Fibroma Of Tendon Sheath: Benign Tumor On Tendons

Fibroma of tendon sheath is a benign tumor that arises from the connective tissue surrounding tendons. It is a rare tumor, with an estimated incidence of 0.2 to 0.5 cases per 100,000 people. The tumor is typically slow-growing and painless, and it can occur in any part of the body, but it most commonly affects the hands and feet. The exact cause of fibroma of tendon sheath is unknown, but it is thought to be related to a genetic mutation. The tumor is typically diagnosed based on its clinical presentation and imaging findings. The treatment of choice for fibroma of tendon sheath is surgical excision. The prognosis for this tumor is excellent, with most patients experiencing no long-term complications.

Explain the concept of the closeness to topic score and its significance in this context.

Entities with High Closeness to Topic Score: Unraveling the Hidden Connections

Imagine you’re a detective trying to solve a perplexing case. You have a mountain of evidence—documents, photos, and even DNA samples—but you need a way to connect the dots and zero in on the crucial pieces. That’s where the concept of closeness to topic score comes into play.

Think of it as a GPS for your text, helping you navigate through a sea of information to find the most relevant entities. These entities are like key players in your story—characters, locations, or events—that hold the power to shed light on your topic. The closeness to topic score measures how closely related an entity is to your core subject, making it a valuable tool for understanding the context and identifying the most important aspects.

In this blog post, we’ll embark on a journey to explore entities with high closeness to topic scores. We’ll dive into the world of rare tumors, starting with Tenosynovial Fibroma, a curious and seldom-seen benign growth. Along the way, we’ll encounter Nodular Fasciitis, a reactive lesion that plays tricks on your body, and Aggressive Fibromatosis, a locally invasive tumor that demands our respect. Our final destination is Giant Cell Tumor of Tendon Sheath, a rare and aggressive entity that puts our diagnostic skills to the test.

So, buckle up and let’s uncover the hidden connections that bind these entities to our topic. Together, we’ll unravel the mysteries and gain a deeper understanding of the fascinating world of human health.

Entities with High Closeness to Topic Score

Imagine you’re a detective on the hunt for the most relevant entities related to your topic. Well, let’s say it’s like that popular game, “Guess Who?” And the topic of the day is… soft tissue tumors around joints or tendon sheaths.

After some sleuthing, our detective has narrowed down the suspect list to a handful of entities with a “closeness to topic score” of 8 or 9. So, let’s meet the usual suspects:

• Tenosynovial Fibroma: A rare and friendly tumor that likes to hang out in tendon sheaths.
• Nodular Fasciitis: A reaction to injury that can sometimes look a bit scary.
• Aggressive Fibromatosis: A sneaky infiltrator that can be quite stubborn.
• Giant Cell Tumor of Tendon Sheath: A rare and aggressive tumor that isn’t keen on playing nice.

Now that we’ve got our suspects in the lineup, let’s take a closer look at each one to see if they match our “soft tissue tumor around joints or tendon sheaths” profile.

Entities with High Closeness to Topic Score

When it comes to musculoskeletal tumors, some are like A-list celebrities, getting all the attention, while others are like indie bands, known only to a small but passionate group. In this blog, we’ll shine the spotlight on the unsung heroes of the tumor world: Tenosynovial Fibroma, Nodular Fasciitis, Aggressive Fibromatosis, and Giant Cell Tumor of Tendon Sheath.

Tenosynovial Fibroma: The Shy Tumor

Tenosynovial Fibroma is a rare tumor that likes to hang out in your synovium, the thin lining that coats your joints and tendons. It’s like the quiet kid in class, often misdiagnosed as a more common tumor called a ganglion cyst. But don’t let its shy nature fool you! Tenosynovial Fibroma can cause pain, swelling, and limited range of motion, especially if it’s in a joint that gets a lot of action, like your wrist or knee.

Epidemiology and Etiology

Tenosynovial Fibroma is an equal-opportunity tumor, affecting men and women of all ages. As for why it shows up in the first place, that’s still a mystery. But one thing’s for sure: it’s not contagious, so you can’t catch it from someone else.

Diagnosis

To diagnose Tenosynovial Fibroma, your doctor may order an MRI. This fancy imaging technique can help differentiate it from other tumors with similar symptoms. Sometimes, your doctor may even need to do a biopsy, where they take a small tissue sample to examine under a microscope.

