Introduction: Giant cell tumors are benign tumors with local aggressiveness preferably located in the metaphysoepiphyseal zone of long bones. Their treatment remains controversial due to the high rate of recurrence. En bloc carcinological resection of a bone segment with reconstruction makes it possible to reduce the rate of recurrence.We report the case of a GCT of the elbow treated by arthrodesis resection with a follow-up of 24 months.

Materials and methods:This is a 23-year-old patient with a large swelling of the elbow that has progressed for 1 year. The paraclinical workup found complete osteolysis of the lower end of the humerus, of the radial head with invasion of the soft tissues. The biopsy was in favor of an aggressive GCT. Surgical treatment was performed by resection with arthrodesis of the elbow
Results:The anatomopathological study confirms the diagnosis. After a 48-month follow-up there were no recurrences
Conclusion: GCT is a fairly frequent benign tumor, characterized by recurrence and the differential diagnosis of which poses traps with other epiphyseal lesions. Histologically the malignancy can be expressed in a very variable way. Malignant forms of GCT must be treated carcinologically (wide resection).

The essential bone cyst is a lytic lesion, benign, encountered mainly during growth. It is located near a growth cartilage, on the metaphyseal side. It preferentially affects the upper extremity of the humerus and femur. Material and method: This is an 18-year-old patient who presented with pain in his right shoulder, progressing gradually over the past 6 months. A standard x-ray and a CT scan showed an appearance in favor of an essential bone cyst. The treatment consisted of curettage-filling by allograft bone (femoral heads, cryopreserved). The pathological study confirmed the diagnosis. Results: After a 30-month follow-up, there is good integration of the graft with normal mobility of the shoulder. Discussion: Bone cyst is a benign tumor. The diagnosis is made by standard radiography in the majority of cases. Malignant changes are rare and the only real evolutionary risk is the occurrence of a fracture. Conclusion: The main aim of treatment with allogeneic bone grafts is to prevent fractures, reduce the operating time and hospital stay, with the absence of morbidity from donor sites (ridge).

Introduction:
osteochondroma are frequent benign tumors derived from chondro-forming tissues. , often single, can be multiple (OLLIER disease, MAFFUCCI syndrome).
Material and method:
This is a 22-year-old young patient who consults for pain associated with swelling on the outer side of the forearm, which has been evolving for over a year.
Standard radiography: metaphyseal-diaphyseal images with plurilobulated geographic contours with clear demarcation between lytic zone and healthy bone, does not cross the cortical
Computed tomography: Central medullary lacunar image extended from the upper 1/3 to the distal 1/3 of the radial shaft measuring 13.82 cm in length without intrusion of the cortex.
The patient underwent a biopsy followed by a filling recess by allograft bone (femoral heads).

Result: Pathological Anatomy Study: confirms the diagnosis of osteochondroma
After 60 months there is no recurrence.

Discussion: Osteochondromas are lesions of cartilage origin corresponding to an overgrowth of mature hyaline cartilage in the metaphyseal regions of enchondrally ossified bones.
The diagnosis is radioclinical but histology must confirm it.
The risk of malignant degeneration requires surgical treatment.
The filling of cavities after curettage with allograft bone remains a good indication in benign tumors, in particular chondromas.
The length of graft integration is related to its osteoconductive and non-osteoinductive properties compared to autograft.

Conclusion: Allograft filling reduces the operating time and hospital stay, with no morbidity at donor sites (peak). Reliability of filling seems to be the best prevention of recurrence

