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Two cases of clear cell sarcoma of tendons and aponeuroses, one with prominent melanogenesis, are reported. One tumour arose in the left buttock of a young male and the other in the left fourth toe of a young female. Both had a rapid fatal course with local and distant metastases. Electron microscopy shows melanosomes in one case, suggesting a melanotic origin.
Contusion or prolonged compression of the buttock produced severe local injury in 3 cases. Rhabdomyolysis with acute renal failure occurred in 2 of these cases, and one of them had an associated sciatic nerve palsy. The affected muscles included the gluteus maximus, gluteus medius, and the tensor fascia latae. Clinically and experimentally, these muscles were shown to be functionally enclosed within separate compartments like the peripheral limb muscles. Prompt decompression in the two cases with pressures exceeding 30 mm Hg resulted in muscle and nerve recovery.
A 13-year-old girl incurred gas gangrene after intramuscular injection of adrenaline to the buttock. Clinical evidence of very severe pain at the site of injection with septicemia and collapse within 24 to 48 hours should arouse the suspicion of clostridial myositis rather than pyogenic infection. Early diagnosis and treatment by adequate excision of necrotic muscle (with a wide margin of normal-appearing muscle) can prevent loss of life or limb in these patients.
The buttockectomy is an en bloc resection of the gluteus maximus muscle and is usually performed for low-grade malignancy tumors of the buttocks that are encompassed by the muscle excised. After the incision of the skin widely around the tumor, skin flaps are created to expose the entire gluteus maximus muscle; the inferior rolled edge of the muscle is identified and traced laterally to its insertion on the iliotibial tract. For a left buttockectomy the operator proceeds clockwise, first releasing the insertions of the muscle from the iliotibial tract and greater trochanter and the origins from the crest of ilium and sacrum. For a right buttockectomy one proceeds in a counterclockwise fashion, again starting at the inferior aspect of the gluteus maximus muscle. Care must be taken to avoid damage to the sciatic nerve and to secure the inferior and superior gluteal vessels before they are transected. Suction drainage is secured to remove serum and ensure adherence of skin flaps to the resection site. If the skin closure is tight, retention sutures may be needed.
Involvement of the skin in advanced Hodgkin's disease is well known. However, Hodgkin's disease initially seen in the skin is extremely rare. A patient had Hodgkin's disease that was initially seen as a cutaneous lesion on the buttock. Lymphadenopathy developed two months after completion of local radiotherapy to the cutaneous lesion and seven months after initial diagnosis. The histologic changes in both instances were those of Hodgkin's disease. We discuss problems in the diagnosis and treatment of skin involvement with Hodgkin's disease.
Erysipelas developed in a young woman whose condition had been in remission for ten years after treatment of stage IIIA Hodgkin's disease. The erysipelas was atypical both in its clinical manifestation and its causative organism. The patient had an erythematous, macular eruption on both buttocks and thighs. Group G streptococci, a rare cause of erysipelas, were isolated from both blood cultures and a skin biopsy specimen. The unusual clinical manifestation of the disease when the patient was initially seen may have been the result of a group G streptococcal bacteremia, coupled with impairment of the lymphatic drainage of the involved area from a partial thoracic duct obstruction and a restrictive cardiomyopathy, both secondary to previous irradiation treatment.
A case of 12 years old girl operated on because of genu recurvatum and paretic clubfoot after buttock and thigh phlegmon in infancy has been presented. There were 2 stages. In the first one the correction of clubfoot was performed, m.quadriceps was elongated in the second one. Good cosmetic and functional result has been achieved.
A persistent sciatic artery results from lack of regression of the fetal arterial blood supply of the leg and is often combined with an abnormally developed superficial femoral artery. A rare case of bilateral persistent sciatic artery with unilateral thrombosed aneurysm of the right buttock was found. The right sciatic artery was completely developed and terminated in the popliteal artery, which showed thromboembolic occlusion. The right superficial femoral artery was hypoplastic and showed no connection with the popliteal artery. The left sciatic artery was incompletely developed, and the popliteal artery was fed by a normal superficial femoral artery. All of the 104 cases published of persistent sciatic artery were reviewed according to the degree of development, side localization, clinical signs and frequency of aneurysms, as well as the morphology of the ipsilateral superficial femoral artery.
We report three cases of a rare morphologic variant of the cellular blue nevus, which usually occurs in young patients on the buttocks and lumbar area. This variant is characterized by the myxoid degeneration of the stroma, which separates alveolar nests of nevus cells. The uncommon occurrence and atypical pathologic features may bring about diagnostic pitfalls and unnecessary excessive treatment modalities, therefore, we tried to re-evaluate the criteria of diagnosis of cellular and malignant blue nevi.
Elephantiasis is an uncommon disease in the United States. We present a case of nonfilarial elephantiasis nostras verrucosa in a 14-year-old girl. Most commonly, the upper and lower extremities are affected; the disease, in this patient, was confined to the buttock. The patient has done well after excision and primary closure. The patient is currently undergoing pressure therapy 1 year after surgery. She has no evidence of recurrence. We present this case and review the literature.
This is the case of a 13 year-old female evaluated for a congenital skin lesion on the left buttock. Physical examination revealed a well-defined light brown patch with a 4mm papule on the center. A skin biopsy revealed an increased number of eccrine glands associated to a proliferation of vascular channels, particularly capillaries. These findings are consistent with a diagnosis of eccrine angiomatous hamartoma.
