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Teixeira JC, Simão DC, Pimentel J, Livraghi S. A Rare Case of Radiculopathy: Monostotic Fibrous Dysplasia of the Sacrum. ACTA MEDICA PORT 2019; 32:466-468. [PMID: 31292029 DOI: 10.20344/amp.9331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
Fibrous dysplasia is a bone disease characterized by an osteoblastic dysfunction resulting in a fibrous replacement of the normal medullary bone. We describe the case of a 33-year-old who presented with low back pain irradiating to her right leg. Both the computed tomography scan and magnetic resonance imaging showed an osteolytic, multicystic lesion of the right hemi-sacrum with invasion of the right S1 foramen. She underwent foraminotomy and curettage of the lesion. Histological diagnosis was fibrous dysplasia, without features of malignant transformation. Three years after surgery the patient is asymptomatic and imaging is stable. This is the fifth known case of monostotic fibrous dysplasia involving the sacrum, a rare entity that must be considered in the differential diagnosis when approaching patients with sacral lesions.
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Affiliation(s)
- Joaquim Cruz Teixeira
- Department of Neurosurgery. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisbon. Portugal
| | - Diogo Cardoso Simão
- Department of Neurosurgery. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisbon. Portugal
| | - José Pimentel
- Laboratory of Neuropathology. Department of Neurology. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisbon. Portugal
| | - Sérgio Livraghi
- Department of Neurosurgery. Hospital de Santa Maria. Centro Hospitalar de Lisboa Norte. Lisbon. Portugal
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2
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Hishmeh S, Said J, Checo FJ, Kondratyeva A. Ureter and Nerve Root Compression Secondary to Expansile Fibrous Dysplasia of the Transverse Process. Am J Orthop (Belle Mead NJ) 2016; 45:E50-E53. [PMID: 26866323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Considering their proximity to abdominal viscera, transverse process lesions may pose a diagnostic challenge. We present a case of fibrous dysplasia of the transverse process, causing urinary retention, frequent urinary tract infections, and thigh numbness. This is the first reported case of a transverse process fibrous dysplasia lesion, causing simultaneous urinary retention and neurologic symptoms. Clinicians may consider lesions of the lumbar transverse processes in patients presenting to orthopedic surgeons with urinary symptoms, especially when combined with neurologic symptoms. In these lesions, fibrous dysplasia should be within the differential diagnosis. We discuss the diagnosis and present a brief review of fibrous dysplasia.
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Affiliation(s)
| | - Joseph Said
- Stony Brook Medical Center, Stony Brook, NY.
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Carini F, Saggese V, Porcaro G, Baldoni M. Treatment of craniofacial fibrous dysplasia: a case report. Minerva Stomatol 2014; 63:43-49. [PMID: 24487949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The concept of "fibro-osseous lesions" of bone has evolved over the last several years and now includes two mayor entities: the fibrous dysplasia (FD) and the cement-ossifying fibroma (COF). Fibrous dysplasia is considered to be a developmental, tumor-like (hamartomatous), fibro-osseous disease of unknown etiology. There is a maxillary predominance when craniofacial FD occurs in the jaws and the maxillary sinus is commonly involved. Differentiation of OF from FD is important because of differences in treatment and behaviour. This article report a case of 60-year-old female with a history of painless unilateral palatal swelling.
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MESH Headings
- Antibiotic Prophylaxis
- Biopsy
- Chromogranins
- Diagnosis, Differential
- Female
- Fibrous Dysplasia, Monostotic/diagnostic imaging
- Fibrous Dysplasia, Monostotic/genetics
- Fibrous Dysplasia, Monostotic/pathology
- Fibrous Dysplasia, Monostotic/surgery
- GTP-Binding Protein alpha Subunits, Gs/genetics
- Humans
- Maxillary Diseases/diagnostic imaging
- Maxillary Diseases/genetics
- Maxillary Diseases/pathology
- Maxillary Diseases/surgery
- Middle Aged
- Osteoclasts/pathology
- Osteosarcoma/diagnosis
- Palate, Hard/diagnostic imaging
- Palate, Hard/pathology
- Palate, Hard/surgery
- Point Mutation
- Tomography, Spiral Computed
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Affiliation(s)
- F Carini
- Ospedale San Gerardo, Monza, Italy -
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4
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Park HJ, Cho MS, Lee SS. Fibrous dysplasia of the inferior turbinate. Int J Clin Exp Pathol 2013; 6:531-535. [PMID: 23411641 PMCID: PMC3563202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/03/2013] [Indexed: 06/01/2023]
Abstract
Fibrous dysplasia (FD) is a benign skeletal disorder in which abnormally overgrowing bony lesion replaces normal bone. FD can affect one bone (monostotic form) or multiple bones (polyostotic form). The craniofacial bones are involved in about 10% of subjects with monostotic FD. However, its occurrence in the sinonasal tract is very rare. We report a case of monostotic FD developed only in the inferior turbinate in a 29-year-old woman. To the best of our knowledge, it is the second report of monostotic FD involving the inferior turbinate in the medical literature. We, therefore, report this rare case with a review of literature.
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Affiliation(s)
- Hyun Joo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University School of MedicineSeoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Womans University School of MedicineSeoul, Korea
| | - Seung-Sin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University School of MedicineSeoul, Korea
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Abstract
Monostotic fibrous dysplasia in the finger is rare. We are aware of only 4 cases, none of which involved the distal phalanx. We present a case of a 16-year-old boy with a fibrous dysplasia of the left long finger distal phalanx. Treatment consisted of curettage and bone grafting.
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Affiliation(s)
- Dariusz Borys
- Department of Pathology, University of California Davis, Sacramento, CA 95817, USA.
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6
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Abstract
Fibrous dysplasia has been frequently reported to involve the spine in the polyostotic form, but only rarely in the monostotic form of the disease. The present case demonstrates monostotic fibrous dysplasia of the fourth cervical vertebra. We present the plain radiographic, CT-scan, scintigraphy and histologic examinations. C3-C4 posterior and anterior arthrodesis was performed. The post-operative follow-up was satisfactory.