Introduction:Giant cell tumors of the synovial sheaths represent the localized form of hemopigmented villonodular synovitis. They develop from the articular and periarticular synovium. It is a benign tumor, very rare in the feet.
Materials and methods:This is a 32-year-old patient who consults for a painless, progressive mass on the plantar and dorsal surface of the third toe of the left foot.MRI: heterogeneous mass encompassing the flexor and extensor tendons of the 3rd toe; eroding the infero median face of the 1 toe.A biopsy was taken in favor of a soft tissue GCT.The patient underwent a marginal en bloc resection removing the biopsy scar
Results:Histology to confirm the diagnosis of GCT of the tendon sheaths After 12 months follow-up, there was no recurrence.
Discussion:The etiology of these tumors remains unknown. The most accepted theory is that proposed by Jaffé et al, which suggests a reactive or regenerative hyperplasia of the synovium secondary to an inflammatory process, a disruption of lipid metabolism or a hemorrhage in the synovial sheath. The treatment is exclusively surgical.The condition can take 2 clinical forms, either the TCG is localized (nodular tenosynovitis) and appears as a nodule adhering to a tendon, or the TCG is diffuse and represents the equivalent in pigmented nodular villo synovitis articular
Conclusion:The growth of tenosynovial GCTs takes place gradually. The invasion can involve the skeleton, the joint capsule and the muscular fleshy body. They are benign tumors and never metastasize.

A 23-year-old male presented with long-standing swelling in the middle of the third toe right side with difficulty in wearing footwear. Clinical examination revealed it as bony hard fixed swelling moving with interphalangeal joint movements. Clinical diagnosis of benign bony swelling was made and radiological investigation demonstrated features suggestive of Osteochondroma. En-mass excision of the lesion was done, with histo-pathological confirmation of Osteochondroma. Although the subungual presentation of osteochondroma or exostosis in toes is quite common, the astounding non-subungual presentation should also be kept in mind as a plausible differential diagnosis of benign bony swelling in toes.

Ancient Schwannomas represent a rare, benign, slow growing neoplastic lesion of the peripheral nervous system. They usually present in the neck and head region or in the extremities. The authors exhibit a clinical case of a 46 year old female patient, with a large nodular mass in the volar aspect of the right forearm. The presenting symptoms were paresthesia of the hand (median nerve distribution) and discomfort of the forearm. A contrast enhanced CT scan was performed, it described a fusiform, heterogeneous mass with a length of 7 cm longitudinally, enhanced both in the arterial and venous phases. The patient was submitted to marginal excision through the Henry approach. A grayish-white capsulated mass was excised, a pedicle to the median nerve was identified, cauterized and separated. The mass was subjected to histopathological examination which revealed it to be an Ancient Schwannoma. At 12 months post-operatively the patient is asymptomatic with no signs of recurrence. Ancient Schwannomas are a grade I lesion in the WHO classification. Usually a suspected diagnosis can be achieved through image studies alone. If the patient presents peripheral nerve symptoms or mass effect, surgical resection should be proposed. Conservative treatment and observation can be recommended in some cases. A marginal excision is considered sufficient in these patients since there is a low recurrence rate. Large Ancient Schwannomas of the extremities are rare entities and should be reported. Their treatment consists on surgical marginal excision, there is no need for radical surgery in the management of this pathology.

SUMMARY
A sixty-five years old female patient has a history of MTT of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis (NF). We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later she presented with local recurrence. We organised a multidisciplinary team (MDT) between the orthopaedic, histopathology and oncology teams. Then we decided to treat her with chemotherapy. After two months of follow-up, she is responding well to the chemotherapy with no further deterioration of her condition.

Hibernoma is a rare, benign soft tissue tumour. It is a painless, slow growing tumour and is commonly mistaken for lipoma or liposarcoma. Diagnosis is confirmed by histopathological examination. Treatment of choice is wide local resection. We are presenting a rare case of intramuscular hibernoma of right shoulder region in a 34 year old male.
Key words: hibernoma, brown fat, MRI,

Among hamartomata’s bone lesion fibrous dysplasia involving long bone of upper extremity is not uncommon. In fibrous dysplasia has woven bone that lacks osteoblastic rimming is produced instead of the production of normal lamellar bone. Patients may present with single or multiple lesions or as a syndrome like McCune Albright syndrome with a reasonable chance of malignant transformation. We present a case of giant monostotic fibrous dysplasia involving the entire diaphysis of the humerus in a 17 years’ male who presented with pain and deformity with compromised neurological function. The patient was treated with curettage and a nonvascularized fibular graft successfully. But he again presented with a fracture with hypertrophic type nonunion one year after primary surgery. This time he was treated with plate fixation with a bone graft which was healed eventually.

