Pseudo Tumours Research Articles

REVISION OF METAL-ON-METAL HIP ARTHROPLASTY WITH DUAL MOBILITY BEARINGS AND ACETABULAR COMPONENT RETENTION

In metal-on-metal (MoM) hip replacements or resurfacings, mechanical induced corrosion can lead to a local inflammatory response, pseudo tumours and elevated serum metal ions, requiring revision surgery.The size and diametral clearance of Anatomic (ADM) and Modular (MDM) Dual Mobility bearings matches that of certain MOM components. Presenting the opportunity for revision with exchange of the metal head for ADM/MDM bearings without removal of the acetabular component if it is well-fixed and appropriately positioned.Between 2012 and 2020, across two centres, 94 patients underwent revision of a MoM hip replacement or resurfacing. The mean age was 65.5 (33–87) years. In 53 patients (56.4%), the acetabular component was retained, and dual mobility bearings were used (DM); in 41 (43.6%) the acetabulum was revised (AR). DM was only considered where the acetabular component was satisfactorily positioned and well-integrated into bone, with no surface damage. Patients underwent clinical and radiographic follow-up to at least one-year (mean 42.4 (12–96) months).One (1.1%) patient died before one-year, for reasons unrelated to the surgery. In the DM group, two (3.8%) patients underwent further surgery; one (1.9%) for dislocation and one (1.9%) for infection. In the AR group, four (12.2%) underwent further procedures; two (4.9%) for loosening of the acetabular component and two (4.9%) following dislocations. There were no other dislocations in either group. In the DM group, operative time (68.4 v 101.5 mins, p<0.001), postoperative drop in haemoglobin (16.6 v 27.8 g/L, p<0.001), and length of stay (1.8 v 2.4 days, p<0.001) were significantly lower. There was a significant reduction in serum metal ions postoperatively in both groups (p<0.001 both Cobalt and Chromium) although there was no difference between groups for this reduction (p=0.674 Cobalt; p=0.186 Chromium).In selected patients with MoM hip arthroplasty, where the acetabular component is well-fixed, in a satisfactory position and there is no surface damage, the metal head can be exchanged for ADM/MDM bearings with retention of the acetabular prosthesis. Presenting significant benefits through a less invasive procedure, and a low risk of complications, including dislocation.

Management of pseudo tumour in haemophilia patients

A hemophilic pseudotumor is one of the rare complications of hemophilia that results from repetitive bleeding, forming an expanding destructive encapsulated hematoma and necrosed tissue. It has a considerable amount of morbidity. These have become rare over the years with better treatment modalities like factor replacement. Presently, excision is the preferred treatment by many authors. There are instances where surgical excision is not feasible. In such situations, radiotherapy and arterial embolization should be considered either alone or as an adjunct to surgery. A 32 years old male patient, with severe hemophilia A diagnosed with an abdominal tumour 7 years ago during routine screening, that progressively grew to encompass the lower abdominal area. A 44 years old male patient with hemophilia A presented with slow growing swelling over the left gluteal region since, 10 years associated with ulceration and bleeding since, 3 days. The management of a patient with a haemophilic pseudo tumour is complex, with a high rate of potential complications. Surgical excision is the treatment of choice but can only be carried out by a multidisciplinary surgical team. The main postoperative complications are rebleed, infection, fistula and pathological fractures. Pelvic pseudo tumours can even become complicated by fistula formation to the large bowel and by obstruction of the ureters. Untreated pseudo tumours will ultimately destroy soft tissues, erode bone, and may produce neurovascular complications. The hemophilic pseudo tumour is a rare entity which is slow growing painless tumour, with few reports worldwide in the management of this rare complication.

Tumor miofibroblástico inflamatorio de la mama: presentación de caso y revisión de la literatura

Inflammatory myofibroblastic tumour (IMT) belongs to the group of pseudo inflammatory tumours, composed of fusiform cells mixed with mature plasma cells and inflammatory cells. It is frequently described in the abdomen, pelvis, lung and retroperitoneum in paediatric and adolescent patients. Presentation in the mammary gland is extremely rare (27 cases described in the literature), which is why its natural history, recurrence and metastatic potential remain under study. We present the case of a postmenopausal patient, who was treated with conservation surgery, as well as a review of the literature of this entity.

