Thigh Mass Research Articles

Unusual Presentation of Myeloid Sarcoma as Thigh Mass

IntroductionMyeloid sarcoma (MS) is a tumor containing myeloid blasts, with or without maturation, involving any anatomical site other than the bone marrow. It can occur de novo or following a hematological malignancy. CaseWe report a 6-year-old female who presented with fever and a rapidly enlarging left thigh mass. The initial provisional diagnosis considered was tubercular hip arthritis with an abscess, but imaging investigations suggested neoplastic swelling. A biopsy of the mass showed a malignant small-round cell tumor. Bone marrow aspiration revealed the diagnosis of acute myeloid leukemia without the presence of blasts in the peripheral smear. ConclusionMS is a rare malignancy. The diagnosis is often delayed due to a lack of clinical suspicion and the absence of blasts in peripheral blood. This report aims to enhance the awareness of pediatric nurse practitioners that MS should also be considered as a differential for an extremity mass.

7246 Cardiac Paraganglioma: A Rare Entity

Abstract Disclosure: L. Javed: None. L. Jonea: None. Cardiac paragangliomas are an exceptionally uncommon subset of neuroendocrine neoplasms. We present a case of a patient presenting with this condition. 70-year-old woman with pertinent past medical history of chronic veinous insufficiency complicated by recurrent abscesses of her right leg since venaseal procedure. The patient had positive IgG lambda on immunofixation that raised concerns for MGUS. Therefore, a F-18 FDG PET-CT scan was performed for further evaluation. PET-CT revealed a hypermetabolic mass in the upper inner right thigh and the right atrium (SUV 17.6) raising concern for septic thrombi. She was admitted in the hospital for initiation of antibiotic therapy. Transesophageal echocardiogram (TEE) revealed a 4.5 cm x 4.0 cm mass in the right atrioventricular (AV) groove region, extending over the root of the main pulmonary artery. Following discharge, despite completing six weeks of IV antibiotic therapy a CT scan on a subsequent clinic visit revealed the same mass as seen on TEE. CT imaging raised suspicion of neuroendocrine tumor. This led to referral to the endocrinology department. Laboratory results showed elevated normetanephrine and dopamine levels increasing likelihood of paraganglioma. Lab Results: 24 hr urine normetaneprhine :7197(N ≤ 376 mcg), 24 hr urinary dopamine :879 (N ≤400 mcg), 24 urinary metanephrine: 84 (N ≤96 mcg) & 24 hr urinary epinephrine <3 (N ≤20 mcg). Her home systolic blood pressure readings varied between 120’s & 170’s. She was initiated on Prazosin 1 mg daily in addition to the existing antihypertensive medications of nebivilol, amlodipine & furosemide. Few months later, this patient successfully underwent cardiac mass resection. Histologic findings of the resected mass were consistent with paraganglioma. Post-surgery, anti-hypertensive medications were discontinued, and blood pressure normalized to systolic readings in the 90s to 120s and diastolic readings in the 60s to 80s. Repeat biochemical tests indicated a normalization of normetanephrine & dopamine levels, validating the success of the resection. This case features an extremely rare entity cardiac paraganglioma that had an atypical clinical manifestation of being asymptomatic. Timely diagnosis and appropriate management are crucial for patient outcomes. Surgical intervention, although fundamental, bears significant risks, necessitating meticulous preoperative management to mitigate potential complications. The medical approach focuses on averting perioperative complications such as hypertensive crisis, cardiac arrhythmias and myocardial infarction. This is achieved by administering alpha and beta adrenoceptor blockers for a minimum of two weeks before the scheduled surgery. Regular follow up is also essential due to the unpredictable malignant potential of these tumors. Presentation: 6/3/2024

Neurofibroma in Unusual Localisation: Rare Case

Neurofibroma is a rare entity, with only few cases reported in the literature so far. Magnetic resonance imaging (MRI) is the key to the diagnosis. We report a 23 year-old women with an antero medial thigh mass diagnosed as neurofibroma on the basis of the imaging findings on US and MRI examinations. The differential diagnosis can be excluded by the fine imaging analysis always associated with the clinical context.