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Affiliation(s)
- C Villas
- Department of Orthopaedic Surgery and Traumatology, University Clinic, Faculty of Medicine, University of Navarra, Pamplona, Spain
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7
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Park BY, Cheon YW, Kim YO, Pae NS, Lee WJ. Prognosis for craniofacial fibrous dysplasia after incomplete resection: age and serum alkaline phosphatase. Int J Oral Maxillofac Surg 2010; 39:221-6. [PMID: 20083386 DOI: 10.1016/j.ijom.2009.12.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 09/14/2009] [Accepted: 12/16/2009] [Indexed: 11/17/2022]
Abstract
Complete resection is usually impossible for fibrous dysplasia (FD) involving the cranial base. Incomplete resection could be followed by regrowth of FD, but there is no method for indicating disease progress. Serum alkaline phosphatase (ALP) is significantly high in patients with FD. The authors investigate the relationship between ALP, progress of FD, and age at surgery. 18 patients with craniofacial FD were separated into 3 groups: Group A, complete resection; Group B, incomplete resection followed by regrowth of FD; and Group C, incomplete resection but no regrowth of FD. Medical records and CT scans were reviewed retrospectively. ALP levels were obtained preoperatively, postoperatively and every year during follow-up. The relation between ALP and regrowth and that between age at surgery and regrowth were investigated. There was no recurrence in Group A (n=4). Regrowth in Group B (n=7) was preceded by an abrupt increase in ALP. In Group C (n=7), no regrowth was observed and ALP was maintained within the normal range. 6 patients (85%) in Group B and 2 (28%) in Group C were under 17 years old. The results revealed that the level of postoperative serum ALP could be a reliable marker for predicting the progress of craniofacial FD.
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Affiliation(s)
- B Y Park
- Institute for Human Tissue Restoration, Department of Plastic & Reconstructive Surgery, Yonsei University, College of Medicine, Seoul, Republic of Korea
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8
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Atalar M, Ozum U. Monostotic fibrous dysplasia of the clivus: imaging findings. Turk Neurosurg 2010; 20:77-81. [PMID: 20066628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Fibrous dysplasia (FD) is an uncommon benign disorder of unknown etiology. It most likely represents a disorder of normal bone development. The disease can involve any bone in the body. In the head and neck, the skull and facial bones are involved in 10-25% of cases of monostotic FD. Involvement of the clivus in monostotic FD is extremely unusual, and has rarely been reported previously. The diagnosis is based on radiological images. We retrospectively reviewed our database and identified three patients with the diagnosis of FD of the clivus. We reviewed the clinical and radiological findings of these patients in this paper.
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Affiliation(s)
- Mehmet Atalar
- Cumhuriyet University School of Medicine, Department of Radiology, Sivas, Turkey.
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Abstract
CONCLUSION Surgical treatment of fibrous dysplasia of the temporal bone (TBFD) revealed relatively good outcomes. Also, active surgical intervention is necessary to prevent the formation of secondary cholesteatoma or other complications. In particular, FD involving the inner ear may require greater caution when deciding on the resection area and timing of surgery. OBJECTIVES The purpose of this study was to analyze clinical manifestations of TBFD and its surgical outcomes. PATIENTS AND METHODS Nine patients diagnosed with TBFD after surgery at three tertiary referral centers were included. Pre- and postoperative clinical, audiological, and radiological findings were analyzed retrospectively. RESULTS Most patients (88.9%) showed FD involving the mastoid and adjacent area. Radiological patterns consisted of six pagetoid and three sclerotic forms; seven patients were monostotic, whereas two patients were polyostotic. Canalplasty (CP) was performed in six cases and intact canal wall mastoidectomy was performed in three of them; hearing gain was achieved in five and one patient maintained preoperative normal hearing. Two patients underwent revision CP and showed no recurrence. In addition, one case had secondary cholesteatoma formed by an obstruction of the external auditory canal; another with a fast-growing cystic mass in the petrous bone underwent transmastoid labyrinthectomy and had no recurrence for 11 months.
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Affiliation(s)
- Young Ho Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, Seoul National University Boramae Hospital, Dongjak-Gu, Seoul, Korea.
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Aho AJ, Suominen E, Alanen A, Yli-Urpo A, Knuuti J, Aho HJ. Case report: Remodeling of the tibia after grafting of a large cavity with particulate bioactive glass-hydroxylapatiteon treatment of fibrous dysplasia with 13 years’ follow-up. ACTA ACUST UNITED AC 2009; 74:766-70. [PMID: 14763713 DOI: 10.1080/00016470310018342] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Allan J Aho
- Department of Surgery, Turku University Hospital, POB 52, FI-20520 Turku, Finland.
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Li T, Xing B, Duan H, Liu Y, Pei F, Tu C. [Surgical treatment for fibrous dysplasia of bone involving proximal femur]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009; 23:261-264. [PMID: 19366128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To find an effective method of surgical treatment of fibrous dysplasia of bone involving the proximal femur. METHODS From January 2001 to January 2006, 57 patients with fibrous dysplasia of bone involving the proximal femur were treated. There were 29 males and 28 females, aging 8-50 years (mean 22 years). Thirty-five patients were involved one bone and 22 patients were involved more than two bones. According to Guille's classification, there were 34 cases of type A, 8 cases of type B, 8 cases of type C and 7 cases of type D. Fourteen cases complicated by coax varus and the neck-shaft angle of femur was 78 degrees on average (55-100 degrees). The duration of the disease was 2.3 years on average (4 months to 10 years). The choice of the various operative procedures depended on the quality of the bone and the extent of the lesion. When the quality of the bone was good, then curettage and bone-grafting was performed. When the quality of the bone was poor, curettage and bone-grafting combined with internal fixation was performed. Medial displacement valgus or valgus osteotomies were used to treat fibrous dysplasia of bone involving the proximal part of the femur with coax varus. RESULTS All patients were followed up for 6 months to 5 years with an average of 2.8 years. All bone graft were absorbed slightly at 3 months and markedly at 10 to 14 months postoperatively. The femoral mechanical alignments were corrected completely radiologically in patients complicated by coax varus; the average neck-shaft angle was corrected from 78 degrees (55-100 degrees) preoperatively to 122 degrees (95-130 degrees) postoperatively. The relative length of femur was increased 1.8-3.6 cm (mean 2.7 cm). After operation, 49 patients could walk without support, 5 with claudication, 3 ambulated with the aid of unilateral cane. Pain disappeared in 52 patients and pain was improved in 5 patients. No infections and recurrent fracture and progression of the deformity occurred in all patients. CONCLUSION Impaction allograft is the key of prompting allograft incorporating fully and preventing pathological fracture. An effective internal fixation must be used when the quality of the bone is poor. Medial displacement valgus or varus osteotomies can correct varus deformity, improve function, as well as restore biomechanical axis of femur. It is also able to effectively eradicate lesions and prevent
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Affiliation(s)
- Tao Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China
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12
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Takada Y, Umezawa T, Koshinaga M, Ueno Y, Katayama Y. [Monostotic fibrous dysplasia of the cranial vault: a case report]. No Shinkei Geka 2008; 36:807-811. [PMID: 18800636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fibrous dysplasia, when it occurs in the craniofacial region, mostly involves the skull base and is rarely localized in the cranial vault. Although there have been several reports on magnetic resonance imaging (MRI) findings of fibrous dysplasia involving the skull base, cases occurring in the cranial vault have seldom been reported. We describe here a rare case of monostotic fibrous dysplasia that occurred in the parietal bone and discuss the characteristics of the MRI findings. A 47-year-old female was admitted to our hospital with a complaint of vertigo. A computed tomography (CT) scan did not reveal any intraparenchymal lesions in either the infra- or supratentorium, and her vertigo improved immediately without any treatments. However, a solitary osteolytic lesion was found incidentally in the left parietal bone. MRI showed that the lesion demonstrated hypointensity on T1-weighted images and hyperintensity on T2-weighted images, and was enhanced heterogeneously following injection of Gadolinium-DTPA. Removal of the parietal bone containing the lesion was performed according to the patient's wishes. The histopathological findings of the removed tissues corresponded to fibrous dysplasia. Although it is well known that craniofacial fibrous dysplasia demonstrates iso- or hypointensity on T1- as well as T2-weighted images, in the present case, the lesion showed apparent hyperintensity on T2-weighted images. These findings suggest that fibrous dysplasia can display various MR intensities depending on its origin.
