An unusual management of advanced gonarthrosis: total knee arthroplasty with posterior approach

WOS: 000340227400010PubMed ID: 25036398In this article, we present a 68 year-old female case admitted with complaints of a painful knee and walking difficulty with simultaneous advanced gonarthrosis and a huge osteochondroma in posterior distal femur which was adjacent to the vessel and nerve structures, who was treated with a single incision via posterior approach for tumor excision and arthroplasty. Simultaneous tumor excision and arthroplasty application were scheduled and the knee joint was reached via posterior popliteal approach. Hinged knee prosthesis was applied through the same incision following tumor excision. Two-stage surgical procedures can be an option for coexisting bone tumor and arthrosis. Arthroplasty can be performed following tumor excision. In our case, we managed two distinct different problems in a single session with a single approach. To the best of our knowledge, this is the first knee arthroplasty case performed with posterior approach

A bizarre parosteal osteochondromatous proliferation (Nora's lesion) of metatarsus, a histopathological and etiological puzzlement

WOS: 000346418700013PubMed ID: 25245639Nora's lesion (bizarre parosteal osteochondromatous proliferation) is a rare, benign lesion that is composed of differing amounts of cartilage, bone, and spindle cells and an unusual form of calcified cartilage so-called "blue bone". Whether it represents a reactive proliferation or a neoplastic lesion still remains controversial. We present a 24-year-old woman having a 4.5 cm two lobulated mass attached to second metatarsus of her left foot. The lesion was hyperintense on magnetic resonance imaging and accompanied by an extensive soft tissue and bone marrow edema. In resection specimen, smaller lobule appeared stuck-on the cortex while the larger one had a broader base and a 0.4 cm cartilaginous cap-like formation. The histological picture was best fit to Nora's lesion however showed less fibroblastic tissue and cartilaginous pleomorphism. The lesion also showed areas with cortical invasion and a small focus of fracture callus accompanied by adjacent medullary edema and fat necrosis. The case is presented with the comparative radiologic, macroscopic and microscopic findings for its diagnostic difficulties and etiopathogenetic considerations in favour of a maturation phenomenon in parosteal ostecartilaginous lesions irrespective of the cause. (C) 2014 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved

Traumatic arteriovenous fistula formation after misplaced femoral tunnel in arthroscopic anterior cruciate ligament reconstruction

WOS: 000307145800013PubMed ID: 22765493Vascular injuries are rare complications of arthroscopic anterior cruciate ligament (ACL) reconstruction. In this report, we present a 50-year-old female who has a popliteal arteriovenous fistula formation diagnosed 18 months after arthroscopic ACL reconstruction. The diagnosis was confirmed by angiography. The patient was treated surgically with disconnection of the fistulous communication and repair of the artery and vein with saphenous vein and synthetic grafts respectively. This is the first case report of an arteriovenous fistula following arthroscopic ACL reconstruction

Cystic Bone Lesions: Histopathological Spectrum and Diagnostic Challenges

WOS: 000367954000003PubMed ID: 25652560Objective: Bone cysts are benign lesions occurring in any bone, regardless of age. They are often asymptomatic but may cause pain, swelling, fractures, and local recurrence and may be confused with other bone lesions. Material and Method: We retrospectively re-evaluated 143 patients diagnosed with aneurysmal bone cyst (n= 98, 68.5%), solitary bone cysts (n= 17 11.9%), pseudocyst (n= 10.7%), intraosseous ganglion (n= 3, 2.1%), hydatid cyst (n= 2; 1.4), epidermoid cyst (n= 1, 0.7%) and cysts demonstrating "mixed" aneurysmal-solitary bone cyst histology (n= 12, 8.4%), and compared them with nonparametric tests. Results: Aneurysmal bone cyst, solitary bone cysts and mixed cysts were frequently seen in the first two decades of life while the others occurred after the fourth decade. Aneurysmal bone cysts, intraosseous ganglion and pseudocysts were more common in women contrary to solitary bone cyst and mixed cysts (the female/male ratio was 1.22, 2 and 1.5 versus 0.7 and 0.5, respectively). Aneurysmal bone cyst, solitary bone cysts and "mixed" cysts were mostly seen in long bones, predominantly the femur, while epidermoid, hydatid and pseudocysts were all seen in flat bones like the vertebra, pelvis and mandible (p= 0.001, chi-square). Repeat biopsies were performed in 19 cases (13.3%), 84.2% of which were aneurysmal bone cyst (5 conventional, 9 solid, 1 secondary and 1 subperiosteal) and three (15.8%) were mixed cysts (p= 0.02, chi-square). Notably, some of them were located in inaccessible areas of pelvis (n= 3), femur (n= 3) and maxilla (n= 2). Conclusion: The most common and challenging intraosseous cysts are aneurysmal bone cysts, particularly the "solid" variant. The "mixed" aneurysmal-solitary bone cyst "subgroup" requires further research with larger series to be defined more thoroughly

