Pseudo Tumors Research Articles

Hemophilia, Complications and Management: Series of 3 Cases with a Brief Review of Literature

Hemophilic pseudo tumors are rare, but well known complication of severe hemophilia, which most frequently develop at the femur, tibia, pelvic bones.

The Role of Stem Modularity for THA in a Community Based Practice

Every few years there are concerns raised regarding modular junctions and related findings as to fatigue failure, pseudo tumors, surface corrosion5,6,7, and metallosis.1,2,3,4This has not been our experience with the use of modular stems. Modular stem means that the stem has two or more parts that are connected by a mechanical junction. Almost all hip stems today feature a modular head, however that does not meet the current definition of a modular stem. This paper is a review of the senior surgeon’s practice based in two community hospitals and his experience with four different stem styles and three different modular junctions. The S-Rom® Stem8,9,10,15, Apex Modular11 Stem™, Apex K2 Modular32 Stem™ and The Apex ARC™ Modular Stem16. Since 1986 until May 2012 a total of 1,114 modular stems have been implanted for Primary Total Hip Arthroplasty. To-date there has been no failures of any modular junctions. No fatigue failure, no pseudo tumors, no surface corrosion, no metallosis, etc. We have found the use of stem modularity to be safe and effective in the use in Primary Total Hip Arthroplasty.14Key Words: Modularity, neck, fatigue failure, pseudo tumors, corrosion, metallosis

Prevalence of Small Solid Pseudo papillary Tumors

AJR 2011; 197:W964 0361–803X/11/1975–W964 © American Roentgen Ray Society Prevalence of Small Solid Pseudo papillary Tumors Regarding the detection of small solid pseudopapillary tumors at dynamic contrastenhanced MRI of the pancreas, we read with interest the article by Yu and colleagues [1] in the December 2010 issue of the American Journal of Roentgenology, in which the authors reported a prevalence of about 24.4% in the patients with small solid pancreatic tumors. The recognized prevalence of solid pseudopapillary tumor in all pancreatic tumors is only 1% [2]. Undoubtedly, the prevalence of solid pseudopapillary tumors is high in their study. Our unpublished experience does not fully support the data of Yu et al. [1]. We observed a lower prevalence of small solid pseudopapillary tumors in solid pancreatic tumors. We believe that a solid pseudopapillary tumor is a relatively benign tumor, usually without significant symptoms, leading clinicians to ignore its existence. When a solid pseudopapillary tumor is large, secondary symptoms probably cause it to be found. In contrast, small adenocarcinomas and endocrine tumors usually easily attract the attention of physicians because they present evident clinical symptoms. Thus, we believe that small adenocarcinomas and endocrine carcinomas of the pancreas are confirmed much earlier than small solid pancreatic tumors. A further speculation is that small solid pseudopapillary tumors are rare in small lesions of the pancreas. A recent study partly confirmed our speculation that the prevalence of small solid pseudopapillary tumors is lower (28.6%) in whole solid pseudopapillary tumors [3]. Therefore, we think that the prevalence of small solid pseudopapillary tumors in the study by Yu et al. [1] needs to be further explained. In addition, over a 10-year time span, we wonder whether there are other small solid tumors in the authors’ case collection, such as neurogenic tumors, inflammatory pseudotumors, and sarcomas. If so, it would be best to give an explanation to the reader. Wenguang Liu Linyi People’s Hospital, Shandong Province, China Wenjie Liang Shunliang Xu First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, China

Anti‐VEGF treatment in ocular oncology

AbstractPurpose To present the indications of Anti‐VEGF treatment in ocular oncology.Methods Intraocular anti‐VEGF injections were used for: • The prevention or the treatment of neovascular glaucoma following irradiation treatment of intraocular tumors (uveal melanomas, choroïdal hemangiomas, choroïdal metastasis). • The control of cystoids macula edema related to the conservative management of intraocular tumors. • The treatment of secondary retinal detachment related to vascular tumors and pseudo tumors and mainly the Coat’s disease.Results A dramatic decrease of the risk of neovascular glaucoma was obtained with intravitreal anti‐vasoproliferative treatment following irradiation treatment of intraocular tumors. The presence of retinal ischemia associated to the secondary exudative retinal detachment is observed with panoramic (150°) fluorescein angiography. The anti‐vasoproliferative treatment is delivered during the period preceding the reatachment of the retina which allows a photocoagulation treatment. Anti‐vasoproliferative treatment in case of established iris neovascularisation allows a functional success (IOP less than 20mm Hg) in 84% of the cases and anatomical success (reduction of the iris neovascularisation and of diffusion of the dye in fluorescein angiography) in 75% of the cases. Impressive reduction of the secondary retinal detachment is obtained following anti‐vasoproliferatives treatment in cases of Coat’s disease allowing the photoablation of the reattached retina.Conclusion Anti‐vasoproliferative treatment in ocular oncology is a major contribution for the reduction of side effects induced by irradiation treatment and to maintain useful function in treated eyes.