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Affiliation(s)
- Yoshiyuki Takada
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Japan
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13
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Demiralp B, Ozturk C, Ozturan K, Sanisoglu YS, Cicek IE, Erler K. Prophylactic intramedullary nailing in monostotic fibrous dysplasia. Acta Orthop Belg 2008; 74:386-390. [PMID: 18686466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fibrous dysplasia of bone is an enigma with no known cure. Treatment currently consists of curettage and bone-grafting in an attempt to eradicate the lesion and to prevent progressive deformity. This study presents the results of prophylactic intramedullary nailing in 10 patients with monostotic fibrous dysplasia, pain increasing with movement, and scintigraphically established activity. Ten patients with monostotic fibrous dysplasia in their upper or lower extremities treated between 2001 and 2003 were included in the study. Seven patients were male and 3 were female; their mean age was 26.9 years. The mean duration of follow-up was 33.5 months. Closed intramedullary nail without reaming was used in all cases. Bone grafting was not performed. Patients were allowed full weight bearing on the affected extremities on the second postoperative day. Mean VAS for functional pain was 5.33 +/- 0.65 preoperatively and 2.26 +/- 0.57 at final follow-up (p < 0.05). Radiographs showed no changes in lesion size, and the intramedullary fixation appeared to be stable. Prophylactic intramedullary nailing appeared to be beneficial in monostotic fibrous dysplasia with scintigraphically proven activity and functional pain. It also avoids problems that may occur following pathological fracture.
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Affiliation(s)
- Bahtiyar Demiralp
- Gulhane Military Medical Academy, Department of Orthopaedics and Traumatology, Ankara, Turkey.
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Iwasaki M, Hida K, Yano S, Iwasaki Y. [Case of cervical monostotic fibrous dysplasia with a large cyst]. No Shinkei Geka 2008; 36:429-433. [PMID: 18516861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a rare cervical monostotic fibrous dysplasia with a large cyst in the C2 region in a 55-year-old man complaining of headache. MRI revealed an expanding bony tumor at the C2 spinous process. Gd-DTPA MRI showed slight enhancement around a cystic mass. We performed C2 laminectomy and removed the tumor. It was comprised of soft tissue in the C2 spinous process and right lamina and contained a large septated cyst filled with xanthochromic fluid. Histopathology confirmed fibrous dysplasia with typical woven bony trabeculae. His postoperative course was uneventful and outpatient follow-up detected no deficits. Cervical fibrous dysplasia with a distinct cyst is a rare entity and few cases have been reported in the literature. Such cysts are considered to reflect a tumor regression process. Diagnosis based on MRI and CT study alone is difficult. We suggest that these lesions be surgically resected.
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Affiliation(s)
- Motoyuki Iwasaki
- Department of Nuerosurgery, Graduate School of Medicine, Hokkaido University, Sapporo-shi, Japan
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Terui K, Koshimichi S, Nakao N, Uematsu Y, Itakura T. [Radiographic characteristics of fibrous dysplasia of the clivus: a case report and review of the literature]. No Shinkei Geka 2007; 35:895-9. [PMID: 17867309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Whereas fibrous dysplasia is a well-known, developmental skeletal disorder with a benign clinical course, fibrous dysplasia of the clivus is extremely rare and has seldom been reported. Differentiating this benign entity from more aggressive diseases involving the clivus is important for the proper management of lesions in this area. We here report a case of fibrous dysplasia of the clivus and discuss its radiographic features. The patient was 55-year-old male who had suffered from headache for months. Physical and neurological examinations found no abnormalities. The computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed an abnormal mass lesion in the lower of the third clivus. On CT scan, the mass lesion exhibited a ground-glass appearance. The lesion was detected as hypointense and a mixture of hyperintense and isointense areas on T1-weighted and T2-weighted MRI, respectively. Heterogenous enhancement was noted after infusion of GD-DTPA. The patient underwent a transsphenoidal resection of the mass and the histopathologic diagnosis was fibrous dysplasia.
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Affiliation(s)
- Keita Terui
- Department of Neurosurgery, Hidaka General Hospital
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Calisir C, Inan U, Yavas US, Isiksoy S, Kaya T. Mazabraud's syndrome coexisting with a uterine tumor resembling an ovarian sex cord tumor (UTROSCT): a case report. Korean J Radiol 2007; 8:438-42. [PMID: 17923787 PMCID: PMC2626811 DOI: 10.3348/kjr.2007.8.5.438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Accepted: 07/10/2007] [Indexed: 12/25/2022] Open
Abstract
The association of intramuscular myxoma and fibrous dysplasia is a rare disease known as Mazabraud's syndrome. We present a case of Mazabraud's syndrome coexisting with a uterine tumor and resembling an ovarian sex cord tumor (UTROSCT). This uterine tumor showed a high mitotic index and cytological atypia. To the best of our knowledge, the coexistence of the two different entities has not been reported in the literature.
