Foreign body synovitis with extensive granulomatous giant cell reaction to refractile polyethelene debris is a complication of subtalar arthroereisis not previously reported. We present two cases whereby STA-peg implants were used to treat bilateral painful flexible flatfoot deformities in children. Two boys, presented at 7 and 10 years of age, 2 years after STA-peg procedures and tendo-Achilles lengthening for painful flatfeet. They each had minimal subtalar motion and pain at the sinus tarsi. Radiographs demonstrated surgical defects in the calcaneus with surrounding high signal on the magnetic resonance imaging (MRI) in the subchondral bone of the calcaneus and talus. Both patients failed conservative management and had their implants removed with good relief of their pain. Histology was submitted at the time of implant removal. We present the radiographic and pathologic findings seen in these two patients with failed subtalar arthroereisis due to extensive implant reaction. The pathologic process seen in these patients is a previously unreported complication of this procedure. We do not recommend arthroereisis in the treatment of painful flexible flatfoot in children.
arthroereisis; pes planus; children; subtalar synovitis
A retrospective review identified six patients with seven painful rigid flatfeet. In each case, pain was localized laterally to an accessory facet of the anterolateral talus. cross-sectional imaging demonstrated no evidence of tarsal coalition. In five of the six, preoperative magnetic resonance imaging (MRI) was obtained and in each case demonstrated focal abutting bone marrow edema consistent with impingement between the accessory facet and the anterior calcaneus.
Seven feet in six patients underwent resection of the accessory facet with additional subtalar joint-sparing reconstructive procedures. At an average follow-up of 11 months, clinical results were graded as four good and two fair.
An association between this accessory facet and pain in the rigid flatfoot has not been previously reported. Obesity was universal and may represent a risk factor for facet impingement. At early follow-up, facet resection with subtalar joint-sparing flatfoot reconstruction provided good results with symptomatic and functional improvement in the majority of patients.
Ureteral cancer is a rare entity. Typical symptoms are painless hematuria as well as flank pain. Bone metastasis of ureteral cancer can occur in nearby bone structures, such as the spine, pelvis, and hip bone. Distal bone metastasis, such as that in the calcaneus bone, however, is rare.
An 82-year-old woman presented to the orthopedic clinic at the university hospital with a 3-month history of left heel pain. A magnetic resonance imaging (MRI) of her foot demonstrated a calcaneal lytic lesion. A biopsy of the lytic lesion showed urothelial carcinoma with squamous differentiation. A computed tomography (CT) scan of the abdomen and pelvis showed left hydronephrosis and an obstructive mass in the left ureter, at the iliac crossing. The patient received combined therapy that included local radiation, bisphosphonate, and chemotherapy, with complete resolution of her cancer-related symptoms. However, she eventually died from the progressive disease, 20 months after the initial diagnosis.
This case highlights the rare presentation of ureter cancer with an initial presentation of foot pain, secondary to calcaneal metastasis. Multimodality therapy provides effective palliation of symptoms and improved quality of life. We also reviewed the literature and discuss the clinical benefits of multidisciplinary cancer care in elderly patients.
urothelial carcinoma; elderly; calcaneal acrometastasis; multimodality therapy; chemotherapy; radiation
While injuries of the upper extremity are widely discussed in rock climbers, reports about the lower extremity are rare. Nevertheless almost 50 percent of acute injuries involve the leg and feet. Acute injuries are either caused by ground falls or rock hit trauma during a fall. Most frequently strains, contusions and fractures of the calcaneus and talus. More rare injuries, as e.g., osteochondral lesions of the talus demand a highly specialized care and case presentations with combined iliac crest graft and matrix associated autologous chondrocyte transplantation are given in this review. The chronic use of tight climbing shoes leads to overstrain injuries also. As the tight fit of the shoes changes the biomechanics of the foot an increased stress load is applied to the fore-foot. Thus chronic conditions as subungual hematoma, callosity and pain resolve. Also a high incidence of hallux valgus and hallux rigidus is described.
