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The authors report a case of carcinoma of the prostate with an unusual presentation. The patient, an 80-year-old man, had swelling of the right buttock and right side of the lower abdomen, diffuse bony pain and increasing weakness of both lower limbs. He responded well to therapy. Aggressive management of previously untreated carcinoma is warranted even in elderly patients with metastatic disease.
The authors describe a cases of sacrococcygeal teratoma observed in an infant after pregnancy without ultrasound surveillance. The mass was located in the buttock with a mainly exo-pelvic extension. There was no other malformation. Ultrasound examination revealed a heterogeneous structure with solid and liquid areas. Alphafoetoprotein level was high but the beta-HCG level was normal. The surgical specimen weighed 1990 grams and presented microcystic cavities and calcifications. Histological examination confirmed the diagnosis of benign complex multitissue teratoma. Postoperative recovery was uneventful and development of the child was normal 45 months after the procedure. The authors review the histologic, diagnostic, and prognostic features of teratomas and emphasize the importance of early surgical management, which is usually feasible in Africa.
A six year old child was diagnosed to have a rhabdomyosarcoma of the muscles of the right buttock. Because of impossibility of radiotherapy and chemotherapy, treatment with Ukrain 10 mg i.v. once every two days, 10 injections (100 mg) was instituted. The following clinical effects were recorded: reduced pain in joints, improved appetite and condition, increased physical activity, reduced fever. The haematological, biochemical, immunological data and some urinary hormone excretion levels were studied before and after treatment.
PURPOSE OF THE STUDY: The authors report 4 observations of Piriformis syndrome, defined as a truncked sciatalgy with sciatic nerve and branches located compression at the buttock passing through the subpiriformis canal. MATERIAL: 4 sportive patients, 26 to 41 years old have been treated surgically after an average of one year and a half of evolution and failure of conservative treatments. The surgical procedure consisted in section of the piriformis muscle and neurolysis of the sciatic nerve. METHODS: The follow-up ranged from one year and a half. The observations were confronted with 11 english language publications, representing 20 observations. RESULT: 2 excellent results. One fair. The result of the last patient is uninterpreted due to a post-operative deficiency of the inferior gluteus nerve. But the pre-operative symptomatology has completely disappeared. DISCUSSION: Symptomatology associated a trunked sciatalgy arising during effort and during a long time sitting position, without lumbar pain. Paresthesy and dyspareunia can sometimes added. The specifics clinical signs are pain induced by palpation at the sacrum lateral edge, perception of a tense piriformis ("sausage shaped mass"), pain reproduction by stretching the piriformis (Freiberg) or by its opposite tensing (Pace and Nagle, Beatty). The complementary exams first allow to eliminate all rachidian or discal aetiology. The diagnosis is based on CT, MRI and bone scan which can show modifications of the piriformis muscle and especially the electrommyogram which confirms the syndrome and specifies the compression level. The aetiology is changeable, mainly represented by modification of piriformis (hypertrophy, contracture or micro traumatisms due to sport or after-effects of direct traumatism) and by anatomical modifications of the sciatic nerve, passing completely or in part through the muscle. First, the treatment must be conservative by sport rest, correction of occupational diseases, local injections and especially stretchings. The results are more often favourable. In case of failure and diagnosis certitude, the surgical treatment is the neurolysis of the sciatic nerve and the muscle section at the musculo-tendinous junction. CONCLUSION: This syndrome must be known but, in spite of its proved authenticity now, must stay an exceptional diagnosis and be based on irrefutable criteria.