Intramuscular lipomas posing diagnostic and pre-operative counselling challenges in a low-resource setting: A case series

IntroductionIntramuscular lipomas (IMLs) are uncommon primary adipose tissue tumours deep within the muscle. A high likelihood of misdiagnosing them as other benign and malignant masses necessitates imaging studies to confirm the diagnosis and plan treatment. Ultrasonography is useful but CT and MRI provide a more accurate diagnosis. While diagnostic tests are suitable, they may not always be accessible or affordable in low-resource settings. We present three cases of IMLs that emphasise the difficulties posed by limited resources and the significance of a comprehensive medical history and physical examination in low-resource settings. Presentation of casesThe patients included a 57-year-old male with a distal right thigh mass, a 65-year-old female with a proximal right thigh mass, and a 60-year-old female with a mass at the left scapular area. The three patients underwent surgical excision and had an uneventful postoperative course, with no reported recurrence during their ongoing follow-up. DiscussionThe management of IMLs is not complicated if the requisite resources are available. Conversely, in low-resource settings with limited diagnostic facilities and human expertise, management may take a challenging path. Patient 1, despite undergoing diagnostic tests confirming IML, initially declined treatment due to challenges with pre-operative counselling. Patients 2 and 3 lacked health insurance and could not afford diagnostic imaging tests. ConclusionHealthcare professionals in low-resource settings should familiarise themselves with the clinical characteristics and pathology of IMLs to minimise misdiagnosis and ensure appropriate counselling is provided to patients. IMLs are slow-growing mostly asymptomatic benign swelling. On physical examination, they are usually non-tender, soft, masses, not fixed to the bed or overlying tissue. The overlying skin is normal and lymphadenopathy is absent.

Abstract PO5-20-07: A Case of Metastatic Breast Cancer to Soft Tissue of the Thigh

