Simple bone cysts with the location of calcaneus are not a rare entity. According to our series, simple bone cysts have been shown to be typically located in the calcaneus bone in middle-aged patients in particular. Furthermore, in such patients, heel pain is considerably severe, which is a symptom to be kept in mind in differential diagnosis. Curettage and autogenous grafting is the successful method of treatment and it provides good results.
Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed.
Renal cell carcinomas (RCCs) are one of the leading causes of cancer-related death worldwide (1). About one-third of RCCs are metastatic at initial diagnosis, and skeletal metastases are the second most frequent type of RCC metastases following lung metastases (43%) (2, 3). Surgical intervention is an option for the treatment of skeletal metastases of RCCs. Although local ablative therapies like thermal ablation may be preferred for tumors <3 cm, systemic chemotherapy and radiotherapy are other options for suitable patients (4). However, RCCs are usually chemo/radio-resistant (50%), and these treatment options are usually favored for palliative intent (3-5).The 5-year overall survival of patients with RCC bone metastases increases when surgical metastasectomy is performed (4). However, since RCC metastases in the skeletal system are usually hypervascular, the operative blood loss could be as high as 18500 mL, which could threaten patients' lives (6). Transarterial embolization (TAE) of bone tumors was first described in 1975 (7). The operative blood loss can be reduced by adequate devascularization after TAE of the bone metastases (8-11), and a blood loss of less than 3000 mL was defined as clinical success for spinal tumor surgeries (12). Selective TAE of bone metastases can be performed pre-operatively in a single session. Successful embolization can clarify the tumor margins from the surrounding tissue planes, simplifying surgical manipulation of the tumors. Thus, recurrence rates may be lower in patients undergoing this treatment PURPOSE Our purpose is to clarify the optimal timing of surgery after transarterial embolization (TAE) for renal cell carcinoma (RCC) bone metastases. METHODSThis retrospective study included 41 patients with RCC bone metastases embolized between 2013 and 2019. Different-sized particulate and/or liquid embolic agents were used for TAE. Embolizations were categorized into groups 1-3 according to the interval between TAE and surgery (group 1: <1 day, group 2: 1-3 days, group 3: >3 days). Degree of embolization after TAE was graded visually based on angiographic images (<50%, 50%-75%, 75%-90%, >90%). The relationship between the TAE-surgery interval and intraoperative blood loss (IBL) and the correlation between IBL and embolization grade were examined. Lesion sizes and the relationships among lesion localizations and contrast media usage, intervention time, and IBL were also analyzed. RESULTSForty-six pre-operative TAEs (single lesion at each session) were performed in this study (26 in group 1, 13 in group 2, 7 in group 3). Lesion sizes and distributions were similar between groups (p = 0.897); >75% devascularization was achieved in 40 (TAEs 86.96%), but the IBL showed no correlation with the embolization rate (r=0.032, p = 0.831). The TAE-surgery interval was 1-7 days. The median IBL in group 1 (750 mL; range, 150-3000 mL) was significantly lower than those in the other groups (p = 0.002). Contrast media usage (p = 0.482) and intervention times (p = 0.261) were similar for metastases...
Malignant peripheral nerve sheath tumor (MPNST) is almost always seen in soft tissue. Skeletal involvement by MPNST is uncommon and usually results from secondary invasion. Primary MPNSTs are exceptionally rare. We report a surgically proven case of intraosseous MPNST, with local recurrence and lung metastasis during follow-up. The imaging and histological features of the case are described and the literature on the subject briefly reviewed.
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