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PubMed1994

MR imaging of benign fatty tumors in children: report of four cases and review of the literature.

This study correlates the magnetic resonance imaging characteristics with the pathologic findings in rare benign fatty soft tissue tumors in four children. A review of the literature is presented. Two cases of infiltrating lipoma displayed bright signal on both T1- and T2-weighted images, similar to that observed in subcutaneous fat. Histological study revealed extensive muscle infiltration by mature fat, with some areas of total fatty replacement. The case of facial lipomatosis revealed an extensive process of fatty invasion of adjacent soft tissue and osseous deformity by mass effect of the tumor. This lesion was bright on T1- and T2-weighted images. Histopathologic examination showed widespread invasion of squamous mucosa and skeletal muscle. The single case of lipoblastoma involved the presacral region and right buttock. This lesion, although bright on both T1 and T2 weighting, was relatively hypointense to subcutaneous fat on T1. Microscopic examination revealed a well-encapsulated fatty mass made up of cells ranging from lipoblasts to mature lipocytes. In childhood, when fatty lesions are almost always benign, a morphologic characterization by magnetic resonance may be sufficient basis on which to make critical therapeutic judgements.

Adolescent↗
PubMed1982

von Recklinghausen's disease and malignant changes in three patients.

Three Japanese patients with von Recklinghausen's disease and malignant changes were studied. The primary lesions of malignant changes were the chest wall in Case 1, the buttock in Case 2, and the neck in Case 3. After excision of the tumors, there were local recurrences in Cases 1 and 2. Distant metastases developed during treatment in these patients. One of the patients (Case 1) died 21 months after the initial diagnosis of malignancy. Multidisciplinary treatment was of some value in suppressing local recurrences and pulmonary metastases in Case 2. Pulmonary metastases were evident at the time of admission to our hospital in Case 3. Although the primary and metastatic tumors were removed, the patient died 8 months after the initial diagnosis of malignancy. We conclude that careful follow-up should be required in patients with von Recklinghausen's disease because of the possibility of malignant changes. When there is a suspicion of malignancy, an extended en-block excision must be performed.

Adolescent↗
PubMed1979

Aneurysm of a persistent sciatic artery.

Angiographic examination in a patient with sciatic-like pain on the right side and a firm, pulsatile, non-tender mass in the right buttock revealed a large sciatic artery aneurysm. The aneurysm was successfully resected at surgery. The primitive sciatic artery is the main arterial supply to the lower extremities in the 9-mm embryo. Its persistence, while very rare, is of clinical significance because of the tendency for aneurysms to develop in the artery. Surgical resection is indicated in sciatic artery aneurysms because of the danger of rupture or embolic occlusion of arteries distal to the aneurysm.

Adult↗
PubMed2002

Sarcoidosis breaching the fascia and mimicking a sarcoma.

A 55-year-old woman complained of a subcutaneous mass in her left buttock. MR images revealed an ill-defined soft tissue mass that crossed the fascia of the gluteus maximus muscle. Some surrounding edema was noted. The lesion showed some contrast uptake after administration of Gd-DTPA. An excisional biopsy revealed sarcoidosis involving both the muscle and subcutaneous tissue across the fascia, mimicking a sarcoma.

Buttocks↗
PubMed2003

Low-grade liposarcoma with osteosarcomatous dedifferentiation: radiological and histological features.

We describe the radiological and pathological findings of a rare case of a low-grade liposarcoma associated with a high-grade osteosarcomatous component in a 78-year-old woman. Pre-operative imaging demonstrated a well-encapsulated homogeneous fatty tumour in the right buttock deep to the gluteal musculature. Centrally within the fatty tumour a region of increased soft tissue attenuation on CT and heterogeneous high signal on fat-saturated T2-weighted MRI was seen with amorphous calcification/ossification. Histological assessment revealed a low-grade liposarcoma containing an area of dedifferentiation that resembled an osteosarcoma. We describe the radiological-pathological findings in this rarely reported clinical entity and discuss the differential diagnosis of calcification within lipomatous tumours.

Aged↗
PubMed2004

Ischiogluteal bursitis: an uncommon type of bursitis.

Ischiogluteal bursitis is a rare, infrequently recognized soft tissue mass of the buttock region. Of importance is the radiological differential diagnosis with other benign and malignant soft-tissue tumors. We describe the imaging findings of bursitis.