Abstract Breast cancer is the most diagnosed cancer in women worldwide. The predominant cause of breast cancer mortality is metastatic disease with bone, lung, liver and brain being most common sites of metastasis. After melanoma, breast cancer is the most common cancer to have cutaneous metastatic disease and this presentation represents half of all cutaneous metastases. We are presenting a case of a 70-year-old female with distant recurrence of breast cancer to the left thigh. A 70-year-old female presented to clinic with a palpable left breast mass noted July 2022. Her medical history was notable for right sided upper lobe stage IIIB squamous cell lung cancer diagnosed in 2013 treated with chemotherapy and chest radiation (RT), menopause at 25 years old following TAH/BSO for fibroids. Family history included prostate cancer and genetic testing was negative for pathogenic mutation. Diagnostic mammogram showed a lesion in the left breast at 9:00 of 1.4 cm x 1.2 cm x1.4 cm, and biopsy showed grade 3 triple negative invasive ductal carcinoma (IDC). Her nodes were clinically and radiologically negative. She opted for breast conservation. In September of 2020 the patient had a left lumpectomy with sentinel lymph node biopsy. Final pathology (path) was pT1cN0 with two foci of IDC, grade 3, measuring 1.9 × 1.9 × 1.1 cm and 0.4 × 0.2 × 0.2 cm with negative margins. Two sentinel lymph nodes were negative for carcinoma. She received 4 cycles of doxorubicin and cyclophosphamide and started paclitaxel, but only completed 5/12 planned cycles. During these treatment cycles she was admitted twice for shortness of breath and found to have an exudative pleural effusion, repeat cytology was negative for malignancy at which point fluid did not recur. There was no CT evidence of lung nodules or plural thickening. Echocardiogram showed normal ejection fraction of 45%. PET scan was negative. Chemotherapy was stopped in February of 2021. Initial pre-operative discussion with radiation oncology indicated no contraindication to adjuvant RT. However, after simulation, it was deemed by radiation oncology that the patient was no longer a candidate for RT as during her lung cancer treatment, she had received RT of 69.4 Gy including the area of the current lumpectomy cavity. She then opted for bilateral mastectomy with immediate reconstruction in June 2021. Final path from both breasts showed no carcinoma. In November of 2021 she was admitted for shortness of breath and on CT scan was noted to have a left sided lung nodule. The patient declined biopsy and underwent a left wedge resection in January of 2022. Final path showed a 2.2. cm carcinoma consistent with breast primary that was ER 0, PR 0, and Her 2 neu 1+. She was started on capecitabine with plan for 6 months of treatment but stopped taking this after one month due to severe pain in her hands and feet. In November 2022 the patient noted a left thigh mass. Exam showed a firm, palpable thigh mass without overlying skin changes and core needle biopsy showed adenocarcinoma, favoring breast primary, ER 0, PR 0, HER 2 neu 2+ and FISH negative. PET scan showed no uptake in the chest abdomen or pelvis, however a 2.6 × 2.3 × 3.1 cm round mass in the left thigh was seen with SUV max of 8.6. She was started on traztuzumab-deruxtecan by medical oncology in December of 2022. The thigh tumor shrank significantly, however, patient discontinued after two infusions, citing intolerable hand weakness. She then received RT to the thigh. She was treated using 3D technique and 6 MV photons for a total dose of 5400 cGY, from February to March of 2023. Repeat PET June 2023 showed no avid uptake in the thigh. She has declined any additional systemic therapy. Soft tissue metastasis in distant recurrent breast cancer is uncommon and little guidance exists on clinical management. In cases of metastatic disease to the skin, hormone positive lesions can be managed with hormonal therapy. Early detection and biopsy for receptor studies may help guide therapy in cases of distant soft tissue recurrence. Citation Format: Rangel Melissa, Julia Alexieva, Alison Coogan, Lily Hussein, Elizabeth Marcus, Julie Wecsler. A Case of Metastatic Breast Cancer to Soft Tissue of the Thigh [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-07.

Uncommon Thigh Mass in Neurofibromatosis Type 1: Unveiling Aggressive Epithelioid Sarcoma.

Patients with neurofibromatosis type I (NF1) have an increased risk of developing soft-tissue sarcomas, particularly those related to the nervous system. Epithelioid sarcoma (ES) is an exceptionally rare subtype of soft-tissue sarcoma, with limited knowledge about its clinical presentation and optimal management in NF1. This report aims to provide insights into the characteristics and outcomes of ES in NF1 patients. A 37-year-old man with a history of NF1 presented with a progressively worsening mass on his right inner thigh. An MRI scan revealed a well-defined tissue mass originating from the adductor magnus muscle, later confirmed as ES through histopathology and immunohistochemistry. Considering poor local and general prognosis, the multidisciplinary team recommended salvage hip disarticulation, however the patient refused and opted for palliative marginal resection to reduce the tumour size. The patient's condition declined rapidly, and he succumbed six days after the surgery. This case highlights the rarity of ES in NF1 patients and underscores the potential for malignant tumour development in this population. Further research is needed to improve our understanding and management of sarcomas in the context of NF1. Patients with neurofibromatosis type 1 or von Recklinghausen's disease have a higher risk than those with other types of neurofibromatosis of developing benign or malignant soft-tissue tumours especially related to the nervous system.Epithelioid sarcoma is an extremely rare subtype of soft-tissue sarcoma and is exceptionally associated with neurofibromatosis type 1.A multidisciplinary approach remains essential in the diagnosis, management, and treatment of soft-tissue sarcomas in patients with neurofibromatosis type 1.