Treatment Options and Prognosis

The good news is that Tenosynovial Fibroma is benign, meaning it won’t spread to other parts of your body. Treatment usually involves surgical removal, which can be done arthroscopically (through small incisions) or with a more open approach. The prognosis is generally excellent, with most people regaining full function of the affected joint.

Discuss its epidemiology, etiology, and diagnosis.

Entities with High Closeness to Topic Score

Entities that are closely related to the topic of rare soft tissue tumors have a high closeness to topic score. This score measures the relevance of each entity to the subject matter. Let’s dive into the entities that scored 8 or 9 on this scale, starting with a particularly rare gem.

Tenosynovial Fibroma: A Rare Benign Tumor

Imagine a curious wanderer exploring the realm of soft tissue tumors. Suddenly, they stumble upon Tenosynovial Fibroma, a rare and enigmatic tumor. It’s like a shy creature hiding in the shadows, waiting to be discovered. This enigmatic tumor commonly resides in the hands, feet, and ankles, often causing a painless lump that can be firm to the touch. But don’t be fooled by its benign nature; it can sometimes be locally aggressive, meaning it may spread within the surrounding tissues.

Epidemiology, Etiology, and Diagnosis

The search for the origins of Tenosynovial Fibroma is still a mystery, as the cause remains unknown. However, this elusive tumor seems to favor adults, especially those in their fourth or fifth decade of life. To uncover its presence, doctors may rely on imaging techniques like MRI or ultrasound to visualize the tumor’s unique characteristics. A biopsy, where a tiny tissue sample is examined under a microscope, can confirm the diagnosis, revealing the distinctive cellular features that set it apart.

Nodular Fasciitis: A Reactive Lesion

Next up, we have Nodular Fasciitis, a fascinating reactive lesion that’s like a chameleon in the soft tissue world. It can mimic various other tumors, making it a diagnostic puzzle. This enigmatic growth often appears as a rapidly growing lump, sometimes painful, especially in the arms and legs. Histologically, it’s a whirlwind of cells, resembling a fibroblastic frenzy. Fortunately, Nodular Fasciitis is usually benign, fading away on its own or with a gentle nudge from surgery.

Management and Outcomes

Nodular Fasciitis typically responds well to conservative management, like observation or simple excision. However, if it’s causing significant symptoms or doesn’t seem to be resolving on its own, surgical removal may be necessary. The prognosis is generally excellent, with most people making a full recovery without any lingering issues.

Unveiling the Treatment Odyssey of Tenosynovial Fibroma: From Diagnosis to Hope

In the realm of medical wonders, Tenosynovial Fibroma emerges as a enigmatic entity, tantalizing researchers with its rare yet benign nature. While it may sound like something straight out of a fantasy novel, this curious tumor has its own unique story to tell, and we’re here to unravel it together!

A Diagnostic Puzzle: Embarking on the Journey

Imagine a patient presenting with a mysterious lump that’s sending shivers down their spine. The doctor, acting as a medical detective, delves into a series of clues, from the patient’s history to physical examination. X-rays and MRIs become their trusty sidekicks, providing visual evidence of this puzzling mass that seems to be attached to a tendon sheath.

After meticulous analysis, the diagnosis is revealed: Tenosynovial Fibroma. It’s like solving a real-life whodunit, with the tumor playing the role of the enigmatic culprit. But here’s the twist—it’s not a malignant villain, but rather a benign enigma. Whew!

Treatment Tales: Unlocking the Secrets to Healing

So, what happens next? How do we tame this friendly giant? The treatment journey for Tenosynovial Fibroma is as unique as the tumor itself, and it all boils down to individual circumstances.

In some cases, the doctor may suggest a watch-and-wait approach, keeping a close eye on the tumor’s behavior. After all, if it’s not causing any trouble, why disturb it?

But if the tumor is playing the role of a nuisance, causing pain or interfering with daily life, then surgery may become the knight in shining armor. The goal is to remove the tumor while preserving the surrounding tissues and structures—a delicate balancing act that requires the skill of an experienced surgeon.

Prognostic Ponderings: Embracing the Future

Now, let’s talk about the big question: what’s the long-term outlook for Tenosynovial Fibroma? Well, my dear readers, this tumor has a reputation for being a cooperative patient. After successful treatment, the vast majority of individuals regain full function and bid farewell to any lingering symptoms.

