1/18. carcinoma of the uterine cervix metastatic to behind the zygomatic arch: a case report.PURPOSE: We propose to present a novel case of a genital malignancy metastatic to the head and neck. carcinoma of the uterine cervix is the third most frequent malignancy of the female genital tract. Early detection and improved radiation and surgical techniques have resulted in better control of the pelvic tumor and a greater incidence of distant metastasis. Metastases to the soft tissue of the head and neck region have not been reported. methods: We present the first known case of a 35-year-old woman with cancer of the uterine cervix who presented with metastasis to the soft tissue behind the zygomatic arch. RESULTS: The patient received radiation therapy to the zygomatic region and cisplatin therapy with a near-complete remission. CONCLUSION: This case shows that not all squamous cell cancers detected above the clavicles are from a thoracic or a head and neck primary tumor. The atypical location should alert the physician to suspect distant metastasis, rather than locoregional disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Melanotic schwannoma. An unusual case of an ossified soft tissue mass.A case of a melanotic schwannoma presenting as a soft tissue mass of the abductors of the hip is reported. The radiographic findings suggested myositis ossificans, but several subtle findings raised the concern for something else. A bilobed appearance, lack of classic zoning pattern of the ossification, and atypical pain pattern should alert the physician. biopsy should be considered if the radiographic and clinical presentations are not classic for myositis ossificans.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/18. Malignancy in chronic ulcers and scars of the leg (Marjolin's ulcer): a study of 21 patients.OBJECTIVE: To study the imaging features of patients with chronic ulcers of the leg that were associated with malignancy. DESIGN AND patients: All patients who on biopsy were proven to have malignancy--the majority of which were squamous cell carcinoma-were included in a prospective study. Ulcers limited to the foot were excluded but ulcers of the leg which extended into the foot were included. amputation was performed in all but two patients, due to pain, bleeding or tissue necrosis. RESULTS: The etiology was multifactorial. The mean duration of the ulcers was 36 years including venous ulcers, extensive scarring of the leg secondary to infection, injury or burns. One ulcer was secondary to a snake bite. The remainder, usually in the upper part of the leg, had repeated episodes of blunt trauma or knife wounds, which were also complicated by infections which failed to heal or, if they healed, regularly recurred. Although arterial insufficiency was not primary in any patient, most were of advanced age and it may have been an element in some patients. Despite infection, osteomyelitis was present in only one patient. The essential features were bone destruction, soft tissue mass and periosteal reaction. The bone destruction was visible on the radiographs in all but one case. The soft tissue masses varied in size but in general were very large. The periosteal reaction varied in type but most commonly was lamellated. The classic undulating solid periosteal reaction of venous stasis was only occasionally present. The periosteal reaction was nonspecific in the majority of cases and did not aid in the diagnosis or etiology. MRI and CT studies were performed in six patients. These were helpful in defining the extent of bone destruction and periosteal reaction but were not essential in management. CONCLUSION: Chronic ulcer present for decades that then undergoes malignant change is a disease of developing countries where patients only consult physicians when they have developed complications such as pain, bleeding or tissue necrosis. Chronic ulcers may require to be biopsied at regular intervals as malignant change in these ulcers is directly related to their duration.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/18. Extraskeletal osteosarcoma histologically mimicking parosteal osteosarcoma.An extraskeletal osteosarcoma histologically mimicking parosteal osteosarcoma arising in a 63-year-old female is described. The intramuscular lesion in the left lower thigh was a 7 x 4 cm, well-defined mass with marked central calcification and ossification. The tumor was composed predominately of a centrally located osteocartilaginous component and a peripheral, non-osseous fibrous component. The former was characterized by a complex interanastomosing pattern of woven-bone trabeculae with small osteocytes and a minor cartilaginous element. The intratrabecular stroma consisted of benign-appearing fibroblasts. The peripheral fibrous part was characterized by fascicular and interlacing proliferations of spindle cells with mild atypia, rare mitosis and low to moderate cellularity. There were a few scattered foci of proliferating pleomorphic cells, constituting 5% of the tumor, indicating high-grade transformation. There was no evidence of zoning phenomena, cortical erosion, periosteal reaction or intramedullary involvement. The patient is well without recurrence or metastasis at 12 months follow up. This soft tissue neoplasm, mimicking parosteal osteosarcoma, should be distinguished from other bone-forming tumors or tumor-like lesions with which they may be confused. Pathologists and physicians should know the existence of this type of extraskeletal osteosarcoma and treat it as a high-grade extraskeletal osteosarcoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/18. Clear cell sarcoma presenting as an interdigital neuroma.The incidence of malignant soft-tissue sarcomas in the general population is approximately 1.4 per 100,000. Approximately 2% of all cancer deaths are attributable to these tumors. Presented is a case history of a soft-tissue malignant neoplasm that was originally thought to be an interdigital neuroma and that eventually required a modified Chopart's amputation. A review of the literature is presented on other soft-tissue malignant tumors that have an affinity for the foot and ankle. The intention of presenting this case is to caution physicians that malignant lesions can simulate a benign process and should always be considered in the differential diagnosis of any foot mass.