1/535. Atypical chondroma of the cricoid cartilage: fine-needle aspiration cytologic and histopathologic findings. Chondroma of the laryngeal skeleton is a rare, benign neoplasm manifested either as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness, or dyspnea. The most common site is the posterior plate of the cricoid cartilage. An atypical perichondrial chondroma arising from the anterior plate of the cricoid cartilage membrane as a neck mass in a young female is presented. The diagnosis was made on a fine-needle aspiration of the mass and subsequently confirmed by histologic examination of the excised mass. Although rare, cartilaginous tumors of the laryngeal skeleton can manifest as a neck mass, and the diagnosis can be made by fine-needle aspiration biopsy in combination with radiographic and clinical examinations. Therefore, the existence and inclusion of these tumors in the differential diagnosis of neck masses by aspiration biopsy should be considered by clinicians and pathologists, and especially cytopathologists, when cartilaginous components are encountered. ( info) |
2/535. Calcified bodies in popliteal cysts: a characteristic radiographic appearance. Calcified bodies in popliteal cysts have a characteristic radiographic appearance which can be confirmed by arthrography. Calcified bodies may arise in the true joint due to trauma, arthropathy resulting in joint destruction, or synovial osteochondromatosis. These calcified loose bodies may pass into a popliteal cyst through posterior joint-bursal communications or can arise in a popliteal cyst by chondrometaplasia. Correct radiographic interpretation will exclude soft tissue tumors and vascular lesions as differential considerations. Management of these patients will be determined by the clinical circumstances since neither popliteal cysts nor synovial osteochondromatosis are necessarily symptomatic. ( info) |
3/535. Enchondroma as a cause of midfoot pain. Enchondroma is a common bone tumor of the foot. It is often reported in the phalanges and distal metatarsals. The authors, however, present a rare case study of two patients with enchodromas as the cause of midfoot pain. One case presented in the lateral cuneiform which to the authors' knowledge is the first reported case in the literature. Two cases are presented with their surgical management including autogenous calcaneal graft and follow-up. ( info) |
4/535. Preoperative PET activation for assessment of motor cortex area in precentral chondroma. BACKGROUND: A main problem in the preoperative planning for precentral tumors is the exact assessment of the spatial relationship between the tumor and the functionally relevant brain areas, which may be difficult using only morphologically oriented imaging (CT, MRI). Therefore, we applied motor activation PET and PET/MRI overlay in a patient with a precentral tumor. DESCRIPTION: We report the case of a 21-year-old woman suffering from progressive right-sided headache and intermittent dysesthesia of the left leg. MRI showed a hypointense tumor with inhomogenous contrast enhancement in the right precentral area. For preoperative assessment of the spatial relationship between the tumor and the motor cortex area, the patient underwent two F-18-fluorodeoxyglucose positron emission tomography (PET) scans (1. resting condition and 2. motor activation of the left leg) and subsequent calculation of subtraction images of activation minus rest. Fusion of PET and MRI data (PET/MRI overlay) was performed for bimodal function and morphology presentation. PET revealed an activation pattern behind and below the tumor, indicating that the motor cortex area was shifted to the back. PET findings were confirmed by intraoperative electrophysiology. Cortical stimulation combined with intraoperative neuronavigation localized the motor area of the left foot and leg exactly at the dorsal border, below and lateral to the lesion. After complete resection of the solid tumor, histopathological examination revealed a chondroma. The postoperative course was uneventful, and the patient was discharged without neurological deficits. CONCLUSIONS: This case shows that biomodal imaging (PET/MRI) provides a noninvasive exact assessment of functionally important cortex areas for preoperative planning in patients with cerebral lesions. ( info) |