Primary seronegative intermuscular hydatidosis in a child, an infection that should be approached like a tumor: a case report and review of the literature

IntroductionIntermuscular hydatid cyst is one of the rarest types of hydatid cyst, and as far as we know, only nine cases were reported in the literature before this study.Case presentationWe present a 10-year-old Iranian child with an intermuscular cystic mass in the medial-distal thigh. Despite the typical imaging findings, the patient's serological and hematological tests were negative for hydatid cyst. The cyst underwent wide excision accompanied by neoadjuvant and adjuvant chemotherapy with Albendazole. No evidence of recurrence was detected during the one-year follow-up.ConclusionHydatid cysts should always be considered in the differential diagnosis of soft tissue cystic masses in endemic areas, and aspiration or drainage should be avoided as much as possible, even when serological tests are negative and imaging is non-diagnostic. In cases where the diagnosis of a hydatid cyst has been confirmed before the surgery, it is recommended to approach the cyst, like a tumor with chemotherapy using Albendazole both before and after wide cyst excision.

Research Note: Effect of fasting time on the fasting heat production, blood metabolites, and body components of layer-type pullets

Fasting heat production (FHP) is used to assess the maintenance net energy requirement of animals. Herein, the FHP of layer-type pullets was estimated. In trial 1, 16 40-day-old Jingfen layer-type pullets were divided into 4 groups of 4 chickens and placed in 4 respiratory chambers. Pullets had free access to feed and water. After 4-d acclimatization, feed was withdrawn, and chickens were measured for FHP for 3 consecutive days. In trial 2, twenty-four 40-day-old pullets were placed in 4 respiratory calorimetry chambers, with 6 pullets per chamber. After 4-d acclimatization, one chamber was randomly selected and all pullets in the chamber was sampled at 5, 25, 50, or 65 h after feed withdrawal. The result showed that FHP declined with fasting time and reached the lowest level between 48 and 72 h. Respiratory quotient was decreased (P < 0.05) between 24 and 48 h compared with that in the first 24 h after fasting. The FHP in the light period showed a significant to decline with fasting time (P < 0.01), whereas the FHP in the dark period was decreased (P < 0.01) 24 h after fasting. Body weight, thigh mass, and abdominal fat decreased (P < 0.05) at 25 h after fasting. Serum glucose were increased (P < 0.01) and while triglycerides were significantly decreased (P < 0.01) at 50 h compared with that at 5 and 25 h time point. The result suggests that the adequate measuring period for FHP for layer-type pullets is from 24 to 48 h after fasting. The FHP of 7-wk-old layer-type pullets was 562.20 kJ/kg of BW0.75/d under a 10-h light and 14-h dark lighting regime.

Myeloid sarcoma with RBM15::MRTFA (MKL1) mimicking vascular neoplasm.

Extramedullary involvement of acute myeloid leukemia (AML), aka myeloid sarcoma, is a rare phenomenon in acute megakaryoblastic leukemia with RBM15:: MRTFA(MKL1) fusion, which might mimic non-hematologic malignancies. A 7-month-old infant presented with leukocytosis, hepatosplenomegaly, multiple lymphadenopathies, and a solid mass in the right thigh. Initially, the patient was diagnosed with a malignant vascular tumor regarding the expression of vascular markers from the biopsy of the right thigh lesion that was performed after the inconclusive bone marrow biopsy. The second bone marrow biopsy, which was performed due to the partial response to sarcoma treatment, showed hypercellular bone marrow with CD34 and CD61-positive spindle cell infiltration and > 20% basophilic blasts with cytoplasmic blebs. RNA sequencing of soft tissue biopsy revealed the presence of RBM15::MRTFA(MKL1) fusion. Based on these findings, myeloid sarcoma/AML with RBM15::MRTFA(MKL1) fusion diagnosis was made. AML with RBM15::MRTFA(MKL1) fusion can initially present as extramedullary lesions and might cause misdiagnosis of non-hematologic malignancies.