The incidence of nonmelanoma skin cancer, including both squamous cell carcinoma and basal cell carcinoma, is a significant health problem in the United States. Actinic keratosis (AK), the precursor of cutaneous squamous cell carcinoma, is a major risk factor for nonmelanoma skin cancer. In addition, AKs are tissue targets for the identification of biomarkers for use in chemopreventive studies. The biomarker addressed in this study is epidermal cell proliferation, as quantitated by proliferating cell nuclear antigen (PCNA). Shave biopsies were obtained from AKs, tissue immediately adjacent to AKs, normal-appearing, upper-medial arm skin, and non-sun-exposed skin from 19 subjects. When any degree of PCNA staining was considered positive (semiquantitative 1-4 scale), there was a significant difference and a progressively increasing mean PCNA labeling index (LI) in the total epidermis (basal and suprabasal layers), beginning with non-sun-exposed buttock skin, with the lowest LI (2.5 + or - 1.6%), followed by upper-medial arm skin (12.3 + or - 7.4%; P = 0.0015), skin adjacent to AKs (19.2 + or - 12.2%; P = 0.0218), and finally, AKs with the highest LI (34.6 + or - 20.1%; P = 0.0017). This same pattern was observed when the epidermis was separated into basal and suprabasal layers, with the exception of a nonsignificant result for upper-medial arm skin compared with adjacent skin in the basal layer (P = 0.3981). PCNA LIs were also analyzed separately by staining intensity (i.e., scores of 1-4). The PCNA LI in skin with varying degrees of sun damage and/or histological atypia is a candidate surrogate end point biomarker for skin cancer chemoprevention studies.
A case of cholesterol embolisation (CE) following instrumentation of an aneurysmal aorta is presented. The patient developed myalgias, livedo reticularis in the buttocks, suprapubic area and legs, that progressed to patchy gangrene and renal failure. Maximum conservative management including heparin, iloprost and haemodialysis was ineffective, in keeping with previous reports that there is no known therapy for CE. The aetiology, presentation, treatment and prognosis of this condition is discussed. With the ever increasing use of endovascular treatment of abdominal aortic aneurysms, this complication may be more frequently encountered.
The authors report a case of malignant granular cell tumor present in right buttock of a 40 year-old male. The diagnosis of these very rare (less than 50 cases reported in literature) and poor prognosis tumors is difficult. The diagnosis criteria of malignancy are reviewed regarding this clinical case and the literature.
We describe 15 soft tissue solitary fibrous tumors (SFTs) occurring in patients 24 to 78 years old (average, 50.6 yr). Ten tumors were benign and arose in the head and neck area (three tumors), thigh (two), vulva (two), upper arm (one), lower leg (one), and retroperitoneum (one). Five tumors were histologically malignant and arose in the thigh (two), abdominal wall (one), buttock (one), and retroperitoneum (one). All of the tumors were grossly well circumscribed. The benign tumors measured from 2 to 10 cm (average, 4.8 cm) and the malignant ones from 3 to 5.5 cm (average, 4.3 cm) in greatest diameter. Microscopically, the benign tumors showed areas of hypercellularity with variable amounts of collagenous and myxoid stroma; one had amianthoid fibers. The malignant tumors were composed of cytologically atypical cells enmeshed in a collagenous or myxoid extracellular matrix. Ultrastructural study of three benign and three malignant tumors showed fibroblastic differentiation; one benign tumor showed myofibroblastic differentiation. Immunohistochemically, all of the tumors examined were immunoreactive for vimentin, and seven of nine were positive for CD34, including all of the malignant ones. There was focal staining for muscle actin in two benign tumors and for Leu-7 in one benign tumor; there was no staining for cytokeratin, desmin, S-100 protein, epithelial membrane antigen, or smooth muscle actin in any of the examined tissues. Follow-up was available for eight patients for 6 to 21 months (average, 12 mo). No tumor recurred locally or metastasized. The SFTs reported herein support the experiences of others who recently described these tumors in the somatic soft tissues. In addition, our series highlights the occurrence of malignant SFTs in the soft tissues. SFTs should be separated from other spindle cell sarcomas, with which they can be confused.
