Introduction Adolescent total hip arthroplasty (THA) is guarded partially due unclarity as to when pediatric hip joints reach full development. This study sought to identify when maximum acetabular and femoral head diameters are achieved with relation to chronological and skeletal age. Materials and Methods Consecutive femoral head and acetabular diameters were measured in a random sample of 54 female and 78 male subjects, which were queried from a historical collection of annual radiographs of children. Femoral head and triradiate physeal plates were scored according to Oxford bone parameters. Results At 14 years females had femoral diameters of 4.16 +/− 0.23 cm and acetabular diameters of 5.15 +/− 0.30 cm. At 16 years males had femoral diameters of 4.85 +/− 0.30 cm and acetabular diameters of 5.90 +/− 0.35 cm. In the year following maximal femoral Oxford scores, no significant change was seen in femur and acetabulum diameters in females and in femur diameters in males. In the year following maximal acetabular Oxford scores, there was a significant increase in both femur and acetabulum diameters in both females and males. Conclusions Females on average reach maximum pelvis maturity at 14 years and males reach maximum pelvis maturity at 16 years. A closed femoral head was found to be a good marker of full hip growth, while a closed triradiate was not. This study provides anatomical data for surgeons to consider in assessing risk factors of THA failure in adolescents.
Background: Aggressive angiomyxoma is a rare soft tissue mesenchymal tumor, locally infiltrative with a tendency to repeated local recurrence. The first description was in 1983. Normally it occurs in the vulvovaginal region, perineum and pelvis of females in reproductive age. Local wide excision of the tumor is the primary management. The local recurrence rate is high. The expression of estrogen and progesterone receptors in aggressive angiomyxoma suggests a hormone dependency of the tumor. Case report:A 50-year-old woman reported first in 2013 with a painless swelling at the perineum. She underwent surgical excision. Pathologic findings reported the tumor as an aggressive angiomyxoma. The patient did not appear to the follow-up examinations. In 2016 she reported again with a painless swelling at the perineum and underwent a local wide resection. The perineal body had to be reconstructed because of the deep infiltration of the tumor. Conclusion:Aggressive angiomyxoma is a rare disease, but when treating women with a painless swelling in the vulvovaginal region, perineum or pelvis aggressive angiomyxoma should be considered as a differential diagnosis. There is no standardised therapy described, but complete resection seems to be important. Descriptions of pharmacologic treatment exist with gonadotropinreleasing hormone agonists.
Introduction:Aggressive angiomyxoma (AA) is a very rare soft tissue mesenchymal tumor (only about 250 cases described in literature), locally infiltrative with a tendency to repeated local recurrence. The first description was in 1983 1 . It normally occurs in the vulvovaginal region, perineum and pelvis of females in reproductive age. But there are rare cases of AA in the inguinoscrotal region of males and these usually appear in older age 2 . Metastases have been described in literature in three cases. These distant metastases were all to be found in the mediastinum or lungs 3,4,5 . This suggests that AA is not only a local disease. Wide local excision of the tumor is the primary management. The local recurrence rate is 25 to 47% after surgical excision 6,7 .The expression of estrogen and progesterone receptors in AA and the growth of the tumor during pregnancy suggest a hormone dependency of the tumor 6 . Descriptions of drug treatment exist with gonadotropin-releasing hormone (GnRH) agonists in premenopausal women 8,9,10,11 . As diagnostics ultrasound and computerized tomography are nonspecific. In magnetic resonance imaging the AA is distinctive. On T2-weighted scans the tumors are hyperintense, except for their lower signal internal structure which looks swirled or layered 11,12 . Microscopically AA is composed of many thick-walled vessels of varying size in a loose collagenous and myxoid stroma with spindle and stellate like cells 9 . Except for estrogen and progesterone receptors, there are also other immunohistochemical markers, such as vimentin, desmin, SMA (smooth muscle actin), CD 34 13,14 . Genetic findings showed a chromosomal abnormity involving chromosome 12, associated with rearrangement of HMGIC, the architectural transcription factor, but the pathogenesis of AA is poorly understood 2,15,16,17,18 . Case report:A 50-year-old woman reported first in 2013 with a painless swelling of 3x2cm at the perineum. She underwent surgical excision. Pathologic findings reported the tumor as an AA. The margins were not tumor free. The patient didn't appear to the follow-up examinations. In 2016 she reported again with a painless swelling of 2x2cm at the perineum and underwent a wide local excision. The tumor infiltrated the perineal tissue deeply and for the complete resection it was necessary to resect a part of the bulbospongiosus muscle and the soft tissue of the perineum above the rectum. Then the perineal body had to be reconstructed. The wound healing was without difficulties, resection margins were tightly tumor free (<1mm) and the immunohistochemical examination showed a hormonal receptor positivity of estrogen and progesterone and expression of CD31 and desmin. There was no expression of CD 34. At followups after 3 and 6 months there was no recurrence. The patient has refused a hormonal treatment so far. Conclusion:AA is a rare disease, but when treating women with a painless swelling in the vulvovaginal region, perineum or pelvis AA should be considered as a differential diagnosis. There is no standar...
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