Giant cell tumour of tendon sheath in a child: a case report.

Giant cell tumour of the tendon sheath is uncommon in children. We describe this tumour arising from the right ring finger in an eight-year-old girl. Plane radiographs showed a soft tissue mass with erosion of the distal phalanx. The tumour was treated by surgical excision with good outcome.

Musculotendinous anomalies in musician and nonmusician hands.

Musculoskeletal abnormalities of musicians' hands and upper extremities are well-recognized and potentially career-threatening problems. Of the many types of potentiality problematic musculoskeletal disorders that could be assessed, this study focused on joint instability and musculotendinous anomalies. For this study, the hands of 92 music students were compared with the hands of 64 nonmusician control subjects. Flexor anomalies were observed much more frequently than extensor musculotendinous anomalies; clinical evidence of the Linburg-Comstock anomaly was noted for 60 to 70 percent of subjects in both groups. Further analysis of the Linburg-Comstock anomaly demonstrated that the sites of pain among test-positive subjects were variable, test positivity was more frequent in the left hand and among string players, and test positivity tended to decrease from the radial side to the ulnar side of the hand. There were only two definite extensor musculotendinous anomalies (1.3 percent), and both involved a subluxating extensor mechanism affecting the little fingers. Forty-three percent of all subjects exhibited a degree of instability affecting the joints of their hands.

Identification of mesenchymal stem cells in perinodular fat and skin in Dupuytren's disease: a potential source of myofibroblasts with implications for pathogenesis and therapy.

Dupuytren's disease (DD) is a fibroproliferative disorder characterized by aberrant proliferation of myofibroblasts, the source of which remains unknown. Recent studies indicate that circulating and tissue-resident mesenchymal stem cells (MSCs) can differentiate into myofibroblasts. Therefore, the aim of this study was to profile MSCs from phenotypically distinct DD sites including cord, nodule, skin overlying nodule (SON), and perinodular fat (PNF) compared with unaffected internal controls, that is, distant palmar fat (DPF) and transverse palmar fascia (Skoog's fibers) as well as external control carpal tunnel (CT) tissue including skin, fat, and fascia. Freshly isolated primary fibroblasts as well as cells grown up to passage 5 (P5) from DD (n=27) and CT (n=14) samples were analyzed for the presence of established MSC markers CD73, CD90, and CD105 and absence of hematopoietic marker CD34 using fluorescence-activated cell sorting, in-cell quantitative western blotting, immunohistochemistry, and immunocytochemistry. Freshly isolated cells from SON, PNF, and cord biopsies had a higher number of CD34(-)73(+)90(+)105(+) cells compared with Skoog's fibers and CT controls. P3 cells obtained from all DD biopsies compared with CT samples differentiated into osteocytes, adipocytes, and chondrocytes. P3 cord and nodule cells expressed intense α-smooth muscle actin staining compared with skin and fat cells. Stem cell markers including stem cell factor, MSC-homing marker CXCR4, and Wnt/ß-catenin downregulator Dkk-1 were all upregulated in SON and PNF compared with CT skin and CT fat, respectively, as shown by real-time quantitative polymerase chain reaction. However, osteogenic marker OSF-1 had a significantly higher expression in the PNF (P=0.002) and cord (P=0.01) compared with the nodule. In conclusion, we have shown the presence of MSCs in specific DD tissue phenotypes compared with internal and external control tissue. These findings provide preliminary support for a potential alternative source of disease myofibroblasts originating from sites such as SON and PNF as opposed to palmar fascia alone.

Metastatic implantation squamous cell carcinoma in a split-thickness skin graft donor site.

We present the case of a patient who developed a possible implantation metastatic squamous cell carcinoma (SCC) at a donor site 2 months following split-thickness skin graft (STSG) harvesting. This case highlights implantation of malignant cells from a contaminated hollow needle as a mechanism of spread to skin graft donor sites and offers an important learning point in the practice of local anaesthetic cutaneous cancer surgery.

Dupuytren's diathesis revisited: Evaluation of prognostic indicators for risk of disease recurrence.

PURPOSE: The term diathesis relates to certain features of Dupuytren's disease (DD) and dictates an aggressive course of disease. The initial description of DD diathesis included 4 factors: (1) ethnicity, (2) family history, (3) bilateral DD, and (4) ectopic lesions (DD outside the palm). The degree of diathesis is considered important in predicting recurrence and extension of DD after surgical management. Prognostic indicators of risks associated with surgery are important. We aimed to evaluate these 4 factors and known associated risk factors to formulate a statistical predictive value for DD diathesis. METHODS: Caucasian patients diagnosed with DD between the ages of 25 and 90 years (n = 322) from Northwest England were assessed for DD diathesis with a clinical history and examination. DD diathesis assessment was analyzed by calculating the odds ratios of developing recurrent DD using logistic regression. RESULTS: The observed recurrence rates in the presence of notable risk factors and corresponding odds ratios of recurrent DD were calculated. Of note, recurrent disease was observed in 121 (46%) males, 105 (47%) with bilateral DD, 68 (48%) with a family history of DD, 75 (47%) with age at onset younger than 50 years, 35 (52%) in those with ectopic lesions, and in 26 (63%) with Garrod's pads. CONCLUSIONS: The original DD diathesis factors have been evaluated and modified. The original factors of family history, bilateral DD, and ectopic lesions now include 2 additional factors: male gender and age at onset of younger than 50 years. Family history and ectopic disease have now been modified to specify family history with one or more affected siblings/parents and ectopic lesions in the knuckles (Garrod's pads) alone. The presence of all new DD diathesis factors in a patient increases the risk of recurrent DD by 71% compared with a baseline risk of 23% in those DD patients with none of the earlier-described factors. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

The heritability of Dupuytren's disease: familial aggregation and its clinical significance.

PURPOSE: Dupuytren's disease (DD) is a benign, fibroproliferative disease affecting the hands. The familial occurrence of DD and its presence in identical twins suggests a genetic basis for the condition. Our aims in this study were (1) to provide evidence for familial aggregation of DD by estimating the sibling recurrence-risk ratio and (2) to link previously associated environmental risk factors with family history of DD. METHODS: Patients diagnosed with DD between the ages of 58 and 81 years (N = 92) were interviewed to assess potential risks and the severity of their conditions. A clinical history and examination were performed and we attempted to interview every family member either in person or through a postal questionnaire. RESULTS: The sibling recurrence-risk ratio (lambda(s)) equaled 2.9 and ranged from 2.6 to 3.3 based on the 95% confidence intervals for the population prevalence. This suggests a high genetic basis for the causation of DD. A lower age of onset and greater severity of DD were associated significantly with a positive family history of DD. Other factors showed no statistical significance with familial aggregation of DD. CONCLUSIONS: The familial clustering observed in DD likely is due to genetic influence rather than shared environment, as shown by the lack of association with exposure to environmental risk factors and family history. Understanding the genetic basis of DD is important for developing novel diagnostic, preventative, and therapeutic regimens in the future. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level II.