Tumeurs fibrolipomateuses hémosidérotiques: une nouvelle entité à ne pas méconnaître

Fatty tissues lesions are the most frequent of both benign (lipoma) and malignant tumor (liposarcoma) of soft tissues in the adult. We here describe the case of female patient having a fatty tissue mass of the ankle corresponding to an hemosiderotic fibrohistiocytic lipomatous lesion (HFHLL). This very rare tumour of recent description is specific of the ankle/foot area of the middle age women. These lesions are always benign and frequently recur following incomplete resection. This tumor may have invasive local growth and metastases have not been described so far. We describe the anatomopathologist's key points of their diagnostic. We discuss the main differentials diagnosis and treatment.

Oncogenic osteomalacia: localization of underlying peripheral mesenchymal tumors with use of Tc 99m sestamibi scintigraphy

OBJECTIVE

To highlight a strategy for potential detection of mesenchymal tumors in oncogenic malacia, as illustrated by 3 cases.

METHODS

Three case reports are presented in which successful localization of the offending neoplasm was accomplished by using whole-body Tc 99m sestamibi scanning. Alternative localization techniques are also reviewed.

RESULTS

Oncogenic osteomalacia occurs infrequently and is caused by neoplasms that secrete phosphatonins, substances that interfere with proximal tubular resorption of phosphorus and can result in phosphaturia, hypophosphatemia, reduced 1,25-dihydroxyvitamin D concentration, and osteomalacia. Removal of the underlying neoplasm results in complete resolution of all biochemical, pathologic, and physical manifestations of this disorder, as shown in our 3 patients. Because the neoplasms are small and can occur in any tissue compartment, they are difficult to localize, a feature that often results in therapeutic failure.

CONCLUSION

We conclude that use of whole-body Tc 99m sestamibi scanning may be an appropriate and cost-effective initial strategy for the localization of peripheral phosphatonin-secreting tumors.

Obesity: an endocrine tumor?

Obesity is one of the most common disorders in clinical practice. The prevalance of obesity has increased by more than 60% since 1990. Adipose tissue acts as an endocrine organ secreting many factors into the blood, known as adipokines, including leptin, adipsin, acylation-stimulating protein, adiponectin, etc. This article examines the hypothesis that obesity may be evaluated as an endocrine tumor, regarding its genetic basis, hyperplasia and hypertrophy of adipocytes, neovascularisation within the adipose tissue associated with growth, and beneficisal metabolic effects of surgical removal of excess adipose tissue by liposuction. Assuming obesity as an endocrine tumor may bring out new treatment modalities. Liposuction as "cytoreductive surgery", antiangiogenic teraphy or anti-neoplastic drugs may be important components of obesity treatment in future.

Lipoblastomatosis of the neck causing hemiparesis: a case report and review of the literature

BACKGROUND

Lipoblastoma and lipoblastomatosis are rare pediatric adipose tumors that sometimes affect the neck or spinal cord. This case is the third report of lipoblastoma extending into the spinal canal, the first report of intradural tumor extension, and the first report of hemiparesis resulting from lipoblastoma compressing the spinal cord.

METHODS

A 13-month-old boy was seen by a pediatrician for a firm, supraclavicular neck mass on the left side. After being evaluated by CT and MRI scanning, the tumor was partially resected.

RESULTS

Postoperative microscopic examination of the tumor showed adipose cells with mature nuclei and well-formed fat vacuoles interspersed with fibrovascular septa, a finding consistent with maturing lipoblastoma.

CONCLUSIONS

Although lipoblastomatous tumors are treated with complete surgical resection when possible, location of these tumors in the neck may dictate partial resection to avoid intraoperative injury to the spinal cord.

[Isolated trigeminal neuropathy associated with a fatty tumor of Meckel's cavum]

INTRODUCTION

In recent years there has been increasing interest in isolated trigeminal sensory neuropathy. We present a case with an unusual association of this neuropathy and a fatty tumour of Meckel's cavum.

CLINICAL CASE

A 24 year old man consulted for occasional episodes (during the previous two months) of dysesthesia of the right maxillary region. These were self-limiting and lasted only a few minutes. There was no lacrimation, apparent trigger factor, conjunctival injection or reduction in level of consciousness. There were no abnormal findings either on general or on full neurological examination. On cranial CT there was no signal from the tip of the right petrous temporal bone, but no space-occupying lesion nor pathological uptake of contrast material. On cranial MR there was an extra-axial lesion in the superior part of the tip of the right petrous temporal bone of 2 x 2 cm, localized to Meckel's cavum and right cavernous sinus, with a small lobule in the right lateral part of the prepontine cisterna.

CONCLUSIONS

Trigeminal sensory neuropathy has been described in association with different connective tissue disorders, infections of the central nervous system, vascular dilatations and very varied types of tumours, particularly meningioma. The commonest site for lesions related to this clinical condition is the posterior fossa. A tumour in Meckel's cavum is rarely found in relation to this diagnosis, and from our review of the literature, involvement of fatty tumours seems to be rare.