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Affiliation(s)
- Cuneyt Calisir
- Department of Radiology, Eskisehir Osmangazi University.
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Endo M, Kawai A, Kobayashi E, Morimoto Y, Yamaguchi U, Nakatani F, Chuman H, Seki K, Beppu Y. Solitary intramuscular myxoma with monostotic fibrous dysplasia as a rare variant of Mazabraud's syndrome. Skeletal Radiol 2007; 36:523-9. [PMID: 17139504 DOI: 10.1007/s00256-006-0234-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 08/21/2006] [Accepted: 10/13/2006] [Indexed: 02/02/2023]
Abstract
The rare coexistence of intramuscular myxoma (IM) and fibrous dysplasia (FD) is known as Mazabraud's syndrome. IM tends to occur multifocally and is associated most frequently with polyostotic FD in Mazabraud's syndrome. We present an extremely rare combination of a solitary IM and monostotic FD as a variant of Mazabraud's syndrome, and discuss the importance of recognizing this rare coexistence for appropriate management of the patient.
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Affiliation(s)
- Makoto Endo
- Division of Orthopaedic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Durand S, Hamcha H, Pannier S, Padovani JP, Finidori G, Glorion C. [Fibrous dysplasia of the proximal femur in children and teenagers: surgical results in 22 cases]. ACTA ACUST UNITED AC 2007; 93:17-22. [PMID: 17389820 DOI: 10.1016/s0035-1040(07)90199-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE OF THE STUDY Fibrous dysplasia is a rare benign bone tumor which occurs preferentially in the proximal femur. In children, there is a risk of repeated fractures and coxa vara deformity, particularly in the polyostotic form. The most common orthopedic problem is fibrous dysplasia of the proximal femur which generally requires surgical treatment. The purpose of this study was to analyze clinical and radiological outcome after surgical treatment. MATERIAL AND METHODS All children who underwent surgical treatment for fibrous dysplasia of the proximal femur between 1979 and 2001 were reviewed retrospectively. The study cohort included 22 children (11 boys and 11 girls). Eight patients had a monostotic form and 14 a polyostotic form of the disease. For the monostotic forms, the type of treatment depended on the size of the tumor and its localization but curettage was used in all cases. For the polyostotic forms, treatment consisted in valgus osteotomy with "humeralization" in the event of associated coxa vara in combination with internal fixation, generally with a centromedullary nail. RESULTS In the monostotic forms, the clinical outcome was considered good in all cases. Nearly total involution of the tumor was noted in 75% of patients. In the polyostotic forms, osteotomy with "humeralization" and centromedullary nailing provided stable correction of the deformation. Outcome was less satisfactory because of fractures and deformities. DISCUSSION In light of our results and those reported in the literature, the prognosis of the monostotic form can be considered good after surgical treatment. For the polyostotic form, preventive fixation is necessary. Osteotomy with "humeralization" appears to correct the deformity and prevent coxa vara in certain cases. For the more severe forms, medical treatment with biphosphonates may be a useful complement to the surgical treatment.
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Affiliation(s)
- S Durand
- Service d'Orthopédie et Traumatologie Pédiatrique, Hôpital des Enfants-Malades, 149, rue de Sèvres, 75015 Paris.
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Corsi A, De Maio F, Ippolito E, Cherman N, Gehron Robey P, Riminucci M, Bianco P. Monostotic fibrous dysplasia of the proximal femur and liposclerosing myxofibrous tumor: which one is which? J Bone Miner Res 2006; 21:1955-8. [PMID: 17002568 DOI: 10.1359/jbmr.060818] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Clinical, histological, and genetic studies of two cases of isolated fibro-osseous lesions of the femur in adults show the overlap between monostotic fibrous dysplasia (MFD) of the proximal femur and the so-called liposclerosing myxofibrous tumor. The two cases highlight how the incomplete understanding of the natural history of MFD may result in diagnostic pitfalls or incorrect classification of individual lesions.
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Affiliation(s)
- Alessandro Corsi
- Dipartimento de Medicina Sperimentale e Patologia, Università La Sapienza, Rome, Italy
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20
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Marshman L, David KM. Fibrous dysplasia. J Neurosurg Spine 2006; 4:516-7; author reply 517. [PMID: 16776368 DOI: 10.3171/spi.2006.4.6.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Aslan A, Emekli U, Ozden BC, Bilgiç B, Kesim SN. Osseous hyperplasia of the glenoid fossa. ACTA ACUST UNITED AC 2006; 101:e71-5. [PMID: 16504855 DOI: 10.1016/j.tripleo.2004.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 01/14/2004] [Accepted: 05/06/2004] [Indexed: 11/25/2022]
Abstract
Neoplasia and hyperplasia of the temporomandibular joint-related connective tissue are among the rare causes of disc displacement and temporomandibular joint (TMJ) dysfunction. Here we present an unusual case of hyperplasia of the glenoid fossa, treated for TMJ dysfunction.
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Affiliation(s)
- Alp Aslan
- Istanbul Medical Faculty, Department of Plastic and Reconstructive Surgery, Istanbul University, Istanbul, Turkey.
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22
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Abstract
Monostotic fibrous dysplasia of the spine is extremely rare. We present a 57-year-old man who complained of persistent low back pain with monostotic fibrous dysplasia of the lumbar spine. Computed tomography revealed a lytic expansile lesion and marginal sclerosis in the L2 posterior element, although a bone scan did not reveal increased uptake in the lesion. The patient underwent total excision of the tumor via a posterior approach. Two years later, he is asymptomatic with no recurrence of the lesion, as confirmed by imaging.
