Pseudo Tumors Research Articles

Long-Term Outcome of Metal-on-Metal Total Hip Arthroplasty with Modular Neck Stem.

Background: This study aimed to report the long-term outcomes of total hip arthroplasty (THA) using a Conserve Plus (Wright Medical, Japan) metal-on-metal (MoM) acetabular prosthesis with a modular neck stem. Methods: This study enrolled 50 patients (10 men and 40 women; mean age, 65.8 (39-87) years) who underwent primary THA using a Conserve Plus MoM acetabular prosthesis with a modular neck stem. The preoperative diagnosis in most patients was osteoarthritis. Clinical function of hip joint outcomes was investigated using the Japanese Orthopedic Association (JOA) hip score preoperatively and at the final follow-up. The perfect JOA hip score was 100, while the worst score was 0. Radiological analyses were evaluated during the final follow-up visit. Magnetic resonance imaging (MRI) images were evaluated to screen for pseudotumors in 43 hips postoperatively. Results: Six patients did not visit before their 10-year follow-up for unknown reasons. Therefore, 44 patients were evaluated at a mean of 11-years of follow-up (10-12 years). The mean (±SD) preoperative JOA hip score of 44.2 (±15.5) improved significantly to 85.1 (±12.9) postoperatively at the final follow-up (n = 36 hips, excluding eight revision cases). One patient underwent femoral fixation for a periprosthetic fracture due to trauma that occurred 4 years postoperatively. Spot welds were identified in 93.2% (41/44 hips) of cases. Severe (third- and fourth-degree) stress shielding was identified in 40.9% (18/44 hips) of cases. Twenty-two patients (51.2%) had pseudotumors attributable to MoM articulation based on MRI results, 2 to 10 years after arthroplasty. Three hips showed cup osteolysis (7%) and three showed trochanteric region osteolysis (7%). There were seven cup and/or three stem revisions for aseptic loosening and/or osteolysis at 4 months (with trauma) and 3.3 to 11 years (with pseudotumor) postoperatively. The Kaplan-Meier survivorship for the THA construct in this group was constant at 93.0% and 75.9% at 10 and 12 years after arthroplasty, respectively. The rates of survivorship of revision and loss of follow-up at 10 and 12 years were 83.9% and 66.8%, respectively. Conclusions: In summary, we reported on the long-term treatment results of MoM THA, precautions based on our cohort's findings, and the measures taken to address these issues, such as revision replacement and its outcomes. Clinical scores revealed good outcomes during the mean 11-year follow-up period. However, the prevalence of pseudotumors (PTs) was 51.2%. Some cases required revisions even after the 10 years following surgery. This is because in MoM THA, PT occurrence increases over time, and as a result, there were cases in which revised THA was required even after 10 years.

Tracheal resection anastomosis for rare tracheal inflammatory lesions mimicking malignancy: report of 2 cases

BackgroundTumor-like lesions of the trachea are rare and challenging in diagnosis and management. Inflammatory myofibroblastoma, also known as Inflammatory pseudo tumors (IPTs), as well as Rosai Dorfman Disease (RDD) are inflammatory lesions that may involve the central airways with variable non-specific clinical features mimicking tumors.Case presentationIn this study 2 cases with tumor-like lesions are presented. One case with an inflammatory pseudotumor and the other one with Rosai–Dorfman disease affecting the upper trachea. Both cases were successfully managed with tracheal resection anastomosis.ConclusionTracheal Inflammatory myofibroblastoma, and Rosai–Dorfman diseases are rare tumor like lesions that present with upper airway obstruction. Despite being benign, these lesions may have features suggestive of malignancy, requiring prompt management. Complete surgical excision by segmental resection and primary anastomosis (if feasible) is the treatment of choice with an optimum outcome.

LES XANTHOMATOSES HYPERLIPIDEMIQUES: AU-DELA DE LA RARETE, QUELLE PRISE EN CHARGE ?