Bursitis↗
PubMed2006

Subcutaneous panniculitis-like T-cell lymphoma: US and CT findings in three patients.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare disorder. We examined two females and one male with multiple soft-tissue masses in the abdominal wall. One of these three patients also had soft-tissue masses in the right thigh and right buttock. The histologic diagnosis was revealed as SPTCL in all three cases. The ultrasound (US) findings in two of these cases were diffuse, ill-defined hyperechoic areas with a linear vascular signal. The findings of the abdominal and pelvic computed tomography (CT) scanning with contrast enhancement were multiple enhancing nodules with an infiltrative pattern of peripheral subcutaneous fat layer in all three cases. We report US and CT findings of SPTCL in these three patients.

Adult↗
PubMedDate not supplied

Remodeling bodylift with high lateral tension.

Body lifts are surgical procedures that are infrequently performed because the length of operating time increases the risk to the patient as well as the likelihood of surgeon fatigue. The other drawback of body lifts is the long incision line. However in our experience, these incisions are well accepted if they are well placed and if the results of body change is significant. The goal of this paper is to show how operating time can be shortened and the scar be correctly positioned by using precise preoperative markings. In addition to high superior tension abdominoplasty, the two innovations of this type of body lift are the dermal fat flap and the suspension of tissue in the trochanteric and buttock regions. Meticulous hemostasis limited undermining, and the closure of dead space are factors that produce a more reliable procedure, both in terms of postoperative problems and the final results.

Abdomen↗
PubMed2004

The concentric medial thigh lift.

Plastic surgeons often are asked to perform horizontal medial thigh lifts because the skin of this area has poor elasticity, inducing excess skin, and also because there is upper fat deposit. This excess skin and fat lead to irritation and even functional problems. But surgeons dislike this operation because of its justified bad reputation. Obviously, this area is difficult to manage because of the many possible side effects (e.g., healing difficulty, scar migration, necrosis, effusions, pain) and unreliable results. A new way of thinking is proposed to lighten this operation and make its more frequent use possible. This horizontal technique presents several innovating points: -A new incision line located along the labia major in the perineal crease remains at the same height backward. The incision never descends into the buttock fold. -No undermining whatsoever occurs even in the resection area. Liposuction is the key to avoidance of any undermining. It is performed everywhere in the thigh, but most importantly under the resection area where all the fat must be eliminated to lighten the flap and favor its lifting. -The resection removes only the skin layers (epidermis and dermis) and not the liposucted tissue, which is very thin. Consequently, all lymphatic and other vessels are preserved, and the healing process is much easier. Moreover, there is no dead space after ascension of the flap and no risk of effusion. -The resection is realized on demand, depending on the excess of skin brought on the incision line by each anchor suture. Therefore, any tension on the skin closure is avoided. -The direction of the skin stretching is concentric toward the labia minor. Consequently, the length of the scar is shortened at both the front and the rear. -Anchor sutures pull a nonundermined skin, thus drastically decreasing the risk of necrosis. In the past 2 years, 25 patients, most of them as outpatients, have undergone surgery using this technique, with a real improvement in the quality of the result, as compared with the results from the standard technique.

Adipose Tissue↗
PubMedDate not supplied

Restoration of the gluteal fold by a deepithelialized skin flap: preliminary observations.

BACKGROUND: The gluteal fold represents an important aspect of the gluteal region. Destruction of this anatomic landmark as a consequence of trauma or tissue harvest can result in an aesthetically disturbing disfigurement. A technique for reconstruction of the gluteal fold and preliminary results are presented. METHODS: The newly formed gluteal fold is created by fixation of a deepithelialized skin flap to the periosteum of the tuber ischiadicum. RESULTS: The operative procedure is quick and easy to apply. The method is used mainly for patients with a distorted gluteal fold after tissue harvest for breast reconstruction. However, it also can be used after trauma such as that associated with burn injuries. In all patients, reconstruction of the gluteal fold yielded aesthetically pleasing and reliable results with high patient satisfaction. CONCLUSIONS: The authors present a simple and effective technique for reconstruction of the gluteal fold by a deepithelialized skin flap. The technique is applicable for patients who have lost their natural gluteal sulcus, with a resultant altered buttock shape, after trauma or other causes.

Adipose Tissue↗
PubMedDate not supplied

Augmentation gluteoplasty: the XYZ method.

