Epithelioid sarcoma in the thoracic spine

Epithelioid sarcoma is a rare and highly malignant soft tissue tumor that is commonly found in the extremities and rarely in the trunk area. This malignant tumor often mimics granuloma or nodular fasciitis, which causes a delay in establishing the diagnosis. This type of cancer has a high recurrence rate. Surgical treatment requires wide radical resection. The objective of this case report is to highlight the unique location of a rare neoplasm and to illustrate the relentless course of epithelioid sarcoma despite initial radical resection. A 14-year-old boy was admitted to our facility with a soft tissue mass on the right lower thoracic spine. The large tumor mass had deeply penetrated into the muscles, infiltrated the neuroforamen of T9–T10 level, and compressed the dural sac. Immunohistological study of the biopsy was highly consistent with an epithelioid sarcoma. Wide excision of the mass, laminectomy and spine fusion with instrumentation was performed. The patient received chemotherapy and irradiation. The first recurrence of the neoplasm was seen as a contralateral metastasis 21 months after the resection. On the last follow-up, 3 years postoperatively, the patient was in a good general condition. However, further progression of the sarcoma had to be recognized. Our case encompasses multiple features that represent negative prognostic factors. Initial wide excision of the neoplasm and adjuvant therapy including chemotherapy and irradiation seem to slow down the relentless course of epithelioid sarcoma in the trunk

Revision Knee Arthroplasty Including Reconstruction of the Lateral Collateral Ligament by Allograft: A Case Report

A 53-year-old woman presented with an unstable and painful total knee arthroplasty 6 months after the index procedure. Disruption of both collateral ligaments as a young adult and the subsequent development of traumatic arthritis required repeated surgical and extensive conservative treatment before a prosthesis was implanted. Examination disclosed marked instability of the lateral collateral ligament (LCL) and loosening of the tibial and the femoral components. Review of the MRI obtained prior to the total knee replacement revealed discontinuity of the LCL with intense scarring of the posterolateral ligament complex. Definitive management of this twofold problem was not helped by literature review, which failed to reveal a gold standard or a broad consensus as a rationale for treatment. Consequently, an individual approach to the problem was defined: A one-stage revision arthroplasty was performed using a modular non-articulated constrained prosthesis and a bone–tendon–bone allograft to reconstruct the LCL in a one-stage operation. Postoperative rehabilitation included continuous passive motion, which was begun immediately after surgery and was gradually increased to 90° of flexion. The LCL reconstruction was initially protected in a hinged knee brace and weight-bearing was initially limited to toe-touch and gradually increased over 6 weeks. Pain-free motion to 0–115° flexion was achieved at 3 months after surgery and the patient had returned to her normal activities. The 4-year-follow-up displayed a stable and functional knee with no evidence of loosening or wear