Of course, every case is different, and like any medical journey, there are no absolute guarantees. But the statistics paint a positive picture, giving hope and reassurance to those who are navigating this path.

So, there you have it—a glimpse into the world of Tenosynovial Fibroma, from its diagnostic adventures to its treatment odyssey. It’s a story of **mystery, intrigue, and ultimately, hope, reminding us that even the rarest of medical encounters can have a happy ending.**

Nodular Fasciitis: A Reactive Lesion with a Twist!

Have you ever heard of a tumor that’s not really a tumor? Meet Nodular Fasciitis, a reactive lesion that can puzzle even the most seasoned medical detectives. It’s like your body’s overzealous construction crew working overtime, building up extra tissue in response to an injury or surgery.

Nodular Fasciitis might give you a scare at first glance, with its firm, tender lump that can pop up anywhere on your body. But fear not! These benign growths are usually harmless and go away on their own within a few months. It’s like a temporary construction site that your body cleans up once the repairs are done.

So, how does Nodular Fasciitis come to life? Well, it’s a mystery that doctors are still trying to solve. Some say it’s a response to an injury, while others blame it on surgery or even certain medications. But what we do know is that it’s not contagious, so you can’t catch it from anyone else.

If you’re worried about that lump on your body, it’s always good to consult a doctor. They’ll usually give it a good poke and prod, maybe even order an ultrasound or MRI, to make sure it’s not something more sinister. But in most cases, Nodular Fasciitis is just a little hiccup in your body’s repair process.

Entities with High Closeness to Topic Score

In the world of medical research, we use a concept called the “closeness to topic score” to measure how relevant a topic is to a given entity. It’s like a secret handshake between computers and medical journals, telling them how closely connected certain keywords, phrases, and concepts are to each other.

For our topic, we’re looking for entities that have a high closeness to topic score. These are the superstars that are most directly related to our discussion. After some serious number-crunching, we’ve identified Tenosynovial Fibroma, Nodular Fasciitis, Aggressive Fibromatosis, and Giant Cell Tumor of Tendon Sheath as our champions with scores of 8 or 9. They’re like the VIPs of our medical party!

Tenosynovial Fibroma: A Rare Benign Tumor

Imagine a tiny, unassuming growth tucked away in your tendons or tendon sheaths. That’s Tenosynovial Fibroma! This rare benign tumor is like a shy recluse, minding its own business without causing any trouble. It’s usually found in your hands, feet, or wrists, but sometimes it can pop up in other places like your knee or elbow.

Clinical Features:

• Small, firm lump that may be painful or painless
• Usually grows slowly
• Can cause stiffness or restricted movement in the affected area

Histology:

• Composed of spindle-shaped cells arranged in a storiform pattern
• May have areas of myxoid change

Differential Diagnosis:

• Giant cell tumor of tendon sheath
• Nodular fasciitis
• Fibrosarcoma

Nodular Fasciitis: A Reactive Lesion

Nodular Fasciitis is like a hyperactive toddler who just can’t sit still. It’s a reactive lesion that develops when your body goes into overdrive after an injury or trauma. Think of it as your body’s way of saying, “Hold on, we need to fix this right now!”

Clinical Features:

• Rapidly growing, firm lump
• Usually painless
• Most commonly occurs in young adults
• Can mimic a soft tissue sarcoma

Histology:

• Composed of plump spindle-shaped cells with a high mitotic rate
• May have areas of hemorrhage and extravasated red blood cells

Differential Diagnosis:

• Soft tissue sarcoma
• Inflammatory myofibroblastic tumor
• Fibromatosis

Nodular Fasciitis: A Reactive Lesion with a Unique Story

Nodular Fasciitis, a curious reactive lesion, often makes an unexpected appearance in the human body. Picture this: imagine your body saying, “Hey, I found something unusual, let’s send in the repair crew!” That’s Nodular Fasciitis in a nutshell. It’s like a temporary construction site, with cells rushing in to fix something that’s not quite broken.

Unveiling the Mysteries of Nodular Fasciitis

Nodular Fasciitis is known for its rapid growth, like an eager child who can’t wait to show off their new toy. It usually presents as a firm, round lump under the skin, often near joints or areas that have experienced some trauma. This sneaky lesion can mimic other conditions, but biopsy is the golden ticket to revealing its true identity.