Gluteal implants offer a good way not only to correct hypoplasias, but also to remodel and give rounded shape to buttocks, achieving beauty and sensuality. However, until recently, only a few surgeons have used this procedure. An intramuscular introduction of the implants may be a good means of reaching this goal, but because the undermining is performed without direct view, difficulties may occur in obtaining a symmetric and safe plane, and this can lead to unpleasant results. This report presents an intramuscular method based on geometry, in which three points (X, Y, and Z) and a line (G) in the pelvis define the plane in which the dissection must be performed, allowing more precise and safe undermining. From 1986 to 2003, 746 patients underwent surgery using this technique, achieving good results. This technique has proved to be a safe and reproducible way of performing augmentation gluteoplasty.

Adolescent↗
PubMedDate not supplied

Morphology of the gluteal region in the female population 5 to 83 years of age.

This study evaluated the development of gluteal region morphology in the female population 5 to 83 years of age. For the study, 132 female subjects were placed into four groups: prepubertal (ages 5 to 8 years; n = 10), pubertal (ages 9 to 14 years; n = 38) postpubertal (ages 15 to 41 years; n = 34), and menopausal-postmenopausal (older than 42 years; n = 29). The age, weight, and height of the subjects were routinely recorded, and body mass index was estimated. In addition, 11 measurements were performed on the gluteal region. The data were analyzed by Pearson and Spearmen correlation analyses using SSPS 11.0 for Windows. In the prepubertal group, the intergluteal sulcus and infragluteal sulci did not actively change. Weight gain was the major factor influencing the shape of the gluteal region, whereas age had no effect. In the puberty group, the gluteal region expanded in all directions. During this period, it was difficult to determine any specific relation between measurements because of significant correlation involving all parameters. However, it should be mentioned that among the four groups, only in pubertal group did age significantly affect the shape of the gluteal region. In other three groups, weight seemed to be a major determinant. In the pospubertal and menopausal-postmenopausal groups, the buttocks sagged with weight gain, contrary to the belief that this happens with aging. This causes movement of the infragluteal sulci in downward and lateral directions as well as lengthening of intergluteal sulcus. Although the gluteal shape is open to the effects of demographic factors such as ethnicity, feeding habits, and lifestyle, according to these findings, it might be advised that in the assessment of the gluteal region morphology, it would be better to consider its dynamic nature. Reshaping its only one part, which can be devastating unless the whole gluteal region and upper limb are addressed.

Adult↗
PubMedDate not supplied

Etiology, definition, and classification of gluteal ptosis.

BACKGROUND: Despite the growing interest in aesthetic surgery of the buttocks and posterior body contouring, there is no clear definition of gluteal ptosis nor any classification enabling standardized diagnoses and treatments of the problem. The author proposes a classification to differentiate between pseudo-ptosis, PRE-ptosis, and true ptosis. The classification includes five degrees of severity and two factors (the length of the lower gluteal crease and the measurement, in centimeters, of posterior gluteal tissue exceeding the crease at a sagittal line that passes through the middle of the thigh, seen from behind, which the author proposes to call the "M" line). The article exposes the anatomy involved in ptosis and presents a theory about the mechanism through which gluteal ptosis is formed. METHODS: During a 1-year period, 87 patients, eligible for different types of body aesthetic surgery, were assessed according to the proposed classification. Their ages ranged from 16 to 64 years, and their weight ranged from 43 to 82 kg. Body mass index was used to classify overweight patients. Weight loss was considered in 10% increments. RESULTS: The authors were able to classify all the patients according to the proposed classification. Weight, age, and weight loss were directly related to the severity of the ptosis. CONCLUSIONS: The proposed classification is easy to apply and has the ability to standardize diagnoses and treatments for gluteal ptosis. This study also shows that weight gain, aging, and weight loss are etiologic agents of ptosis.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging assessment of gluteal fat grafts.

BACKGROUND: One goal of lipoplasty is to create a round and projected buttock contour. Despite multiple papers evaluating lipoinjection, controversies still remain. METHODS: This report describes a series of patients who underwent liposuction, gluteal lipoinjection, and evaluation with magnetic resonance imaging (MRI). From January 2003 to January 2004, the patients scheduled for contour surgery by the investigators were evaluated using MRI, photographic records, and gluteal circumference measurement 1 week before surgery, then 2 weeks and 3 months after the procedure. A statistical analysis was performed for 10 patients who received, on the average, a 350-ml injection of fat obtained during liposuction. RESULTS: Gluteus muscle volume increased, reaching a higher level 2 weeks after the injection than the level 3 months afterward (p < 0.001). The gluteal circumference, modified 2 weeks after surgery by about 1 to 3 cm, came back to previous values 3 months after the procedure (p < 0.05), a phenomena interpreted as reabsorption and resolution of the postoperative edema. There is no correlation between the gluteus muscle volume obtained by MRI and the gluteal circumference (p > 0.05). CONCLUSIONS: The findings led to the conclusion that enhancement of the gluteal contour after fat injection results from survival of the injected tissue 3 months after the surgery, which was objectively evaluated by MRI as having a calculated reabsorption rate of 24% to 36%.