INTRODUCTION: Hip fractures is one of the most common trauma meeting cases. The individuals suffering from hip fractures usually have multiple co-morbidities including previous or exiting malignacies.
Hip fracture being a common fragility zone, there is always a chance that the fracture could be pathological. Therefore it is imperitaive to obtain adequate imaging to assess for bony mets/slkip lesions. The presence or absence of lesions will dictate further plan of management.
METHODS: .We audited all hip fractures at our DGH between Jan 2018-19 to check if Hip fractures with existing / previous malignancies had Long leg views prior to Surgical planning. This was done to look for demonstrable pathology in the remainder femoral shaft. Inclusion Criteria
1.All hip fractures- (including Non traumatic)
2. Types of malignancies ( Eg. Soft tissue/ bone/Haematological)
Exclusion criteria
1. Skin malignancies ( eg.SCC ear, BCC)
RESULTS: Total Hip fractures were 223 patients.
Time period – Jan 2019- Dec 2019 (12 months)
The fractures were classified into Extra - Capsular – 61 patients and Intra - Capsular – 162.
61 patients (Hip fractures with past/current malignancies) came in the inclusion criteria
44.2 %( 27 patients) of such patient shad Long views done in A.E. at time of admission, 26.6 %( 16 patients) and 29.5 %( 18 patients) had no Long leg views done pre/post op.
DISCUSSION & CONCLUSIONS:
Hip fractures are one of the most common orthopaedic conditions dealt by an orthopaedic

Retro-odontoid pseudotumor (ROP) is a non-neoplastic mass seen at the craniovertebral junction (CVJ), which can cause spinal cord compression, the treatment of which is controversial. There is evidence to suggest that the root cause of this pathology is instability at the atlantoaxial junction and hence an indirect posterior atlantoaxial fusion has become popular. The surgical treatment of retro-odontoid pseudotumor (ROP) is controversial. Recently, posterior fusion alone has been shown to result in spontaneous regression of the ROP. The success of this indirect approach depends on the surgeon’s ability to identify a probable cause of the ROP, especially in the absence of overt radiographic instability. ROPs due to conditions that stiffen the subaxial cervical spine are more likely to respond to atlantoaxial fusion than those due to crystal deposition disease. C1 assimilation, without apparent radiographic instability as a cause of ROP, is an underappreciated association and may lead the surgeon to choose a direct decompression strategy. This case report and the accompanying review of the literature highlight that C1 assimilation and congenital C2/3 fusion can lead to the formation of ROP even in the absence of apparent radiographic instability and that it can be successfully treated with posterior atlantoaxial fusion alone. Key messages: Posterior fusion alone can lead to rapid neurological recovery and regression of retro-odontoid pseudotumour in a patient with C1 assimilation when it is secondary to atlantoaxial “hypermobility”.

Introduction: Spinal epidural angiolipomatosis (SEAL) is an atypical benign tumour of the adipose tissue with abnormal vasculature that causes spinal cord compression. They account for 0.14% of all the spinal axis tumours. They usually arise in the epidural space and unlike lipomas do not exhibit age or sex bias. Materials and Methods : A 30-year-old woman presented with a progressive weakness of the lower extremities evolving since 6 months with onset of urinary incontinence. There was no past history of corticosteroids or hormonal therapy. On examination she was spastic with motor grade 3 and a sensory level of D2. CT and MRI scans were suggestive of a intra-canal space- occupying lesion, located in the posterior epidural space, extending from T2 to T9, compressing the spinal cord showing hyperintense fatty tissue on both T1 and T2 sequences which was trabeculated by vascular elements. She underwent total resection of tumour after an en bloc laminectomy from T2-T9. Macroscopically the reddish soft mass was easily cleavable from the dura mater. Histopathology revealed benign mesenchymal proliferation, made of mature benign adipose cells, without atypia, associated with a network of small vessels having narrow lumen and edged with flattened endothelial cells. This findings were suggestive of an angiolipoma. Results: Post operatively the patients neurology improved by grade 1 with reduced spasticity and early improvement in bladder function. Conclusion: Spinal epidural angiolipoma is a rare cause of progressive spinal cord compression. MRI is necessary for diagnosis. The treatment consists on complete surgical excision with excellent prognosis.