Ultrasonographic Assessment of the Foot Pseudotumoural Soft Tissue Lesions

Ultrasonographic Assessment of the Foot Pseudotumoural Soft Tissue Lesions

Outcome of Birmingham hip resurfacing at ten years: role of routine whole blood metal ion measurements in screening for pseudotumours.

Emerging concern has arisen because of recent papers reporting a high prevalence of pseudotumours (PTs), even in patients with surface arthroplasties with a good clinical track record. The aim of our study was to establish the ten year survivorship of Birmingham hip resurfacing (BHR), to investigate whole blood (WB) metal ion levels and prevalence of adverse reactions to metal debris (ARMeD) and to determine the association of blood metal ion levels and symptoms with ARMeD in patients operated on with BHR at our institution. Between May 2001 and May 2004, 261 consecutive BHRs were implanted in 219 patients. All living, nonrevised patients underwent a systematic screening programme consisting of clinical examination, WB cobalt and chromium measurements and targeted cross-sectional imaging. The ten year survival for the entire cohort was 91% (89-93%), with any revision as the endpoint. Prevalence of ARMeD was 6.9% in male and 8.8% in female patients. Symptomatic patients with elevated metal ion levels evinced highest prevalence (63%) of PTs compared with asymptomatic patients with elevated metal ion levels (42%) and symptomatic patients with nonelevated metal ions (11%). Contradicting the current international guidelines, our results suggest that it seems beneficial to combine routine metal ion measurement with clinical assessment, even in patients with well-functioning BHRs. Further follow-up will reveal whether new PTs will develop in these patients and BHR survivorship in the longer term.

Real-time corrosion measurements to assess biotribocorrosion mechanisms with a hip simulator

Due to the reduced wear compared to the metal-on-polyethylene implant, second generation metal-on-metal hip prostheses have been widely used as the replacement in younger patients in recent years. Osteolysis induced by polyethylene wear debris was a major concern with metal-on-polyethylene hip replacements. In metal-on-metal total joint replacements, however, there has been concern about the incidents of pseudo tumours as a result of the production of very fine wear debris and the associated production of metallic ions of Co and Cr. The origins of the metallic ions may be from two potential sources: from the bearing surface and from the dissolution of wear debris produced by the tribological action or the production of ions by depassivation of the CoCr alloys.Although there has been extensive work on simulation of wear processes in hip joint replacements through hip simulators running over prolonged periods and mapping the wear rates, to date there have been several attempts to measure the interactions (biotribocorrosion) between corrosion and tribology in-situ in simulated body fluids using a hip simulator. This paper describes the instrumentation of an integrated hip joint simulator to provide electrochemical measurements in real-time. The open circuit potential and polarization experiment results are reported and the importance of these measurements to gain an understanding of the origins of metal ions and to complement the wealth of wear data available is discussed.

Pseudo tumours in haemophilia patients

Pseudo tumours are amongst the rare yet pathognomonic complications of haemophilia. They are old, encapsulated haematomas which due to their sometimes enormous size can cause massive complaints. These haematomas are surrounded by a thick fibrous capsule. They are attributed to persistent bleedings. The pathophysiology of pseudo tumors is not conclusively established yet. Some believe that they originate from bone material or the periosteum, while others suggest their development from soft tissue. They spread aggressively, displace the surrounding tissue, and cause secondary periosteal erosion of the bone. This results in bone resorption and destruction of surrounding muscular and soft tissue. Pseudo tumours develop slowly over many years. They occur primarily in adults and are largely unresponsive to conservative treatment. A 48-year-old man with moderate hemophiliaA (FVIII:C 2%) and no FVIII inhibitor. Due to recurrent bleeding into the muscle of the right thigh diagnosis of two pseudo tumours (psoas, adductor magnus). In 2004 tumour extirpation with subsequent relapse; because of high local bleeding tendency (despite permanent prophylaxis with FVIII concentrate and adjusted lifestyle) surgical revision in 02/2008. Postoperatively, no recurrent bleeding; the patient is fully fit for work three months later. In order to reduce the complication rate when a pseudo tumor is suspected, patients should be treated in a specially equipped interdisciplinary center with adequately trained and experienced surgeons and haemostaseologists.