Ninety people were evaluated on age-related changes of the dermal connective tissue in light-exposed and protected skin areas non-invasively by 20-MHz sonography. The method allows sonographic structures to be measured and densitometric values to be quantified in a region of interest. Sonography of sun-exposed skin regions shows an echo-poor band in the upper dermis, which corresponds to actinic elastosis in the histological picture. The band is sharply demarcated from the entry echo. The border towards the non-actinically altered dermis below is often serrated. The sonographic phenomena can be explained by the micromorphological changes that develop in the upper dermis in actinic elastosis. An increased amount of elastic material and the destruction of the fiber architecture as well as an increase in ground substance and a mild inflammatory reaction cause a reduction in echogenicity. The extent of elastotic alterations and their progression is expressed in the densitometric values. These are low in areas of high sun exposure (the forehead and the infraorbital region). The echogenicity of the echolucent band (ELB) diminishes with increasing age. In highly exposed regions we found the lowest densitometric values already in the 41- to 50-year-olds. However, the width of the ELB remains relatively constant, extending in all locations to the middle dermis. This finding differs from earlier publications. On the buttock skin as a nonexposed area, an ELB could only be found in 6.7% of the cases.
This case report describes a patient who had a painful and fungating angiosarcoma of the right buttock. A palliative hindquarter amputation was performed. A large, free flap taken from the amputated leg was used to cover the defect. This technique offers a solution for covering large defects in an unsalvageable traumatic amputation or tumor conditions.
Multiple body contour deformities of the trunk and thighs are commonly treated in separate stages to limit postoperative complications and disability. Recent advances in the surgical design of the medial thigh lift and the lateral thigh/buttock lift along with an understanding of the functional anatomy of the superficial fascial system have significantly improved results and decreased complications of trunk/thigh lifts. The enhanced safety of current trunk/thigh lifts has allowed new combinations to treat multiple body contour deformities in a single stage. Laxity of the entire lower trunk and thigh regions can be treated in one stage in selected patients. The lower body lift combines the transverse flank/thigh/buttock lift and the fascial anchoring medial thigh lift in one operation. In addition to the expected tightening of the flank, buttocks, and total thighs, this procedure results in a surprising degree of epigastric and hypogastric tightening of mild to moderate abdominal laxity without direct surgical undermining or umbilical transposition. Ten patients having the lower body lift alone or in combination with liposuction and other body contouring procedures were followed for 6 to 24 months. The primary indication for surgery is moderate to severe soft-tissue laxity of the lower trunk and thighs with minimal or mild residual fat deposits. Skin contour irregularities due to skin laxity (cellulite of laxity) or to postliposuction adhesions are frequently present and may be severe. Patients with significant fat deposits may be treated initially with liposuction 3 to 4 months earlier to become candidates for this procedure. Key technical elements of this procedure include (1) both supine and lateral decubitus positioning with the hip flexed and abducted to allow overcorrection, (2) appropriate direct surgical undermining through superficial fascial system zones of adherence in the superior thigh while avoiding the lymphatics of the femoral triangle, (3) more distal undermining of the thighs with an atraumatic undermining cannula, (4) resection of redundant lower trunk and thigh tissues with incisional closure within high-cut bikini lines, and (5) complete superficial fascial system and dermal suspension throughout the repair. The lower body lift requires 5 to 6 hours of operating time, 2 units of autologous blood, 2 nights of nursing care, and 3 weeks off work. Although no major complications occurred, minor complications were significantly higher than with the component procedures alone and occurred in 50 percent of patients. Technical changes and improved patient selection have significantly improved the rate of complications in subsequent patients. Results have been consistent, and patient satisfaction has remained high.
Persistent sciatic is a vascular malformation resulting in the embryo from the preferential growth of the ischiatic posterior axis remaining atrophic. We report here two cases of unilateral, complete and incompleted, persistent sciatic arteries, complicated by buttock aneurysm.
Epithelioid hemangioendothelioma is an uncommon intermediate-grade vascular tumor which most often presents in soft-tissue and is known to occasionally metastasize. A primary cardiac occurrence of this tumor was resected from the left atrium of a 71 year-old woman. Four months later, she underwent gluteal exploration and resection of three nodules from her right buttock. These nodules, which resembled the previously resected tumor but showed features of malignant transformation, were identified as metastatic epithelioid hemangioendotheliomas. To the best of our knowledge, only one case of primary cardiac epithelioid hemangioendothelioma has been previously reported in the literature. We believe ours is the second such case and the first to demonstrate distant metastases. This rare case of primary cardiac epithelioid hemangioendothelioma with distant metastases is illustrative of many of the known features and behaviors of the tumor. The case is reviewed and discussed alongside a review of recent topical literature.
Central umbilical artery catheterization, currently a widely used procedure in neonatal intensive care units, is accompanied by a substantial risk of vascular complications. Unilateral skin necrosis of the buttock was the initially seen manifestation of vascular occlusion secondary to thromboembolic phenomena or direct vascular damage from central umbilical artery catheterization in a premature male infant. Skin findings, such as transient blanching or erythema in a neonate who has had umbilical artery catheterization, can precede the evolution of gangrene and necrosis. One should be alert to the possibility of a vascular basis for lesions in infants in whom indwelling umbilical artery catheters have been used.
Spontaneous retroperitoneal abscess as a result of Crohn's disease does not always terminate at the psoas or iliac spaces. The abscess may continue downward breaching the obturator fascia. Passage through the sciatic foramina can result in a buttock or posterior upper thigh abscess. This possibility is illustrated in the case presented by a 40 year old female with toxemia and a fluctuant mass in the right gluteal area. Surgical drainage and control of the sepsis was followed by enterocutaneous fistula formation. Small bowel barium series demonstrated communication of the tracking abscess with the caput cecum. Surgical management consisted of formal ileocolectomy. The pathology report revealed Crohn's disease of the terminal ileum and right colon.