Perineal war wounds involve the anterior perineum or urogenital perineum and posterior perineum or ano-sphincteric perineum. They are rare in civilian practice and in war practice, as only a small and hidden surface of this anatomical region is exposed to damaging agents. An isolated wound of the perineum is rarely life-threatening, but always threatens the functional prognosis of these patients, who have a mean age less than 30 years. In war practice, these wounds are often associated with lesions of adjacent of sacral, buttock or abdomino-pelvic regions. This article is confined to perineal war wounds in men. Lesions of the urethra and anus and rectum, as well as lesions of the genital appendages and pelvic nerves, leave micturating, gastrointestinal and sexual sequelae, which are sometimes permanent. These sequelae must not be exacerbated during investigation and surgical repair, despite the unfavourable emergency context, associated lesions and the time required to repair them. The basic principles of surgical treatment remain urinary diversion by a large cystostomy tube for urogenital lesions, faecal diversion by terminal colostomy for ano-sphincteric lesions, conservative debridement of the margins of the anal or urethral wound, debridement and drainage of contaminated soft tissues and connective tissue spaces. First-line immediate suture of the urethra or edges of the anal wound must be considered according to the defect, and the septic and haemorrhagic context. When ideal repair cannot be performed, alignment over an urethral catheter, urethrostomy, fixation-identification of the urethral or anal extremities constitute intermediate procedures allowing secondary urological and proctological specialized procedures in these patients.
Retrorectal cyst hamartomas or so called tail gut syndrome are dystopic lesions, rarely reported in Literature, characterized by the presence of cysts lined by mucous-producing ciliated epithelium. The Authors report a case, recently observed and surgically treated, in a 55 year old male, hospitalized because of an abscess and fistula in the right buttock diagnosed to be a cyst hamartoma. The Literature is reviewed as well.
The gluteal region is an excellent donor site for autogenous breast reconstruction, particularly when the lower abdomen is not suitable. The superior gluteal perforator flap involves microsurgical transfer of skin and fat from the buttock without muscle sacrifice. Gluteal myocutaneous flaps have been described, but they have several problems, including a short vascular pedicle, exposure of the sciatic nerve, and recipient vessel size discrepancy needing vein grafts.
A 47 year-old woman who had a 4-year history of intramuscular pentazocine injections in the lower extremities, developed gradual stiffness and weakness of the lower extremities. The thigh and buttock muscles were "wooden-hard" on palpation. The skin was hard, shiny and hairless. Associated clinical and electrophysiological polyradiculopathy and multiple mononeuropathy of the lower extremities were observed. Imaging studies showed calcification and fibrosis of the involved muscles. Muscle biopsy revealed fibrous myopathy. Caution in longterm usage and early recognition of pentazocine toxicity as a neuromuscular complication are important in order to prevent irreversible drug-induced fibrous myopathy and localized neuropathy.
The glucagonoma syndrome is characterized by dermatitis, stomatitis, elevated serum glucagon levels, abnormal glucose tolerance, weight loss, and anemia--all in association with a glucagon-secreting alpha-cell tumor of the pancreas. A review of 21 cases showed strikingly similar features. A generalized, symmetrical dermatitis initially appeared to be asteatotic or eczematous over the perineum, buttocks, and lower extremities. Gradually, a more characteristic migratory necrolytic erythema with transient bulla formation and erosions developed in intertriginous and dependent areas. Histologically, the most specific features included necrolysis of the upper epidermis, with liquefaction necrosis of the granular cell layer and subcorneal clefting or blister formation. The dermatologist is often first to examine such patients; early recognition of this syndrome with prompt surgical removal of the primary pancreatic lesion may afford cure of the neoplasm.
