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.

Ultrasound in diagnosis of retroperitoneal femoral nerve injury: a case report.

We present a case of retroperitoneal femoral nerve injury after cut wounds at the lower abdomen. Electrodiagnostic tests revealed impaired function of nerve and muscles. A mass was observed at the retroperitoneal part of the femoral nerve by ultrasound, indicating that a traumatic neuroma composed of disordered fascicles was configurated after the injury. Postoperative pathology confirmed hypertrophic and hyperplastic nerve bundles of the mass. Great improvements were shown in the patient's symptoms and electrodiagnostic tests in the subsequent 3 months. This case presented a rare position of neuroma formation by ultrasound.

[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.

Histogenetic and taxonomic considerations on a case of post-traumatic bizarre parosteal osteochondromatous proliferation (BPOP).

A case of bizarre parosteal osteochondromatous proliferation (BPOP) arising in the head of the fibula of a young man following injury on the lateral aspect of the knee is reported. Microscopically, four zones could be recognized proceeding from the periphery to the deep portion: 1) an outer thick fibrous cap showing an abundant cellular component, composed of thin spindled elements of fibroblastic appearance, haphazardly arranged and exhibiting intense and diffuse immunohistochemical expression of S100 protein (a previously unreported observation); 2) an irregular and atypical cartilaginous cap beneath the fibrous cap; 3) a layer of blue bone in which islands of atypical chondrocytes are still present but gradually decreasing, moving towards the deeper areas; 4) a layer of mature bone, pink bone, which is implanted in the skeletal segment (the deep margin is devoid of periosteum). The intratrabecular spaces of blue or pink bone did not contain haematopoietic marrow, but rather a loose myxoid stroma. This case confirms the fact that BPOP can occur in skeletal segments other than those indicated in the original report of Nora, and that trauma, even if minor, is an important factor in the development of the lesion. The latter begins at the periosteal level, where fibroblasts may acquire a chondroformative function (becoming chondrofibroblasts), as witnessed by the strong and widespread expression of P S100, first documented in this report.

Traumatic neuroma of the lower lip / Neuroma traumático del labio inferior

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.

El neuroma traumático es un trastorno raro que consiste en una proliferación reactiva del tejido neural tras producirse un daño en un nervio adyacente. Clínicamente, las lesiones orales normalmente aparecen como un nódulo de coloración normal o blanca grisácea, de superficie lisa, y los pacientes pueden quejarse de dolor como síntoma frecuente. Reportamos el caso de un neuroma traumático del labio inferior labio sin dolor, clínicamente mal diagnosticado como lipoma, en una mujer blanca de 24 años. En el examen intraoral, se observó una lesión nodular amarillenta, sésil, lisa, bien delimitada, e indolora, que medía 10 mm x 7 mm x 4 mm de tamaño, en la mucosa del labio inferior. Se realizó una biopsia, y el diagnóstico final fue un neuroma traumático. Después de 18 meses de seguimiento, el paciente se halla asintomático y no hay ninguna señal de recurrencia.

The role of high-resolution ultrasound in the diagnosis of a traumatic neuroma in an injured median nerve.

Since the development of high-resolution ultrasound, its role in the diagnosis of peripheral nerve lesions has steadily increased. We present the case of a 42-yr-old woman who experienced consistent numbness over the left hand and fingers after cutting the wrist in a suicide attempt and subsequent tendon and median nerve repair and a period of rehabilitation. Electrodiagnostic testing was normal, but high-resolution ultrasound demonstrated hypoechoic, focal swelling in the region of the median nerve consistent with a neuroma. Neuroma was confirmed at surgery, and after excision of the neuroma, nerve repair with a nerve graft was performed. Postoperatively, the patient's symptoms improved significantly. This case suggests that high-resolution ultrasound may be superior to electrodiagnostic studies for the diagnosis of traumatic neuroma.

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.

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.

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.