Xanthomas are benign pseudo tumors, often linked to a disorder of lipoprotein metabolism and which require screening.We report the case of a 33-year-old young adult, with no significant medical history, who consulted for painless yellowish nodules progressively appearing over the past year on the limbs. Cutaneous and mucosal examination reveals small smooth-surfaced nodules, orange-yellow in color, painless, non-pruritic, of varying sizes, located on the forearms, elbows, hands, knees, ears and posterior surface of the neck. The histopathological study of a skin nodule biopsy suggests lipid overload, confirming the diagnosis of xanthomas. The lipid profile, conducted after a 12-hour fast, shows hypertriglyceridemia at 10.28 g/L, hypercholesterolemia at 7.79 g/L, elevated LDL cholesterol levels at 3.64 g/L and decreased HDL cholesterol levels at 0.31 g/L. Thyroid function tests and cardiovascular investigations are unremarkable. The diagnosis of familial combined hyperlipidemia type III, according to the Fredrickson classification is established.The patient is prescribed lifestyle modifications along with treatment consisting of daily pravastatin 40mg and fenofibrate 160mg. The patients condition shows improvement with regression of these lesions.Xanthomatoses linked to familial hypercholesterolemia are very rare. This condition can significantly impact patients lives due to its complications, particularly coronary complications, despite well-managed medical treatment.

Renal Mass Mimicking Prominent Columns of Bertin: A Case Series

Prominent column of Bertin (PCB), also known as hypertrophic column of Bertin, are often referred to as pseudo tumors, given that they can mimic the appearance of renal tumors. This case series demonstrates a reverse situation where renal masses mimicked PCB. Two patient cases are presented to demonstrate how renal masses mimicked PCB, and a third comparative case is presented to demonstrate a split sinus sign that represents a PCB, a pseudo tumor confirmed with a computed tomogram (CT). Considering the renal masses mimicking PCB, CT, and histology confirmed the presence of renal cell carcinoma. Renal masses which present sonographically as PCB, are most likely to be overlooked and have negative impacts when undetected. Early detection of renal tumors is vital in improving a patient’s prognosis. This case series is useful in providing further evidence of how renal masses can mimic PCB, with sonography. Careful sonographic examination of PCB should be encouraged, and if sonographic features are uncertain, consider further evaluation by urology, especially for those patients with a background of hematuria and no previous imaging studies.

Sensitivity and specificity for detecting pseudotumors in patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene total hip arthroplasty-MRI versus ultrasonography performed by an orthopedic surgery resident.

Metal artifact reduction sequence magnetic resonance imaging (MRI) scan is a common method to detect adverse reaction to metal debris in total hip arthroplasty (THA). It might be quicker and cheaper if ultrasonography (US) could screen for the need for an MRI. However, both require trained personnel. We aimed to investigate the sensitivity and specificity of US for detecting pseudotumors (PT) when performed by an orthopedic surgery resident compared to MRI. We also investigated the sensitivity and specificity of US to detect PTs in obese and non-obese patients. We examined 205 patients with hip resurfacing arthroplasty, metal-on-metal or metal-on-polyethylene THA with both MRI and US. US was performed by an orthopedic surgery resident who was trained according to a standardized training program in musculoskeletal US. Results from MRI were used as gold standard. US had a sensitivity of 0.92 (95% CI 0.81-0.98) and specificity of 0.94 (95% CI 0.89-0.97) for detecting PT. It had a positive predictive value of 0.84 (95% CI 0.73-0.91) and a negative predictive value of 0.97 (95% CI 0.93-0.99). US performed similarly in obese and non-obese patients. US had a high sensitivity and specificity for detecting PT when performed by an orthopedic surgery resident. Trained orthopedic surgeons could screen for the need of an MRI scan when searching PTs.