5/535. Para-articular chondroma and osteochondroma of the infrapatellar fat pad: a report of three cases. We report three cases of para-articular chondroma and osteochondroma in the region of infrapatellar fat pad. All three lesions were resected and examined histologically. Two of them were primarily cartilaginous with a lobular pattern internally, and one uniformly osseous with peripheral cartilage. We conclude that these lesions are not the same. The former should be designated para-articular chondroma after Jaffe and the latter, osteochondroma. ( info) |
6/535. Conservative surgery for chondrosarcoma of the first metacarpal bone. A rare case of a chondrosarcoma of the first metacarpal bone is presented. The lesion was radiographically interpreted initially as an enchondroma and treated conventionally by curettage and cancellous autologous bone grafting. After final histology, a low-grade chondrosarcoma was reported. A resection of the entire first metacarpal bone was performed, followed by reconstruction using an autologous corticocancellous bone graft and plate fixation, creating arthrodeses of the adjacent joints. Although isolated enchondromas are considered to have no malignant potential, histological examination is essential to rule out malignancy. A preoperative biopsy should be recommended in lesions suspected to be chondromas. Chondrosarcomas are rarely located in bones of the hand, where they are usually treated by amputation. With the case presented we wish to advocate that cases of low-grade, intraosseous chondrosarcoma (stage IA) can be treated by conservative surgery, especially when it is located in the thumb. ( info) |
7/535. Chondrolipoma of the breast: a case report and review of the literature. Chondrolipoma of the breast is a rare benign cartilage-containing mesenchymal tumor. In the case presented, a patient with a breast mass detected by physical examination was found to have a discrete nodule containing fibrolipomatous tissue with focal areas of cartilage. A review of the literature and differential diagnosis of benign mesenchymal tumors of the breast are discussed. ( info) |
8/535. Vertebral intra-osseous chordoma or giant notochordal rest? Chordomas of the lumbar vertebral bodies are rare. We report an unusual case of an entirely intraosseous chordoma of the fifth lumbar vertebra treated by vertebrectomy. Conventional radiographs and scintigraphy were normal. The lesion was well visualised by MR imaging, but showed only slight sclerosis on CT. We give our reasons for making a diagnosis of chordoma rather than giant notochordal rest and discuss the problems of management resulting from this diagnostic dilemma. ( info) |
9/535. A new observation of the Carney's triad with long follow-Up period and additional tumors. The etiology of the Carney's triad (gastrointestinal stromal tumors, pulmonary chondromas, and paragangliomas) is unknown, and only 57 cases have been reported since its identification in 1977. We report the clinical course of a female with the complete triad and some additional tumors. Bilateral vagal paragangliomas were treated surgically and with radiotherapy between the ages of 24 and 26 years. Subsequently she underwent surgery for a gastric leiomyosarcoma (27 years), a pleomorphic adenoma of the parotid gland (49 years) and a multifocal breast cancer with axillary spread (50 years). A calcified lesion was also noticed in the left lung, the radiologic diagnosis of which was consistent with chondroma. A mediastinal paraganglioma, detected at 56 years on a control X-ray of the chest, was partially excised at 63 years. At the last control, performed at 66 years, the patient was alive with residual cervical and mediastinal paraganglioma. Her younger brother was affected by Hirschsprung's disease and died at 54 years of rectal cancer. Her daughter is 33 and has been suffering since birth with severe constipation. In conclusion, this is one of the longest followed-up patients with Carney's triad. Her case illustrates the need for early recognition of the setting in order to detect the component tumors at a stage when surgery may be curative, and careful and life-long follow-up, both because the multicentricity of the classic components tends to manifest metachronously and because of the tendency to develop other tumors, some of which may be malignant. Furthermore, the presence of Hirschsprung's disease in the patient's family, coupled with the alleged common origin of two component lesions from derivatives of the neural crest, open new avenues for the understanding of this disorder. ( info) |
10/535. Chondroma of the hyoid bone: a case report. Chondroma of the hyoid bone is extremely rare. We report the case of a 24-year-old woman with a chondroma of the greater cornu of the hyoid bone. In addition, we discuss the clinical and pathologic differential diagnoses. ( info) |