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Scheele C, Toepfer A, Beischl S, Dammerer D, Harrasser N, von Eisenhart-Rothe R, Lenze F. Insights into the Distribution Patterns of Foot and Ankle Tumours: Update on the Perspective of a University Tumour Institute. J Clin Med 2024; 13:350. [PMID: 38256484 PMCID: PMC10815983 DOI: 10.3390/jcm13020350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
The rarity of foot and ankle tumours, together with the numerous histological entities, presents a challenge in accumulating sufficient patients to draw reliable conclusions. Therefore, we decided to present an update of a retrospective analysis of their distribution patterns, comprising 536 cases of foot and ankle tumours presented to our tumour board between June 1997 and June 2023. Our aim was to provide a comprehensive overview of the prevalence and distribution patterns of benign and malignant bone and soft tissue tumours of the foot and ankle. A total of 277 tumours involved bone (51.7%). Of these, 242 (87.4%) were benign and 35 (12.6%) were malignant. In addition, 259 soft tissue tumours (48.3%) were found, of which 191 (73.7%) were benign and 68 (26.3%) were malignant. The most common benign bone tumours were simple bone cysts, enchondromas, osteochondromas, aneurysmal bone cysts, and lipomas of bone. Common benign soft tissue tumours included a tenosynovial giant cell tumour, haemangioma, plantar fibromatosis, schwannoma, and lipoma. The most common malignant soft tissue tumours were synovial sarcoma, malignant melanoma, and myxofibrosarcoma. In terms of anatomical location, the hindfoot was the most common site (28.7%), followed by the midfoot (25.9%), ankle (25.4%), and forefoot (20.0%). The distribution of benign entities often follows typical patterns, which may facilitate an early diagnosis even without biopsy (e.g., simple bone cyst, plantar fibromatosis). On the other hand, the distribution patterns of many rare or malignant entities are inconsistent. Individual soft tissue malignancies occur very sporadically, even over long periods of time and in specialized tumour centres. It is therefore important to recognise that any suspicious mass in the foot and ankle must be considered a possible malignancy until proven otherwise.
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Affiliation(s)
- Christian Scheele
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Andreas Toepfer
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007 St. Gallen, Switzerland;
| | - Simone Beischl
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Krems University Hospital, 3500 Krems, Austria;
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
| | - Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Klinikum Rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany; (S.B.); (N.H.); (R.v.E.-R.); (F.L.)
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2
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Thomson L, Putt O, Rennie W, Ashford R, Mangwani J. Benign soft tissue tumours of the foot & ankle: A pictorial review. J Clin Orthop Trauma 2023; 37:102105. [PMID: 36755760 PMCID: PMC9900435 DOI: 10.1016/j.jcot.2023.102105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
The purpose of this pictorial review is to aid the clinician in distinguishing different benign lesions within the foot and ankle. We discuss the typical clinical and radiological findings as well as management options for intra and extra-compartmental lesions. Differentiation between sarcoma and benign lesions is imperative when presented with any mass in the foot or ankle.