Imagerie des affections synoviales du genou

Synovial diseases are common in the knee; they are a varied and heterogeneous group of cystic lesions, pseudo tumors and tumors. They are characterized by a slow clinical course explaining their delay in diagnosis. Conventional radiographs are not talking. MRI is the investigation of choice in the exploration of these conditions. The purpose of this paper is to demonstrate the contribution of imaging in the diagnosis, etiology and the therapeutic management of these synovial diseases.

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.

Phantom Tumor of the Lung

A 45 year old, chronic smoker with a past history of hypertension was admitted with complaints of shortness of breath, orthopnea, and cough productive of pink frothy sputum. Examination revealed a blood pressure of 160/100 mmHg, pulse 112/min, tachypnea, jugular venous distention, bilateral pitting pedal edema, and extensive bilateral crackles over both lung fields. The findings were consistent with the diagnosis of acute pulmonary edema. A chest radiograph (Figure1) showed a sharply marginated biconvex opacity in the right interlobar fissure. A repeat radiograph (Figure2) after successful treatment of the acute pulmonary edema showed complete resolution of the opacity consistent with the diagnosis of “pseudotumor” or “vanishing tumor” or “phantom tumor” of the lung. Pseudo tumors of the lung are transient collections of pleural fluid in the interlobar pulmonary fissure predominantly on the right, usually seen in congestive heart failure, renal failure or hypoalbuminemia by transudation from the pulmonary vasculature. The pathogenesis involves the adhesion and obliteration of the pleural space due to pleuritis that may be transient, thereby preventing the free accumulation of fluid. Recognition of this radiographic presentation is important because it may be the sole manifestation of heart failure; it also avoids unnecessary workup for a pulmonary malignancy. Managing the underlying condition leads to resolution of the pseudotumor. Figure 1 Figure 1: Chest Xray PA view on admission shows sharply marginated biconvex opacity in the right interlobar fissure. Phantom Tumor of the Lung 2 of 3 Figure 2 Figure 2: Chest Xray PA view after treatment of acute pulmonary edema with diuretics shows complete resolution of the opacity consistent with the diagnosis of “pseudotumor” or “vanishing tumor” or “phantom tumor” o CORRESPONDENCE TO Ganesh Athappan : Department of Medicine Madurai Medical College Madurai India 625020. email id : ganeshathappan@gmail.com

Giant cell tumors of the tendon sheath may present radiologically as intrinsic osseous lesions

The purpose of this study was to explain radiographic features of giant cell tumors of the tendon sheath (GCTTS), in particular, osseous extension, by correlating imaging findings with histology in order to increase the accuracy of radiological diagnosis. In a series of 200 consecutive osseous (pseudo) tumors of the hand, on radiography, six patients presented with an intrinsic osseous lesion caused by a histologically confirmed neighboring GCTTS. Available radiographs, computed tomography (CT), and contrast-enhanced magnetic resonance (MR) images were correlated with histology. Radiography showed osseous lesions consisting of well-defined cortical defects in four (one of whom also demonstrated cortical scalloping) and a slightly expansile, well-defined osteolytic lesion in two patients. MR obtained in four patients showed the extraosseous tumor invading/eroding bone and causing cortical scalloping (three and one patients, respectively). Extension depicted on MR was confirmed on the two available resection specimens. All lesions were polylobular (cauliflower or mushroom like) and neighboring tendon sheaths. Dense collagen and hemosiderin-loaded macrophages explained the high CT attenuation and the low MR signal intensity on T2-weighted images that was observed in all four MR and in all two CT scans. The high density of proliferative capillaries explained the marked enhancement observed in all four patients with gadolinium (Gd)-chelate-enhanced MR imaging. GCTTS is a soft tissue (pseudo) tumor that may invade bone and as a consequence mimick an intrinsic osseous lesion on radiographs. In such cases, specific MR and CT features that can be explained by histological findings can be used to suggest the correct diagnosis.

Bone tumors at the cranio-cervical junction. Surgical management and results from a series of 41 cases