Intriguing Cases of Rare Malignancies of Childhood and Adolescence- A Series of Six Cases

Intracranial teratomas constitute the majority of congenital Central Nervous System (CNS) germ cell tumours. Pure mature or immature teratomas present with giant intracranial masses that cause irreversible brain damage and impair the quality of life. Two such cases are reported here: the first involves a four-month-old female infant with a large right hemispheric lesion, and the second involves a three-month-old female infant with a similar large right hemispheric space-occupying lesion. Both underwent craniotomy but ultimately succumbed to death within a few days after the operation. Immature teratomas of the ovaries are the second most common malignant germ cell tumour following dysgerminoma, with good prognosis and excellent overall survival rates. One such case is presented here, involving a 16-year-old adolescent female with a history of irregular and painful menstruation presenting with a large abdomino-pelvic mass that was determined to be of ovarian origin through imaging studies. Alveolar Soft Part Sarcoma (ASPS) is a rare soft-tissue sarcoma with a poor prognosis, demonstrated in a 17-year-old girl who presented with a painless left thigh mass that was clinically misdiagnosed as a benign intramuscular lipoma. Another case involves a 14-year-old boy with Ewing sarcoma of the ring finger, an extremely rare hand tumour with a high potential for misdiagnosis and delayed treatment, accompanied by a focus of pulmonary metastasis. The final case involves a poorly differentiated carcinoma of the Ileum in a 17- year-old girl who was eventually lost to follow-up checkups.

PLAG1 Rearranged Soft Tissue Tumor in an Adult

Abstract Introduction/Objective PLAG1 rearranged soft tissue tumor is a recently described entity in the pediatric population. Less than 10 cases have been reported identifying PLAG1 gene fusions with various gene partners. This tumor is characterized by spindled cells with low cellularity in fibromyxoid stroma, expressing CD34 and desmin. PLAG1 gene fusions have been identified in various other tumors, including lipoblastoma, salivary gland pleomorphic adenoma, myoepithelial tumors, uterine epithelioid and myxoid leiomyosarcomas, and chondroid syringoma. To our knowledge, we report the first case of a PLAG1 rearranged soft tissue tumor in an adult. Methods/Case Report A 32-year-old female with no significant medical history presented with a left thigh mass. MRI showed a 9.8 cm mass involving subcutaneous fat and causing marked sartorius muscle displacement. Resection showed a well-circumscribed, spindle cell tumor of low cellularity in a myxo-collagenous stroma. Bland, elongated, and ovoid-shaped spindled cells with occasional punctate nucleoli were seen. No mitoses or necrosis were identified. The tumor cells expressed CD34 and androgen receptors, partially expressed desmin and estrogen receptors, and focally expressed S100. MUC4 and beta-catenin were negative. Next-generation sequencing performed at Mayo Clinic Labs identified UBC::PLAG1 gene rearrangement. Results (if a Case Study enter NA) NA Conclusion To our knowledge, we describe the first case of PLAG1 rearranged soft tissue tumor in an adult. This case is also unique as the fusion partner gene, UBC, was not previously identified. All other cases reported occurred in those four years of age or younger, with one report in a 15-year-old female. Our patient has had less than six months of follow-up with no recurrence. With few cases reported, and relatively short follow-up periods thus far, the behavior of these tumors remains undetermined.

Pleomorphic liposarcoma of the extremity with solitary huge liver metastasis at initial diagnosis treated with conversion surgery combined with adjuvant chemotherapy: a case report

