomatosa del Colon/diagnóstico , Genes APC , Mutación de Línea Germinal , Osteoma/genéticaRESUMEN
Introducción: La enfermedad de Caffey es una patología ósea inflamatoria, rara, autolimitada, casi exclusiva de lactantes. Objetivos: Jerarquizar el abordaje diagnóstico de una patología poco frecuente. Caso clínico: 4 meses 22 días, varón, consulta por irritabilidad y edema de miembro inferior izquierdo de 4 días de evolución. Sin traumatismos ni fiebre. Examen físico: edema indurado en tercio medio e inferior de pierna izquierda, no rubor ni calor local. Dolor a la palpación de cara anterior y lateral de tibia y peroné. Limitación funcional, no resaltos óseos. Radiografía: engrosamiento del periostio en tibia y peroné a nivel diafisario. Hemograma: Glóbulos blancos 15.380 KU/L, Hemoglobina 10,8 g/dL, Plaquetas 816.400 10/ul, proteína C reactiva 13,90 mg/dl. Con planteo de probable infección osteoarticular se inicia clindamicina ( gentamicina e ingresa a cuidados moderados. Dada la persistencia de edema e irritabilidad, al quinto día se solicita resonancia magnética: hallazgos sugerentes de un probable proceso inflamatorio- infeccioso de partes blandas con compromiso óseo. Completa 14 días de clindamicina y 7 días de gentamicina intravenosa, hemocultivo negativo. Persiste con edema, irritabilidad y dolor. A los 21 días, se revalora la presentación clínica-imagenológica, se plantea enfermedad de Caffey. Se inicia anti-inflamatorio con buena evolución. Conclusiones: La enfermedad de Caffey es una colagenopatía rara, que afecta lactantes. El diagnóstico es clínico - radiológico (irritabilidad, tumefacción de partes blandas y alteraciones radiológicas). El pronóstico a largo plazo suele ser favorable. Es importante considerar el diagnóstico en lactantes que se presentan con esta sintomatología para evitar retrasos diagnósticos e instauración de tratamientos innecesarios.
Introduction: Caffey's disease is a rare disease that is reported almost exclusively in infants. Objective: Describe the case of a rare pathology, prioritizing the diagnostic approach. Clinical case: 4 month -old, healthy male. Consultation due to irritability and edema of the left lower limb for 4 days. No trauma or fever. Physical examination: indurated edema in the left leg, no redness or local heat. Pain on palpation of the anterior and lateral aspect of the tibia and fibula. Functional limitation, no bony protusions. Leg x-ray: thickening of the periosteum in the tibia and fibula at the diaphyseal level. Hemogram: White Blood Cells 15,380 KU/L Hemoglobin: 10.8 g/dL. Platelets: 816,400 10/ul, C-reactive protein: 13.90 mg/dl. He was admitted with a suggestion of probable osteoarticular infection. Clindamycin ( gentamicin is started. Given the persistence of edema and irritability despite treatment, on the fifth day an MRI was requested: findings suggestive of a probable inflammatory-infectious process of soft tissues with bone involvement. Completed 14 days of clindamycin and 7 days of intravenous gentamicin, blood culture negative. It persists with edema, irritability and pain. After 21 days, the clinical-imaging presentation was reassessed and Caffey's disease was considered. Anti-inflammatory begins with good evolution. Conclusions: Caffey's disease is a rare collagenopathy, that affects infants. The diagnosis is clinical - radiological (irritability, soft tissue swelling and radiological alterations). The long-term prognosis is usually favorable. It is important to consider the diagnosis in infants who present with these symptoms to avoid diagnostic delays and initiation of unnecessary treatments.