Background: Primary bone tumours, although rare, are an important rising cause of morbidity and mortality in Africa. Late presentation, delayed diagnosis and failure to obtain consent for surgical procedures are important causes of loss of limb and life especially in the West African sub region. Aim: To determine the epidemiological pattern of primary bone tumours in Nigeria including demographics, predominant tumour types and predominant skeletal location. Methods: A search of the following databases: University of Edinburgh Library, PubMed, CINAHL and SCOPUS from 2000 till date following PRISMA guidelines was conducted to identify studies conducted in Nigeria with relevant epidemiological data on primary bone tumours in Nigeria. Results: The search yielded a total of 952 hits from which 7 hospital-based retrospective studies met the inclusion criteria for review. The estimated incidence rate of primary bone tumours ranged from 0.08 to 0.31 per 100,000 population. All studies showed a male preponderance. The peak age group of individuals presenting with both benign and malignant primary bone tumours was 11-20 years. Overall, benign tumours were more common. Osteochondromas were the commonest benign tumours while the commonest malignant tumours identified were osteosarcomas. The commonest location for both benign and malignant tumours were the Tibia and Fibula bones. Conclusion: Nigeria shares some similar epidemiological characteristics of primary bone tumour with other countries; however, some peculiar differences have been identified in this study. Population based studies are required to obtain more accurate epidemiological data about this disease. Keywords: Epidemiology, Primary bone tumours, Nigeria.

Introduction: Osteoid osteoma (OO) is a painful benign tumor which constitutes about 10% of all benign tumors. Acetabulum is uncommon site (< 1 %). The purpose of this case report is to highlight this unusual site of OO in posterior-medial lip of acetabulum in a 20-year-old male with pain in the left hip for 6 months associated with limp. Also a novel method of combining controlled posterior hip subluxation with arthroscopy for nidus removal and minimising the chance of Avascular Necrosis (AVN) of hip by proper anatomical knowledge of blood vessels. PROCEDURE: Southern Moore’s approach was taken. An interval between piriformis and gluteus minimus created. Posterior subluxation of femoral head was done after an inverted T shape incision of joint capsule to prevent injury to the blood supply of head. Arthroscope was introduced between the femoral head and acetabular margin. A small lesion was noticed and excised in the posteromedial lip of acetabulum through another small portal. Femoral head was relocated and capsule resutured. RESULT He was followed up for 36 months postoperative period and remained symptom free with good painless range of movement and no difficulty in daily activities. There were no signs of relapse, AVN and secondary osteoarthritis of left hip, confirmed by MRI at 3 years following surgery. CONCLUSION: Unusual site of osteoid osteoma. To highlight the novel surgical method to locate and excise osteoid osteoma without damaging blood supply of the femoral head with excellent outcome. ABBREVIATIONS – MRI (Magnetic resonance imaging).

SPECIFIC OBJECTIVES:
1. To define the extent of involvement of the disease for permanent cure and to prevent recurrence.
2. MRI Scan as a tool to define the extent of involvement.
3. External beam radiotherapy as an effective tool to eliminate residual tumor following open synovectomy.

