[Tako-Tsubo syndrome (transient apical dyskinesia). An entity that can mimic a myocardial infarction]. / Síndrome de Tako-Tsubo (discinesia apical transitoria). Un síndrome que simula un infarto de miocardio.

Tako-Tsubo syndrome or transient apical dyskinesia, is an entity that can mimic an acute coronary event. It is characterized by anginal chest pain with ST-T changes in precordial leads, no coronary obstruction on angiography and a characteristic left ventricular antero-apical dyskinesia that recovers to normal in a few days. This syndrome has been described in Japan, but few cases have been reported in Western countries. We report a case of Tako-Tsubo syndrome after thyroid surgery.

Primary epithelioid leiomyosarcoma of bone. Case report and literature review.

We describe an epithelioid leiomyosarcoma of bone located in the right knee of a 51-year-old woman. Plain radiograph and CT scan revealed a poorly defined lytic and destructive mass in the upper metaepiphyseal right tibia which involved surrounding soft tissues. The lesion was composed of proliferating monotonous round cells with a high mitotic activity with scanty intersecting spindle cell fascicles. Immunohistochemistry of both areas demonstrated a strong positivity for actin (HHF-35 and alpha-SMA) and vimentin, and negative reactions for desmin, keratin (AE1 AE3), epithelial membrane antigen, S-100 protein, factor VIII-related antigen, CD 31 and CD 34. Ultrastructural study confirmed a diagnosis of leiomyosarcoma. This is the first detailed description of the microscopic and radiological features of primary epithelioid leiomyosarcoma of bone.

Primary aneurysmal cyst of soft tissue. Report of a case with ultrastructural and MRI studies.

We report a case of primary aneurysmal cyst of soft tissues in a 57-year-old woman presenting with a painful mass in her left arm. Conventional radiography showed a radiolucent soft tissue mass surrounded by a ring of bone. MRI displayed an unusual, ill-defined soft tissue lesion that was not connected to the nearby humerus and appeared to be an aggressive tumour. Microscopically, the mass consisted of multiple anastomosing cavernous channels surrounded by a peripheral band of mature trabecular bone. These bloody channels were separated by fibrous septa containing fibroblasts, histiocytes and multinucleated giant cells, as well as fibromyxochondroid material. Some of these giant cells lined the septa and partially occupied the lumen of the channels. Ultrastructurally, the features observed in this tumour were similar to those described in aneurysmal bone cyst; the giant cells lining the septa were an additional observation. Whereas most bone tumours have a well-known extraosseous counterpart, this unique lesion is not well recognized by surgical pathologists and the few published cases have been reported under different names. Gross, microscopic, radiological and ultrastructural findings are presented to familiarize pathologists with this underdiagnosed condition.

Limb salvage procedures in osteosarcomas around the knee joint.

Surgical techniques developed for restoring skeletal continuity after a local resection of a bone tumor (limb salvage procedures) revolutionized the management of the patient suffering from osteosarcomas around the knee. In this article the authors review the current status of various reconstruction procedures; they include osteoarticular allograft arthrodesis, rotation plasty, expandable prosthesis and knee arthroplasty. In summary they suggest that the knee arthrodesis is the preferred procedure for young and active patients, the rotation plasty should be recommended as the alternative to amputation for very young patients, and the customized prostheses are preferred for patients with limited longevity.

Primary aneurysmal cyst of soft tissues (extraosseous aneurysmal cyst)

In this report we describe a soft-tissue aneurysmal cyst located in the left shoulder of a 20-year-old woman. Although the tumor initially was clinically considered a myositis ossificans, the microscopic features were identical to those found in classic aneurysmal bone cyst (ABC). Light microscopy showed a lesion composed of a peripheral band of mature trabecular bone surrounding a multicystic central area made up of anastomosing cavernous blood channels separated by fibrous septa that contained osteoid, mineralized myxochondroid material and osteoclastic giant cells. Whereas most bone tumors have an extraosseous counterpart, ABC has been found outside the bone only once, in an artery, but never in soft tissues. Moreover, major reviews state that aneurysmal bone cyst occurs exclusively within bones. This unique case is a very rare occurrence of one of these lesions in the soft tissues.

[Schistosomiasis (bilharziosis). Importance of cytology. Report of 2 cases]. / Esquistosomiasis (Bilharziosis). Importancia de la citología. A propósito de dos casos.

We report two cases of bilharziasis of the bladder in immigrants who presented with spontaneous hematuria. This condition was diagnosed by urine cytology. The current tide of immigration and tourism have led to an increased number of diseases acquired abroad. A simple, economic and rapid method for diagnosing schistosomiasis in patients at risk with hematuria is described.

Secondary chondrosarcoma. Four cases and review of the literature.

The authors present four new cases of chondrosarcoma secondary to multiple osteochondromatosis (MOC). As MOC is a familiar and hereditary condition, the patients should be evaluated throughout their lives, from childhood to adulthood. Because of the risk of malignant transformation in this condition, any adult patient complaining of pain and excessive increase in tumor size should be investigated for sarcomatous degeneration. Wide resection, when possible, must be the elected treatment in this type of patient, in order to avoid the risk of local recurrence.

Circumscribed myositis ossificans. Report of nine cases without history of injury.

The clinical features of 9 patients with circumscribed myositis ossificans (CMO) are described and the effects of treatment with surgical removal of ectopic bone are assessed. The average age of these patients was 24.4 years, and the average follow-up period was 7.4 years. Early correct diagnosis remains unusual, mainly because myositis may be mistaken for bruising, sarcoma or mumps. Once histological diagnosis was established in biopsy, surgical resection of the mass was found in these series. Although spontaneous recurrence was found in this series. Although spontaneous regression of the clinical findings has been reported, we consider surgery to be necessary in CMO in order to establish the diagnosis; furthermore, when the clinical and radiological diagnosis is uncertain or when the lesion causes pain or mechanical blocking of a joint, the removal of the mass is mandatory.

Intracortical osteosarcoma. A case report.

Intracortical osteosarcoma (IO) is the rarest form of osteosarcoma. A 19-year-old man had one of these lesions in the upper diaphysis of the femur. Microscopically, IO was a well-differentiated osteosarcoma with an osteoblastic histologic pattern. The typical location in the diaphysis and the peculiar histologic and roentgenographic findings with intracortical origin clearly separate this entity from conventional osteosarcomas as well as periosteal and parosteal osteosarcomas. IO are lytic neoplasms confined to the cortex of the diaphysis with a benign roentgenographic appearance, but are included in the differential diagnosis of benign tumors.

Case report 639: Malignant fibrous histiocytoma (MFH) of the patella.

Malignant fibrous histiocytoma of bone is a rare skeletal neoplasm, reported in the patella on only a few occasions. We describe an additional case in this bone in an 84-year-old woman. We believe this neoplasm should be considered in the differential diagnosis of malignant tumors of the patella.