Introdução: A doença de Caffey é uma patologia óssea inflamatória rara, autolimitada, quase exclusiva de lactentes. Objetivos: Priorizar a abordagem diagnóstica de uma patologia rara. Caso clínico: 4 meses 22 dias, sexo masculino, consulta por irritabilidade e edema do membro inferior esquerdo de 4 dias de evolução. Sem trauma ou febre. Exame físico: edema endurecido em terço médio e inferior da perna esquerda, sem vermelhidão ou calor local. Dor à palpação das faces anterior e lateral da tíbia e fíbula. Limitação funcional, sem saliências ósseas. Radiografia: espessamento do periósteo na tíbia e fíbula ao nível diafisário. Hemograma: Glóbulos brancos 15.380 KU/L, Hemoglobina 10,8 g/dL, Plaquetas 816.400 10/ul, Proteína C reativa 13,90 mg/dl. Com sugestão de provável infecção osteoarticular, foi iniciada clindamicina + gentamicina e internado em cuidados moderados. Dada a persistência do edema e da irritabilidade, no quinto dia foi solicitada ressonância magnética: achados sugestivos de provável processo inflamatório-infeccioso de partes moles com envolvimento ósseo. Completou 14 dias de clindamicina e 7 dias de gentamicina intravenosa, hemocultura negativa. Persiste com edema, irritabilidade e dor. Após 21 dias, o quadro clínico-imagem foi reavaliado e considerada doença de Caffey. O antiinflamatório começa com uma boa evolução. Conclusões: A doença de Caffey é uma colagenopatia rara que afeta lactentes. O diagnóstico é clínico-radiológico (irritabilidade, edema de partes moles e alterações radiológicas). O prognóstico a longo prazo é geralmente favorável. É importante considerar o diagnóstico em lactentes que apresentam esses sintomas para evitar atrasos no diagnóstico e início de tratamentos desnecessários.
Asunto(s)
Humanos , Masculino , Tibia/patología , Hiperostosis Cortical Congénita/diagnóstico por imagen , Peroné/patología , Dolor/etiología , Edema/etiología , Inflamación/etiología , Antiinflamatorios/uso terapéuticoRESUMEN
Introdução: Várias são as vantagens da utilização de retalhos fibulares para as reconstruções de defeitos craniomaxilofaciais, incluindo a baixa morbidade da área doadora, boa qualidade óssea possibilitando a realização de implantes osteointegrados quando indicados, além da possibilidade de inclusão de uma ilha de pele quando indicado. Durante a dissecção do retalho, próximo à região do pedículo vascular, normalmente inclui-se um cuff muscular e uma faixa de periósteo. O potencial osteogênico do periósteo transplantado tem sido objeto de estudo. Relato de caso: paciente de 15 anos, submetido à reconstrução microcirúrgica com um retalho fibular para um defeito mandibular pós-ressecção de um sarcoma ósseo. Evoluiu com aumento de volume, de consistência óssea na região cervical próximo à cervicotomia realizada para anastomose vascular. Exames de imagem mostravam características ósseas da massa. Foi então submetido à nova cervicotomia e exploração da massa, sendo observada uma formação de tecido ósseo no local da anastomose vascular. Exame anatomopatológico da peça mostrava formação de tecido ósseo adjacente ao retalho periostal. Discussão: Durante a dissecção do retalho fibular, a osteotomia é realizada a alguns centímetros da articulação do joelho, isto a fim de facilitar a dissecção do pedículo vascular na região do oco poplíteo. O pedículo vascular fica então envolto por uma cuff muscular e por uma tira de periósteo. Este mantém sua capacidade osteogênica, que pode ser ativada de acordo com o estímulo do local. A ossificação do periósteo do pedículo vascular de retalhos livres de fíbula permanece um evento raro, porém relatado por centros diferentes.
Introduction: The use of fibula flaps for the reconstruction of craniomaxillofacial defects has many advantages, including the low morbidity of the donor area, good bone quality for use of osseointegrated implants, and the possibility to include a skin island, when indicated. During the dissection of the flap, a muscle "cuff" and a periosteal strip are usually included near the region of the vascular pedicle. The osteogenic potential of the transplanted periosteum has been the object of studies. Case report: A 15-year-old male patient underwent microsurgical reconstruction using a fibula flap for a mandibular defect caused by the resection of a bone sarcoma. He developed increased volume and bone consistency in the cervical region next to the area where a cervicotomy was performed for vascular anastomosis. Imaging examinations showed the characteristics of the bone mass. He then underwent a new cervicotomy and mass exploratory surgery because bone tissue formation was observed at the site of vascular anastomosis. Anatomopathological examination of the specimen showed bone tissue formation next to the periosteal flap. Discussion: During fibula flap dissection, osteotomy is performed a few centimeters from the knee joint to facilitate the dissection of the vascular pedicle in the region of the popliteal fossa. Then, the vascular pedicle is surrounded by a muscle cuff and periosteal strip. This maintains its osteogenic capacity, which can be activated according to the stimulus of the area. Although periosteal ossification of the vascular pedicle in fibula free flaps is a rare event, it has been reported in different centers.
