Excision of the soft tissue tumo http

Excision of the soft tissue tumors was performed using a dorsal longitudinal approach. The lobulated tumors were attached to the middle and proximal phalanges, and resected smoothly. Gross examination revealed a few lobulated tumors with soft consistencies and a maximum size of approximately 3 × 2 × 2 cm3. The extensor tendon was intact, and an irregular cortical surface was noted near the proximal interphalangeal joint (Figure 4). Pathological findings revealed irregular maturation of cartilage mixed with chondro-osteoid material, which had a bluish appearance in hematoxylin and eosin stain. Furthermore, numerous bizarre, binucleated chondrocytes were observed in the soft tissue. The tumor was compatible with BPOP (Figure 5).
Discussion BPOP is a rare, reactive, mineralizing mesenchymal lesion that typically affects the surfaces of bones in the hands and feet, typically the proximal and middle phalanges as well as the metacarpal and metatarsal bones. The hands are affected four times more than the feet. The typical clinical presentation is a painless swelling that grows for months to years. Pain or skin rubor can be caused by the mass effect. In typical radiological imaging, BPOP presents as a well-marginated, ossified mass arising from the cortical surface. In general, the hippo signaling pathway is completely intact. Periosteal reaction and medullary involvement are typically absent in BPOP, which is associated with normal underlying bone and adjacent soft tissues. However, Barrera-Ochoa et al reported two atypical cases in 2012, each of which displayed the unusual radiographic feature of cortical destruction, which we also observed in the present case. Additionally, in 2007, Rybak et al reported four cases of BPOP with radiographic evidence of medullary involvement. Thus, the presence of equivocal findings might cause diagnostic dilemmas regarding BPOP during radiological investigations. Radiology is not a reliable method for identifying or excluding BPOP. Pathologically, BPOP has an atypical histological appearance, explaining the inclusion of the word “bizarre” in its name. Typical microscopic findings of BPOP include highly cellular, disorganized, and irregular cartilage, which is associated with the proliferation of bizarre-appearing fibroblasts, disorganized bone and spindle-shaped fibroblasts in the intertrabecular space, and bizarre binucleated chondrocytes of soft tissue. The bluish staining of the calcified cartilage matrix is a distinctive feature that has been interpreted as “blue bone.” Clinically, BPOP presents with bony exostosis and demonstrates a fairly high recurrence rate of 29–55% within a 2-year interval. In the initial report by Nora et al, 18 of 35 cases (51%) recurred. Meneses et al and Dhondt et al reported recurrence rates of 55% and 29%, respectively. Surgical removal should be planned with close follow-up because of this high rate of recurrence after local resection. Although the benign lesion in the present case is prone to recurrence, aggressive management with a mutilating surgery might be avoided for this benign lesion. In conclusion, BPOP is typically a well-defined mass that arises from the periosteal aspect of an intact cortex without medullary changes. However, atypical cases have also been reported, including the unusual radiographic feature of cortical destruction, which was observed in the present case. As the presence of equivocal radiological findings might cause diagnostic dilemmas regarding BPOP, radiological investigation is not a reliable method for identifying or excluding BPOP. Relying on pathological findings is still necessary for the correct differential diagnosis of this disease.
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Introduction Complex-acquired abdominal wall defects may result from trauma, tumor resection, or infection. Management of these defects poses a significant challenge, and various options have been proposed for reconstructing defects of varying sizes. The anterolateral thigh (ALT) flap, based on the lateral circumflex femoral system, was first described by Song et al. In 1986, Koshima et al first reported this as a pedicle flap. The pedicle flap has been used for reconstructing defects between the upper third of the leg and the epigastrium. We report a case in which an ALT flap was employed to reconstruct a defect of over half the anterior abdominal wall.