Nonsurgical Treatment as Alternative to Surgical Treatment in Enchondromas of the Distal Phalanx. Analysis of a Series of 11 Cases.

PURPOSE: To describe the results of nonsurgical and surgical treatment of enchondromas of the distal phalanx of the hand. METHODS: Eleven enchondromas of the distal phalanx were retrospectively reviewed. Five patients underwent surgery (curettage and autogenous cancellous bone graft from the iliac crest) and 6 patients were treated nonsurgically. Clinical records and radiographs were reviewed for each patient. We recorded complications and cosmetic and functional results. Radiographic healing in surgical patients was scored according to the classification of Tordai and to the criteria of Wilhelm and Feldmeier. The average follow-up of the nonsurgical and surgical cases was 45 and 62 months, respectively. RESULTS: Eight patients were women. Average age at diagnosis was 40 years. Nine patients presented with a pathological fracture. The demographic characteristics of the surgical group and nonsurgical group were similar. Among the cases treated nonsurgically (6), 1 had 2 pathological fractures after diagnosis. At final follow-up, the average pain on a visual analog scale was 2.8. With the exception of 1 patient, the range of motion of the fingers was normal or minimally reduced. Among the surgical cases (5), there were no complications in the bone graft donor site, 2 patients developed infections in the operated finger, and no postoperative pathological fractures were found. At final follow-up, the average pain was 3.2. Joint mobility was normal in 3 patients. Postoperative radiological examination revealed complete bone healing in all patients (grade I in the Tordai classification). No local recurrence was seen. According to the criteria of Wilhelm and Feldmeier, there were 3 excellent, 1 good, and 1 satisfactory results in the surgical group, and 2 excellent, 3 good, and 1 satisfactory results in the nonsurgical group. CONCLUSIONS: Surgical and nonsurgical treatment in distal phalanx enchondromas appear to be associated with satisfactory results, although each has their own advantages and disadvantages. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Bursectomy, Curettage, and Chemotherapy in Tuberculous Trochanteric Bursitis.

We presented three patients with trochanteric tuberculosis and described the clinical and imaging findings of the infection. Histology revealed a necrotizing granulomatous bursitis and microbiology confirmed tuberculosis. All cases were successfully treated with bursectomy and curettage of the trochanteric lesion and antituberculous chemotherapy including isoniazid, pyrazinamide, rifampicin, and ethambutol.

Lung carcinoma with rhabdoid component. A series of seven cases associated with uncommon types of non-small cell lung carcinomas and alveolar entrapment.

Rhabdoid tumor, included in the WHO classification among large cell carcinomas of the lung, is an uncommon type of lung carcinoma with poor prognosis. We report a series of 7 cases of lung carcinomas with rhabdoid component in 10% and 80% of the tumor. The associated tumor was adenocarcinoma in 3 cases--one of them with focal micropapillary pattern--large cell carcinoma in 2 cases, squamous cell carcinoma in 1 case and pleomorphic carcinoma in 1 case. Two adenocarcinomas showed a focal spindle cell component. Micropapillary and pleomorphic types had not been reported before as a component associated with rhabdoid carcinomas. All cases were positive for vimentin, and AE1/AE3 cytokeratin and 5 cases for cytokeratin 7. All cases were negative for muscle and endothelial markers and for chromogranin A. Synaptophysin was focally positive only in one case. Alveolar trapping inside the tumor was present in 3 cases--a phenomenon not well studied in lung carcinomas and also not reported in tumors with rhabdoid component. Five patients died because of the tumor within 2 to 31 months after diagnosis, one of myocardial infarction and only one is alive and disease free 123 months after the diagnosis. In summary, we describe 7 new cases of this uncommon lung tumor with aggressive clinical course, associated with infrequent histological types in nonrhabdoid component and with alveolar trapping, a nondescribed finding.