BackgroundPleomorphic liposarcoma is the rarest subtype of liposarcoma. Pleomorphic liposarcomas are generally unresponsive to chemotherapy and radiotherapy. Moreover, metastasis in the liver, as the first and sole site, from a primary extremity soft tissue sarcoma, including pleomorphic liposarcoma, is extremely rare. Information regarding the appropriate management of these lesions is limited.Case presentationA 50-year-old Japanese woman presented with a mass in the left thigh. Imaging examination revealed a soft tissue sarcoma on the left posterior thigh. The tumor was histologically diagnosed as pleomorphic liposarcoma. Computed tomography examination for assessment of metastases incidentally detected a huge liver mass. Wide excision of sarcoma was performed prior to chemotherapy. Right trisectionectomy was necessary to achieve hepatic clearance; however, the future liver remnant volume was insufficient. Therefore, we decided to administer anthracycline-based chemotheraphy to shrink the tumor. After seven courses of adriamycin-based chemotherapy, the liver tumor size was reduced from 211 mm × 106 mm × 180 mm to 105 mm × 66 mm × 90 mm. Finally, a right hemihepatectomy was performed. The patient was continuously monitored and was metastasis or local recurrence free within 5 months after liver surgery.ConclusionChemotherapy is effective in some cases for the treatment of unresectable liver metastases of pleomorphic liposarcoma, and complete resection is possible with conversion surgery. If the patient’s general condition permits, anthracycline-based chemotherapy can be used for the treatment of stage 4 pleomorphic liposarcoma.

An Unexpected Diagnosis of Femoral Paraganglioma: A Case Report

Paragangliomas are rare neuroendocrine neoplasms, commonly located in the head and neck. They are sometimes first found in the bone, especially when there are contributing factors such as trauma, which can make clinical diagnosis more challenging. In this reported case, a patient presented with a painful mass in the right thigh caused by trauma. During the procedure for resecting the right femoral mass, the patient’s blood pressure significantly increased upon touching the tumor. Subsequently, a biopsy of the right thigh femur and a whole-body contrast-enhanced computed tomography (CT) examination confirmed the diagnosis of a right femoral paraganglioma with metastasis to the right neck.

Degloving Injury of Rectus Femoris Presenting as Mass in the Anterior Thigh: A Case Report

Injuries to the rectus femoris muscle are common in athletes. The complex muscle-within-amuscle anatomic configuration of the rectus femoris muscle makes it susceptible to various types of injuries. The purpose of this study was to describe the MRI characteristics of injuries to the rectus femoris whereby the inner bipennate component of the indirect head is dissociated from its superficial unipennate component resembling a finger in a glove. Finally, treatment and functional outcome may vary depending on the type of tear. Knowing different imaging patterns of these tears is important to provide accurate diagnosis and treatment.

Woman With a Thigh Mass.

A previously healthy 48-year-old woman presented to the emergency department with a large mass on her right thigh that had started over 7 years ago. On examination, she had a blood pressure of 138/101 mmHg; a pulse rate of 94 beats/min; and was afebrile. A large, soft, 20 × 20 × 10 cm mass was noted on her right medial thigh. (Figure 1) Point-of-care ultrasound (Figure 2 and Video E1) and contrast-enhanced computed tomography (Figure 3) were performed.Figure 2Left panel: Transverse ultrasonography of the right thigh revealing a heterogeneous intermuscular mass (arrowhead) with both hypoechoic and hyperechoic components, indicating myxoid liposarcoma. Right panel: the tumor vascularity observed in the color Doppler mode.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Contrast-enhanced computed tomography showing a multilobulated intermuscular mass (arrowhead) with low attenuation, which is a pathognomonic appearance of myxoid liposarcoma.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Myxoid liposarcoma. Tumor biopsy results demonstrated myxoid liposarcoma, and metastatic laboratory findings revealed liver metastases. The tumor was removed, and she was treated with adjuvant chemotherapy. Although soft tissue tumors are relatively common, liposarcoma is a rare finding. On ultrasound, liposarcomas are typically well-defined, multilobulated, hypoechoic, intermuscular lesions with posterior acoustic enhancement.1Murphey M.D. Arcara L.K. Fanburg-Smith J. Imaging of musculoskeletal liposarcoma with radiologic-pathologic correlation.RadioGraphics. 2005; 25: 1371-1395Crossref PubMed Scopus (231) Google Scholar eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIzZGI5NzJkMTNhNWUyMWRmZTJmNDNlNzgzMmE2OTBhNCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc1NzYwNDk0fQ.dblsc3wCsuWCbaJ_G67RiTJT7oADx5qrgPJ0Qrkd_YgGvBUJZZgG7EGLjYtPZk85lZY-CQhfAi_T6M_mFZPQubzU7QI3wZF1_-77bziPWetMfgfohE0rEHYiU2zljaJ58s3GSi-ipz9dcqqiiZ01B2mM8l9KZ0rkBCor-pjFqb0G83uhgAXTEp77ZyWJXIDwajwi0phs9An_0c7JG7Tq-VICO2e4JltxYzdIbyqXyhRZ0Dso5FWFmVhQ1m-ZAj4oDdM1c9SalO9wInsqcsyxmRXqhBoDl5CsQ0MnIOUlINJwFH_vwOrn3Ky8rOMsLFsmN6EekXaA1hot27oMo72jaw Download .mp4 (2.97 MB) Help with .mp4 files Video E1Transverse ultrasonography of the right thigh revealing a multilobulated heterogenous intermuscular mass with posterior acoustic enhancement.