Solitary sphenoid sinus benign lesions: management and prognostic values as retrospective audit of seven case series

BackgroundSolitary sphenoid sinus pathology is uncommon. The deep position of the sphenoid sinus makes symptoms related to solitary sphenoid sinus pathology non-specific and contributes to a significant diagnosis delay. Moreover, surrounding anatomical elements cause its pathology to be potentially serious and make surgical management challenging.MethodsThis retrospective study includes 7 cases presented with primary benign sphenoid sinus pathology managed between January 2019 and January 2022. Epidemiological features, clinical aspects, and treatment modalities are presented.ResultsSix female patients and one male patient were operated; their age ranges from 11 to 67 years old. Etiologies are divided into infection, tumors, and pseudo tumors. Sphenoid sinus approach was performed through the sphenoethmoid recess in 5 cases, through the septum in one patient and through the ethmoid in one patient.ConclusionEndoscopic procedures have significantly improved the management of the sphenoid sinus pathology. They offer good access and control of the sphenoid pathology but require a perfect mastery of radiologic and endoscopic anatomy and its variations.

Gg4 Pseudo tumors Mimicking Urologic Malignancies: Comprehensive Review and Management of a Rare Infiltrative Upper Tract Lesion

Objectives: Immune-mediated fibroinflammatory conditions are known to affect multiple organ systems, as seen in the IgG-4 related disease. While tubulointerstitial nephritis and membranous glomerulonephritis are the more common intrinsic renal diseases, IgG-4 mediated disease can mimick urologic malignancies and can pose a significant management dilemma. Our goal is to understand how to better diagnose, exclude malignancy, and preserve renal function in a rare Urologic disease. Materials and Methods: A review of current literature was obtained to provide additional insight and understanding on this rarely observed Urologic disease. In discussing the case presented, a pertinent clinical history, physical exam, and review of cross-sectional imaging is presented. Immunohistochemical analysis of the specimen was thoroughly performed with expert analysis by our consulting pathologist. Results: Very rare reports of renal, ureteral, pelvic, or scrotal IgG4 mediated pseudotumors have been published. In the absence of pathologic tissue analysis of biopsy samples, the diagnosis of this rare disease can be significantly challenging. In our presentation, a male patient was noted to have a 7cm mass replacing the left renal sinus and causing moderate left hydronephrosis. Initial concern was for upper tract urothelial cell carcinoma. However, left ureteropyeloscopy demonstrated normal left renal and ureteral architecture and excisional biopsy of a PET avid left cervical lymph node was performed however pathologic diagnosis was not able to be confirmed. This led to a management dilemma due to the progressing mass size, worsening renal drainage, and symptoms. The patient opted for surgical excision. Final pathology from a left radical nephrectomy was significant for an IgG-4 related inflammatory pseudotumor. Conclusions: IgG-4 related diseases are known to represent a systemic disease that leads to lymphoplasmacystic inflammation and fibrosis within the affected tissues. At this time, there is no standardized method for the diagnosis and treatment of patients with retroperitoneal involvement. Additional research is needed to identify improved diagnostic modalities, the role of immunosuppressive therapy, and the surgical management in this disease process.

87 Intracerebral inflammatory pseudotumor in Behçet’s disease: a pediatric case report

IntroductionBehçet's disease is a chronic, relapsing, multisystem vasculitis. The diagnosis is essentially clinical, due to the absence of specific biological criteria, which remains very difficult to establish in pediatric age because of often insidious or atypical disease onset. The association of Pseudo Inflammatory Non-Specific Tumors (PTINS) and Behcet's disease (BD) is exceptionally reported. We report the case of a 12-year-old boy with Behçet's disease who presented with an inflammatory pseudotumor during the course of his disease.Methods and resultsA 12-year-old boy, from Batna (Algeria), with no relevant past medical history, admitted in 2010 for the management of a venous thrombosis of the right lower limb without any obvious cause and which responded well to anticoagulant treatment.A year later, the child was readmitted for polymorphic clinical signs made up of joint damage (inflammatory arthralgia of the large joints), digestive (glairo-bloody diarrhea) and ocular (decreased visual acuity) and skin and mucous membranes (oral-genital apthosis and erythema nodosum of the 4 limbs).Lab work-up showed significant inflammatory syndrome with erythrocyte sedimentation rate (ESR) of 100 mm at the first h, C-reactive protein (CRP) up to 400 mg/l and thrombocytosis (700 000–900 000 elements/mm2). HLA B51 was negative.The patient was treated with Colchicine, Steroids, and Aspirin with partial response. Subsequently, a treatment with azathioprine was started, with clinical improvement (despite occasional digestive crises) but with persistent biologic inflammation.In 2012 the patient presented with a unilateral decrease in visual acuity. A CT scan was performed showing an intracranial tumor compressing the right optic nerve with all the criteria of a malignant tumor (rupture of the cortex, increase in volume on 2 successive CT scans). A transsphenoidal biopsy of the mass revealed a non-specific inflammation. Biological treatment with anti-TNF alpha (Infliximab) was associated with a spectacular tumor regression, allowing retrospectively the diagnosis of an inflammatory granulomatous lesion related to Behçet's disease rather than a malignant tumor. The outcomes were favorable with clinical and biological improvement for the first time since the onset of the disease.ConclusionBehcet is rare in the pediatric age group and it is difficult to diagnose. Nonspecific inflammatory pseudotumors can be associated with Behçet's disease and constitute a real diagnostic and therapeutic challenge.Disclosure of InterestNone declared

