PMC9996063_01
Preoperative imaging evaluation of the right forearm (white triangle indicates the location of the lesion). (A,B) Preoperative anteroposterior and lateral radiographs revealing the lesion in the right radius. (C,D) Three-dimensional computed tomography reconstruction demonstrating the positional relationship between the tumor and the bone in the anteroposterior and lateral views. (E,F) Lateral and anteroposterior magnetic resonance imaging indicating the invasion. The lesion measured approximately 4.8 cm x 3.7 cm x 3.6 cm, inclusive of the occupied radius.
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F1
Preoperative radiography (Figure 1A,B), 3D computed tomography (CT) reconstruction (Figure 1C,D), and magnetic resonance imaging (MRI) (Figure 1E,F) were performed.
Intraoperative records of the lesion in the right forearm and free iliac bone flap. (A) Soft tissue mass originating from the dorsal interosseous nerve through the volar aspect of the distal radius. (B) A 3.5-cm-long radial bone defect through the dorsal aspect. (C) Macroscopic appearance of the excised lesion. (D) Macroscopic appearance of the vascularized free iliac bone flap for repairing the radial bone defect.
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F2
The lesion originated from the dorsal interosseous nerve via the volar aspect (Figure 2A). After exposing and eliminating the lesion, a 3.5-cm-long radial bone defect was identified (Figure 2B,C). Considering the patient's need for early functional recovery and return to social activities, we used free iliac bone flaps with deep circumflex iliac vessels to repair the bone defects, and the spaces were filled with a cancellous bone to promote healing (Figure 2D).
(A) 3D-CT reconstruction of the radius (yellow) and tumor (blue, white arrow) in the translucent view. (B) Radius (yellow) after tumor removal. The white arrow indicates the location of the bone defect. (C) Radial tumor (blue) after 3D reconstruction. (D) 3D reconstruction imaging (green: iliac crest, white arrow: blood supply). (E,F) Radiography revealing satisfactory healing (white triangle) of the radial bone defect 12 months postoperatively. 3D, three-dimensional.
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F3
Segmentally, the tumor invaded the radius (Figure 3A). The bone defect was then reconstructed (Figure 3B), and the tumor size, i.e., the size of the bone defect, was measured. The defect's maximum length, width, and height were calculated (Figure 3C), which was the maximum length, width, and height of the iliac crest flap (Figure 3D). Follow-up radiography indicated the union of the bone gap (Figure 3E,F), and a patient-rated wrist evaluation score of 5 was recorded after 12 months.
Flow chart of surgery mechanisms.
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F4
Also, Figure 4 was used to illustrate the surgery procedure and mechanisms briefly.
Histopathological features. (A) (HE x10) Spindle tumor cells in bundles and the vortex arrangement. (B) (HE x20) Alternating compact Antoni A (thick arrow) and loose Antoni B (thin Arrow) areas). (C) (HE x40) Grid-like nuclear structure revealing Verocay bodies. Immunohistochemical analysis revealing positive staining for (D) S-100 (x10), (E) SOX10 (x10), and (F) Vimentin (x10) in most cells. HE, hematoxylin and eosin.
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F5
The histological features comprised intermixed Antoni A and B areas combined with Verocay bodies, which were consistent with the typical clinicopathological features (Figure 5A-C). Immunohistochemistry for S-100 and SOX10 revealed diffuse and significant positivity, while Vimentin demonstrated weak positivity (Figure 5D-F).