Unilateral Hypertrophy of Tensor Fasciae Latae: A Report of Two Cases

Unilateral hypertrophy of the tensor fasciae latae (TFL) is an uncommon radiologic finding that may present as a palpable soft tissue mass in the thigh. Accurate radiologic diagnosis can circumvent unnecessary biopsy for this benign finding. We report two cases of unilateral hypertrophy of tensor fasciae latae muscles, both of which presented as a proximal thigh mass. We provide examples of sonographic, computed tomography (CT), and magnetic resonance imaging (MRI) features.

Epithelioid haemangioendothelioma: case report and brief revision of a rare vascular tumour

We describe the case of a 71-year-old man who presented with a single painful soft tissue mass of the right thigh. Following imaging and subsequent excision, histological and immunohistochemical assessment of the tumour was performed, and the diagnosis of epithelioid haemangioendothelioma (EHE) was made. EHE is a rare translocation-related vascular sarcoma with variable clinical behaviour ranging from a low grade malignancy with ability to recur locally, to that of a high grade sarcoma, with propensity for systemic involvement.

Regional anesthesia for a patient with extensive von Recklinghausen's disease

We report the case of a 60-year-old male posted for surgery on the left inner thigh mass with extensive neurofibromas covering the whole body. The patient was administered a subarachnoid block at L3-L4 level for excision of the mass on the left inner thigh. There were no postoperative anesthetic complications. This case report aims to highlight the importance of regional anesthesia in patients with neurofibromatosis and its anesthetic implications.

Double trouble: Atypical presentation of myeloid sarcoma as thigh mass complicated by hypercalcemia in a challenging clinical encounter

Double trouble: Atypical presentation of myeloid sarcoma as thigh mass complicated by hypercalcemia in a challenging clinical encounter

Multi-objective Fractional Order PID Controller Optimization for Kid's Rehabilitation Exoskeleton

Fractional order Controllers have been used in several industrial cases to achieve better performance of the systems. This paper proposes a Fractional Order Proportional Integral Derivative (FOPID) controller. It is synthesized using Oustaloup approximation, and its parameters are tuned using the Genetic Algorithm (GA) optimization method. The aim is to minimize the error, the energy and the startup torques using two objective functions to improve the control performances and the robustness. The validity of the proposed controller is shown via simulation by controlling a two-link exoskeleton for children's gait rehabilitation, and the results are compared to an Integer order PID (IOPID) controller. Simulation results clearly indicate the superiority of the optimized FOPID in terms of trajectory tracking and the used torques. Moreover, the FOPID controller is tested with parameter uncertainties. Its robustness is proven against thigh and shank masses variation. Both controllers are simulated under the same frequency conditions using Simulink MATLAB R2018a.