FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3106732544> ?p ?o ?g. }

• W3106732544 endingPage "552" @default.
• W3106732544 startingPage "550" @default.
• W3106732544 abstract "During our clinical practice, we have encountered a hitherto unrecognised recurrent, large soft tissue mass on the chest wall, which we believe is a reactive and reparative response to repetitive, long term local injury in serious surfers. Since the size, location and history of recurrence may cause concern for a neoplastic process, we wish to bring this lesion to the attention of our peers. A 50-year-old male presented for investigation and management of a unilateral mass protruding from his left subcostal region. At the time of this presentation, the mass had been present for several years but had grown. The lesion had been biopsied 4 years previously and had recurred locally. The prior histological findings were fat necrosis and fibrosis. Detailed history established that the patient surfed at least twice a week for 2 hours at a time. The size of the mass fluctuated directly with the amount of time spent surfing, frequency of the sessions and the nature of protective clothing: wearing a wetsuit resulted in reduction of the mass. On examination, a broad-based 7 cm soft tissue mass protruded from the left subcostal margin, just below the 9th–10th costal cartilages, near the mid-clavicular line. A healed surgical scar from the prior biopsy was evident. On palpation, a firm, non-tender and non-mobile 7 cm ovoid mass was confirmed. Based on the finding of a large, clinically obvious mass, a history of local recurrence and the patient's concern, a decision for surgical excision was made. No imaging studies were performed due to limited access to radiology services in the rural location of this patient. The lesion was excised under general anaesthetic and submitted for histopathological analysis. A soft, brown, irregular shaped piece of soft tissue measuring 50×25×20 mm was received. On histology the nodule showed the collapsed, elongated walls of a multiloculated cystic structure, lined partially by a monolayer of synoviocytes (Fig. 1). Hyalinised, paucicellular fibrous tissue, including areas showing fibrinoid change, protruded into the cyst lumen. Focal myxoid change of the stroma was evident. In some areas, the synovial lined spaces showed a layer of fibroblastic and myofibroblastic cells that merged with an area of fat necrosis and hyalinisation. Vessels with thick, hyalinised walls were incorporated in this process. Wider afield, the lesion blended with the surrounding fat. The PAS-D stain was negative for mucin. The elastin stain highlighted fragmented elastin fibres as components of this lesion, but the typical beaded structures associated with elastofibroma were not identified. Immunohistochemistry for ERG and CD34 highlighted the vasculature of the lesion. A number of mesenchymal cells within the stroma displayed a histiocytic phenotype, demonstrated by CD68 positivity. The appearances were consistent with those of a bursa, surrounded by fibrous tissue, demonstrating features of chronic soft tissue injury, including fat necrosis, fibrosis and associated vascular changes. The prior biopsy showed fibrosis, fibrinoid change and nodular zones of fat necrosis, along the same spectrum of the findings as in the recurrence. A synovial lining was not identified in the earlier, smaller biopsy. The wound healed well following surgical excision. Since his diagnosis 24 months ago, the patient routinely wears a Lycra surfing vest with in-built padding over the pressure points. The bursa has not recurred. We describe surfer's bursa as a large, recurrent chest wall mass, which we believe is a previously unrecognised lesion associated with long term surfing. In surfing communities, anecdotal evidence exists that clinicians see such lesions on an intermittent basis. Thus, it is likely that this phenomenon is under-reported. A blog post by a female surfer was found by the patient, representing a very similar lesion to his own (Fig. 2). A range of mass lesions associated with chronic injuries have been described in the literature. Perineal nodular indurations, thought to be caused by repetitive trauma associated with ‘saddle sports’, such as cycling or horse riding are among these entities.1Awad M. Murphy G. Gaither T. et al.Surgical excision of perineal nodular induration: a cyclist’s third testicle.Can Urol Assoc J. 2017; 11: 244Crossref PubMed Scopus (6) Google Scholar ‘Bowler's thumb’, caused by chronic repetitive impaction of the ulnar soft tissue of the thumb against the thumbhole of a bowling ball, manifests as pain, neuropathy and a mass lesion.2Showalter M. Flemming D. Bernard S. MRI