Rock climbing; Sport climbing; Feet injuries; Hallux valgus; Overstrain injuries
We report the successful arthroscopic treatment of a case of subcalcaneal bursitis with plantar fasciitis. To our knowledge, this is the first report on arthroscopic excision of a subcalcaneal bursa. Right heel pain developed in a 50-year-old woman, without any obvious cause. She reported that the heel pain occurred immediately after waking and that the heel ached when she walked. Magnetic resonance imaging showed an extra-articular, homogeneous, high-intensity lesion in the fat pad adjacent to the calcaneal tubercle on T2-weighted sagittal and coronal images and thickening of the plantar fascia on T2-weighted sagittal images. A diagnosis of a recalcitrant subcalcaneal bursitis with plantar fasciitis was made, and surgery was performed. The arthroscope was placed between the calcaneus and the plantar fascia. With the surgeon viewing from the lateral portal and working from the medial portal, the dorsal surface of the degenerative plantar fascia was debrided and the medial half of the plantar fascia was released, followed by debridement of the subcalcaneal bursal cavity through the incised plantar fascia. Full weight bearing and gait were allowed immediately after the operation. At the latest follow-up, the patient had achieved complete resolution of heel pain without a recurrence of the mass, confirmed by magnetic resonance imaging.
Objective: To present the case of a rare tumor in the sphenoidoclival area and discuss potential pitfalls in diagnosis and management. Design: Case report with literature review. Setting: Tertiary referral center. Case Summary: Our patient presented with headache, vertigo, vision problems, and feeling of pressure in the central segment of the face. MR and CT showed a lesion in the body of the sphenoid, with signs of bone destruction and irregular borders. Differential diagnosis included intraosseous meningioma, chordoma, and inflammatory process. Results: Endoscopic/microscopic transnasal approach was performed to reach clival bone and to biopsy the tumor. Histopathological examination showed intraosseous lipoma. Conclusion: Intraosseous lipoma is a rare tumor, or more accurately a hamartoma, and is usually found in the calcaneus or in the proximal femur. It is even rarer in the skull base. Usually it does not present any symptoms and is an incidental finding during imaging for other symptoms. As a rule it runs an indolent course and does not require any treatment. Since no definitive diagnosis can be made only on the basis of imaging (CT and MRI), it requires an open biopsy that if possible should be made in accordance with the principles of minimally invasive surgery.
Intraosseous lipoma; sphenoclival; skull base
Renal cell carcinomas (RCCs) are known for their unpredictable metastatic pattern. We present the case of a 63-year-old woman who initially presented in 1992 with a metastasis in the left calcaneus that led to the discovery of RCC. In 1998, a new metastasis was found in the ovary. In 2008, the diagnosis of a gallbladder metastasis was made. All metastases were surgically removed; no additional systemic therapies were used. Aggressive surgical treatment can prolong the survival of patients with resectable metastases. Patterns of metastasis are discussed, and a brief review of the literature is given regarding each localization.
Foot involvement in osteoarticular tuberculosis is uncommon and isolated bony involvement of foot bones with an osteolytic defect is even more rare; diagnostic and therapeutic delays can occur, worsening the prognosis. We present a retrospective series of osteolytic variety of foot tuberculosis.
Materials and Methods:
We present 24 osteolytic variety of foot tuberculosis (Eleven calcaneus, four cuboid, two cunieforms, one talus, three metatarsals, three phalanges) out of 92 foot TB cases collected over last 20 years. There were 16 adults and eight children. Tissue diagnosis was established in 23 of 24 cases based on PCR AFB staining, culture, and histopathology. Surgical intervention was reserved for patients with either a juxtaarticular focus threatening to involve a joint or an impending collapse of a midfoot bone with cystic destruction.
Fifteen cases had an osteolytic lesion on the radiographs resembling a space-occupying lesion, five had patchy osteolysis, while four showed coke like sequestra; one patient had a lesion in two bones. Antitubercular chemotherapy after biopsy was sufficient to heal the lesion in 19 cases, while in five cases surgical debridement needed to be done. The lesions healed eventually. At an average followup of 8.3 years, (range 2-15 years) there were no recurrences and all patients were free from pain, with no restriction of movements. Six patients complained of occasional pain during walking on uneven ground.
When tuberculous pathology is limited to the bone, the prognosis is better than in articular disease, as there is less deformity, and hence, less residual pain and disability.
