Extranodal MALT Lymphoma of the Right Triceps Muscle following Influenza Vaccine Injection: A Rare Case with an Interesting Presentation.

The study describes a case of a 67-year-old female who developed a Stage I E marginal zone lymphoma of the right triceps muscle 1 month after influenza vaccination at the same site. She was treated with single modality, involved field radiation therapy (IFRT) to 4000 cGy in 20 fractions with excellent response and no evidence of disease after one year followup.

Wide en bloc extra-articular excision of the elbow for sarcoma with complex reconstruction.

We describe a consecutive series of five patients with bone or soft-tissue sarcomas of the elbow and intra-articular extension treated by complex soft tissue, allograft bone and prosthetic joint replacement after wide extra-articular en bloc excision. All had a pedicled myocutaneous latissimus dorsi rotation flap for soft-tissue cover and reconstruction of the triceps. Wide negative surgical margins were obtained in all five patients. No local wound complications or infections were seen. There were no local recurrences at a mean follow-up of 60 months (20 to 105). The functional results were excellent in four patients and good in one. Longer term follow-up is necessary to confirm the durability of the elbow reconstruction.

Distal phalangeal resorption in an adult with infantile malignant osteopetrosis: a case report.

Osteopetrosis is a rare inherited skeletal disorder characterized by a defect in bone resorption. The autosomal-recessive infantile malignant form usually results in death in the first few years of life. The natural history of the disease into adulthood is unknown. Reported here is the case of a 27-year-old man with bilateral resorption of the tufts of the distal phalanges in multiple fingers. It is unclear whether this finding constitutes a previously undescribed aspect of the natural course of the disease or a long-term consequence of therapy.

Recurrent aneurysmal bone cyst of the proximal phalanx treated with cryosurgery: a case report.

A recurrent aneurysmal bone cyst of the proximal phalanx treated with curettage, cryosurgery, and bone grafting is presented. There is no evidence of recurrence after 5 years. Although cryosurgery is commonly used as an adjuvant for intralesional treatment for aneurysmal bone cyst, there have been no reports of its use for the treatment of a lesion arising in the hand.

Intraosseous schwannoma of the metacarpal.

Intraosseous schwannoma (neurilemmoma) is an extremely rare, benign neoplasm, constituting less than 0.2% of primary bone tumors. It infrequently involves the bones of the hand. We present a case of intraosseous neurilemmoma of the metacarpal.

Autogenous fibular graft and silicone implant arthroplasty following resection of giant cell tumor of the metacarpal: a report of two cases.

Two cases of reconstruction after resection of giant cell tumor of the distal metacarpal are reported in which reconstruction was achieved with a nonvascularized fibular autograft and silicone metacarpophalangeal joint arthroplasty. At 2-year and 1-year follow-up evaluation, respectively, the patients were found to be doing well. This method of reconstruction appears reliable and presents the possibility for vascularized reconstruction if that is thought necessary.

Giant cell tumors of the bones of the hand.

The cases of all patients with a diagnosis of giant cell tumor of bone occurring in the hand and seen at the Mayo Clinic during a 50-year period were reviewed to assess the results of treatment. There were 5 lesions in the phalanges, 7 in the metacarpals, and 1 in the scaphoid. The mean duration of symptoms and interval to recurrence were shorter than those seen in giant cell tumor of bone occurring in sites other than the hand. Radiographically advanced disease was common at presentation. Local recurrence was seen after 11 of 14 intralesional procedures (79%) involving curettage or curettage and bone grafting. Local recurrence was seen after 5 of 14 procedures (36%) involving local excision, wide excision, amputation, or ray resection. Lung metastases developed in 2 patients after or concurrent with local recurrence. Local control was most effectively achieved with wide excision or ray resection.

Metastatic thymic carcinoma in a digit: a case report.

Acrometastases are a rare but important clinical entity. We present the case of a 54-year-old man with a metastasis to a digit from a primary thymic carcinoma. The prognostic implications of such a diagnosis are discussed.

Selection of fusion position during forearm arthrodesis.

