Introduction. Congenital fibrosarcoma is a rare soft tissue neoplasm, distal extremities being more commonly involved. This tumor has a rapid growth and extensive local invasion, but metastasis is rare. It is usually observed in children younger than two years old and is present at birth in up to 30% of the cases. Purpose. Evaluation of the methods of diagnosis and treatment in a case of a newborn known from intrauterine life, with a large tumor of the right arm. Materials and methods. We present the case of a 1-day-old patient, who was transferred from maternity in our clinics with the following diagnostics: large tumor of the right thoracic member, cardiac insufficiency, prematurity, severe respiratory distress. The tumor was visible at ultrasonography from intrauterine life, and the evolution was the increase in volume with necrosis areas and hair presence on its surface. After imagistic investigation, taking into account the tumoral extension with neurovascular involvement, without the possibility of a tumoral resection, but also the imminent danger of spontaneous rupture, we decided to perform a shoulder disarticulation without a biopsy in advance. Results. Postoperative evolution and the treatment of the cardiac insufficiency were good under antibiotics. The histopathological results advocate for the diagnosis of congenital fibrosarcoma, also confirmed by immunohistochemical tests. Conclusions. Soft tissue tumors are very rare and they need a multidisciplinary evaluation for the establishment of the right treatment. Imagistic and laboratory investigations can guide the diagnosis and the therapeutical conduct. The certainty diagnosis is established only after the histopathological results.
Purpose. Evaluation of reconstructive procedures after oncologic resection of malignant bone tumors of the calf in children. Materials and methods. The study contains 4 patients with ages between 5 and 18 years, 2 of the cases being diagnosed with osteosarcoma, respectively 2 with Ewing sarcoma of the tibia. In 3 of the cases, the surgical treatment consisted of en bloc tumoral resection and reconstruction with metal acrylic spacer and, in the 4th case, the tumoral resection was followed by endoprosthetic replacement. In all cases, the surgical treatment was preceded by biopsy and chemotherapy. Results. In 3 of the patients we used a gastrocnemius flap and one patient needed a negative pressure dressing for 11 days after surgery. The follow-up varied between 8 and 17 months after surgery. The patient who underwent endoprosthetic replacement was immobilized in a mobile orthosis and partial weight bearing at 2 weeks PO. The patient who underwent endoprosthetic replacement needed a surgical revision at 10 months PO consisting in the reinsertion of a locking screw of the patellar tendon fixation device. 2 of the presented cases are waiting for replacement of the metal acrylic spacer with a definitive reconstruction procedure, 1 case is proposed for amputation. Conclusions. Malignant bone tumors of the calf in children represent a pathology with high complexity giving the possible complications that can occur, a redoubtable risk being implant loss due to lack of coverage. The discussion remains open regarding the right time for definitive surgical procedure with modular endoprosthesis in children, and other reconstructive techniques available in these cases.
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