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Affiliation(s)
- Takashi Asazuma
- Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
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23
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Affiliation(s)
- I Loeb
- Service de Stomatologie et Chirurgie Maxillo-Faciale, CHU Saint-Pierre, 129, bd de Waterloo, 1000 Bruxelles, Belgique
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24
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Contratti F, Menniti A, Fraioli FM. Fibrous Dysplasia. J Neurosurg Spine 2005; 2:510; author reply 510. [PMID: 15871496 DOI: 10.3171/spi.2005.2.4.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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Márquez Moyano JA, Ostos Aumente P, Sánchez Gutiérrez R, Roldán Nogueras J, López Villarejo P. [Fibrous displasia of the temporal bone. Presentation of one case]. An Otorrinolaringol Ibero Am 2005; 32:389-95. [PMID: 16156368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We present one case of a 14 years old girl, diagnosed of fibrous displasia of the temporal bone, who developed a conductive hearing loss of progressive character. We analyse the clinic manifestations, radiologic and histopathologic study, and therapeutic indications of this disease.
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Affiliation(s)
- J A Márquez Moyano
- Servicio de Otorrinolaringología, Hospital Universitario Reina Sofia, Cordoba.
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26
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Berlucchi M, Salsi D, Farina D, Nicolai P. Endoscopic surgery for fibrous dysplasia of the sinonasal tract in pediatric patients. Int J Pediatr Otorhinolaryngol 2005; 69:43-8. [PMID: 15627445 DOI: 10.1016/j.ijporl.2004.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 07/23/2004] [Accepted: 07/25/2004] [Indexed: 11/30/2022]
Abstract
Fibrous dysplasia (FD) is a non-neoplastic, expansile lesion of unknown origin. In about one-fourth of cases this disorder affects the head and neck area, where the mandible and maxilla are the most frequently involved sites. Its localization to the ethmoid is a rare event. Since the disease slowly progresses, its management is delayed until significant clinical symptoms or non-well-tolerated aesthetic deformities are present. When required, surgery is the treatment of choice. Several external procedures have been used to manage the lesion, but recently, more conservative transnasal approaches have been proposed. We report the history of a 6-year-old boy with fibrous dysplasia of the ethmoid labyrinth that underwent successful transnasal endoscopic removal. Furthermore, an analysis of the literature is presented with particular emphasis on clinical picture, diagnosis, and treatment of this rare illness.
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Affiliation(s)
- Marco Berlucchi
- Department of Pediatric Otorhinolaryngology, Spedali Civili, Brescia, Italy
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27
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Kiroğlu AF, Yuca K, Cankaya H, Kutluhan A, Kara T. Maxillary and temporal fibrous dysplasia: three cases. B-ENT 2005; 1:177-80. [PMID: 16429749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PROBLEMS/OBJECTIVES Fibrous dysplasia (FD) is a benign, expansile lesion of bone with slow progression and unknown origin. The purpose of this report is to make physicians aware of the symptoms, methods for differential diagnosis, and treatment options. METHODOLOGY Three cases of monostotic FD are presented; two involving the maxillary sinus, and one in temporal bone. CT scans are the definitive diagnostic and follow-up method. Surgical approaches to alleviate the symptoms, including facial deformity, are described. RESULTS FD went undiagnosed for three years in these patients. All three patients were relieved of the symptoms by limited surgery, and remained asymptomatic for up to two years after the surgery, with no signs of recurrence. CONCLUSIONS Practitioners should be alert to the possibility of FD, particularly if patients develop narrowing of the ear canal, or progressive postauricular or maxillofacial enlargement. Minimal surgery to alleviate the symptoms is the treatment of choice.
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Affiliation(s)
- A F Kiroğlu
- Yuzuncu Yil University, Faculty of Medicine, Department of Otorhinolaryngology, Van, Turkey.
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28
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Delozier JB, Egger ME, Bottomy MB. Infantile fibrous dysplasia of the mandible. J Craniofac Surg 2004; 15:1039-43. [PMID: 15547401 DOI: 10.1097/00001665-200411000-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fibrous dysplasia of the craniofacial skeleton is an uncommon benign neoplasm. Its appearance in infancy (<1 year) is extremely rare. The authors report a case of mandibular fibrous dysplasia presenting in a patient 12 weeks of age as a painless, primarily left-sided, enlarging neoplasm of bone. Surgical contouring was successfully performed when the patient was 9 months of age. The authors anticipate recurrence, but at 6 months of follow-up no new growth has been observed.
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29
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Abstract
A 20-year-old male with fibrous dysplasia involving the right fronto-orbital and malar regions showed no significant progression of disease by serial computed tomography (CT) scans over 6 years. Two prior attempts to recontour the right maxilla and zygoma in situ and to increase the right orbital volume had been unsatisfactory. To solve the problem of persistent right-sided proptosis and facial asymmetry, a three-dimensional model of the midface and orbits was made on the basis of a pre-operative CT scan. Removable components transformed the model of the affected right side of the midface into a mirror image of the unaffected side, giving a precise indication of where and how much bone needed to be removed. Surgical correction was performed using a right malar osteotomy in which the zygoma was mobilized in continuity with the lateral and inferior orbital rims. This approach gave direct access to the orbit, through which the lateral and medial orbital walls were re-contoured to increase intraorbital volume. The freely mobilized zygoma was then shaped to match the prefabricated model. The zygoma was repositioned, and the affected maxilla was recontoured to blend with the remodeled zygoma. Follow-up CT scan and physical examinations postoperatively demonstrate excellent facial symmetry and correction of right-sided proptosis. When there is no documented progression of fibrous dysplasia in the face over several years, three-dimensional modeling as a guide to ex situ malar recontouring can improve the accuracy of facial reconstruction. This approach also provides direct access to the orbit for the correction of bony orbital volume.
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Affiliation(s)
- Arun K Gosain
- Department of Plastic Surgery, The Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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30
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Ruchelsman DE, Madan SS, Feldman DS. Genu valgum secondary to focal fibrocartilaginous dysplasia of the distal femur. J Pediatr Orthop 2004; 24:408-13. [PMID: 15205624 DOI: 10.1097/00004694-200407000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We report a case of unilateral genu valgum secondary to focal fibrocartilaginous dysplasia (FFCD) isolated in the posterolateral cortex of the distal femur. This case is the first incidence of a discrete fibrous band occurring in conjunction with a FFCD lesion in the distal posterolateral femur treated with excision of the tether and the overlying periosteum with curettage of the cortical focal fibrocartilaginous defect. Treatment was considered successful with gradual resolution of the 30 degrees valgus deformity over 24 months, and we avoided the necessity of corrective osteotomy and its associated risks. To our knowledge, resolution of genu valgum secondary to FFCD in the distal posterolateral femur after curettage has not been previously described in the literature.