Efectividad de las válvulas gravitacionales en la prevención del hiperdrenaje en pacientes adultos con hidrocefalia

To evaluate the effect of gravitational valves on over-drainage in hydrocephalus in adults. We performed a retrospective study of the shunt systems placed in patients over the age of 18 years between 1998 and 2006. Patients were divided into two groups: non-GV group (without gravitational valve) and GV group (with a gravitational valve, Aesculap-Miethke 5/35). The complications that occurred during the first year following the placement of the shunt system were recorded. Of a total of 137 patients, 91 were from the non-GV group and 46 belonged to the GV group. Mean age: non-GV group, 62.1 years; and GV group, 64.2 years, without any significant differences. In 80 patients the aetiology was chronic adult hydrocephalus, 19 were due to expansive processes, 15 due to vascular causes, eight pseudo tumours, six post-traumatic injuries and nine were due to other causes. In the non-GV group, 9.89% presented over-drainage, whereas there were no cases in the GV group; the difference was statistically significant (p = 0.029). In the rest of the complications there were no significant differences between the two groups. The total complications in the non-GV group were 25.27% and in the GV group, 6.52%, and there were significant differences (p = 0.01), although, above all, at the expense of over-drainage, because if this complication was excluded, then the differences were no longer significant (p = 0.175). In our series, the use of gravitational valves in the prevention of over-drainage in adult hydrocephalus proved to be more effective than employing valves without the gravitational device.

Nora’s lesion, a distinct radiological entity?

To describe the radiological findings of "Bizarre parosteal osteochondromatous proliferation"(BPOP)-otherwise known as Nora's lesion, to describe the natural evolution of BPOP and to assess radiologically if BPOP is indeed part of a spectrum of reactive lesions including florid reactive periostitis and turret exostosis. Four experienced musculoskeletal radiologists studied plain radiographs and other imaging documents of histologically-proven Nora's lesions, looking for soft-tissue changes, periosteal reaction/calcification and calcified/ossified pseudotumours, and compared those findings with findings on pathology reviewed by a peer group of pathologists. Twenty-four Nora's lesions originating from a series of 200 consecutive, histologically-verified bone (pseudo)tumours of the hand, seen by the "Netherlands Committee on Bone Tumours" for review and second opinion. Nora's lesions have a recognised presentation on radiographs without specific MR characteristics. Natural evolution could be assessed retrospectively in four cases. Recurrent lesions were seen in seven cases and are difficult to differentiate from primary lesions. Nora's lesion, defined as a "well-marginated mass of heterotopic mineralization arising from the periosteal aspect of an intact cortex, without medullary changes" has a distinct radiological presentation and is part of a spectrum of reactive lesions which includes florid reactive periostitis and turret exostosis. As it has a distinct radiological appearance, differential diagnosis of malignant lesions such as osteosarcoma and chondrosarcoma should be clear. It does not require immediate biopsy unless the natural evolution is unspecific.

Inflammatory focal myositis of the sternomastoid muscle: is there an absolute indication for biopsy? A case report and review of the literature

Focal myositis is a localised inflammatory process affecting skeletal muscles belonging to the pathological group of inflammatory pseudo tumours of soft tissue that includes myositis ossificans, proliferative myositis and nodular pseudosarcomatous fasciitis. Very rarely, it may affect one of the neck muscles and present as a neck lump, in which case both the clinical and pathological picture can mimic a sarcoma. We describe a case of focal myositis of the sternocleidomastoid muscle, present a review of this rare condition and debate the necessity of biopsy.