Secondary osteosarcoma arising in fibrous dysplasia, case report

WOS: 000264117000003PubMed ID: 18560851Malignant transformation of fibrous dysplasia is very rare. The frequency is increased in polyostotic forms, in McCune-Albright and Mazabraud's syndromes and previously irradiated cases. Pain, which is rapidly becoming worse over a short period unrelated to trauma is the most alarming symptom. Early radiological features of sarcomatous transformation are moth-eaten or cystic areas of osteolysis, cortical destruction and gradual formation of a soft tissue mass. The prognosis is unfavorable as most of the cases are in an advanced stage in the time of diagnosis. We present an unusual case of unsuspected secondary osteosarcoma arising in a previously unirradiated, monostotic fibrous dysplasia. A 46-year-old woman was admitted with hip pain, which worsened after a minor trauma occurred 1 year ago. Plain graphies of left femur showed a well-delineated lesion with endosteal scalloping and areas having a ground-glass appearance. The MRI revealed minimal contrast enhancement but no heterogenous signal intensity, cortical destruction, periost reaction or accompanying soft tissue component was noted. The lesion was initially curetted. But being diagnosed as osteosarcoma histologically, classical osteosarcoma protocol pre and postoperative chemotherapy was applied. Resected femur showed areas of fibrous dysplasia admixed with osteosarcoma having fibroblastic, chondroblastic and osteoblastic areas that were focally invading the soft tissue. Tumor viability was estimated as 95%. The clinical course worsened rapidly after the operation. She did not respond to postoperative chemotherapy and lost with pulmonary metastases less than a years' time after the operation. The case is presented to increase awareness on the possibility of malignant transformation in an otherwise unsuspected fibrous dysplasia

Clinical and morphological characteristics of osteoid osteoma and osteoblastoma: a retrospective single-center analysis of 204 patients

WOS: 000345196100002PubMed ID: 25224389Osteoid osteoma and osteoblastoma are histologically similar, benign bone-forming tumors. In this retrospective study, we aimed to evaluate the natural history; clinical, pathologic, and radiologic findings; and treatment results in 204 patients between 1959 and 2006 in a single institution. According to the World Health Organization's definition, tumors = 2 cm, as osteoblastoma. For tumors between 1 cm and 2 cm, other criteria, such as the bone involved, the site, the presence of a nidus, and presence of peripheral sclerosis, were used for diagnosis. There were 131 patients with osteoid osteoma (93 male, 38 female) and 73 patients with osteoblastoma (40 male, 33 female). The mean age in the osteoid osteoma and osteoblastoma groups was 16.4 +/- 7 and 19.6 +/- 9.9 years, respectively. The osteoid osteoma cases were mostly localized in the extremities, whereas the osteoblastoma cases involved the vertebral column and sacrum. The nidus size varied between 0.2 and 1.5 cm in osteoid osteoma cases, and the tumor size range was 1.3-10 cm in the osteoblastoma cases. The pain was encountered in 89% of osteoid osteoma and 45% of osteoblastoma patients. Histopathology was similar in both cases. The treatment of choice was conservative surgery for both diagnoses. In conclusion, osteoblastoma is clinically and radiologically more aggressive than osteoid osteoma. (C) 2014 Elsevier Inc. All rights reserved

Black joint and synovia: Histopathological evaluation of degenerative joint disease due to Ochronosis

WOS: 000355639400008PubMed ID: 25869213Introduction: Ochronotic arthropathy is a rapidly progressive and disabling arthropathy predominantly encountered after the fifth decade of life, caused by homogentisate1,2 dioxygenase enzyme deficiency. As it is rare disease, the literature on histological findings is fragmented. Materials and methods: We retrospectively re-evaluated histopathological findings in resection and/or curettage materials (5 hip joint, 4 knee joint, one hip joint synovium, one intervertebral disk and one paravertebral disk tissue) of seven ochronosis cases diagnosed between 1995 and 2013 in a single center. Results: Necrotic brown chondroid detritus was present in all cases either in synovia or in subchondral area, some of which evoked giant cell reaction. Notably, brown pigmentation was prominent in upper middle parts of the articular cartilage but not that prominent in superficial parts and in osteochondral junction, almost stopping at the tide mark. Pigmentation was observed both in extracellular matrix and in cytoplasm either in granular or homogeneous fashion. Depositions were less prominent in osteophytic processes, regenerated cartilaginous areas and loose bodies. Almost all cases showed synovial detritic and inflammatory reaction, fibrillation, eburnation, and subchondral sclerosis. Disk degeneration and findings of ligament rupture were also observed. Conclusions: Histopathological diagnosis of ochronosis is not complicated given the unique "black coloring" of the affected tissues and it can easily be differentiated from other causes of detritic synovitis both clinically and histopathologically. However, there is no definitive cure for today and the reasons for late onset of arthropathy in disease course, and the mechanisms of tissue reaction to fragmented detritus remain elusive. (C) 2015 Published by Elsevier GmbH