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Affiliation(s)
- David E Ruchelsman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases Orthopaedic Institute, New York, New York 10003, USA
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31
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Fu CJ, Hsu CY, Shih TTF, Wu MZ. Monostotic fibrous dysplasia of the thoracic spine with malignant transformation. J Formos Med Assoc 2004; 103:711-4. [PMID: 15361945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Monostotic fibrous dysplasia involving the spine is rare. There have been only 6 previous reports of monostotic fibrous dysplasia involving the thoracic spine and none had malignant transformation. We report a case of monostotic fibrous dysplasia of the thoracic spine with malignant transformation. Findings on plain radiographs, isotope bone scan, computed tomography and magnetic resonance imaging are discussed and compared with those of the previously reported cases.
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Affiliation(s)
- Chen-Ju Fu
- Department of Radiology, Medical College, National Taiwan University College of Medicine, National Taiwan University, Taipei
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32
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Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T. Variations on the Standard Transsphenoidal Approach to the Sellar Region, with Emphasis on the Extended Approaches and Parasellar Approaches: Surgical Experience in 105 Cases. Neurosurgery 2004; 55:539-47; discussion 547-50. [PMID: 15335421 DOI: 10.1227/01.neu.0000134287.19377.a2] [Citation(s) in RCA: 373] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Accepted: 02/24/2004] [Indexed: 11/18/2022] Open
Abstract
Abstract
OBJECTIVE:
The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region.
METHODS:
From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar region. This study specifically reviews the breadth of pathological lesions operated and the complications associated with the approaches.
RESULTS:
Variations of the standard transsphenoidal approach have been used in the following series: 30 cases of pituitary adenomas extending laterally to involve the cavernous sinus, 27 craniopharyngiomas, 11 tuberculum/diaphragma sellae meningiomas, 10 sphenoid sinus mucoceles, 18 clivus chordomas, 4 cases of carcinoma of the sphenoid sinus, 2 cases of breast carcinoma metastatic to the sella, and 3 cases of monostotic fibrous dysplasia involving the clivus. There was no mortality in the series. Permanent neurological complications included one case of monocular blindness, one case of permanent diabetes insipidus, and two permanent cavernous cranial neuropathies. There were four cases of internal carotid artery hemorrhage, one of which required ligation of the cervical internal carotid artery and resulted in hemiparesis. The incidence of postoperative cerebrospinal fluid fistulae was 6% (6 of 105 cases).
CONCLUSION:
These modifications of the standard transsphenoidal approach are useful for lesions within the boundaries noted above, they offer excellent alternatives to transcranial approaches for these lesions, and they avoid prolonged exposure time and brain retraction. Technical details are discussed and illustrative cases presented.
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Affiliation(s)
- William T Couldwell
- Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA.
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33
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Abstract
Fibrous dysplasia (FD) of the sphenoidal sinus is a rare disease, especially during adulthood. We report a case of FD of the right sphenoidal sinus in an adult male patient who presented with nonspecific symptoms limited to headache localized to the right temporal area and to the inferior orbital rim of both sides. Magnetic resonance imaging revealed a dense mass that occupied the entire right sphenoidal sinus and skull base with typical ground-glass opacification and bony sclerosis of the whole sphenoidal wall. The diagnosis of FD was confirmed on pathological examination of a biopsy taken through sphenotomy. The patient underwent a subcranial craniotomy for tumor resection. After more than 4 years of follow-up, the patient was disease-free. On the basis of these clinical features, it is important to consider sphenoidal FD in both young and adult patients complaining of an unexplained headache, because it may present unusually with headache localized to the temporal region or the inferior orbital rim.
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Affiliation(s)
- Ziane Selmani
- Department of Ear, Nose, and Throat Diseases, Central Hospital of Satakunta, Pori, Finland.
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34
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Gillman G, Bryson PC, Rao UNM. Radiology quiz case 1. Isolated fibrous dysplasia of the sphenoid sinus. ACTA ACUST UNITED AC 2004; 130:479, 481-2. [PMID: 15096436 DOI: 10.1001/archotol.130.4.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Grant Gillman
- University of Pittsburgh School of Medicine, Pittsburgh, Pa., USA
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35
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Arazi M, Guney O, Ozdemir M, Uluoglu O, Uzum N. Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up. J Neurosurg Spine 2004; 100:378-81. [PMID: 15070149 DOI: 10.3171/spi.2004.100.4.0378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent.
The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.
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Affiliation(s)
- Mehmet Arazi
- Department of Orthopaedic Surgery and Traumatology, Selçuk University, Meram Medical School, Konya, Turkey.
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36
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Kutluhan A, Kiroğlu AF, Yurttas V, Arslan H, Ozen S. Monostotic fibrous dysplasia originating from ethmoid bone: treatment with endoscopic approach. Ann Otol Rhinol Laryngol 2004; 113:139-41. [PMID: 14994770 DOI: 10.1177/000348940411300211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case of monostotic fibrous dysplasia of the ethmoidal sinus in an 11-year-old boy. This condition is of interest to the otorhinolaryngologist because of the difficulty of differential diagnosis and treatment. This tumorlike growth was not restricted to the right ethmoidal sinus, but also compressed the orbit and the globe. Endoscopic and transnasal removal of the mass with a drill was performed under general anesthesia. No residual tumor was observed 6 months later.
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Affiliation(s)
- Ahmet Kutluhan
- Department of Otolaryngology, Yüzüncü Yil University, School of Medicine, Van, Turkey
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37
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Tornero Saltó J, Girons Bonells J, Nogués Orpí J, González Compta X, Haag Haag O, Dicenta Sousa M. [Monostotic fibrous dysplasia. Three cases and literature review]. An Otorrinolaringol Ibero Am 2004; 31:147-58. [PMID: 15185611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The fibrous dysplagia is a rare benign osseous pathology of unknown aetiology. It presents an incidence of craniofacial affectation of a 10% in its monostotic variety and a 100% in the poliostotic. The temporal bone implication is very rare, being usually referred in the monostotic variety. The diagnosis is based on radiology (CT) and histology. The majority of the authors agree in a conservative treatment. We present three clinical cases of monostotic fibrous dysplagia with craniofacial affectation, two of them in the temporal bone and another one in the frontal bone.
