Background We reviewed the literature to evaluate the demographic, clinical and histological profile of giant cell tumour of tendon sheath of the digits (GCTTSD). The overall recurrence rate and the factors affecting tumour recurrence were also assessed. Methods We searched for published articles regarding the GCTTSD in the English literature the last 30 years using the PubMed search engine. All retrieved papers were analysed and their reference lists were also screened if relevant. Clinical studies with less than five patients and follow-up less than 2 years were excluded from further evaluation. For each report, information was gathered related to trial characteristics and study population. Location and multicentricity of lesions, kind and severity of symptoms, type of applied treatment modality and histopathological features of the excised tumours were additionally recorded. A meta-analysis for estimating the pooled recurrence rate after surgical excision was also conducted. Statistical significance was assumed for p ≤0.05. Results We found 21 studies with histological confirmation of GCTTS. However, only 10 studies including 605 patients were reviewed according to selection criteria (average follow-up 36.7 to 79 months). The male-to-female ratio was 1:1.47 (p < 0.005) and the mean age ranged from 32 to 51 years. Pain or sensory disturbances reported only in 15.7% and 4.57% of cases, respectively. A definite history of trauma recorded in 5% of lesions. The most frequent tumour location was the index finger (29.7%). In total, 14.8% of patients had tumour recurrence. Type I tumours (single lesions) were more frequently detected (78.7%) than type II tumours (two or more distinct tumours that were not joined together) (21.3%) but the latter were associated with a higher recurrence rate (p < 0.001). Study design also affected the possibility of recurrence as it was lower in prospective studies compared to retrospective studies (p = 0.003). Even though bone erosion was detected in 28.39%, recurrence was not more common in this group. In addition, recurrence was not significantly associated with a specific finger or phalanx. Conclusions Intrinsic biology of the tumour seems to play a more fundamental role in recurrence than tumour location or local invasiveness. More prospective welldesigned studies including a large number of cases are necessary to identify tumours prone to recurrence and determine the proper treatment protocol for each individual patient.

BackgroundIsolated thumb carpometacarpal dislocation is a rare injury pattern and the optimal treatment option is still controversial.Case DescriptionWe present a 27-year-old basketball player who underwent an isolated dorsal dislocation of the thumb carpometacarpal joint after a fall. The dislocation was successfully reduced by closed means but the joint was found to be grossly unstable. Due to inherent instability, repair of the ruptured dorsoradial ligament and joint capsule was performed.The ligament was detached from its proximal insertion into trapezium and subsequently stabilized via suture anchors. The torn capsule was repaired in an end-to-end fashion and immobilization of the joint was applied for 6 weeks.ResultsAt 3-year follow up evaluation the patient was pain free and returned to his previous level of activity. No restriction of carpometacrpal movements or residual instability was noticed. Radiographic examination showed normal joint alignment and no signs of subluxation or early osteoarthritis.ConclusionSurgical stabilization of the dorsal capsuloligamentous complex may be considered the selected treatment option in isolated carpometacarpal joint dislocations, that remain unstable after closed reduction in young and high demand patients.Level of Clinical Evidence: Level IV

BACKGROUNDPatellar tendon and anterior cruciate ligament (ACL) tear is an uncommon injury. Moreover, the mechanism of injury and the best surgical approach have not been established yet. We believe that case reports like ours contribute to a better understanding of the mechanism of injury and help the surgeon to decide whether to proceed in one-or twostage procedure. CASE PRESENTATIONA 47-year-old professional driver presented in the outpatient clinic of our department after sustaining an injury in his left knee. He was manually unloading a heavy package from his truck and while descending to the ground he felt a double 'pop' in his left knee and fell down. Physical examination revealed diffuse knee swelling. The knee was extremely tender, even in slight palpation, especially anteriorly and medially. A palpable defect of the patella tendon was detected, and active knee extension was impossible. Valgus stress demonstrated medial collateral ligament (MCL) disruption while Lachman-Noulis and pivot-shift test could not be performed because of the intense pain. The anteroposterior and lateral radiographs showed superior displacement of the patella without any other osseous pathology. Consequently, the patient was admitted in our department, under the diagnosis of patellar tendon and MCL tear.

Background and objective: Medical thoracoscopy (MT) is useful for the management of pleural disease. Rapid on-site evaluation (ROSE) of transbronchial needle aspirates proved to be useful during bronchoscopy. We aimed to evaluate the diagnostic performance of ROSE of MT biopsy specimens and thoracoscopists' impression of the macroscopic appearance and assess the intermodality agreement between ROSE and final histopathologic diagnosis. Methods: Sixty two patients with exudative pleural effusions further investigated with MT were enrolled. MT was performed under local anaesthesia and conscious sedation, using the rigid pleuroscope. ROSE with the Hemacolor rapid staining method of the biopsy specimens was performed. Thoracoscopists' impression of the macroscopic appearance was recorded. The final diagnosis was established following histopathological examination. Results: Thoracoscopic pleural biopsies were diagnosed in 61 patients (98.4%). Group A (n = 25) consisted of patients with malignancy and group B (n = 37) with benign disorders. Area under the curve of ROSE for the diagnosis of malignancy was 0.86 (95% CI: 0.76-0.96, P < 0.001), with a sensitivity of 79.17%, specificity of 94.59%, diagnostic accuracy of 88.5%, positive predictive value of 90.5% and negative predictive value of 87.5%. Intermodality agreement between ROSE and histopathology was good (κ ± SE = 0.615 ± 0.084, P < 0.001). Area under the curve of the thoracoscopists' impression of macroscopic appearance was 0.72 (95% CI: 0.58-0.85, P = 0.001), with a sensitivity of 100%, specificity of 44.7%, positive predictive value of 53.33% and negative predictive value of 100%. Conclusion: Rapid on-site evaluation during MT was found to have high accuracy for predicting malignancy. ROSE can provide the thoracoscopist with an on-site

We present a case of a 58 years old man with a large heterogeneous and well circumscribed soft tissue mass arising from the right pleural surface, found at a computer tomography of his chest. This mass after complete resection through a right lateral open thoracotomy, proved to be a Solitary Fibrous Tumor, previously known as ‘benign mesothelioma’. This tumor is usually discovered at routine chest X-rays since patients are either asymptomatic or report atypical symptoms. Only 10–20% of the published cases report a malignant solitary fibrous tumor, however, definite diagnosis can only be made after complete resection which is the proposed diagnostic algorithm for these cases.