Calcaneus; foot; infection; osteolytic; tuberculosis
Unlike other soft tissue sarcomas, myxoid/round cell liposarcoma (MRCL) has a tendency to spread to extrapulmonary sites but bone metastases are thought to be uncommon. In case reports, negative bone scintigraphy has been noted in patients with myxoid/round cell liposarcoma and bone metastases but the prevalence and optimal method of diagnosis of bone metastases in this common subtype of liposarcoma are unclear. In an attempt to answer these questions, data were obtained from a prospective database of patients with sarcoma, including MRCL, and the diagnostic imaging used was examined. A variety of imaging tools were used including plain X-rays, bone scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). Eight patients (4.3%) developed skeletal metastases all of which were positive on MRI. Bone scintigraphy was negative in two out of four cases, CT was negative in six out of seven, and X-rays were negative in four. Radiography and CT measure mainly cortical bone involvement, whereas MRI examines bone marrow. When investigating patients with MRCL for bone pain, negative X-rays and bone scans do not rule out bone metastases. In our experience, MRI provides the most sensitive technique for the diagnosis of bone metastases in MRCL.
Reproductive tract sarcomas metastasizing to the breast are uncommon. To our knowledge, metastasis of vaginal leiomyosarcoma to the breast has not been previously reported in the literature.
We present the first report of a FIGO stage IV primary vaginal leiomyosarcoma with metastases to the lung and left breast. Treatment included neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy. Lung metastasis disappeared but recurred 14 months later in conjunction with left breast metastasis which was resected.
Primary vaginal sarcoma with lung and breast metastases is very rare in female genital malignancies. We present this case to alert gynecologists to the need for early diagnosis and aggressive management.
Vaginal leiomyosarcoma; Breast metastasis; Lung metastasis; Neoadjuvant chemotherapy
Myeloid sarcoma is a rare condition that's caused by the aggregation of immature myeloid cells in leukemic patients. Myeloid sarcoma occurring in the temporal bone more frequently involves the mastoid bone than is the case for metastatic lesions arising from non-systemic malignancies. The disease is difficult to diagnose when it presents with symptoms that mimic otomastoiditis. However, an early diagnosis is important in order to achieve complete remission of the disease. Magnetic resonance imaging of the temporal bone is useful for making the diagnosis of myeloid sarcoma, and especially to evaluate the extent of disease. High-dose radio- or chemotherapies are the first-line approaches and possibly the only approaches to achieve complete remission and to cure the disease. With the aim of improving our understanding of myeloid sarcoma in the temporal bone, the present report describes our experience with 5 such cases and we compare the clinical features of these 5 patients with those clinical features of patients who have metastatic lesions.
Myeloid sarcoma; Temporal bone
Synovial sarcomas, which represent 5% to 10% of all adult soft-tissue sarcomas, usually metastasize to the lungs. Metastasis to the spine is rare. Spinal cord compression due to spinal metastasis occurs in approximately 3% of patients with extraspinal soft-tissue sarcomas.
A 26-year-old woman presented with neck pain, arm weakness, and a history of metastatic synovial sarcoma originating at the right knee. Computed tomography revealed destruction of the odontoid and C2 body. Magnetic resonance imaging revealed tumor in the posterior elements of C2 and in the ventral epidural space from C2–C5. She was treated with C2–C3 laminectomy, posterior C2 corpectomy with occipital-C7 fixation, and fusion. Postoperatively, her neck pain resolved and left upper extremity strength returned to normal.
Conclusion and Clinical Relevance:
Metastatic spinal cord compression from synovial sarcoma is rare. Surgical resection can lead to neurologic improvement.
Sarcoma, synovial, metastatic; Cervical vertebrae, neoplasia; Spinal fusion; Spinal cord, compression; Tumor, spinal, epidural
The occurrence of pediatric skeletal (extra-spinal) tuberculosis in the developed world is extremely rare. The purpose of this study was to review the cases at our institutions.
We performed a retrospective review of all pediatric biopsy-proven skeletal (extra-spinal) cases of tuberculosis over a five-year period.
Eighteen patients of biopsy-proven tuberculosis were identified. The mean age was 12 years (range 7–20). Lesion locations included: distal humerus, ulna, scapula, acetabulum, proximal femur, proximal tibia, distal tibia, and calcaneus. All had symptoms of pain, swelling, and stiffness. Five cases had multi-focal involvement. Twenty-four lesions were noted in 18 patients. Nineteen lesions were cystic in nature at presentation. The sedimentation rate was normal in six and purified protein derivative (PPD) was negative in five patients. All received chemotherapy. Six patients underwent surgery.