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38
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Kotova EN, Titova AA. [Maxillary affection in fibrous dysplasia in children]. Vestn Otorinolaringol 2004:34-6. [PMID: 15159736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The article reviews foreign and domestic literature on the problem of maxillary fibrous dysplasia (MFD) and reports 10 cases of disseminated monoosseous MFD in children aged 3-14 years treated surgically. The scope of the intervention depended on the process location, age of the patients and function-sparing principle. All the operations provided satisfactory cosmetic and functional effect. Their results advocate an individual approach to choice of the scope and kind of surgical intervention.
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Abstract
AIM To report a case of focal cemento-osseous dysplasia (FCOD) affecting a single tooth misdiagnosed as an inflammatory periapical lesion. SUMMARY The patient, a black 47-year-old woman complained of pain affecting the right side of the mandible. Routine X-ray examination discovered a periapical radiolucency on the mandibular left lateral incisor (tooth 32), which was otherwise normal and not carious. As the response of this tooth to a vitality test was doubtful, the lesion was diagnosed as a periapical granuloma or cyst secondary to pulpal necrosis. Endodontic treatment and curettage of the periapical lesion were performed, and histological examination of the curettage material revealed a localized osseous dysplasia. KEY LEARNING POINTS FCOD may rarely affect only one tooth, resembling a periapical granuloma or cyst. Careful diagnosis is of paramount importance in cases of questionable periapical lesions affecting normal-looking teeth, before beginning treatment. FCOD generally requires no treatment. Biopsy is warranted in case of doubt.
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40
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Abstract
Monostotic manifestation of fibrous dysplasia in the spine is exceedingly rare. We report the case of a 30 year-old woman suffering from slowly increasing low back pain. Radiologically a polycyclic, slightly gadolinium-enhancing, solitary lesion within the first lumbar vertebral body was detected. The lesion was removed and stabilized with bone marrow transplant. We describe the radiological and histopathological findings.
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Affiliation(s)
- F Hertel
- Department of Neurosurgery, Brüderkrankenhaus Trier, Germany.
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41
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Abstract
Fibrous dysplasia named after Jaffè and Lichtenstein is a benign, self-limiting disorder of the bone structure. The normal bone is replaced by cellular fibrous connective tissue. Fibrous dysplasia can be differentiated into monostotic and polyostotic forms and the McCune-Albright syndrome (combination of polyostotic areas in the bone with hyperpigmentation of the skin and endocrinological disturbances). The rare disease is predominantly found in the 1st to 3rd decade of life in the femur or humerus. In about 15% of all cases it affects the facial bones, and one-third of these is located in the jaw bone. Extremely rare is the invasion of the petrous bone. A 45-year-old female patient was examined because of tinnitus persisting for 1 year. In addition, she was suffering from increased hearing reduction and recurrent vertigo. The CT and MRT showed a milky glass-like tumor, which was limited by an osteolytic process situated in the left petrous bone. The process was removed via the mastoid. Histological examination revealed fibrous dysplasia. A highly differentiated osteosarcoma and an ossifying fibroma as important differential diagnoses have to be excluded because of the different therapeutic consequences.
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Affiliation(s)
- K Neumann
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Medizinische Fakultät, Martin-Luther-Universität, Halle-Wittenberg.
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42
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Abstract
INTRODUCTION We evaluate the role of surgery in the treatment of fibrous dysplasia of the skull in children. METHODS We identified 48 consecutive cases of fibrous dysplasia of the skull that were surgically treated at a single institution over a 23-year interval. The 28 patients that initially presented during the first two decades of life were selected for further analysis. Presenting symptoms, signs, surgical treatment, surgical outcome and the state of the disease at the extended follow-up interval were recorded. RESULTS Fibrous dysplasia of the skull in children most often involved the frontal, sphenoid and ethmoid bones. Most patients presented with facial asymmetry or proptosis. A gross total resection was achieved in 7 patients, subtotal resection in 17 patients, and 4 patients underwent biopsy alone. Over the follow-up interval, 7 patients had symptomatic progression of subtotally resected fibrous dysplasia and 3 patients had asymptomatic progression. The extent of resection was correlated with recurrence risk. CONCLUSIONS In order to prevent progression of disease, an attempt at gross total resection is indicated in cases of fibrous dysplasia of the skull in childhood where the risk of neurologic morbidity is low and cosmetic results will be acceptable.
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Affiliation(s)
- Cormac O Maher
- Department of Neurological Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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43
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Becelli R, Perugini M, Cerulli G, Carboni A, Renzi G. Surgical treatment of fibrous dysplasia of the cranio-maxillo-facial area. Review of the literature and personal experience form 1984 to 1999. Minerva Stomatol 2002; 51:293-300. [PMID: 12434124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
OBJECTIVE The aim of this study is to report personal experience on the evolution of the therapeutical approach and surgical treatment in 66 patients with fibrous dysplasia (FD) of the cranio-maxillo-facial area. METHODS From January 1984 to December 1999, 66 cases of FD of the cranio-maxillo-facial area were diagnosed. 21 patients were still growing (under 17 years), while 45 were adults (over 17 years). 50 (75.7%) patients showed FD in monostotic form; 15 (22.7%) patients showed FD in polyostotic form; one (1.51%) patient affected by Mc Cune-Albright Syndrome presented the involvement of the left hemimandible. In 24 (36.3%) patients the clinical onset of the disease was insidious, lacked evident symptomatology and the diagnosis was fortuitous. The remaining 42 (63.6%) patients showed different signs and symptoms according to the location of the pathology. RESULTS In this time the patients who underwent surgical treatment showed the resolution of the functional and aesthetical problems; the patients who did not undergo surgical treatment, in relation to age and type of pathology, showed an arrest during clinical and radiographic checks. CONCLUSIONS We have pointed out the importance of a careful differential diagnosis of fibrous dysplasia with other pathologies with clinical and radiographic conditions similar to it and the importance of a correct surgical planning, carried out according to the patient's age, location, mono or polyostotic form of fibrous dysplasia and to the presence or absence of functional limitations, and aesthetic problems. Further-more we have pointed out the great possibilities of reconstruction of the surgical defects deriving from the utilization of autologous bone grafts and the benefits deriving from the introduction of the internal rigid fixation for the stabilization of these grafts in the surgical defects.