Managing the Mischievous Nodular Fasciitis

The good news is, Nodular Fasciitis is usually harmless. It’s like a stubborn child who just wants to be left alone to play. In most cases, it will eventually calm down and disappear on its own. However, if it’s causing you discomfort, your doctor might suggest surgery to remove it. Don’t worry, it’s a minor procedure that’s like taking out a splinter.

Prognosis: A Happy Ending

Nodular Fasciitis has a very good prognosis. It’s like a fleeting visitor who comes and goes without leaving a trace. After treatment, you’ll likely be back to your old self, with the only reminder of this temporary adventure being a cool scar that tells the tale of your body’s mysterious repair crew.

Unveiling the Aggressive Nature of Fibrous Tumors

Imagine your body as a bustling city, where tissues and cells are like buildings and roads. Now, let’s zoom in on a particular neighborhood called Aggressive Fibromatosis. This is no ordinary neighborhood; it’s a fickle and invasive one.

Aggressive Fibromatosis is a rare but aggressive tumor that likes to play hide-and-seek. It can pop up anywhere in your body, but its favorite hangouts are your arms, legs, and back. It’s a sly character that sneaks into your tissues and starts growing uncontrollably.

Warning signs that you’re in the presence of Aggressive Fibromatosis:

• A stubborn lump: It’s not going away anytime soon and just keeps getting bigger.
• Pain: It can feel like a throbbing or aching sensation that won’t let you rest.
• Tenderness: Touching or pressing the area is like poking a sore spot.

Unlike other tumors that play nice, Aggressive Fibromatosis is not content with just staying in one place. It’s like a hungry beast that starts invading the surrounding tissues, disrupting the neighborhood and causing a lot of damage. This aggressive behavior is what gives it its “aggressive” name.

Now, let’s take a closer look at the telltale signs that you’re dealing with Aggressive Fibromatosis:

• Imaging: X-rays or MRI scans can show a mass or thickening in the affected tissue.
• Microscope magic: When doctors take a tiny sample and examine it under a microscope, they see bundles of spindle-shaped cells that look like little bricks.

Treating Aggressive Fibromatosis can be a challenge. The goal is to remove the tumor and prevent it from coming back. Surgery is often the first line of defense, but sometimes radiation therapy or chemotherapy may also be needed.

The prognosis for Aggressive Fibromatosis varies. It depends on how big the tumor is, where it’s located, and how much it has invaded the surrounding tissues. With early detection and treatment, it’s possible to achieve a good outcome. But don’t be fooled by its name; this is a tumor that you don’t want to mess with.

Unraveling the Enigmatic Tumors: A Journey into the World of Musculoskeletal Rarities

Entities with High Closeness to Topic Score

The closeness to topic score measures how closely related entities are to the main topic. In this case, our focus is on rare musculoskeletal tumors. Entities with a score of 8 or 9 are considered highly relevant to our expedition.

Tenosynovial Fibroma: A Rare Benign Traveler

Tenosynovial Fibroma is a friendly, benign tumor that resides in the synovial linings of joints and tendon sheaths. It’s a bit of a recluse, preferring to keep to itself and cause minimal trouble. Despite its rarity, it’s one of the most common tumors in this area, so it deserves our attention.

Nodular Fasciitis: A Reactive Rascal

Nodular Fasciitis isn’t a true tumor, but rather a reactive mischief-maker that forms in response to an injury or trauma. It’s a temporary guest that usually vanishes within a few months, but it can leave us scratching our heads until it decides to depart.

Aggressive Fibromatosis: A Formidable Foe

Aggressive Fibromatosis is the bad boy of the bunch, a locally invasive tumor that can spread aggressively. It’s a rare but persistent opponent that can cause pain, swelling, and damage to surrounding tissues.

Giant Cell Tumor of Tendon Sheath: A Stealthy Aggressor

The Giant Cell Tumor of Tendon Sheath is a rare and aggressive predator that loves to hide in the tendon sheaths of our hands and feet. It’s a sneaky infiltrator that can cause bone destruction and damage to the tendons, making it a formidable adversary.

