Surgical treatment for symptomatic non-ossifying fibromas of the lower extremity with calcium sulfate grafts in skeletally immature patients.

BACKGROUND: Non-ossifying fibromas (NOFs) are common benign bone lesions found in children and adolescents. They usually involve metaphysis of long bones, tend to gradually disappear with age and usually do not require surgery, while they are not associated with pathological fractures. The aim of this study was to evaluate the outcome and efficacy of a single-stage procedure, comprising curettage of the lesion and calcium sulfate pellet (CaSP) grafting, in skeletally immature patients with large, symptomatic NOF of the lower extremity, and the possible limitations of the procedure. METHODS: Nine skeletally immature patients with symptomatic NOF of the lower extremity were treated between 2013 and 2016. Details of age, history of presentation, location and size (in mm) of the lesion, histology and follow-up details were recorded. Lesions were classified in Ritschl radio-morphological stages. CaSP integration was assessed by Irwing's classification. The average size of lesions was 54.6 mm in length (range 31-95). All lesions were symptomatic. The average bone expansion in relation to the bone diameter was 67.4% in the transversal plane (range 31-100) and 77.8% in the sagittal plane (range 55-100). Mean patient age at time of treatment was 9.8 years (range 7-14); mean follow-up was 2 years (range 2-4). All the patients were symptomatic, and 8 out of 9 (89%) NOFs were Ritschl type B. All the patients were treated surgically with a single-step approach, as described. RESULTS: On average, 86 mL of CaSPs was used per case (range 10-250). None of the patients required internal fixation. At last follow-up visit, CaSPs were fully incorporated in all the patients according to Irwing's classification (Stage 3). No serous drainage from wounds was recorded in any of the patients. No cases of pathological fracture, bone deformity, growth arrest or growth disturbance or infection were observed. At last follow-up visit, all the patients had resumed full sport and daily life activities. CONCLUSIONS: CaSPs offer a safe, cheap, convenient alternative to the autograft as an implant substitute that helps regeneration of bone in the defects produced by curettage of large, symptomatic NOFs. Chemical cauterization of bone walls does not interfere with CaSP integration into bone tissue.

Double papillary fibroelastoma: beautiful, innocent flowers in the left heart.

Papillary fibroelastoma is a rare, benign tumor, and multiple papillary fibroelastomas are even more uncommon. In an asymptomatic patient scheduled for carotid endarterectomy, transthoracic echocardiography discovered a fibroelastoma on the mitral valve. Then, transesophageal echocardiography showed another fibroelastoma on the aortic valve. Because he also needed a right coronary artery bypass, the patient underwent surgical excision of both masses. Fibroelastomas are not always as innocent as they seem, and surgical excision is necessary because of their potential for systemic or coronary embolization. Transoesophageal echocardiography may improve the diagnosis of multiple papillary fibroelastomas.

Removal of an irritation fibroma using an Er,Cr:YSGG laser: a case report.

The irritation fibroma is a benign proliferation that occurs as a response to local irritation. It is an elevated pedunculated or sessile lesion that ranges in size from a few millimeters to a few centimeters and is normal in color, although it may appear to be more pale than the normal mucosa. This article describes the case of a 39-year-old woman with an asymptomatic nodular lesion that involved the left buccal mucosa. The lesion was removed using an Er,Cr:YSGG laser. Only topical anesthesia was applied to the fibroma and adjacent mucosa and no infiltration was required. No pain medication or antibiotics were required after surgery and wound healing was excellent and achieved rapidly. The oral pathology report confirmed the presurgical clinical diagnosis. Laser excision is a modern approach for treating oral soft tissue lesions and should be considered as an alternative to conventional scalpel surgery.

[Soft-tissue tumors: primary excision or wait and see?]. / Lipom, Atherom, Fibrom. Wann muss ein Weichteiltumor raus?