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Humanos , Masculino , Adolescente , Historia del Siglo XXI , Osteogénesis , Periostio , Colgajos Quirúrgicos , Colgajos Quirúrgicos/cirugía , Huesos , Informes de Casos , Literatura de Revisión como Asunto , Osteosarcoma , Procedimientos de Cirugía Plástica , Peroné , Pierna , Osteogénesis/fisiología , Periostio/cirugía , Huesos/cirugía , Osteosarcoma/cirugía , Procedimientos de Cirugía Plástica/métodos , Peroné/cirugía , Peroné/patología , Pierna/cirugíaRESUMEN
La fractura de tobillo es una patologíatraumática muy frecuente, que cuando debe ser intervenidaquirúrgicamente, lo habitual es el uso de placade osteosíntesis, la misma puede ser colocada en unade sus dos caras, externa o posterior. La externa se encuentradividida por una cresta en una superficie triangularanterior subcutánea y una pósteroexterna, diferentesautores recomiendan la colocación en una u otracara. El objetivo de este trabajo es evaluar cuál de lascaras del tercio distal del peroné, es la más adecuadaanatómicamente para la colocación de la placa deosteosíntesis.MATERIALES Y MÉTODOS: Se evaluó el tercio distal de25 perones, 15 correspondieron al lado izquierdo y 10 allado derecho las muestras fueron obtenidas de la Cátedrade Anatomía Normal. Facultad de Ciencias Médicas(UNC. Córdoba), se realizaron mediciones tanto de lacara ánteroexterna como de la pósteroexterna. Para lamedición se utilizó un calibre digital.RESULTADOS: Los resultados obtenidos indicaron unadistancia promedio de la cara ánteroexterna de 75 mmdesde el maléolo hasta el vértice de la cresta (rango 65mm a 92 mm) y una distancia promedio de 65 mm en lacara pósteroexterna desde la fosita de los peroneos hastala unión de ambas (rango 60 mm a 72.3 mm).CONCLUSIÓN: El estudio anatómico del peroné distalnos permite afirmar que ninguna de sus caras terminansiendo ideales para la colocación de una placa, estaosteosíntesis de 7 orificios puede utilizarse en ambascaras ánteroexterna y pósteroexterna, cuando se tratade una fractura transindesmal, pero no es anatómicamenteviable colocar en la cara ánteroexterna cuandohablamos de fracturas suprasindesmales. Debe colocarseen la cara pósteroexterna aunque en esta partetambién interfiera la unión de ambas caras...
The fibula is a long thin bone thatarticulates with the tibia at both ends. A study wasconducted over 25 perones anatomical and analyzed thedistal third. Our goal is to evaluate which of the faces ofthe distal fibula is the most appropriate anatomically tothe placement of the osteosynthesis plate.MATERIALS AND METHODS: Was evaluated peronesdistal third of 25, 15 corresponded to the left and rightside 10 samples were obtained from plants of NormalAnatomy Chair Faculty of Medical Sciences (UNCCordoba), were measured both as the anterolateral theposterolateral was used for measuring a digital caliper.RESULTS: The results showed an average distance of75 mm anterolateral from the malleolus to the apex of theridge (range 65 to 92 mm) and an average distance of 65mm in the posterolateral from the pit of the peroneal tothe junction of two (range 60 to 72.3 mm).CONCLUSION: We conclude that none of its faces endup being suitable for placement of a plate, theosteosynthesis plate of holes 7 may be used on both sidesanterolateral and posterolateral when dealing with fractureanatomically syndesmotic but not feasible to placeon the face when speaking of fractures anterolateralsuprasindesmales. Should be placed in the posterolateralbut also interfere in this part of the union of both sides...
