Angio-fibro-lipomatous hamartoma is a benign adipose tissue tumor very rarely seen in musculoskeletal distribution, and its incidence in the knee joint has never been reported. The histopathological picture of this benign adipose tissue tumor contained a mixture of mature adipose tissue and fibrous and vascular tissues. Here, in this case report,PTEN gene causes PTEN hamartoma of soft tissue and angiolipoma presentations and its variants.
A 24-year-old male patient presented with a history of pain in the right knee for 2 years. He had a history of blunt injury by a gas cylinder over the inner aspect of the lower thigh about 2 years back. His pain was dull aching and occasionally increased in severity on exertion and walking long distance. , he complained of increased pain for 1 month prior to his consultation in clinic. He had a second episode of blunt trauma following which pain was present throughout the day which increased on walking even a short distance.
On clinical examination, he was found to have diffuse swelling on the medial aspect of the knee. It was tender to palpation,, and the margins of the swelling could not be demarcated clinically. Swelling turned prominent on the flexion of the knee. The patient was evaluated with X-rays and further evaluated with magnetic resonance imaging (MRI), computed tomography scan, and ultrasonography screening. MRI was reported to have venolymphatic malformation over the medial femoral condyle with minimal extension into the medial femoral condyle and vastus medialis obliquus. All the other blood parameters were within the normal limits. The patient was taken for diagnostic arthroscopy and excision biopsy. Multiple, small, dark maroon, grape-like multiloculated cystic tissue was identified in the medial gutter over the medial femoral condylar area and over the medial wall extending into the medial capsule and articular surface of the vastus medialis muscle.The lesional area was identified to be highly vascular with prominent vessels seen arthroscopically. RF uses rates of oscillations in the range of around 3 kHz to 300 GHz which corresponds to the frequency of radio waves
The main goal is to perform coblation, which is controlled ablation. First, a plasma layer of reactive particles that disrupts the tissue’s organic bonds is applied which rapidly disintegrates the tissue. This allows for large amounts of tissue removal with minimal damage to the surrounding tissue. This plasma layer is created by a current flowing between closely spaced electrodes. It vaporizes a layer of conductive fluid, and then the plasma layer is formed which is very reactive with energized electrons and ions. Next, an ablative layer is established quickly, using high current density, and then coblation occurs.4-6 Hemostasis was achieved, and wound was closed over a drain. The postoperative period was uneventful, and the patient had very good pain relief after the surgery. He was asymptomatic at the time of final followup of 1 year
Conclusively, a rare lesion like angio-fibro-lipomatous hamartoma may cause severe knee pain, and arthroscopic examination will be useful in identifying the gross appearance and diagnosing rare lesions. Possibility of gene mutations needs to be ruled out, and search of occult lipomas in other parts of body will be helpful in identifying certain rare syndromes.
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