Soft tissue tumors are relatively commonly seen lesions in the doctor's office. An initial differentiation between malignant and benign tumors is usually possible on the basis of the case history and a careful physical examination. In adults, primary excision under local anesthesia is the treatment of choice in many cases, while in children and in the case of large tumors suspected of being malignant, a histological diagnosis must always be obtained. A number of procedures are available for biopsy taking. If the definitive histological work-up confirms malignancy, or if the findings are uncertain, the diagnostic investigation should be extended to include such imaging procedures as CT scanning or MRI.

Fibroma de vulva (molluscum pendulum). Relato de Caso / Vulvar fibroma. Case report

É apresentado um caso de fibroma de vulva, modalidade molluscum pendulum, em uma jovem de 20 anos. O tumor desenvolveu-se após a menarca com evoluçäo lenta e progressiva. Ao exame físico, observou-se volumosa massa pediculada, indolor, com inserçäo no terço superior do grande lábio esquerdo, de consistência elástica, com diâmetro maior em sua parte distal de 12 cm por 23 cm de comprimento. Como tratamento, optou-se pela exérese pela base do pedículo, sob anestesia local. O tumor apresentou o peso de 950 g. Complementa-se com revisäo de literatura.

Atypical presentation of plantar fasciitis secondary to soft-tissue mass infiltration.

This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient's description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient's pain.

[Giant fibroma of mesocolon transverse imitating tumor of ovary: a case report]. / Olbrzymi wlókniak krezki okreznicy poprzecznej imitujacy guz jajnika--opis przypadku klinicznego.

OBJECTIVES: The fibroma of mesocolon transverse is a rare lesion occurring primarily in age about 45-55 of years. The rarity of these lesions and the absence of characteristic clinical findings makes diagnosis difficult. STUDY DESIGN: The authors describe a case of fibroma mesocolon transverse in woman aged 75 years which became directed to Department of Gynecology & Obstetric in Hospital of Slupsk on account suspicions of ovarian tumor. RESULTS: Fibroma mesocolon transverse usually present as abdominal distention of long duration, pain, vomiting, less frequently as a palpable abdominal mass. Rarely they cause an acute abdominal surgical crisis clinically resembling appendicitis with peritonitis. Ultrasonography was the diagnostic method of choice. Other diagnostic modalities included intravenous pyelogram, barium enema examination, upper gastrointestinal tract series, CT scan and MRI in selected patients exclude gastrointestinal and genitourinary cysts and tumors. Histologically, several specific types could be distinguished of intra-abdominal lesions: lymphangioma, nonpancreatic pseudocyst, enteric duplication tumor, mesothelial tumor, enteric tumor, torsion of an omental segmental infarction cyst, hydatic omental cyst, omental fibromatosis tumor, ectopic ovarian cyst of the omentum, benign teratoma of the omentum or mesocolon. Treatment of choice of fibroma mesocolon transverse is always surgical (enucleation or resection of fibroma). Morbidity and mortality should be very low because of modern surgical techniques and follow-up procedures.

Case report: Spontaneous isolated mesenteric fibromatosis presenting as megaduodenum.

A case of spontaneous isolated mesenteric fibromatosis presenting as megaduodenum is reported. The lesion was small, only 2 cm in its greatest diameter. However, because of its location near the ligament of Treitz and because of its characteristic infiltrative growth pattern, the tumour involved the distal duodenum and resulted in acute angulation and obstruction early in its course. We successfully resected the mass and the patient is in fair physical condition 6 months after operation.

Diffuse intra-abdominal fibromatosis in association with bilateral ovarian fibromatosis and oedema.

A case of bilateral ovarian enlargement secondary to massive ovarian oedema with underlying intra-abdominal and pelvic fibromatosis is presented. Bilateral salpingo-oophorectomy and hysterectomy led to rapid progression of the intra-abdominal and pelvic fibromatosis, which was previously unsuspected. The case highlights the importance of recognizing massive oedema of the ovary as a distinct entity as it is a benign condition affecting young females and can be confused with ovarian neoplasm. In this case, the major morbidity was from the underlying diffuse intra-abdominal fibromatosis. Conservative management with prolonged bowel rest, total parenteral nutrition, and intravenous steroid and Tamoxifen successfully led to complete resolution of bowel obstruction from diffuse fibromatosis.