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/18. leiomyosarcoma of the femoral vein in a marathon runner.leiomyosarcoma of the femoral vein is a rare tumor. physicians involved in the care of athletic patients must not be cavalier in evaluating overuse injuries and should endeavor to make a specific diagnosis. If atypical findings, such as generalized extremity swelling, are present, the physician must consider systemic illness including malignancy in apparently healthy, physically active individuals.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/18. Classic Kaposi's sarcoma.Classic Kaposi's sarcoma is one form of Kaposi's sarcoma. It is usually first seen in the skin of the lower extremities, where it is frequently misdiagnosed as a bruise. As time progresses, the lesions increase in size, number, and color. early diagnosis is paramount to decrease metastasis to other organ systems such as the lungs, kidneys, and liver. The podiatric physician must take a detailed history, follow the course of the illness, and be aware that definitive diagnosis is made by a skin biopsy. This article provides a case history of Kaposi's sarcoma and discusses diagnosis and treatment of this disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/18. Musician's cramp: a case report and literature review.Musician's focal dystonia is a motor dysfunction that appears in artists after years of repetitive and fine movements during performance. This is the condition most feared by musicians because it leads to difficulties in controlling movements, which can interrupt or terminate their careers. It is characterized by the onset of involuntary muscle contractions and movements; its distinguishing feature is that it only occurs during a specific and well-defined action. It is rarely diagnosed because those who experience it do not seek medical attention for fear or shame, but also because many physicians do not consider the disease in the differential diagnosis of motor dysfunction. We describe the case of a guitarist who presented to our outpatient clinic after many years of experiencing musician's focal dystonia. He reported a long list of misdiagnoses and a variety of unsuccessful treatments.Musician's focal dystonia is an under-diagnosed condition. Treatment benefit is limited despite recent innovative approaches. Rheumatologist should be aware of this condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/18. case reports: acral myxoinflammatory fibroblastic sarcoma: a report of five cases and literature review.During the past 2 years, we treated five patients with acral myxoinflammatory fibroblastic sarcoma at our institution. Four patients presented with a firm, painless mass in the hand that appeared over several months. One patient discovered a painless mass in his shoulder region. The five patients initially were diagnosed as having benign conditions and treated with intralesional or marginal excision by referring physicians, only to have the lesion reappear as sarcoma. Each patient was treated with wide resection of the tumor bed. Acral myxoinflammatory fibroblastic sarcoma is a rare, but increasingly recognized sarcoma of the distal extremities, which often is confused with benign lesions. Surgeons should be familiar with this tumor's clinical, radiographic, and histologic appearances as it has a high rate of recurrence and can metastasize.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/18. A non-healing ulcerated fingertip following injury.A man went to his primary care physician 3 months after slamming his right thumb in a car door. The nail had turned black and sloughed off several weeks later, leaving a red, draining wound on the tip of his thumb. The wound drained continuously for the next 2 months and showed little progress in healing. His physician started him on antibiotics, but the wound still showed no progress in healing over the next 6 weeks. Cultures were obtained that grew out staphylococcus and streptococcus spp. Another course of antibiotics was given, but the patient's condition failed to improve. At this point the patient was referred to a surgeon. He missed several appointments before finally presenting to the surgery clinic nearly 6 months after his original office visit. He was diagnosed clinically as having a giant pyogenic granuloma and was given antibiotics as well as silver nitrate sticks to cauterize the wound daily. After missing several more follow-up appointments, the patient returned with a spongy, weeping soft-tissue wound over the dorsum of his right thumb [that] doubled in size over the past 3 months. Radiographs obtained at that time were normal, but a bone scan revealed late uptake, cause for concern that this was osteomyelitis. What is the differential diagnosis, and what tests are necessary?- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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