The purpose of this study was to determine the optimal position for forearm arthrodesis. We attempted to determine functional difficulties associated with different positions of simulated fusion and whether there was a difference between men and women in their preference for fusion position. The forearms of 30 subjects were immobilized in neutral, 45 degrees supination, and 45 degrees pronation. The subjects performed 2 functional tests in each splint: the Jebsen hand function test and a subjective evaluation of the difficulty of activities of daily living. Each subject was asked to choose a preferred position for forearm fusion. Overall, subjects found the supinated position the most difficult to adapt to; the majority (63.3%) preferred neutral. Based on the results of our study we recommend forearm fusion in neutral or slight pronation. A thorough preoperative activity history and functional assessment may assist in determining the desired forearm arthrodesis position in a given individual.

A rotating-hinge knee replacement for malignant tumors of the femur and tibia.

We evaluated the 2- to 7-year results of a rotating-hinge knee replacement after excision of malignant tumors of the knee joint. There were 25 distal femoral and 7 proximal tibial replacements. The 5-year prosthetic survival for distal femoral replacements was 88%, compared with 58% for proximal tibial replacements. Seven patients underwent prosthetic exchange: 1 for aseptic loosening, 2 for wound slough and perioperative infection, and 4 for articulating component failure. One patient underwent above-knee amputation owing to skin necrosis. The median functional scores at the latest follow-up were 27 by the International Society of Limb Salvage evaluation system and 80 by the Hospital for Special Surgery Knee Score system. This implant is a promising choice for joint reconstruction after excision of tumors at the knee joint.

Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors.

BACKGROUND AND OBJECTIVES: Limb-sparing surgery has become the preferred surgical treatment of malignant bone tumors. The objective of this study was to evaluate factors that influence the morbidity and outcome of prosthetic knee replacement after resection of malignant tumors of the distal femur. METHODS: Eighty-two patients who had a resection of malignant tumor of the distal femur and implantation of a segmental knee prosthesis (minimum follow-up, 2 years) were retrospectively reviewed. RESULTS: Twenty-nine patients (35%) underwent 32 prosthetic revisions, 6 from perioperative wound complications, 13 from aseptic loosening, and 13 from other complications. The 3-, 5-, and 10-year Kaplan-Meier prosthetic survival rates were 82%, 71%, and 50%, respectively. On univariate analysis, patients who had more than 40% resection of the distal femur (P = 0.010) and those who had all their vasti muscles resected (P = 0.011) had significantly worse prosthetic survivals than the others. On multivariate analysis, resection of more than 40% of the distal femur was a significant negative prognostic factor for prosthetic survival (P = 0.017). Aseptic loosening was the primary cause of late prosthetic failure. Differences in the magnitude of resection influenced prosthetic survivorship more than prosthetic design. CONCLUSIONS: In the distal femoral endoprosthetic replacement, higher short- and long-term complications were found after extensive resections. Aseptic loosening was the primary cause of prosthetic failure.

Hormonal regulation of thyrotropin alpha and beta subunit mRNAs.

We have examined the effects of 3,5 3'-triiodo-L-thyronine (T3), dexamethasone, bromocriptine, thyrotropin releasing hormone (TRH) and estrogen on the levels of pituitary alpha and TSH-beta protein and mRNA levels in hypothyroid mice. After 3 days of treatment with T3 (0.5 micrograms/100 g body weight) serum TSH, alpha and TSH-beta levels were 77%, 79% and 44% of control, respectively. Pituitary alpha and TSH-beta mRNA content was estimated by dot blot hybridization of total RNA with 32P-labelled alpha and TSH-beta plasmid probes. There was no change in alpha mRNA after 3 days of T3 treatment but TSH-beta mRNA had decreased to 60% of control. With T3 at 2 micrograms/100 g body weight for 3 days, TSH protein was 27% of control and TSH-beta was undetectable, but there was no change in alpha. TSH-beta mRNA was decreased to 40% of control at 1 day and was barely detectable at 3 days, whereas alpha mRNA was 70% of control at 1 day and 42% at 3 days. Dexamethasone and bromocriptine caused no consistent change in pituitary levels of alpha and TSH-beta mRNA. Treatment with TRH caused small increases in serum TSH and in both alpha and TSH-beta mRNA levels. Estrogen treatment increased serum TSH and subunit levels and TSH-beta mRNA, but not alpha. We conclude that thyroid hormones decrease alpha and beta subunit mRNA levels discordantly in both the hypothyroid pituitary and in thyrotropic tumors and that the suppressive effect of thyroid hormone is the major regulator of TSH.