Semi-Automated Determination of Heavy Metals in Autopsy Tissue Using Robot-Assisted Sample Preparation and ICP-MS

The endoprosthetic care of hip and knee joints introduces multiple materials into the human body. Metal containing implant surfaces release degradation products such as particulate wear and corrosion debris, metal-protein complexes, free metallic ions, inorganic metal salts or oxides. Depending on the material composition of the prostheses, a systemic exposure occurs and may result in increasing metal concentrations in body fluids and tissues especially in the case of malfunctions of the arthroplasty components. High concentrations of Cr, Co, Ni, Ti and Al affect multiple organs such as thyroid, heart, lung and cranial nerves and may lead to metallosis, intoxications, poly-neuropathy, retinopathy, cardiomyopathy and the formation of localized pseudo tumors. The determination of the concentration of metals in body fluids and tissues can be used for predicting failure of hip or knee replacements to prevent subsequent severe intoxications. A semi-automated robot-assisted measurement system is presented for the determination of heavy metals in human tissue samples using inductively coupled plasma mass spectrometry (ICP-MS). The manual and automated measurement processes were similarly validated using certified reference material and the results are compared and discussed. The automation system was successfully applied in the determination of heavy metals in human tissue; the first results are presented.

Intracranial Mass Lesion Caused by Inflammatory Pseudotumor: A Case Report and Discussion

Inflammatory pseudo tumors are uncommon lesions that may, on occasion, occupy the intracranial space. Their management is unstandardized. We present a case of skull-based inflammatory pseudotumor in a 14-year-old boy who presented with multiple cranial nerve palsies mimicking Gradenigo syndrome. This illustrative case and a review of the literature is presented to highlight noteworthy features of this rare condition. These include that inflammatory pseudotumor may be multifocal and biopsy of a more accessible, smaller lesion may prove diagnostic.

Detection of pseudo brain tumors via stacked LSTM neural networks using MR spectroscopy signals

Magnetic resonance spectroscopy (MRS) is one of the non-invasive tools used in the detection of brain tumors. MRS provides a metabolic profile about the brain. In this profile, MRS patterns of the tumors and pseudo tumors can be similar to each other. For this reason, accurate diagnosis and classification of brain tumor is of vital importance for the patient's treatment planning. It has been widely preferred by physicians in recent years because it does not pose the risk of infection and death due to surgery like biopsy. In this study, binary classification of brain tumors and normal brain tissue with pseudo-brain tumors is achieved via deep neural networks using MRS data. For the classification of MRS signals, a stacked model based on Long Short-Term Memory (LSTM) and Bidirectional Long Short-Term Memory (Bi-LSTM) deep neural networks is proposed. In the experimental studies in the study, MRS signals from normal brain tissue, brain tumor and pseudo-brain tumors in the INTERPRET database are used. Since the MRS data belonging to a large number of tumors and pseudo-tumors are required for training and testing of the LSTM neural networks, the number of data for the MRS dataset is increased by data augmentation methods. Training and testing of the LSTM neural networks used are performed with a repeated 5-fold cross validation and 10 repetitions for each model. As a result of this study, proposed a stacked model for computer-aided binary classification of MRS data, classification results of 93.44%, 85.56%, 88.33% and 99.23% are obtained for the classification of pseudo brain tumor with glioblastoma, diffuse astrocytoma, metastatic brain tumors and normal brain tissue, respectively. Therefore, it is confirmed that the proposed LSTM-based stacked method is successful in detecting pseudo brain tumors using MRS signals.

