Karonidis Athanasios, Kostopoulou Akrivi, Pappa Sofia, Tsoutsos Dimosthenis
Department of Plastic Surgery, Microsurgery, Burns Unit and Reference Centre for Melanoma, General Hospital of Athens "G. Gennimatas," Athens, Greece.
Department of Pathology, General Hospital of Athens "G. Gennimatas," Athens, Greece.
J Hand Microsurg. 2020 Oct;12(Suppl 1):S50-S53. doi: 10.1055/s-0039-1679102. Epub 2019 Feb 25.
This article describes a rare case of giant cell tumor of the tendon sheath (GCTTS) that was developed over the substance of chimeric-free latissimus dorsi and -serratus -anterior muscle flaps performed for lower limb reconstruction. To our knowledge, development of GCTTS over a free flap is first described in the literature. A 71-year-old -woman was presented with a large protuberant ulcerated tumor mass that was developed over the substance of chimeric free muscle flaps at the foot and ankle. We performed an extensive tumor resection, and the pathology report confirmed the presence of a primary giant cell tumor. The patient was advised to have a below-knee amputation. However, the patient refused the amputation, and 4 months later, she was presented with a metastatic mass proximally at the upper thigh. We believe that the GCTTS was associated with the chronic inflammation of the soft tissue and bones along with the recurrent episodes of infection, mainly due to proteus mirabilis and proteus syndrome (PS). PS may lead to the development of malformations and overgrowth of different tissues in unusual locations. In cases resistant to antibiotics, the radical surgical debridement should be considered as the most effective treatment.
本文描述了一例罕见的腱鞘巨细胞瘤（GCTTS），该肿瘤发生于为下肢重建而进行的无嵌合体背阔肌和前锯肌皮瓣组织上。据我们所知，文献中首次描述了游离皮瓣上发生GCTTS的情况。一名71岁女性，足部和踝部的无嵌合体游离肌皮瓣组织上出现了一个巨大的突出溃疡肿瘤块。我们进行了广泛的肿瘤切除，病理报告证实为原发性巨细胞瘤。建议患者进行膝下截肢。然而，患者拒绝截肢，4个月后，她大腿近端出现了转移瘤。我们认为，GCTTS与软组织和骨骼的慢性炎症以及反复感染发作有关，主要是由于奇异变形杆菌和变形杆菌综合征（PS）。PS可能导致不同组织在不寻常部位出现畸形和过度生长。在对抗生素耐药的病例中，应考虑彻底的手术清创作为最有效的治疗方法。