Glucagon-secreting tumors of the pancreatic islets (glucagonomas) produce a distinctive syndrome in which weight loss, diabetes mellitus, anemia,and prominent mucocutaneous findings occur. The cutaneous component-necrolytic migratory erythema--may be polymorphous, but most commonly manifests as erosions and crusts of the groin, perineum, buttocks, distal part of the extremities, and central area of the face. Alternatively, scaly papules and plaques may predominate in these areas. The eruption may resemble such dermatoses as pemphigus foliaceus, acrodermatitis enteropathica, chronic mucocutaneous candidiasis, psoriasis, and severe seborrheic dermatitis. Two patients with chronic, previously undiagnosed dermatoses had necrolytic migratory erythemia, which led to the discovery of glucagonomas present in each. In one patient surgical resection of the tumor resulted in total clearing of the rash within 48 hours. Awareness of this distinctive entity may lead to early diagnosis and, possibly, cure.
An 18-month-old infant had diffuse, gray-blue pigmentation on the buttocks bilaterally, extending the entire length of his right leg in a dermatomal pattern. In the lesion there were several conspicuous macules of considerably darker hue. Histologic and ultrastructural examinations revealed numerous dermal melanocytes. Clinically and pathologically, the patient had a distinctive type of dermal melanocytosis for which we propose the name "dermal melanocyte hamartoma."
Although paraneoplastic phenomena occur frequently in patients with hepatocellular carcinoma, cutaneous changes have rarely been reported. During the past two years, ten South African blacks with hepatocellular carcinoma and pityriasis rotunda have been seen in a single hospital. The rash affected the trunk, especially the lower back and buttocks. The lesions ranged in size from 1.5 to 25 cm and were always multiple. They had a characteristic circular or arcuate configuration with scaling and varying degrees of hyperpigmentation. Pityriasis rotunda may prove to be a useful cutaneous marker of hepatocellular carcinoma in South African blacks.
BACKGROUND: Exposure to UV radiation is a major risk factor for skin cancer, including malignant melanoma. Photocarcinogenesis is caused largely by mutations at sites of incorrectly repaired DNA photoproducts, of which the most common is the thymine dimer. Over the past decade, controversy has arisen over the use of sunscreens to prevent UV-induced skin cancer. OBJECTIVES: To determine if daily application of a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 protects human skin against UV-induced DNA damage as determined by the formation of thymine dimers after repeated exposures to simulated solar light and, if so, to determine whether daily applications are required to achieve this protective effect. METHODS: Over 4 consecutive days, an SPF 15 sunscreen was applied homogeneously to each of 4 buttock sites of 18 women 30 minutes before exposure to 2 minimum erythemal doses of UV radiation. Of these 4 sites, 1 was treated with SPF 15 daily, and the remaining 3 were treated on 3 of the 4 irradiation days, skipping application on day 2, 3, or 4. A fifth site served as the untreated control and was also not irradiated. The number of cells per square millimeter positive for thymine dimer formation was determined using immunohistochemical and image analyses. RESULTS: There was no significant difference in thymine dimer formation between nonirradiated and irradiated skin when application of sunscreen preceded each irradiation. However, when sunscreen application was omitted even once prior to irradiation, a statistically significant increase in thymine dimer formation was apparent. At 48 hours after irradiation of unprotected skin, 50% of epidermal dimers present 24 hours after irradiation had been removed; at 72 hours, more than 75% were gone. CONCLUSIONS: Our study indicates that regular use of a broad-spectrum sunscreen is effective in preventing a major form of UV-induced DNA damage. Irregular and inadequate use of sunscreen during exposure to UV radiation results in thymine dimer formation, which may lead to mutation and subsequent cancer development.
BACKGROUND: The immunomodulatory role of vitamin D and its analogues has been demonstrated in vitro and in vivo using animal models. We evaluated the effect of a vitamin D analogue, calcipotriene, in vivo on human subjects using a contact hypersensitivity model. OBSERVATIONS: Subjects were pretreated with topical calcipotriene, simulated solar radiation, or both on buttock skin. They were then sensitized and challenged using the contact allergen dinitrochlorobenzene. Immune response was measured by change in skinfold thickness before vs after elicitation across the challenge sites. CONCLUSIONS: Calcipotriene-treated individuals demonstrated 64% immunosuppression compared with untreated controls. This is equivalent to the immunosuppression induced by UV exposure.