High throughput sequencing reveals high specificity of TNFAIP3 mutations in ocular adnexal marginal zone B-cell lymphomas.

The majority of ocular adnexal (OA) lymphomas (OAL) are extranodal marginal zone lymphomas (MZL). First high throughput sequencing (HTS) studies on OA-MZL showed inconsistent results and the distribution of mutations in reactive lymphoid lesions of this anatomic region has not yet been sufficiently addressed. We characterized OAL and lymphoid lesions of the OA by targeted HTS. The study included 34 OA-MZL, 11 chronic conjunctivitis, five mature small cell B-cell lymphomas spreading to the OA, five diseases with increase of IgG4+ plasma cells, three Burkitt lymphomas (BL), three diffuse large B-cell lymphomas (DLBCL), three mantle cell lymphomas, three idiopathic orbital inflammations/orbital pseudo tumors (PT), and three OA lymphoid hyperplasia. All cases were negative for Chlamydia. The mutational number was highest in BL and lowest in PT. The most commonly (and exclusively) mutated gene in OA-MZL was TNFAIP3 (10 of 34 cases). Altogether, 20 out of 34 patients harbored mutually exclusive mutations of either TNFAIP3, BCL10, MYD88, ATM, BRAF, or NFKBIE, or nonexclusive mutations of IRF8, TNFRSF14, KLHL6, and TBL1XR1, all encoding for NK-κB pathway compounds or regulators. Thirteen patients (38%) had, to a great part, mutually exclusive mutations of chromatin modifier-encoding genes: KMT2D, CREBBP, BCL7A, DNMT3A, EP300, or HIST1H1E. Only four patients harbored co-occurring mutations of genes encoding for NK-κB compounds and chromatin modifiers. Finally, PTEN, KMT2D, PRDM1, and HIST1H2BK mutations were observable in reactive lymphoid lesions too, while such instances were devoid of NF-κB compound mutations and/or mutations of acetyltransferase-encoding genes. In conclusion, 80% of OA-MZL display mutations of either NK-κB compounds or chromatin modifiers. Lymphoid lesions of the OA bearing NF-κB compound mutations and/or mutations of acetyltransferase-encoding genes highly likely represent lymphomas.