The diagnosis of pediatric skeletal tuberculosis can be made with good correlation of clinical, radiographic, and laboratory findings. Biopsy and culture are the gold standards in diagnosis. Prognosis is good with chemotherapy and non-operative management. Surgical intervention may be needed in select cases.
Skeletal tuberculosis; Children; Western world
Introduction. Follicular thyroid carcinoma (FTC) frequently metastasizes to the lungs and bones. However, metastasis to the skeletal muscles is an extremely rare manifestation of FTC. To date, only seven cases of FTC have been reported in the literature. Skeletal muscle metastases from FTC usually remain asymptomatic or manifest as swelling and are associated with dismal prognosis. Case Presentation. A 45-year-old Saudi woman presented with right buttock swelling since 8 months. Physical examination revealed right gluteal mass of size 13 × 10 cm and right thyroid lobe nodule. The rest of examination was unremarkable. Magnetic resonance imaging (MRI) showed 13 × 11.7 × 6.8 cm lobulated mass arising from the gluteus medius muscle, and tru-cut biopsy confirmed the metastatic papillary carcinoma of thyroid origin. The patient subsequently underwent palliative radiotherapy followed by total thyroidectomy and radioactive iodine ablation. At the time of publication, the patient was alive with partial response in gluteal mass. Conclusion. Skeletal muscles metastases are a rare manifestation of FTC, and searching for the primary focus in a patient with skeletal muscle metastasis, thyroid cancer should be considered as differential diagnosis.
Fractures of the medial tubercle of the posterior process of the talus are rare injuries. They are often misdiagnosed, resulting in increased morbidity and symptoms of chronic ankle pain and instability. When undetected, these fractures may become displaced, with potential additional injuries such as to the flexor hallucis longus tendon which may become interposed between the fracture fragments. We report a case of a clinically unsuspected fracture of the medial tubercle of the posterior process of the talus seen on magnetic resonance imaging, treated conservatively, with interval satisfactory healing of the fracture at 6 weeks follow-up.
magnetic resonance imaging; ankle; talus; fracture; trauma
Primary central nervous system (CNS) sarcomas are exceedingly rare, and, to the best of our knowledge, there has not yet been a report of intramedullary sarcoma. Here, we report a primary intradural intramedullary sarcoma of the spinal cord in a four-year-old boy who presented with low back pain and a radiculopathy involving both lower extremities. The tumor showed significant enhancement on magnetic resonance (MR) images due to its extreme vascularity. Gross total tumor removal was performed with microelectrical pulse recording, and the patient also received adjuvant radiotherapy and chemotherapy. After the operation, the patient's sensory deficits were improved. Because CNS dissemination is common, entire neuraxis evaluation is essential, although there was no evidence of dissemination in this case. The prognosis of primary CNS sarcoma is poor due to infiltrative nature and early CNS dissemination is common, and the treatment of choice is radical surgical resection. Adjuvant therapy is also beneficial with radiotherapy and chemotherapy.
Central nervous system; Intramedullary; Primary; Sarcoma
Introduction. Pirogow's amputation at the ankle presents a valuable alternative to lower leg amputation for patients with the corresponding indications. Although this method offers the ability to stay mobile without the use of a prosthesis, it is rarely performed. This paper proposes a modification regarding the operation method of the Pirogow amputation. The results of the modified operation method on ten patients were objectified 12 months after the operation using a patient questionnaire (Ankle Score). Material and Methods. We modified the original method by rotating the calcaneus. To fix the calcaneus to the tibia, Kirschner wire and a 3/0 spongiosa tension screw as well as a Fixateur externe were used. Results. 70% of those questioned who were amputated following the modified Pirogow method indicated an excellent or very good result in total points whereas in the control group (original Pirogow's amputation) only 40% reported excellent or very good result. In addition, the level of pain experienced one year after the completed operation showed different results in favour of the group being operated with the modified way. Furthermore, patients in both groups showed differences in radiological results, postoperative leg length difference, and postoperative mobility. Conclusion. The modified Pirogow amputation presents a valuable alternative to the original amputation method for patients with the corresponding indications. The benefits are found in the significantly reduced pain, difference in reduced radiological complications, the increase in mobility without a prosthesis, and the reduction of postoperative leg length difference.