Bone tumors located at the cranio-cervical junction (CCJ)are rare. Tumoral involvement of the neighbouring structures including bone, nerves and vertebral artery and the dynamic aspects of the bone structures raise technical difficulties in the surgical approach. The surgical management includes tumoral resection and stabilization of the CCJ. Forty-one patients presenting a bone tumor (26 benign and 15 malignant tumors), excluding chordomas, located at the CCJ (including lower third of the clivus, C1 and C2) were observed over 20 years from 1981 to 2001. Imaging work-up included CT scanner with bone windows sequences and reconstruction in the coronal and sagittal plane; since 1984 most of the patients (N=35) underwent a MRI and angioMR scanning. Vertebral angiography was rarely performed (N=9) and mostly when the diagnosis was doubtful. In some cases the diagnosis was clear but in others, imaging studies showed destructive lesions suggesting a malignancy, which sometimes required a biopsy (N=4). The surgical resection was only performed through a lateral approach. Complete resection was achieved in 38 cases while in 3 cases a small remnant was left behind. A complementary stabilization procedure was necessary in 18 cases using either bone grafting during the same procedure and through the same approach (N=5) or a craniocervical plating and bone grafting (N=13). No recurrence in the group of benign tumors was seen during an average follow-up of 6 years (from 2 to 11 years). The pre-operative symptoms of pain and neck stiffness, improved or disappeared in most patients. Three patients with lower cranial nerves (N=2) or sphincter disturbances (N=1) remained unchanged. One patient with tetraplegia eventually died. Various types of bone tumors may be found at the CCJ. Confusion between benign and malignant tumor or pseudo tumors must be avoided, sometimes requiring a biopsy. Surgery using a lateral approach, usually permits the surgeon to achieve a complete resection either preserving the stability of the CCJ whenever intact or associated with a stabilization procedure.

Pseudo tumors of the lung after lung volume reduction surgery

We describe 2 patients who underwent lung volume reduction surgery, who postoperatively had computed tomographic scans that showed symptomatic mass lesions suggestive of malignancy and an inhaled foreign body. Investigations excluded these conditions with the remaining likely diagnosis of pseudotumor secondary to buttressing material. These potential sequelae of lung volume reduction surgery should be recognized in follow-up investigations.

Subjective acoustic analysis of tumor’s dysphonia using 'rbh' scale

The goal of psycho acoustic or subjective voice analysis, in a phoniater's everyday work, is to describe a subjective experience based on the physical parameters created in the process of phonation. The work was a clinical prospective study and the sample consisted of 80 people of both sexes, 40 people with benign and pseudo tumors of vocal cords and 40 people with malign tumors of vocal cords. All the patients were otorinolaringologically and phoniatrically examined. The subjective acoustic analysis was done with the patients pronouncing numbers from 1 to 10 in the comfortable zone. Afterwards, the quality of the voices was estimated in RBH scale. The subjective acoustic analysis found roughness in the voices of 87.50% patients in the first group and the most frequent value was Mod = 3 (intense roughness), 62.50% patients. Hoarseness was present in 90.00% cases, with largest value Mod = 2 (moderate hoarseness), 55.00% patients. In the second group, roughness existed in the voices of 70.00% patients, most often intense one (Mod = 3), 30.00% patients. Hoarseness existed in 95.00% cases, 45.00% with moderate (Mod = 2) and 35.00% with intense one. T test showed that there is a statistically significant difference between the strength of the roughness determined by the subjective acoustic analysis in the first and the second group, with p < 0.01. The difference between the strength of the hoarseness in the first and the second group is also statistically significant, with p < 0.01. All the growths on vocal cords irrespective of their nature change the characteristics of the voice, most of all its clearness. In cases of vocal cords tumors, by the subjective acoustic analysis, i.e. the perception of the psycho physiological characteristics of voice, a human ear can register pathological phenomena of the voice but cannot determine the character of the growth on the vocal cords.

Endoscopic palliation of patients with biliary obstruction caused by nonresectable hilar cholangiocarcinoma: Efficacy of self-expandable metallic Wallstents

Background: The aim of this study was to evaluate the efficacy of an endoscopically inserted self-expandable metal stent for treatment of biliary obstruction caused by nonresectable hilar cholangiocarcinoma. Methods: Data on all patients with nonresectable hilar cholangiocarcinoma receiving self-expandable metal stents between January 1990 and April 2000 were retrospectively reviewed. Patients with pseudo Klatskin tumors (metastases in the liver hilum) and gallbladder carcinoma were excluded. Early complications (within 30 days of stent placement), early and late stent occlusion, stent patency, and biliary reintervention rates were recorded. Results: Fifty-two Wallstents were inserted in 36 patients, with 7, 13, and 16 having, respectively, Bismuth type I/II, III, and IV lesions. Insertion was successful in 35 of 36 (97%) patients. Complications occurred within the first 30 days after insertion in 5 patients (14%) but did not require biliary reintervention. Thirty-day mortality was 6% (2 deaths). There were 3 early (9%) and 8 late (23%) stent occlusions, bringing the total to 11 patients (31%) who required biliary reintervention after Wallstent insertion. Median Wallstent patency and patient survival were, respectively, 169 days (95% CI [154, 184]) and 147 days (95% CI [106, 188]), with no difference between patients with Bismuth I/II, III, IV type tumors. Conclusions: Wallstent insertion is safe and feasible, and achieves successful palliation without the need for further biliary reintervention in the majority (69%) of patients with nonresectable hilar cholangiocarcinoma. (Gastrointest Endosc 2002;56:33-9.)

Tumors of the Orbit and Allied Pseudo Tumors

Tumors of the Orbit and Allied Pseudo Tumors

Tumors of the Orbit and Allied Pseudo Tumors

Tumors of the Orbit and Allied Pseudo Tumors