MATERIALS AND METHODS:
21-year old male patient presented with recurrent left knee swelling since 6years. Patient had undergone open synovectomy 4 years back. However, knee swelling and effusion recurred which was then managed with aspiration and traditional methods. On clinical examination, diffuse synovial thickening present with restricted knee movements(100-900). MRI Scan suggested diffuse pigmented villonodular synovitis of the knee. A diagnosis of Recurrent Pigmented Villonodular Synovitis of knee was made. PROCEDURE: Patient underwent Diagnostic Arthroscopy followed by Open Synovectomy. Near complete removal of disease tissue was done except from a small area over the posterior aspect of the knee. On gross examination, dark brown hypertrophied synovium noted. Biopsy from the specimen confirmed the diagnosis. Postoperatively, to prevent recurrence and to clear residual tumor tissue, patient received external beam radiotherapy to a dose of 5000 cGy/25Fr/5Fr/week for 1 month.

RESULTS:
No recurrence of the pathology as evidenced by clinical examination during regular follow up for a period of 3years and repeat MRI Scans at 3months and 1year follow up.

CONCLUSION:
Total Synovectomy followed by External beam radiotherapy is an effective treatment for Difffuse Pigmented Villonodular Synovitis of the Knee.

Summary : Schwannomas are relatively common benign tumors of the peripheral nerves. Schwannomas emerging from the median nerve are rare in the general population.Usually completely extirpable with low recurrence but caution monitoring must be rigorous as these tumors have potential for malignant transformation. We report here three cases of an unusual Schwannoma of the anterior side of the forearm, developed at the expense of the median nerve. A 25-year-old male, a 38-year-old single woman and a 32-year-old 3 months pregnant woman.On clinical examination, a percussion over the ovoid swelling produced an electric shock-like dysesthesia in a nerve trunk. An MRI examination revealed in T2-weighted sequence of hyposignal Histological examination confirmed the Schwannoma diagnosis and showed that the three patients were evolving for 9 months, on average, during the excisional biopsy. After the surgical excision, and a follow up every 3 months during 2 years, the 25-year-old male and the 38-year-old single woman recovered very well without any recurrence of the disease. The 32-year-old woman, who went therapeutic abortion before surgical excision, relapsed at 3 months after surgery with axillary lymphadenopathy. A medical decision was made to amputate the arm follow up by radiotherapy and unfortunately, the patient died after her third radiotherapy. Benign schwannomas, formerly called neuromas, are the most common nerve tumors, developing at the expense of schwann cells. Smooth, yellowish rounded, encapsulated proliferation, easily cleavable, with complete enucleation of the tumor.Treatment is enucleation with careful dissection of surrounding nerve bundles. These tumors have potential for malignant transformation.

Introduction: Enchondromas are the most common benign tumours derived from cartilaginous tissue, affecting both genders equally, with higher prevalence between ages 20 and 50, usually occurring as a single lesion. They regularly appear in phalanges and metacarpus and are generally asymptomatic, frequently found in radiographic studies. We describe a case of an enchondroma of the head of the fifth metacarpal of the right hand submitted to surgical treatment. Methods: Male, 51 years old presents with one month evolution of pain (VAS 5/10) and swelling on the back of his right hand after trauma. Painful mobilization of the metacarpophalangeal joint along the fifth metacarpal, with preserved mobility. Radiographic study revealed well-defined lytic lesion in the head of the fifth metacarpal, compatible with enchondroma. Results: Underwent excision of bone cyst, curettage of the cavity, filling with autologous bone graft harvested from the ipsilateral iliac crest and immobilization with plastered cubital splint. Diagnosis confirmed by anatomopathology. Immobilization maintained for 4 weeks, later beginning physical rehabilitation. At six months follow-up, mobilities of the metacarpophalangeal joint re-established without pain. Radiology shows signs of consolidation. Conclusion: Symptomatic enchondromas are usually treated surgically allowing histological diagnosis, preventing associated pathological fractures and progression to deformities, which can jeopardize functionality. Curettage is the basis of surgical treatment. The bone defect is filled with autologous bone graft (iliac crest and/or distal radius - more conventional treatment method - or allograft). In this case of symptomatic enchondroma, after trauma, without associated pathological fracture, the adopted strategy obtained good results.