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Affiliation(s)
- R Becelli
- Department of Maxillofacial Surgery, University of Rome La Sapienza, Rome, Italy
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44
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Abstract
Fibrous dysplasia is a nonneoplastic developmental disease of osseous tissue. It is a lesion of unknown etiology, uncertain pathogenesis, and diverse histopathology. In this series of 16 patients with fibrous dysplasia of the craniomaxillofacial bones, the disease was generally monostotic and most commonly maxillary in location. Two patients demonstrated typical symptoms of the McCune Albright syndrome. Marked deformity or functional disturbances were the major indications for treatment. Total excision of the involved bone was the most successful form of treatment but produced the greatest functional and cosmetic deficits and long-term postoperative complications. A conservative therapeutic approach with a modest reduction in the bulk of these lesions may be sufficient to relieve signs and symptoms effectively. Periodic follow-up is indicated to detect recurrences or malignant changes in the early stages.
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Affiliation(s)
- Cuneyt Ozek
- Plastic and Reconstructive Surgery Department, Ege University, Bornova-Izmir, Turkey
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45
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Pasquini E, Ceroni Compadretti G, Sciarretta V, Ippolito A. Transnasal endoscopic surgery for the treatment of fibrous dysplasia of maxillary sinus associated to aneurysmal bone cyst in a 5-year-old child. Int J Pediatr Otorhinolaryngol 2002; 62:59-62. [PMID: 11738696 DOI: 10.1016/s0165-5876(01)00593-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fibrous dysplasia (FD) and aneurysmal bone cyst involving the facial skeleton are rare but their synchronous association in other parts of the body is well-known. The most common treatment for these lesions has been based on surgical resection using an external approach. Only recently has the endonasal endoscopic approach been utilized for the partial or complete removal of these lesions. In this report, we attempt to outline the effectiveness of the endonasal endoscopic approach for the treatment of a 5-year-old child affected by a fibrous dysplasia associated with an aneurysmal bone cyst of the right maxillary.
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46
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Abstract
A 28-year-old man presented with monostotic fronto-orbital fibrous dysplasia associated with convulsions. Signs of meningeal irritation were observed. Computed tomography (CT) showed right frontal sinusitis, and destruction from the inner to outer table with expansion of the diploic space. T1- and T2-weighted magnetic resonance imaging showed an abnormal low-intensity mass, with heterogeneous gadolinium enhancement. Although the meningitis resolved, signs of infection continued for 2 months due to sinusitis. Treatment of the right frontal sinusitis was undertaken, accompanied by open biopsy. The histological diagnosis was fibrous dysplasia. Once the infection had completely resolved, orbitofrontal reconstruction was undertaken. Cranioplasty was carried out using cranial bone cement. Three-dimensional CT was valuable to show the likely postoperative result.
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Affiliation(s)
- Masaru Kanda
- Department of Surgical Neurology, Jichi Medical School, Tochigi.
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47
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Affiliation(s)
- T A Burd
- Department of Orthopedic Surgery, University of Missouri Hospital & Clinics, Columbia 65212, USA
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48
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Abstract
Monostotic fibrous dysplasia of the mandible is an unusual manifestation of the disease that is usually benign, occurs in young individuals, and is managed by conservative curettage or debridement. We present a case of persistent fibrous dysplasia complicated by pain and intraoral bony exposure that was successfully managed by radical resection and reconstruction with a free fibular flap. Although mandibular fibrous dysplasia is preferentially managed conservatively, treatment of this disease has evolved to a point where total excision and immediate reconstruction may be the treatment of choice and offer the best outcome.
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Affiliation(s)
- M R Zenn
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC 27710, USA
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49
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Keijser LC, Van Tienen TG, Schreuder HW, Lemmens JA, Pruszczynski M, Veth RP. Fibrous dysplasia of bone: management and outcome of 20 cases. J Surg Oncol 2001; 76:157-66; discussion 167-8. [PMID: 11276018 DOI: 10.1002/jso.1028] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Fibrous dysplasia of bone is difficult to manage because of its variable clinical course with many different methods of treatment reported. Therefore we report on our experience. METHODS We reviewed a series of 20 patients with 32 lesions included. The average age at the time of diagnosis was 32 years for monostotic disease, 26 years for polyostotic disease, and 3 years for McCune-Albright syndrome. The median follow-up period was 6 years. Functional and radiographic outcomes were scored. RESULTS AND CONCLUSIONS Monostotic disease mostly presented with a circumscribed lesion and monitoring was often sufficient. Symptomatic circumscribed lesions showed satisfactory outcome when treated with curettage, cryosurgery and bone grafting. Lesions of the extended type were most of all seen in polyostotic disease and eventually needed operative treatment. In case of bony deformity, corrective osteotomies and rigid internal fixation were performed in addition to curettage, cryosurgery, and bone grafting. In polyostotic disease, expected outcomes were good, but in McCune-Albright syndrome, results were uniformly poor. J. Surg. Oncol. 2001;76:157-166.
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Affiliation(s)
- L C Keijser
- Department of Orthopaedics, University Medical Center St. Radboud, Nijmegen, The Netherlands.
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Chow LT, Griffith J, Chow WH, Kumta SM. Monostotic fibrous dysplasia of the spine: report of a case involving the lumbar transverse process and review of the literature. Arch Orthop Trauma Surg 2001; 120:460-4. [PMID: 10968541 DOI: 10.1007/pl00013774] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Monostotic fibrous dysplasia of the spine is rare. We report its clinical, radiologic and histologic features affecting a 47-year-old housewife. She presented with low-back pain of 1-year's duration, and radiographs showed a diffuse expansile lesion in the left transverse process of the fourth lumbar vertebra. The lesion was excised and histologically confirmed to be fibrous dysplasia. The patient remained well 8 years after operation. Including the present case, a total of 22 cases of monostotic fibrous dysplasia of the spine were found in the literature. Combining these reported cases, we found that the condition affects either sex with equal frequency and presents at any age, the mean being 32 years. There is no predilection for any part of the spinal column, though sacral or coccygeal involvement is distinctly rare. It most commonly involves the body and adjacent pedicle, although no part of the vertebra is spared. It is worth noting that a propensity for progressive enlargement, even to the extent of causing graft destruction, exists if the lesion is left untreated or incompletely treated. Complete removal of all involved bone, together with stabilization, should therefore be the treatment of choice for this condition.
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Affiliation(s)
- L T Chow
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin, Hong Kong.
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