Tumoral calcinosis in chronic renal failure: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Tumor calcinosis is a rare and benign disorder characterized by calcified periarticular soft tissue masses. It may be idiopathic or caused by a condition known as hyperphosphatemia. There is still no definitive guideline for treating this disease, with excision being one of the primary treatment modalities. CASE PRESENTATION: 2 patients with a history of longstanding diabetes and dialysis presented with a painless lump on their right buttock, measuring 18 × 30 cm in the right gluteal region. Laboratory examinations showed a high ureum, creatinine, and serum phosphate. A radiograph revealed opacity on the right hip joint, without involvement of the proximal femur bone. A biopsy confirmed the diagnosis of tumor calcinosis. Both patients were treated with calcium carbonate to control their high serum phosphate levels. Both patients showed excellent tumor control without progression. CLINICAL DISCUSSION: Tumoral calcinosis (TC) is an extra-articular benign but aggressive tumor. The precise mechanism of TC remains unknown, which partly explains the lack of established treatment modality. We treat our patients with calcium carbonate to reduce the serum phosphate and treat the tumor without surgery. The treatment yielded a satisfactory clinical result. CONCLUSION: This study showed that a secondary TC may be conservatively treated without any surgical excision if we address the underlying problem. But it may not result in a reduction of the tumor's size.

Management of dead limb following traditional practices in Indonesia: A case report.

INTRODUCTION: Traditional bone setting, a centuries-old practice, remains a common method for treating musculoskeletal injuries in many parts of the world, particularly in developing regions. In Indonesia, traditional bone-setters are widely sought after in managing various bone and joint conditions. Despite the widespread use of traditional bone settings, there is limited documentation of their treatment outcomes and potential complications. Complications such as a necrotic limb due to vascular interruption as shown in our case are common complications of fracture reduction by individuals who have not been formally trained. CASE REPORT: This case report presents a 4-year-old boy, who came in the emergency department with pain on the arm after falling from the stairs. After a thorough examination, it was concluded that this patient has a displaced right proximal humerus fracture. The patient and family are educated about the surgery to treat the patient, but they refuse to do so. Two days later, the patient was referred to our hospital with a complaint of a blackened upper arm after undergoing a traditional bone-setting procedure. The patient's condition was characterized by loss of motor and sensory function in the affected limb, which was confirmed through clinical examination and imaging studies. He underwent shoulder disarticulation by an orthopedic surgeon in our center. This was decided because the limb was non-functional, inconvenient, and is at risk of becoming a focus of infection. DISCUSSION: Dead limb caused by traditional bone setters is a major factor leading to amputations in numerous developing nations. Techniques such as scarification, massage with herbal preparations, and the application of tightly fitting splints can result in infections, vascular impairment, and compartment syndrome, ultimately culminating in gangrene or limb loss. This case highlights the progressive and potentially limb-threatening nature of such infections, underscoring the critical need for early identification of compartment syndrome, prompt resuscitation or stabilization efforts, and immediate, vigorous treatment. CONCLUSION: This case is reported to highlight the risks associated with traditional bone-setting practices and the inherent dangers they pose. Individuals misled by misconceptions should be educated through public awareness campaigns. Additionally, governmental legislation should be enacted to integrate traditional bone-setting practices with modern orthopedic care services.

Soft tissue tumor of metastatic non-small cell lung carcinoma: A rare case report.

INTRODUCTION AND IMPORTANCE: It is estimated that 1 out of 5 patients with cancer will experience bone metastasis. With non-small cell lung cancer by itself having 220.000 reported cases per year, but the prevalence of soft tissue metastasis from lung cancer is only 2.3 % making it commonly overlooked as a possible metastasis site. CASE PRESENTATION: Male presents with a lump and pain on the right upper arm. A 8 cm × 8 cm mass was palpated under the biceps. CT-scan showed a lung lesion on the anterior segment. Shoulder MRI showed a dense, lobulated, and indefinitely demarcated soft tissue mass approximately 5.6 cm × 7.8 cm × 8.8 cm. The patient was treated with wide excision of the tumor. Core biopsy showed a metastatic adenosquamous carcinoma with suspected primary lesion from the respiratory tract. Treatment with targeted chemotherapy and radiotherapy were then done to the patient. The patient was discharged without any complications and is still at remission at the 6 months post-operative checkup. CLINICAL DISCUSSION: Soft tissue metastasis of lung cancer cell is a rare but a very real phenomenon. In our case the diagnosis of the soft tissue mass as a metastasis from the lungs was decided on a clinical, physical, radiological, and histological basis without using immunohistochemistry. CONCLUSION: MRI, biopsy, and immunohistochemistry are traditionally needed to confirm the diagnosis but in select cases, radiological and microscopic examinations along with clinical correlation are enough to ascertain the diagnosis. While it is rare, a soft tissue metastasis should always be suspected in lung cancer patients that have a palpable mass.