Adipose Tissue↗
PubMed2007

Piriformis muscle: clinical anatomy and consideration of the piriformis syndrome.

Patients with lumbosacral and buttock pain provide tacit support for recognizing the piriformis muscle as a contributing factor to the pain (piriformis syndrome). One hundred and twelve cadaveric specimens were observed to elucidate the anatomical variations of the piriformis muscle referred to the diagnostic and treatment of the piriformis syndrome. The distance between the musculotendinous junction and the insertion was measured and the piriformis categorized into three types: Type A (71, 63.39%): long upper and short lower muscle belly; Type B (40, 35.71%): short upper and long lower muscle belly; Type C (1, 0.9%): fusion of both muscle bellies at the same level. The diameter of the piriformis tendon at the level of the musculotendinous junction ranged from 3 to 9 mm (mean: 6.3 mm). The piriformis showed the following possible fusions with adjacent tendons. In type one (60, 53.57%) a rounded tendon of the piriformis reached the upper border of the greater trochanter. In type two (33, 29.46%) it first joined into the gemellus superior tendon and at last both fused with the obturator internus tendon and inserted into the medial surface of the greater trochanter. A fusion of the piriformis, obturator internus and gluteus medius tendon with the same insertion area as above was observed in type three (15, 13.39%) and finally in type four (4, 3.57%) the tendon fused with the gluteus medius to reach the upper surface of the greater trochanter. Based on this survey anatomical causes for the piriformis syndrome are rare and a more precise workup is necessary to rule out more common diagnosis.

Adult↗
PubMed1998

Ischiogluteal bursitis mimicking soft-tissue metastasis from a renal cell carcinoma.

We report a case of ischiogluteal bursitis mimicking a soft-tissue metastasis from a renal cell carcinoma. A 66-year-old woman suffered from pain over the left buttock 6 months after she was operated on for renal cell carcinoma of the left kidney. CT of the abdomen and pelvis revealed a tumor-like lesion adjacent to the left os ischii, which was suspected to be a soft-tissue metastasis. Percutaneous biopsy revealed no evidence of malignancy, but the histopathological diagnosis of chronic bursitis.

Aged↗
PubMed2001

CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process.

Piriformis muscle syndrome (PMS) is a cause of sciatica, leg or buttock pain and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The aim of our paper was to evaluate the feasibility of CT-guided percutaneous botulinic toxin (BTX) injection for the purpose of PMS treatment. Thirty patients suffering from PMS, suspected with clinical and electrophysiological criteria, after imaging examinations excluding other causes of sciatic pain, resulted positive at the lidocaine test and were treated by intramuscular injection of BTX type A under CT guidance. The follow-up (12 months) was performed with clinical examination in all cases and with MR 3 months after the procedure in 9 patients to evaluate the denervative process entity of the treated muscle. In 26 cases relief of symptoms was obtained after 5-7 days. In 4 patients an insufficient relief of pain justified a second percutaneous treatment which was clinically successful. No complications or side effects were recorded after BTX injection. The MR examination showed a signal intensity change of the treated muscle in 7 patients due to the denervative process of PM, whereas in the remaining 2 cases only an atrophy of the treated muscle was detected. Larger series are necessary to confirm these MRI preliminary results. The CT-guided BTX injection in the PMS is an emergent and feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation.

Adult↗
PubMed2005

A case of recurrent and synchronous fibrous hamartoma of infancy.

We retrospectively reviewed the chart of a patient with recurrent fibrous hamartoma of infancy (FHI). This lesion presented as a gradually enlarging mass on the child's buttock. The child, a 6-month-old male, was followed up, and at 19 months of age the mass was excised. Eighteen months after the initial operation, a local recurrence was noticed. Forty-one months after the initial operation, reexcision was performed. Both masses demonstrated the characteristic features of FHI, which should be considered in the differential diagnosis of subcutaneous mass in young children.

Buttocks↗