1533 Cytomegalovirus as the Forme Fruste of Colorectal Cancer in a Young Female

INTRODUCTION: Cytomegalovirus (CMV) infection is often seen in the GI tract among patients who are immunocompromised and most commonly affects the large bowel. Studies have shown CMV infection presenting as a colorectal cancer (CRC) like mass. We present a case of CMV presenting as the forme fruste of CRC. CASE DESCRIPTION/METHODS: A 31 year old Hispanic woman presented with a one week history of worsening abdominal pain, generalized weakness, hematochezia, and a 30 lb weight loss. She was a nonsmoker who had presented similarly 6 months prior to another institution and was diagnosed with CMV colitis by flexible sigmoidoscopy and biopsy of a rectal ulcer. Pathology revealed focal atypical epithelial proliferation, indefinite for dysplasia, and CMV immunostain was positive. The patient was treated with valganciclovir with improvement in symptoms, but later worsened. She denied change in bowel habits, history of anogenital warts, or HPV vaccination, but admits to a remote history of Chlamydia which was treated. History was also positive for chronic inactive HBV infection diagnosed 6 years prior to presentation. Significant labs were Hb 4.6 g/dL, MCV 65.9, Plt 466 K/uL, AST 43 U/L, ALP 111 U/L, HIV nonreactive, AFP 3.0 ng/ml, HBsAg reactive, HBV viral load of 613 IU/mL, HBcAb total reactive, HCV Ab nonreactive and CEA 44.6. CT abd/pelvis showed an inflammatory, ulcerated, rectal mass with wall thickening compatible with neoplasm (Figure 1). Large hypodensities were seen in both hepatic lobes consistent with metastases (Figure 2). Sigmoidoscopy showed an ulcerated partially obstructing mass in the rectum which was circumferential and friable and located at the anal verge and was approximately 10 cm in length. Biopsy of the mass showed scant adenocarcinoma admixed with ulcer and granulation tissue. Liver biopsy confirmed metastatic adenocarcinoma, colon primary. DISCUSSION: Potential previous exposure to oncogenic viruses such as HBV and HPV may have predisposed our patient to develop CRC at age 31. She had no other risk factors such as HIV infection, radiation exposure, or previous chemotherapy. Her underlying malignancy may have rendered her in an immunocompromised state that would have allowed CMV reactivation. Another possibility is exposure to multiple viruses caused immunocompromise allowing both CMV reactivation and CRC formation. CMV pseudo tumors are known to mimic CRC. Alarm symptoms such as weight loss and hematochezia in this patient warranted close follow up to complete resolution or alternative diagnosis.

Imaging features of atypical bleeds in young patients with hemophilia.

Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.

A RARE ASTHMA MIMIC

SESSION TITLE: Allergy and Airway SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: IgG4 related disease (IgG4-RD) is a recently identified systemic fibro-inflammatory disease associated with elevated circulating levels of IgG4. We are presenting a case of IgG4-RD with hilar mediastinal lymph node and bronchial wall inflammation presenting as an asthma exacerbation. CASE PRESENTATION: A 49 year old male presented to the pulmonary clinic for an evaluation of asthma after several emergency room visits for worsening dyspnea, dry cough and wheezing for 2 months. The patient had no prior history of respiratory issues, and reported that he had never smoked. The patient noted that his facial features appeared to be changing over the previous 4 months. The patient moved from the Democratic Republic of Congo 25 years ago, and currently is a chemistry teacher. The patient reports no recent travel, has no pets. Additionally, the patient denies any recent organic or inorganic fume or dust exposure, and reports no family history of asthma or respiratory issues. Bilateral firm parotid swelling and periorbital edema were prominent on examination making his face appear significantly different from a picture he took 4 months ago. Bilateral wheezes were noted in the lungs with prolonged expiratory phase. The patient’s pulmonary function tests (PFTs) revealed a severe obstructive defect with an FEV1 of 1.33, increased residual volume and a mild diffusion defect. A PET scan was administered to rule out lymphoma as a cause of parotid swelling. Marked enlargement with diffuse hypermetabolic activity was seen in the parotid, submandibular, sublingual, and lacrimal glands. Additionally, multiple mildly hypermetabolic enlarged mediastinal and hilar lymph nodes were observed. There was peribronchial thickening with scattered distal bronchiolar plugging. A biopsy of the submandibular gland revealed sclerosing sialadenitis with interlobular storiform fibrosis, and marked lymphoplasmacytic inflammation. The immunohistochemical findings were consistent with IgG4-RD. A serum IgG subclass analysis was done and showed increased IgG4 level upto 1070mg/dl. The patient was referred to rheumatology and was treated with Rituximab for 3 cycles. His parotid swelling, dysmorphic facial features resolved after the first treatment. So did his dyspnea and wheezing. His repeat PFTs normalized as well. DISCUSSION: IgG-RD is an immune mediated systemic fibro-inflammatory condition that affects almost any organ. Although the inflammation is responsive to steroids, it tends to recur. However, there is a good response to rituximab with less rate of recurrence. CONCLUSIONS: Pulmonary involvement can present as inflammatory pseudo tumors mimicking malignancies, consolidative infiltrates hilar mediastinal lymphadenopathy or bronchovascular inflammation. This patient's symptoms stemmed from bronchovascular inflammation, untreated progression to irreversible bronchovascular fibrosis is highly likely. Reference #1: Clinical Review of Pulmonary Manifestations of IgG4-related DiseaseSabrina N. Campbell, Edmundo Rubio, and A. Lukas LoschnerAnn Am Thorac Soc Vol 2014;11:1466–1475 DISCLOSURES: No relevant relationships by Arezou Khosroshahi, source=Web Response Research support relationship with Boehringer Ingelheim, Sanofi, Fibrogen, Biogen, Please note: >$100000 Added 05/31/2018 by Srihari Veeraraghavan, source=Web Response, value=Grant/Research Support No relevant relationships by Avanthika Wynn, source=Web Response