manifestations of bowler’s thumb.Radiol Case Rep. 2015; 6: 458Crossref PubMed Scopus (2) Google Scholar Elastofibroma dorsi, linked to repetitive trauma of the shoulder girdle, results in a pseudotumour at the infra scapular area.3Pillay Y. Sabarathnam R. Elasto fibroma Dorsi: a case report of bilateral tumours and excision of the symptomatic lesion in a male patient.J Surg Case Rep. 2017; 2017: rjx206Crossref PubMed Google Scholar In surfers specifically, the repetitive low grade trauma caused by the contact with the surfboard may lead to the development of connective tissue nodules in several body parts, described as collagenomas or fibromas and surfer's knots.4McManus L. Thomson A. Whan A. The magnetic resonance appearance of surfers' knots: a case report.Radiol Case Rep. 2016; 11: 201-206Crossref PubMed Scopus (3) Google Scholar, 5Baba A. Okuyama Y. Yakabe H. Yamazoe S. Kobashi Y. Mogami T. Surfers' knots in the anterior chest.Clin Case Rep. 2019; 7: 597-598Crossref PubMed Scopus (2) Google Scholar, 6Erickson J.G. von Gemmingen G.R. Surfer's nodules and other complications of surfboarding.JAMA. 1967; 201: 134-136Crossref PubMed Scopus (28) Google Scholar, 7Cohen P.R. Eliezri Y.D. Silvers D.N. Athlete's nodules: sports related connective tissue nevi of the collagen type (collagenomas).Cutis. 1992; 50: 131-135PubMed Google Scholar, 8Kieliszak C. Junkins-Hopkins J. Athlete's nodule in a figure skater: an unusual presentation.Am J Dermatopathol. 2015; 37: e21-e25Crossref PubMed Scopus (2) Google Scholar Surfer's knots have been described over the tibial tuberosities, dorsum of the feet and occasionally on the chest. Fujimura et al. reported the development of masses on the chins of two male surfers, postulated to be secondary to repetitive blunt trauma to the chin area while paddling the surfboard.9Fujimura J. Sasaki K. Isago T. et al.The treatment dilemma caused by lumps in surfers’ chins.Ann Plast Surg. 2007; 59: 441-444Crossref PubMed Scopus (2) Google Scholar Surfer's bursa shares the connective tissue changes described in the above processes, but is distinctive in having a synovial component and in exhibiting fluctuations in size in proportion with the intensity of surfing. The cystic synovial lined spaces observed in this mass have the appearances of a bursa. Two different types of bursae have been described: synovial bursa and adventitious bursa.10Foisneau-Lottin A. Martinet N. Henrot P. et al.Bursitis, adventitious bursa, localized soft-tissue inflammation, and bone marrow edema in tibial stumps: the contribution of magnetic resonance imaging to the diagnosis and management of mechanical stress complications.Arch Phys Med Rehabil. 2003; 84: 770-777Abstract Full Text Full Text PDF PubMed Google Scholar Synovial bursae or true bursae are present at birth, found throughout the body near bony prominences and between bones, muscles, tendons, and ligaments, acting to decrease friction between moving structures. In contrast, adventitious bursae develop after birth in response to friction and pressure in superficial fibrous connective tissues. Since no true bursa or adjacent synovial lined joint is present at the anatomical site of this mass, we conclude that it corresponds to an adventitious bursa. The partial synovial lining observed within the cysts is likely a metaplastic response of the injured soft tissue. Synovial metaplasia has been observed following mechanical damage to the connective tissue in situations such as experimental injections of air or oily fluids into the subcutaneous tissue, after surgical procedures,11Gonzalez J. Ghiselli R. Santa Cruz D. Synovial metaplasia of the skin.Am J Surg Pathol. 1987; 11: 343-350Crossref PubMed Scopus (43) Google Scholar or in patients with breast implants. The fluctuation in size observed could be explained by fluid resorption by the synoviocytes during periods of inactivity. In addition, it is possible that mesenchymal cells in the stroma surrounding the cysts were subjected to adaptive fibrocartilaginous metaplasia, known to occur in the setting of chronic trauma.12Bottegoni C. Farinelli L. Aquili A. Manzotti S. Baldini M. Gigante A. Fibrocartilaginous metaplasia identified in the long head of the biceps brachii.J Shoulder Elbow Surg. 2018; 27: 1221-1225Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar This would result in cells with a chondrocytic phenotype, showing increased proteoglycan content and consequently increased water content. By this mechanism, variations in proteoglycan production and water retention according to the level of activity could contribute to variations in the size of the mass. In typical cases, aspects of the history, anatomical location and clinical examination may allow a clinical