Taming the Beast: Treatment and Prognosis of Aggressive Fibromatosis

Aggressive Fibromatosis, a notorious bully in the muscle and soft tissue realm, can leave even the bravest surgeons quaking in their scrubs. But fear not, for in this blog, we’ll dive into the depths of this stubborn tumor and uncover the secrets to effectively combating it.

Treatment Modalities

The battle against Aggressive Fibromatosis requires a multi-pronged approach, with each treatment modality tailored to the individual patient’s situation:

Surgery: The most common approach, surgery involves removing the tumor while preserving surrounding tissues. But beware, this tumor is as tenacious as a bulldog, with a high risk of local recurrence.

Radiotherapy: This non-invasive treatment blasts the tumor with high-energy rays, aiming to shrink its size or even eliminate it completely. However, radiotherapy may cause damage to healthy tissues, so it’s not always the first choice.

Chemotherapy: These powerful drugs travel through the bloodstream to target and kill cancer cells, including those pesky Fibromatosis cells. But be warned, chemotherapy can come with its own set of side effects.

Prognosis: The Road Ahead

The prognosis for Aggressive Fibromatosis depends on several factors, including the tumor’s size, location, and response to treatment. Generally speaking, smaller tumors that are completely removed have a better chance of long-term success. However, larger tumors or those that invade critical structures may require more aggressive treatment and have a less favorable prognosis.

While there’s no denying that Aggressive Fibromatosis can be a formidable foe, advancements in treatment have significantly improved the outlook for patients. With early detection, appropriate treatment, and a team of skilled medical professionals, it’s possible to conquer this challenging condition and live a full and active life.

Rare and Aggressive: Unraveling the Giant Cell Tumor of Tendon Sheath

Prepare yourself for an adventure into the realm of the extraordinary! Today, we’re diving into the world of Giant Cell Tumor of Tendon Sheath, a tumor so rare that you might as well be on a hunt for a mythical unicorn. But don’t let its scarcity fool you; this condition is a force to be reckoned with.

Like a cunning ninja, it strikes silently, often hiding in the shadows of our tendons. But when it reveals itself, brace yourself for a ride wild enough to make a rodeo clown envious. The Giant Cell Tumor of Tendon Sheath is the bully of the tumor world, growing aggressively and causing havoc in its wake. It’s like that one kid in school who always picks on the smaller ones, but instead of a playground, this tumor’s playground is your innocent tendons!

Unveiling the Tumor’s Disguise

Picture this: you’re innocently enjoying a casual hike when suddenly, you feel a sharp pain radiating through your tendon. It’s like a rogue ninja has stabbed you in the back, leaving you writhing in agony. Well, that’s how the Giant Cell Tumor of Tendon Sheath announces its presence.

This sneaky tumor has a knack for mimicking other conditions, making it a master of disguise. It can look just like a ganglion cyst or a tenosynovitis, but don’t be fooled! Underneath that innocent facade lies a menacing monster waiting to unleash its destructive power.

The Tumor’s Wrath: A Tale of Invasion

Once this tumor sets its sights on your tendons, it’s like a relentless army laying siege to a castle. Growing aggressively, it invades the surrounding tissues, causing pain, swelling, and discomfort that will make you question the existence of a benevolent universe.

But the Giant Cell Tumor of Tendon Sheath doesn’t stop there. Oh no, it has another trick up its sleeve! This tumor can also spread to other parts of the body, making it a truly formidable foe. It’s like a villain in a superhero movie, always scheming and plotting to conquer the world, except in this case, the world is your body.

Entities with High Closeness to Topic Score

Entities with a Score of 8 or 9:

• Tenosynovial Fibroma
• Nodular Fasciitis
• Aggressive Fibromatosis
• Giant Cell Tumor of Tendon Sheath

The Significance of Closeness to Topic Score

This score measures how relevant an entity is to a specific topic. A high score indicates a close connection and thus high relevance. In this context, it means these entities are strongly associated with the topic at hand.

Tenosynovial Fibroma: A Rare Benign Tumor

Clinical Presentation:

Tenosynovial Fibroma typically appears as a painless lump or swelling in the fingers or toes. It might feel firm or elastic, and it may move slightly when you touch it.

Epidemiology, Etiology, and Diagnosis:

This rare tumor most commonly affects adults between 30 and 50 years old. Its exact cause is unknown, but it’s believed to originate from cells in the lining of tendons. Diagnosis involves a physical exam, imaging tests like ultrasound or MRI, and sometimes a biopsy.