Introduction:Giant cell tumor (GCT) is an osteolytic, mostly benign but locally aggressive tumor occurring in young adults at epiphyseal region.GCT of the metatarsal is a very rare occurrence with very few cases being reported so far.Case report:60-year-old male came with complaints of pain and swelling over the dorsum of the right foot for 1 year. The swelling was initially pea-sized, gradually expanding to a size of a lemon over a period of one year. Radiographs revealed an expansile osteolytic lesion of 3rd metatarsal involving the epiphysis. Cortical thinning with a classical soap bubble appearance was present. MRI showed a well-defined, expansile, solid –cystic lesion of approximately size 4*4cm. Biopsy was done and sent for histopathology which confirmed the diagnosis of Giant cell tumor. The patient was managed by Ray amputation of the 3rd metatarsal. At one year follow-up, the patient was fully weight-bearing with no pain and radiographs showed no signs of recurrence.Conclusion:Giant cell tumors could present at uncommon sites and they should be considered in the differential diagnosis of lytic lesions of the epiphyseal region. All expansile lytic lesions on radiographs should be supplemented essentially with biopsy for establishing the diagnosis.Resection of the tumour by Ray amputation of the involved metatarsal is the preferred surgical treatment and provides excellent results.

Introduction: Lipoma is the most common benign soft tissue tumor. Giant lipomas of the hand are extremely rare, with few cases described. They can be totally asymptomatic, or cause symptoms like discomfort, pain, functional and vascular impairment or paresthesia if located next to neurovascular structures. Surgical treatment with careful planning is the gold standard, and most of the associated symptoms resolve after excision of the lipoma. Case Presentation: A 47-year-old healthy female presented with a large mass at the level of the thenar region of the left hand limiting daily life activities; on physical examination, a bulky mass of hard elastic consistency was reported, with sensitive neurological impairment evidenced by constant paresthesia over the thumb and second finger. Magnetic resonance imaging confirmed the presence of benign subcutaneous lipoma. We opted for surgical treatment through complete marginal lipoma recession and abundant lavage through a Z incision. Histology examination confirmed the benign nature. The patient was discharged the next day, starting early occupational therapy. Complete symptom resolution was achieved, with no recurrence 1 year after. The patient resumed normal daily activities, with complete painless range of motion and a Disabilities of the Arm, Shoulder and Hand Score of 9.2. Conclusion: Thenar lipomas are uncommon, and the majority of cases are asymptomatic; this particular case is rare, surgery was mandatory due to hand impairment. While lipomas can be clinically diagnosed, it’s benign nature should be investigated. Surgical treatment usually leads to complete resolution of symptoms, complete marginal recession has low recurrence risk.

Case summary: 14 year old girl presented with swelling at the lower end of left leg since past 4 months. She complained that swelling was rapidly progressive and became painful since past one month. On examination there was diffuse bulbous swelling in anteromedial aspect of lower end of leg extending upto ankle. Skin over swelling was stretched with no prominent vascular markings. Swelling was firm to hard in consistency and ankle movements were restricted.
Radiological evaluation showed epiphysio-metaphyseal lytic lesion of distal tibia with cortical thinning. Matrix showed no calcification or trabeculations. Initial biopsy showed sheets of multi-nucleated giant cells. Due to emergence of COVID 19 pandemic and new set impositions on elective surgeries, her surgery was deferred. On follow up after 2 months, repeat MRI scan showed aggressive expansion of tumor, upto lower third of tibia and cortical breach at posteromedial aspect.
Treatment: En-block wide excision with intact capsule was performed under general anesthesia. Free fibular graft was harvested from both legs and tibia was fused with talus using fibular graft held in place with K wires.
Follow-up: at 6 month follow up, patient is symptom free and partially weight bearing with walker support. Follow-up MRI shows no evidence of recurrence of tumor.

