Giant pelvic well-differentiated liposarcoma

Herein, we report a case of a giant well-differentiated liposarcoma located subgluteally and extending into the pelvis through the obturator foramen, nearby the urinary bladder and rectum without causing functional disturbances. The tumor was removed simultaneously with transgluteal posterior and anterior transabdominal approach. Six months postoperatively, no clinical and radiological evidence of recurrence was observed

Cases of difficult-to-access benign tumors with the potential risk for bone fracture

During the period from 2022-2023, three patients underwent surgical treatment involving curettage and bone grafting at our clinic (2 females and 1 male) due to hip pain. In two of them, a non-ossifying fibroma of the femoral neck and acetabulum was observed, while in the third patient, a bone cyst in the femoral neck was established. Due to possible fractures in these areas, the patients underwent surgery involving curettage and bone grafting with a synthetic bone substitute. Postoperatively, the patients had no pain and full range of motion

Loosened hip joint prosthesis-decision options

For the period 2013-2015, 36 patients underwent revision surgery because of secondary developed complications after primary hip joint replacement surgery. 14 of them were male and 23 – female, with average age 73 years.  We examined 4 groups of patients depends on the complications type: - Aseptic loosening in 23 patients, appeared 10 years’ average following primary hip prosthesis surgery. - Septic loosening in 2 patients revealed on second to the tenth month post operatively. In two other patients we observed infected hematoma. - Hip joint prosthesis (luxation) because of trauma or extremely wrong motion we notice in 5 patients. In one of them we revealed acetabular cup malposition. - Periprosthetic fractures with aseptic loosening in 3 patients. All 36 patients had primary cemented hip joint prosthesis. In the first group depends on which prosthesis parts were loosened we did acetabular cup and femoral stem replacement in 15 patients, only acetabular cup replacement in 4 patients and in 3 patients only femoral stem replacement. In 2 patients from second group we replaced the primary prosthesis by total spacer for 8 months followed by revision prosthesis surgery. In 2 haematoma patients we performed debridement, lavage-drainage and long term antibiotic treatment. In 2 patients of third group we replaced the primary head with a longer one and in 3 other patients we replaced the primary acetabular cup by shoulder collar cemented cup. In 2 patients of fourth group we replaced the primary acetabular cup and femoral stem by shoulder collar cemented cup and by revisionary stem delivered by Implant and Zimmer (Revitan). In the third patient we implanted revisionary femoral stem (Implant). 3 years after revisionary hip joint prosthesis surgery we monitor good prosthesis stability and good functional score

Benign fibrous histiocytoma of the brachium in a 14-year-old boy

Fibrous histiocytoma is a benign tumor involving soft tissues that can present as a fibrous mass involving various areas of the human body. Herein, we present a case of benign fibrous histiocytoma in the left brachium in a 14-year-old boy treated with surgical excision

Soft tissue chondromyxoid fibroma.An extremely rare case

Chondromyxoid fibroma is a rare benign bone tumor that accounts for less than 1% of primary bone tumors. The soft tissue variant of this tumor is extremely rare. Herein, we present a case of soft-tissue chondromyxoid fibroma in the foot of a 13-year-old boy treated with surgical excision

A rare case of neglected long-term pathologic fracture of the distal femur due to a giant cell tumor of bone

Giant cell tumor of bone is a histologically benign bone neoplasia that clinically has an aggressive course. In rare cases, it can give "benign" lung metastases or undergo malignant transformation. The World Health Organization defines this neoplasia as an "aggressive, potentially malignant lesion". Herein, we present a rare case of a neglected long-term pathologic fracture of the distal femur in a 20-year-old female patient. After a biopsy, a giant cell tumor of bone was diagnosed. The patient was treated with intralesional curettage, osteoplasty and plate fixation of the fracture. Eight months postoperatively, no local recurrence or metastasis of the tumor was observed

Pelvic pseudotumor following total hip arthroplasty. Case report

According to the literature, the development of metallosis after hip arthroplasty occurs in approximately 5% of patients. Metallic debris in the joint results in massive local and systemic release of cytokines. Excision of the pelvic pseudotumor, as well as revision surgery, is mandatory if there is evidence of osteolysis and loosening of the endoprosthesis. Imaging diagnostics, including magnetic resonance and computed tomography, are crucial for the preoperative planning of surgical intervention