The objective of this study was to evaluate the rotation and
translation of each joint in the hindfoot and compare the load response
in healthy feet with that in stage II posterior tibial tendon dysfunction
(PTTD) flatfoot by analysing the reconstructive three-dimensional
(3D) computed tomography (CT) image data during simulated weight-bearing.
CT scans of 15 healthy feet and 15 feet with stage II PTTD flatfoot
were taken first in a non-weight-bearing condition, followed by
a simulated full-body weight-bearing condition. The images of the
hindfoot bones were reconstructed into 3D models. The ‘twice registration’
method in three planes was used to calculate the position of the
talus relative to the calcaneus in the talocalcaneal joint, the
navicular relative to the talus in talonavicular joint, and the cuboid
relative to the calcaneus in the calcaneocuboid joint.
From non- to full-body-weight-bearing condition, the difference
in the talus position relative to the calcaneus in the talocalcaneal
joint was 0.6° more dorsiflexed (p = 0.032), 1.4° more everted (p
= 0.026), 0.9 mm more anterior (p = 0.031) and 1.0 mm more proximal
(p = 0.004) in stage II PTTD flatfoot compared with that in a healthy
foot. The navicular position difference relative to the talus in
the talonavicular joint was 3° more everted (p = 0.012), 1.3 mm more
lateral (p = 0.024), 0.8 mm more anterior (p = 0.037) and 2.1 mm
more proximal (p = 0.017). The cuboid position difference relative
to the calcaneus in the calcaneocuboid joint did not change significantly
in rotation and translation (all p ≥ 0.08).
Referring to a previous study regarding both the cadaveric foot
and the live foot, joint instability occurred in the hindfoot in
simulated weight-bearing condition in patients with stage II PTTD
flatfoot. The method used in this study might be applied to clinical
analysis of the aetiology and evolution of PTTD flatfoot, and may
inform biomechanical analyses of the effects of foot surgery in
Cite this article: Bone Joint Res 2013;2:255–63.
Three-dimensional image; Computed tomography; Stage II PTTD flatfoot; Weight-bearing
Fracture - dislocations of the talus are typically due to high energy injuries. Displaced fracture - dislocations of the talus have poor outcomes in general and complications are common. Although talar fracture is common and comprises the second most common tarsal fracture, bilateral fracture - dislocations of the talus are rare. Not many reports regarding the subject can be found in the literature.
We report a patient with bilateral fracture - dislocations of the talus treated by open reduction and internal fixation. This patient was a 25 year-old man who sustained bilateral fracture - dislocation of the talus due to a motor vehicle accident.
Bilateral talar fracture - dislocation is rare. The surgical approach discussed together with the pathomechanics of this injury can yield good short term results.
Dislocation; Talus; Fracture Fixation, Internal
We report on two sibs with a lethal form of bone dysplasia with distinctive skeletal findings including rhizomelic and mesomelic limb shortening, hooked clavicles, dumbbell femurs, and absence of talus and calcaneus ossification. Other clinical features include Dandy-Walker malformation, congenital heart defects, joint contractures, genital hypoplasia, and distinctive facial features. These sibs appear to have a previously undescribed skeletal dysplasia, which is most likely inherited in an autosomal recessive fashion.
Skeletal dysplasia; bone dysplasia; lethal dysplasia; dwarfism; Dandy-Walker malformation; radial ray abnormality
Conservatism is well recognised after Ponseti's method in the treatment of congenital clubfoot; however, this is not applicable to the complex and resistant arthrogrypotic type which challenges the orthopaedic surgeon. In such a type, soft tissue releases as fasciotomies, tenotomies, and capsulotomies, as well as osteotomies are insufficient, and joint fusions are not suitable in early childhood before skeletal maturity.
PATIENTS AND METHODS
Twelve children (15 feet) with residual resistant arthrogrypotic clubfeet between 2-4 years of age were analysed clinically and radiographically. All of the cases received previous conservative Ponseti's method of treatment in their first year of life followed by soft tissue releases (plantar fasciotomy, posteromedial tenotomies, capsulotomies, and abductor hallucis release) before treatment by decancellation of the cuboid, the calcaneus, and the talus to correct the complex adduction, supination, varus, and equinus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values.
A grading scheme for evaluation of the results using a point scoring system was suggested to evaluate accurately both clinical and radiographic results after a follow-up period of an average of 3.3 years. Six feet (40%) had excellent, six (40%) good, three (20%) fair, and no poor (0%) outcome. There was no major complication. There was significant improvement in the result (P > 0.035).