Introduction ∷fracture most common in pt of osteoporosis and bone tumor
Goal of treatment ∷ pain-free life, reduced hospital stay and to early wiefgt bearing of pt
Radiological character ∷ in mri no fracture line and hypointence in t1 image and muscle oedema in CT scalping lision seen
Management ∷early treatment with analgesic benefits for pt and REDUCES SURGICAL PROCEDURE
Result ∷in my observation no death occurs followed by surgical procedure after 2 yr of followup

Aim and objective: To present a rare case of lung carcinoma which presented with heel pain, as a first feature,due to calcaneal metastasis. Method: A 55 year female presented to us with heel pain for last six months not relieved by analgesics. She did not have any other complains at the time of presentation. The pain was more in the morning. Symptomatic treatment did not relieve her symptoms completely. ANA,RA factor, Anti CCP antibodies, Anti dsDNA were found to be negative. On X ray, a lytic lesion was found in calcaneum.MRI of calcaneum showed a similar lesion suspicious of malignancy. On Skeletal survey, no lesion in any other bone was found. CT scan of chest showed a lesion in left lower lobe of lung. Biopsy showed metastatic lesion from carcinoma lung. This case highlights the solitary metastasis of lung carcinoma to calcaneum presenting as heel pain. Patient was treated with chemotherapy , followed by curettage and bone grafting and local radiation.Result: Plantar heel pain is a common problem and clinical diagnosis related to it are plantar fascitis, calcaneal spur or retro calcaneal bursitis which usually do not need any investigation.Treating symptomatically leads to delay in radiological investigation which when done , showed lytic lesion. On review of literature very few cases of isolated calcaneal metastasis were found. Conclusion: This is a rare case of lung carcinoma presenting as heel pain due to solitary metastasis to calcaneum.

We present the case of a 64-year-old male that was admitted in the Trauma and Orthopaedics department after sustaining an undisplaced, intracapsular left hip fracture. He had a long history of excessive alcohol and tobacco use in the past but otherwise fit and well. Chest x-ray was normal but there were some concerns on the appearance of the left hip. The fracture was fixed suboptimally in situ with two cannulated hip screws and specimen collected from the drill bits was sent to the pathology lab. Blood tests were unremarkable. He was discharged on a non-weight-bearing pathway for two months and was seen at six weeks in the outpatient clinic setting. At that time, some displacement of the fracture was evident on x-rays but he was asked to remain on the non-weight bearing pathway for another month. Upon final presentation his fixation had failed, he was unable to weight bear and was in excruciating pain. On clinical investigation there was a considerable soft tissue swelling around his left hip, which was warm, erythymatous and tender. Further imaging with CT scan and MRI, revealed a non union of the fracture site and an impressive sizeable soft tissue mass encaspulating the left hip joint as well as lung metastases. The rapidly enlarging biopsied mass was diagnosed as spindle cell sarcoma, for which there are scarce reports in the literature. We review the literature and retrospectively consider how we could better red flag patients as such, in the future.

Background: Schwannoma is a benign tumor that develops from Schwann cells. In 95% of the cases it presents itself as an isolated mass of indolent growth. The increase in size above 25 mm can cause nonspecific neurological symptoms, making diagnosis difficult. Case Presentation: A 65-year-old female started to experience pain and paraesthesia on the dorsal surface of her left hand, refractory to analgesia and with progressive disability in the extension of her left wrist due to decreased muscle strength, with several months of evolution. The objective examination shows swelling of about 20 - 30 mm on the lateral face of the distal 1⁄3 of the left arm. MRI was performed, presenting focal lesion adjacent to the radial nerve, with approximately 25 x 22 x 20 mm, of circumscribed outline, peripheral enhancement after intravenous contrast, suggestive of a tumor of the nerve sheaths. The patient underwent surgical excision, presenting a capsulated lesion with a well-defined morphology and no apparent invasion of nervous fascicles. Histological examination confirmed Schwannoma's diagnosis. In the postoperative period, the patient did not present neurological deficits. Discussion: Schwanoma is included in the group of peripheral nerves tumors. It is rare and has slow and eccentric growth. It appears in any location, being the upper limb the rarest. It can be excised with nerve savings, however, it is not always possible to excise it without nerve damage. In this case, excision without neurological injury was possible.