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Humanos , Masculino , Femenino , Peroné , Peroné/anatomía & histología , Peroné/crecimiento & desarrollo , Peroné/patologíaRESUMEN
El carcinoma epidermoide es una neoplasia maligna que se origina del epitelio; en algunas ocasiones se presenta asociada a la osteomielitis crónica: El sitio de mayor presencia es la tibia. Es de difícil diagnóstico dado que se asocia a úlceras generalmente infectadas, con problemas de cicatrización. El diagnóstico histopatológico también es complejo por la gran metaplasia celular que se produce en las úlceras. Un dato que apoya el diagnóstico es la dificultad para la cicatrización a pesar del tratamiento. El diagnóstico se consigue con biopsias de diferentes sitios de la úlcera y el tratamiento generalmente tiene que ser radical. Se reporta un caso de carcinoma epidermoide
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Humanos , Masculino , Anciano , Osteomielitis/diagnóstico , Osteomielitis/fisiopatología , Carcinoma de Células Escamosas/complicaciones , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/fisiopatología , Peroné/anatomía & histología , Peroné/anomalías , Peroné/patologíaRESUMEN
La melorreostosis es una enfermedad poco común, se describió desde 1933, su etiología es poco precisa aun cuando se cree que es de origen genético con defectos en la capa mesodérmica. Se describe el caso de una niña diagnosticada y tratada en el Hospital Shriners. En esta patología se observa, a nivel óseo, el engrosamiento de la cortical y según su extensión, en los huesos de todo un miembro o en una porción de un solo hueso producirá una deformación total o parcial del miembro
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Humanos , Femenino , Adolescente , Melorreostosis/diagnóstico , Melorreostosis/etiología , Melorreostosis/patología , Melorreostosis/terapia , Peroné/cirugía , Peroné/patologíaAsunto(s)
Humanos , Masculino , Adolescente , Tobillo , Quistes Óseos/diagnóstico , Neoplasias Óseas/diagnóstico , Osteosarcoma/diagnóstico , Peroné , Tobillo/cirugía , Biopsia , Trasplante Óseo , Quistes Óseos/cirugía , Quistes Óseos/patología , Errores Diagnósticos , Neoplasias Pulmonares/secundario , Neoplasias Óseas/cirugía , Neoplasias Óseas/etiología , Neoplasias Óseas/patología , Osteosarcoma/etiología , Osteosarcoma/patología , Osteosarcoma/cirugía , Peroné/cirugía , Peroné/patología , RecurrenciaRESUMEN
O adamantinoma, também chamado ameloblastoma, é neoplasia rara dos ossos longos (pouco mais de 100 casos descritos na literatura) e com origem näo estabelecida. Por possuir aspectos que lembram o ameloblastoma da mandíbula, é geralmente correlacionado com aquele tumor, inclusive no próprio nome. Com a finalidade de dar conhecimento à literatura, os autores apresentam um caso considerado clássico de adamantinoma e fazem breve revisäo da clínica, radiologia e patologia deste tumor
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Ameloblastoma , Peroné/patología , Radio (Anatomía)/patología , Tibia/patologíaRESUMEN
Se presenta I gesta de 18 años con diagnóstico de embarazo de 33 semanas y tromboflebitis de pierna izquierda cuya enfermedad comenzó a los 2 meses de embarazo con edema; radiología realizada reveló tumor maligno de peroné izquierdo; la paciente fue referida a otra institución donde tuvo parto vaginal de recién nacida que le sobrevive luego de la muerte de la madre ocurrida 14 meses depués del diagnóstico. La literatura revisada expresa que el estudio radiológico debe ser realizado ante dolor y/o edema persistente, independientemente de la edad del embarazo, ya que hay poca evidencia de efecto teratogénico en embrión humano para dosis menores de 15 rads, que pueden usarse también radionúcleidos (99 technetium) con fines diagnósticos; una vez obtenido radiodiagnóstico el siguiente paso es el estudio histológico mediante biopsia con aguja fina o biopsia abierta; que el embarazo no tiene efecto deletéreo en el curso de los sarcomas ni viceversa, por lo tanto no hay indicación de interrupción del embarazo salvo en los casos en que se requiera quimioterapia en primer trimestre; que no se ha demostrado la transmisión genética ni tampoco han sido descritas metástasis fetales y/o placentarias