Treatment and Prognosis:

Treatment usually involves surgical removal. The prognosis is excellent, with most patients experiencing a complete recovery and no recurrence.

Nodular Fasciitis: A Reactive Lesion

Nature of Nodular Fasciitis:

Nodular Fasciitis is not a tumor but rather a reactive lesion, meaning it’s a response to an injury or inflammation. It can occur anywhere in the body but is most common in the arms and legs.

Clinical Features, Histology, and Differential Diagnosis:

It usually appears as a rapidly growing, tender lump. Histologically, it shows a proliferation of immature cells. Differential diagnosis includes other soft tissue tumors, including sarcomas.

Management and Outcomes:

Nodular Fasciitis often resolves on its own within a few weeks or months. However, if it causes discomfort or grows too large, it may be surgically excised. The outcomes are generally excellent.

Aggressive Fibromatosis: A Locally Invasive Tumor

Definition and Aggressive Characteristics:

Aggressive Fibromatosis is a locally invasive tumor that can occur in various body parts, commonly the limbs and trunk. It’s characterized by its rapid growth and tendency to recur after removal.

Clinical Manifestations, Imaging Findings, and Histopathological Features:

Clinically, it presents as a firm, painless lump that may grow several centimeters in size. Imaging tests like MRI show its infiltrative nature. Histologically, it’s composed of spindle-shaped cells arranged in bundles.

Treatment Modalities and Prognosis:

Treatment options include surgery, radiation therapy, and targeted therapy. The prognosis is variable, with some patients experiencing long-term remission and others experiencing recurrence and distant metastasis.

Giant Cell Tumor of Tendon Sheath: A Rare Aggressive Tumor

Rarity and Aggressiveness:

Giant Cell Tumor of Tendon Sheath is extremely rare, representing less than 1% of all soft tissue tumors. It’s characterized by its aggressive behavior and high risk of recurrence.

Clinical Presentation, Imaging Characteristics, and Histopathological Findings:

It typically presents as a painful, rapidly growing mass in the fingers or toes. Imaging tests like X-ray and MRI show a destructive lesion involving the bone. Histologically, it’s characterized by the presence of multinucleated giant cells.

Treatment Options and Prognosis:

Treatment involves aggressive surgery to remove the tumor and surrounding tissue. Radiation therapy may be used in some cases. The prognosis is guarded, with a high risk of recurrence and metastasis.

Giants in the Tumor World: Giant Cell Tumor of Tendon Sheath

Hey there, curious reader! Welcome to our adventure into the fascinating world of rare and aggressive tumors. Today, we’ll be casting our spotlight on the Giant Cell Tumor of Tendon Sheath (GCTTS), a true “giant” among its counterparts.

Like a sneaky intruder, GCTTS sneaks into the synovium, the delicate lining of your tendons. It’s a rare tumor, so rare that it’s like spotting a unicorn in a crowded city. But don’t be fooled by its rarity; this tumor packs a punch. It’s aggressive, like a tiny army invading your body, attacking surrounding tissues and refusing to give up.

Treatment Options: A Tale of Surgical Precision

When it comes to treating GCTTS, our trusty surgeons pull out their scalpels and prepare for a delicate operation. The goal is to remove the tumor completely, leaving no trace behind. However, this mission can be like defusing a bomb; the tumor often nestles close to important structures, making it a tricky task to avoid collateral damage.

Prognosis: An Uncertain Future

The prognosis for GCTTS varies, and it’s like a rollercoaster ride of uncertainty. In some cases, the tumor behaves like a well-behaved guest, submitting to treatment and leaving no lingering effects. In others, it’s like a stubborn tenant, refusing to depart and potentially causing recurrence.

Early Detection: Your Secret Weapon

The key to tackling GCTTS is early detection, like catching a burglar in the act. If you notice any suspicious lumps or swelling around your tendons, don’t hesitate to call your medical detective. They’ll perform an ultrasound or MRI, like using a magnifying glass to peer into your body, to confirm the villain’s identity.

Remember, this tumor might be rare, but it’s not invincible. With the right diagnosis and treatment, you can conquer this giant and reclaim your health. Keep your eyes peeled for any suspicious symptoms, and don’t hesitate to consult your medical superheroes for help.