A rare case of Ewing's sarcoma in a 4-year-old child treated by tumor endoprosthetics using 3D printing

Orthopedic oncology surgery often requires, by its very nature, precise and often extensive resections of bone and soft tissue involved in or near the tumor mass. One of the most recent and promising innovations is represented by 3D printing technology, whose main advantage in this field of application is patient specificity, which is essential in an operation that requires high precision and maximum respect for the individuality of his bones and soft tissues. Material and methods: In the present report, we present a 4-year-old boy diagnosed with Ewing's sarcoma involving ¾ of the right tibia. In another medical facility, he was offered amputation. Our team decided to use the "3D printed tumor megaendoprosthesis, double growing, from the Czech company Prospon. For reinsertion of the muscle groups to the endoprosthesis, we used a LARS textile tube that was attached to the femoral and tibial components of the endoprosthesis. A vascular surgeon also participated in the team. The patellar ligament was reinserted to the tibial component, and myoplasty was additionally performed with the medial head of the m. gastrocnemius. Intraoperatively, we lengthened the lower limb by 1.5 cm to delay the upcoming staged lengthening. Results: The postoperative period was uneventful, with sutures removed on the 12th postoperative day. For 3 weeks, a tutor orthosis was placed. Active physiotherapy was started after removal of the orthosis 21 days after surgery. Conclusion: Our goal is to perform a total revision at the end of skeletal growth if possible and replace the current implant with a non-growing tumor megaendoprosthesis in the absence of near or distant metastases and long-term patient survival. Future expectations are that non-invasive lengthening mechanisms or a biological approach will be able to meet the special needs of this population

A rare case of Ewing's sarcoma in a 4-year-old child treated by tumor endoprosthetics using 3D printing

Orthopedic oncology surgery often requires, by its very nature, precise and often extensive resections of bone and soft tissue involved in or near the tumor mass. One of the most recent and promising innovations is represented by 3D printing technology, whose main advantage in this field of application is patient specificity, which is essential in an operation that requires high precision and maximum respect for the individuality of his bones and soft tissues. Material and methods: In the present report, we present a 4-year-old boy diagnosed with Ewing's sarcoma involving ¾ of the right tibia. In another medical facility, he was offered amputation. Our team decided to use the "3D printed tumor megaendoprosthesis, double growing, from the Czech company Prospon. For reinsertion of the muscle groups to the endoprosthesis, we used a LARS textile tube that was attached to the femoral and tibial components of the endoprosthesis. A vascular surgeon also participated in the team. The patellar ligament was reinserted to the tibial component, and myoplasty was additionally performed with the medial head of the m. gastrocnemius. Intraoperatively, we lengthened the lower limb by 1.5 cm to delay the upcoming staged lengthening. Results: The postoperative period was uneventful, with sutures removed on the 12th postoperative day. For 3 weeks, a tutor orthosis was placed. Active physiotherapy was started after removal of the orthosis 21 days after surgery. Conclusion: Our goal is to perform a total revision at the end of skeletal growth if possible and replace the current implant with a non-growing tumor megaendoprosthesis in the absence of near or distant metastases and long-term patient survival. Future expectations are that non-invasive lengthening mechanisms or a biological approach will be able to meet the special needs of this population

Comparative electron microscopic and immunohistochemical study of stromal cells in giant cell tumor of bone

Giant cell tumor of bone is an osseous neoplasm that is histologically benign but clinically shows local aggression and high rate of recurrence. The histogenesis of this lesion remains unclear. The histological appearance does not predict the clinical outcome and there are still many unanswered questions with regard to both its treatment and prognosis. In order to further clarify this lesion, we examined ultrastructurally and immunohistochemically the tumor mononuclear cells in ten patients operated on in our hospital for matrix metalloproteinase-9. Positive reaction was detected in the spindle-like stromal cells of giant cell tumor of bone and these cells had the ultrastructural characteristics of fibroblastic cells. The other mononuclear cells did not express matrix metalloproteinase-9 and showed ultrastuctural characteristics of macrophage-like cells. The positive reaction for matrix metalloproteinase-9 in all patients clearly shows that this protease may play a key role in the pathophysiology of giant cell tumor of bone