Tarsal decancellation is particularly applicable to residual resistant clubfoot such as the arthrogrypotic type at an early age. It shortens the period of disability, improves the range of foot motion, and does not interfere with the foot bone growth.
Tarsal decancellation; Arthrogrypotic clubfoot
Skip segment Hirschsprung's is an extremely rare condition, with only 25 reported cases in the English language literature. Diagnosis of skip segment Hirschsprung's may be missed as it is rarely suspected at initial surgery.
PRESENTATION OF CASE
A case report of an infant with total colonic aganglionosis and a skip segment Hirschsprung's in the cecum is presented. A review of literature on current surgical practice is presented along with our suggested modification to the diagnostic and therapeutic algorithm of this rare condition.
In our patient the initial leveling colostomy was incorrectly sited at the level of the first detected ganglionated segment. Subsequent recurrent episodes of enterocolitis led to a diagnosis of a long skip segment involving the ascending colon, cecum and terminal ileum. Correct leveling colostomy and a subsequent Duhamel procedure led to a good outcome.
Determination of the transition zone in Hirschsprung's may be incorrect if intestinal biopsies are terminated at the first evidence of ganglion cells. Extended segment intestinal biopsies should be included in the algorithm for management of long segment Hirschsprung's disease and will enable the surgeon to correctly detect rare manifestations such as skip segment disease at the initial procedure.
Hirschsprung's disease; Skip-segment; Biopsy
To clarify the function of the retrocalcaneal bursa the hindfoot was studied by magnetic resonance imaging at various positions of the ankle joint. In normal individuals a tongue-like extension of the retromalleolar fat pad entered the bursa during plantar flexion as the angle between Achilles tendon and calcaneus widened. The reverse occurred in dorsiflexion. In contrast, in a patient with spondyloarthritis and retrocalcaneal bursitis excessive cavitary fluid prevented the intrusion of the fat pad. The sliding motion of the fat pad in and out of the bursa during ankle motion allows a more caudal, advantageous insertion of the Achilles tendon into the calcaneus.
Alveolar soft part sarcoma (ASPS) with skull and brain metastases is extremely rare. A 53-year-old patient diagnosed as skull metastasis of ASPS visited our clinic complaining of an outgrowing scalp mass in spite of radiation therapy. Past medical history revealed that the patient had been diagnosed and treated for ASPS of the thigh 4 years ago. Magnetic resonance imaging revealed a hyperintense ovoid mass on the T2-weighted image, an isointense on the T1-weighted image, and a homogeneous enhanced mass with gadolinium. Another small-sized enhanced mass with mild peritumoral swelling was found at the deep white matter of the left frontal lobe. A gross total resection of the skull lesion with cranioplasty was performed for the surgical defect. A histologic examination of the specimens revealed metastatic ASPS involving the skull. Surgery with a total removal of the lesions may be effective for improving a patient's symptoms especially from neurological dysfunction.
Alveolar soft part sarcoma; Brain metastasis; Sarcoma; Surgery
Liposarcoma is one of the most frequently occurring soft tissue sarcomas in adulthood. The majority of liposarcomas arise in the lower extremities and retroperitoneum, while the incidence of this tumor in the head and neck region is reported to be extremely low, comprising 1.8%–6.2% of all cases. Nasopharyngeal liposarcoma is exceptionally rare, with only three cases having been reported in the English literature. This paper presents a case of a nasopharyngeal liposarcoma, treated with endoscopic tumor debulking, followed by adjuvant chemotherapy and radiotherapy, and reviews the current literature with regard to diagnosis and management of such lesions. Most authors agree that the imaging modality of choice is magnetic resonance imaging. Although radiographic findings usually support diagnosis, the imaging characteristics of such lesions may considerably vary, depending on the histological subtype and the macroscopic appearance of the tumor. The treatment of choice is complete surgical excision when possible. Although the role of postoperative radiotherapy is not clearly defined, some authors support that radiotherapy might delay or prevent local recurrence. However, there is no adequate evidence that the combination of surgery and radiotherapy lowers the possibility of distant metastasis of the head and neck liposarcomas. The role of adjuvant or neoadjuvant chemotherapy still remains controversial.