diagnosis of surfer's bursa to be made, without the need for radiological evaluation or biopsy. If any atypical features are identified, magnetic resonance imaging (MRI) assessment can be an invaluable tool in the work up of these lesions, as it can help narrow the differential diagnosis, exclude malignancy and avoid unnecessary invasive procedures.5Baba A. Okuyama Y. Yakabe H. Yamazoe S. Kobashi Y. Mogami T. Surfers' knots in the anterior chest.Clin Case Rep. 2019; 7: 597-598Crossref PubMed Scopus (2) Google Scholar If a decision for clinical follow-up rather than excision is made, the patient should be closely monitored to confirm regression of the lesion after periods away from surfing and to detect any atypical clinical changes. If clinically required, MRI could also be used in the follow-up, as imaging changes could alert the clinician to the need for surgical excision to exclude neoplastic or inflammatory pathology. Prevention and mitigation strategies are effective in this condition. Lessening the intensity of surfing led to a reduction in the size of the mass. The use of padding, including wetsuits and a padded vest, offered protection and avoided further recurrence. Surfer's bursa is a fluctuating, broad-based soft tissue mass occurring on the costal margin of long term surfers, believed to represent a response to repetitive, low grade trauma caused by the compression of soft tissues by the surfboard. This causes fat necrosis, fibrosis and the development of a synovial lining that can accumulate synovial fluid. The condition is likely under-reported. In typical cases, clinical history, anatomical location, fluctuating size proportionate to the intensity of surfing and the findings on physical examination will establish a clinical diagnosis and avoid unnecessary investigations. In atypical cases, MRI is an invaluable tool in the diagnosis and/or follow-up of these lesions. Reducing the time surfing and the use of padding may be preventive. If excised, local recurrence after resumption of surfing is possible." @default.
• W3106732544 created "2020-12-07" @default.
• W3106732544 creator A5014339980 @default.
• W3106732544 creator A5017050450 @default.
• W3106732544 creator A5066297253 @default.
• W3106732544 date "2021-06-01" @default.
• W3106732544 modified "2023-09-23" @default.
• W3106732544 title "Surfer's bursa: a recurrent chest wall mass in dedicated surfers that may mimic a sarcoma" @default.
• W3106732544 cites W1991981695 @default.
• W3106732544 cites W2033291648 @default.
• W3106732544 cites W2046227527 @default.
• W3106732544 cites W2090198089 @default.
• W3106732544 cites W2093366835 @default.
• W3106732544 cites W2318671441 @default.
• W3106732544 cites W2434363081 @default.
• W3106732544 cites W2611968601 @default.
• W3106732544 cites W2791520358 @default.
• W3106732544 cites W2914232601 @default.
• W3106732544 doi "https://doi.org/10.1016/j.pathol.2020.08.029" @default.
• W3106732544 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/33272696" @default.
• W3106732544 hasPublicationYear "2021" @default.
• W3106732544 type Work @default.
• W3106732544 sameAs 3106732544 @default.
• W3106732544 citedByCount "0" @default.
• W3106732544 crossrefType "journal-article" @default.
• W3106732544 hasAuthorship W3106732544A5014339980 @default.
• W3106732544 hasAuthorship W3106732544A5017050450 @default.
• W3106732544 hasAuthorship W3106732544A5066297253 @default.
• W3106732544 hasConcept C105702510 @default.
• W3106732544 hasConcept C142724271 @default.
• W3106732544 hasConcept C2778256501 @default.
• W3106732544 hasConcept C71924100 @default.
• W3106732544 hasConceptScore W3106732544C105702510 @default.
• W3106732544 hasConceptScore W3106732544C142724271 @default.
• W3106732544 hasConceptScore W3106732544C2778256501 @default.
• W3106732544 hasConceptScore W3106732544C71924100 @default.
• W3106732544 hasIssue "4" @default.
• W3106732544 hasLocation W31067325441 @default.
• W3106732544 hasOpenAccess W3106732544 @default.
• W3106732544 hasPrimaryLocation W31067325441 @default.
• W3106732544 hasRelatedWork W11336319 @default.
• W3106732544 hasRelatedWork W1325901 @default.
• W3106732544 hasRelatedWork W15401447 @default.
• W3106732544 hasRelatedWork W16015829 @default.
• W3106732544 hasRelatedWork W17282766 @default.
• W3106732544 hasRelatedWork W21901902 @default.
• W3106732544 hasRelatedWork W411231 @default.
• W3106732544 hasRelatedWork W7167528 @default.
• W3106732544 hasRelatedWork W8811007 @default.
• W3106732544 hasRelatedWork W9187695 @default.
• W3106732544 hasVolume "53" @default.
• W3106732544 isParatext "false" @default.
• W3106732544 isRetracted "false" @default.
• W3106732544 magId "3106732544" @default.
• W3106732544 workType "article" @default.