Percutaneous treatment of haemophilic digital pseudo tumours

In young patients with haemophilia, blood cysts in the finger bones may grow rapidly and imitate a malignant tumour (pseudo tumour). The condition must initially be treated with administration of factor VIII-IX. If this does not control the growth, surgical treatment is indicated. We have advised a percutaneous treatment with evacuation of the blood and injection of the cavity with fibrin seal.

Prise en charge rhumatologique de l'hémophilie: 2 e partie : Hématomes musculaires et pseudo tumeurs

Less frequent than haemarthroses, muscular heamatomas generate functional and sometimes lethal risks. Their treatment is not as precisely codified as that of haemarthroses, though it similarly lies upon injections of anti haemophilic factor, the prevention of fixed contractures, and rehabilitation. More difficult yet is the treatment of haemophilic pseudo tumours, which in adult patients is quite always a surgical one. Surgery is now possible even in haemophiliacs who have an inhibitor. In patients who are infected by the human immunodepression virus, surgery depends on a sufficient number of CD4 lymphocytes.

Ektope Deziduareaktion - möglicher Anlaß zur kolposkopischen, histologischen und intraoperativen Fehldiagnose

Three cases with remarkable colposcopical, gross, and histological features caused by cervical and ovarian ectopic decidua formation are reported. The possible clinical significance of ectopic decidua and potential problems in differential diagnosis are highlighted. Marked cervical deciduosis may cause worrisome colposcopical findings which may necessitate biopsy if smear cytology is negative. Cervical decidual reaction underlying a squamous carcinoma in situ of the cervix may mimick invasion histologically. Ovarian ectopic decidua, so-called deciduomas which must be included in the differential diagnosis of ovarian (pseudo)tumours in pregnancy may be an incidental finding at Caesarean section. The pathogenesis of ectopic decidua remains unclear. In the present cases, the immunohistochemical profile of ectopic decidua differed between cervical (sm-actin-, inhibin-negative) and ovarian (sm-actin-, inhibin-positive) forms. Ectopic decidua may be an isomorphic tissue response to various stimuli or may originate from different stem cells in different locations.

The pathology of cervical neoplasia

The World Health Organization classification has clarified the typing of cervical tumours. The category of early stromal invasion has been eliminated from the International Federation of Gynecology and Obstetrics staging scheme of cervical carcinoma. Stage lal is defined now as depth of invasion less than or equal to 3 mm; stage la2 is defined as depth of invasion between 3 and 5 mm in depth. The width should not exceed 7 mm. Small cell carcinoma has been better delineated. An increased incidence of human papillomavirus infection and cervical intraepithelial neoplasia has been observed in patients suffering from the effects of human immunodeficiency virus, in whom invasive cervical cancers run a more aggressive course. The better understanding of pseudomalignant lesions, that is, deep cervical glands, various metaplasias and inflammatory pseudo tumours, as well as some rare tumours, enables the surgical pathologist to make a more accurate diagnosis, resulting in better patient care.

Computed Tomographic and Ultrasound Appearances of Focal Spared Areas in Fatty Infiltration of the Liver

Computed tomography (CT) and ultrasound (US) appearances of diffuse and focal fatty infiltration of the liver (FIL) are well recognized. We have recently seen 10 cases with "fat spared" areas in FIL presenting as pseudo tumours of the liver. Characteristic appearances of fat free areas in FIL which help differentiate these areas from other focal liver lesions include (i) location in the medial segment of the left lobe of the liver, (ii) absence of mass effect on surrounding vessels and liver tissue, and (iii) presence of typical changes of FIL elsewhere in the liver on CT or US examination.

Benign tumours of larynx

50 cases of benign tumours of the larynx in whom surgical excision was done form the basis of this study. It has been emphasized that the tumour should be removed under general anaesthesia with complete relaxation. The scalping of the tumour should be flushed with the surface of vocal cord avoiding any injury to the epithelium of the vocal cord. It has been observed that true benign tomours of larynx are whereas the commonumours of the larynx met with are the pseudo tumours.