[Laser surgery and phototherapy of the larynx and laryngopharynx under indirect laryngoscopy]. / Lazernaia khirurgiia i fototerapiia gortani i gortanoglotki pod nepriamoi laringoskopiei.

The authors elaborated the equipment and technique of endolaryngeal laser surgery under indirect laryngoscopy in conditions of local anesthesia as well as phototherapy of the larynx with coherent and noncoherent monochromatic light in the postoperative period. Therapy was conducted and assessment of its efficacy was made in 93 patients with benign tumours, cysts of the larynx and laryngopharynx, cicatricial membranes of the middle regions of the larynx. The efficacy of the given method was assessed on the basis of long-term laryngoscopic studies, stroboscopy and acoustic measurements of the voice. Indications and contraindications to the mentioned therapy have been specified.

Tumor-induced osteomalacia: long-term follow-up of two patients cured by removal of their tumors.

Two patients with mesenchymal tumors had osteomalacia associated with marked hypophosphatemia and renal phosphate wasting. Their serum calcium and parathyroid hormone levels were normal. The first patient also had aminoaciduria and glucosuria in addition to phosphaturia. Both patients were treated with very large doses of vitamin D2 and phosphate without improvement in the osteomalacia or normalization of the serum phosphate. Complete removal of a low-grade fibrosarcoma in the second patient and removal of an ossifying fibroma in the first patient resulted in a cure in both patients despite no further therapy with vitamin D or phosphate. The excessive aminoaciduria and glucosuria of the first patient also remitted. During a 14-year follow-up period, there has been no evidence of tumor recurrence, hypophosphatemia, or osteomalacia in either patient. The levels of 1,25-dihydroxycholecalciferol remain within the normal range in both patients.

[Nasopharyngeal fibroma. Excision under hemodilution and delayed autotransfusion]. / Le fibrome naso-pharyngien. Exérèse sous hémodilution et autotransfusion différée.

The surgical treatment of juvenile naso-pharyngeal angiofibroma involved a potential haemorrhagic risk: the average intra-operative blood loss was estimated at between 1,300 and 2,800 ml in many reports. Two cases are reported in which haemodilution and autologous blood transfusion were used. The method consisted in pre-operative repeated phlebotomies ("leap-frog") and normovolaemic acute haemodilution; thus, 1,700 ml of autologous blood was collected in the first case, and 2,300 ml in the second one. Autotransfusion was carried out and no homologous blood transfusion was used in the peri-operative period. The use of this method, although compelling, had many advantages (financial saving, suppression of adverse reactions with homologous transfusion, transfusion of fresh blood, reduction of postoperative oedema).

[Use of a carbon dioxide laser in surgery for benign tumors in polyclinics]. / Primenenie uglekislotnogo lazera pri operatsiiakh po povodu dobrokachestvennykh opukholei v poliklinike.

Under conditions of municipal polyclinic 111 operations for benign tumors of skin and subcutaneous fat were performed with the application of laser surgical device "Scalpel-1". This device has been shown to be convenient for out-patient clinics due to its technical characteristics and simple handling. The optimum ways of using the carbon dioxide laser for ablation of lipomas, fibromas, hemangiomas and other benign tumors are proposed.

[Combined therapy of extra-abdominal desmoids]. / Kombinirovannoe lechenie ékstraabdominal'nykh desmoidov.

Basing on a comparative study of the results of combined treatment (irradiation + operation) and surgery alone provided to patients with extra-abdominal desmoid (ED) the authors reach a conclusion that preoperative gamma-beam therapy can be regarded as an important means of recurrence prevention. In incomplete resection of tumors the treatment should be supplemented by postoperative irradiation, because in radiotherapy alone cure can be achieved with high summary doses only. It is still difficult to judge of the advantages of irradiation of ED under the conditions of hyperbaric oxygenation by the frequency of recurrences.