Modular Neck vs Nonmodular Femoral Stems in Total Hip Arthroplasty—Clinical Outcome, Metal Ion Levels, and Radiologic Findings

BackgroundModular neck femoral stem (MNFS) for total hip arthroplasty (THA) was introduced to optimize the outcome, but created concerns about pain, elevated blood metal ion levels, and adverse reaction to metal debris such as pseudotumors (PTs), related to corrosion between femoral neck and stem. We compared these outcomes in patients with MNFS or nonmodular femoral stem (NFS) THA. MethodsThirty-three patients with unilateral MNFS THA were compared with 30 patients with unilateral NFS THA. Levels of pain, serum cobalt, serum chromium were determined. Magnetic resonance imaging was performed to describe PT and fatty atrophy of muscles. ResultsThe MNFS and NFS group had a mean follow-up of 2.3 and 3.1 years, respectively. Four and 13 patients in the MNFS and NFS group had pain, respectively (P = .005). The MNFS group had higher levels of serum cobalt (P < .0001) and chromium (P = .006). PTs were present in both the MNFS (n = 15) and NFS (n = 7) groups (P = .066). PTs were related to serum cobalt (P = .04) but not to pain or serum chromium. Fatty atrophy prevalence in the piriformis and gluteal muscles were higher in patients with MNFS (P = .009 and P = .032, respectively). ConclusionMore patients in the NFS group had pain. Serum cobalt and chromium levels were higher in the MNFS group. Prevalence of PTs was twice as high in the MNFS group, but the difference was insignificant.

Modular Necks and Corrosion - Review of Five Cases

This report updates previous articles and commentary presented on Modular Necks from our Tissue Sparing Implant Study Group. In July 2012 we reported that at two years post-op we had encountered no modular neck taper failures or any signs of fretting corrosion, or pseudo tumors associated with the ARC™ Stem.Today we describe five patients out of five hundred and forty-two who had total hip arthroplasty revision [titanium alloy stem, cobalt-chromium modular neck (c.c.) and c.c. modular head (32 mm or 36 mm), highly-cross-linked polyethylene liner, metal titanium plasma sprayed cementless metal cup]. All patients’ were female and all demonstrated progressive hip pain or late instability. All had debridement of the periarticular soft tissue, stem extraction with new primary length cementless stem replacement. At revision and early follow up all patients are doing well, however, we recommend heighten awareness in all active female patients with modular neck stem junctions.

Pseudotumors in metal on polyethylene total hip arthroplasty: a fibrosis of the joint capsule.

Event Abstract Back to Event Pseudotumors in metal on polyethylene total hip arthroplasty: a fibrosis of the joint capsule. Felipe Eltit1, Michael Cox2, Clive Duncan3, Donald Garbuz3, Bassam Masri3 and Rizhi Wang1 1 University of British Columbia, Materials Engineering, Canada 2 University of British Columbia, Urologic Sciences, Canada 3 University of British Columbia, Orthopedics, Canada Introduction: Pseudotumors (PT) are aseptic lesions in the periprosthetic tissues that destroy soft tissues generating pain and discomfort[1]. They are histologically characterized by the disappearance of the synovial epithelium, variable degree of necrosis in the underlying connective tissue and lymphocyte infiltration, within a thickened synovial membrane[2]. They were firstly described in patients with Metal on Metal (MoM) systems[3], but recently they have been observed in Metal on Polyethylene (MoP) implants, which are the most used prosthesis now days[4]. This work aimed to describe the pseudotumors in MoP implants and compare them with those in MoM to determine their etiological similarities. For this reason a histological study and cytokine analysis was performed. Methods: Patients with PT related to MoM (n=20), MoP (n=17) and control patients (n=10) with no PT were included. Histological sections from biopsies were assessed for necrosis and the ALVAL score was assigned by an experienced pathologist. Tissue slides were incubated in specific antibodies against CD20, CD3, Pro-Collagen I, aSMA and Ky 67. The peroxidase reaction or the incubation of fluorescent antibodies was performed in the samples to observe the immunoreaction under light or fluorescence microscopy. Tissue sections were mechanically pulverized under liquid nitrogen, resuspended in buffer and clarified by centrifugation. Aliquots of 100 µg of total protein were used to assess the presence of 120 human cytokines using a sandwich-ELISA antibody array. The arrays were read in a laser scanner with a wavelength of 532 nm. T-test for independent samples was applied to determine statistical differences between the groups. Results: The pseudotumors in MoM showed to be a cystic cavity surrounded by a thin wall, composed by inflammatory connective tissue with different degrees of necrosis in the synovial surface. However MoP pseudotumors are thick solid structures composed by extensive areas of necrotic dense connective tissue up to 8 cm thick, in which scare viable cells can be observed in the most external part of the tissue. The ALVAL score and necrosis measurement were significantly higher in MoP than in MoM. The immunohistochemistry revealed that the cells in the viable connective tissue in MoP are mostly myofibroblasts (a-SMA+). The cytokine analysis, showed elevated levels of pro-inflammatory cytokines in MoMs, however MoPs didn’t show any significant increase in cytokine secretion compared to controls. Discussion: Our observations showed that MoM PTs are mostly inflammatory, while MoPs are fibro-necrotic lesions. The presence of myofibroblsats could reveal an unresolved reparation process in the tissues, which can explain the significant increase in thickness of the connective tissue in the joint capsule. The mechanisms of this proliferation of fibroblasts and the subsequent cell death are not clear. The used methodology didn’t show any difference in cytokine secretion that could explain that process, but some of them can be responsble of macrophage recruitment and differentiation in MoM pseudotumors. Manju Sharma; Robert Bell

The role of multidetector computed tomography and magnetic resonance recent imaging techniques in the evaluation of intra-conal orbital lesions

ObjectiveThe purpose of our study was to assess the role of multi-detector computed tomography and magnetic resonance recent imaging techniques in the evaluation of intra-conal orbital lesions. Subjects and methods30 patients presented to the Ophthalmic and Radiology Departments at El-Minia University Hospital and El Minia Oncology Center with clinical diagnosis of visual loss and proptosis. They presented during the period from June 2012 to October 2013. Their ages range from 5 to 73years. All patients subjected to MDCT and MRI. Also, contrast injection was injected on some cases. 24 patients were subjected to surgery and histopathology to confirm the radiological diagnosis. ResultsA total of 30 patients were included (their mean age 26years). 8 lesions were diagnosed inflammatory in nature (4 were orbital abscess and 4 were idiopathic orbital inflammatory disease i.e. pseudo tumors). 10 lesions were diagnosed as vascular lesions (2 lesions were carotid cavernous fistula and 8 lesions were cavernous hemangiomas). 6 lesions were diagnosed as optic nerve gliomas and other 6 lesions were diagnosed optic nerve sheath meningiomas. ConclusionThe use of MDCT and MRI recent techniques are mandatory for accurate diagnosis of the nature of intra-conal orbital mass lesions.

Pseudotumeurs et tumeurs primitives de l’articulation temporomandibulaire

The temporomandibular joint (TMJ) can be the site of bone, cartilaginous, or synovial tumors. There is no well-defined histological classification. We listed all benign tumors, malignant primitive tumors, and rare pseudo tumors of the TMJ. We provide a list to help for the diagnosis and the differential diagnosis of non-tumoral lesions by far the most frequent.