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Affiliation(s)
- L. Thomson
- Leicester Institute of Orthopaedics, University Hospitals of Leicester, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - O. Putt
- Leicester Institute of Orthopaedics, University Hospitals of Leicester, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, United Kingdom
| | - W.J. Rennie
- Department of Radiology, University Hospitals of Leicester, Infirmary Way, Leicester, Leicestershire, LE1 5WW, United Kingdom
| | - R.U. Ashford
- Leicester Institute of Orthopaedics, University Hospitals of Leicester, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, United Kingdom
- Leicester Cancer Research Centre, University of Leicester, United Kingdom
| | - J. Mangwani
- Leicester Institute of Orthopaedics, University Hospitals of Leicester, Gwendolen Road, Leicester, Leicestershire, LE5 4PW, United Kingdom
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3
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Jones O, Murphy SH, Poole KES, Watkins AJ, Durrani AJ. Phosphaturic Mesenchymal Tumor of the Ankle: A Case Report and Review of the Literature. J Foot Ankle Surg 2022; 61:185-188. [PMID: 34384701 DOI: 10.1053/j.jfas.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
We report the case of a phosphaturic mesenchymal tumor of the ankle; an extremely rare lesion that causes osteomalacia via paraneoplastic renal phosphate wasting. A 41-year-old man was referred to plastic surgery with a swelling over the anterior ankle, which had been increasing in size for 1 year. Focused ultrasound assessment was inconclusive, but excision biopsy demonstrated features in keeping with a phosphaturic mesenchymal tumor. Evidence of tumor-induced osteomalacia was subsequently identified on review of historical biochemistry. The patient was followed-up for 1 year with normalization of serum phosphate. In this case report, we present a discussion of the differential diagnosis for foot and ankle soft tissue lesions, and a review of the literature regarding the diagnosis and management of these tumors. Accurate identification of any soft tissue lesion on clinical examination alone is extremely challenging and excision biopsy should be considered in cases of diagnostic uncertainty.
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Affiliation(s)
- Oliver Jones
- Department of Plastic Surgery, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK.
| | - Suzanne H Murphy
- Department of Plastic Surgery, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Kenneth E S Poole
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - A James Watkins
- Department of Histopathology, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Amer J Durrani
- Department of Plastic Surgery, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
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4
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Pathak SK, Salunke AA, Virk JS, Kumar N. Giant cell tumour of EHL tendon sheath in young: a rare case report and review of the literature. BMJ Case Rep 2021; 14:e242980. [PMID: 34544702 PMCID: PMC8454440 DOI: 10.1136/bcr-2021-242980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022] Open
Abstract
Giant cell tumour of tendon sheath also known as benign synovioma is a slow-growing benign tumour originating from tendon sheath, ligaments or bursa. We present a case of swelling over the left foot of 7-month duration in 11-year-old boy diagnosed as giant cell tumour of tendon sheath. There was an extensive pressure effect of tumour mass on the second metatarsal evident by scalloping. Local excision was planned and executed, and reduction in scalloping was evident at 26-month follow-up with no recurrence. We conclude that en bloc resection of tumour with a hydrogen peroxide lavage may result in a favourable prognosis without recurrence.
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Affiliation(s)
| | | | | | - Naveen Kumar
- Orthopedics, Maharishi Markandeshwar University, Ambala, Haryana, India
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5
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Ensminger WP, Friedman E, Templeton KJ. Hemorrhagic Synovitis of the First Metatarsophalangeal Joint: A Case Report. JBJS Case Connect 2021; 10:e2000168. [PMID: 32773703 DOI: 10.2106/jbjs.cc.20.00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 69-year-old woman presented with a painful mass at her first metatarsophalangeal joint. Further evaluation was concerning for a neoplastic process, leading to surgical intervention. Pathological examination demonstrated hemosiderotic synovitis, and hematologic evaluation led to a new diagnosis of von Willebrand disease. CONCLUSION Hemorrhagic synovitis, involving mostly larger joints, has been well described. However, a literature search demonstrates no cases of this in the foot or toes. Presentation of hemarthroses and underlying coagulopathies can be subtle and must be considered in patients presenting with soft-tissue masses or pseudotumors, despite having no previous diagnosis.
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Affiliation(s)
- William P Ensminger
- 1Department of Orthopedic Surgery, University of Kansas Medical Center Kansas City, Kansas 2Department of Pathology, University of Kansas Medical Center, Kansas City, Kansas
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6
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Ho K, Ireland M, Armanasco PS. Rare Case of a Very Large Angioleiomyoma of the Dorsum Foot. Cureus 2021; 13:e14525. [PMID: 34007773 PMCID: PMC8121210 DOI: 10.7759/cureus.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Angioleiomyomas are relatively rare benign smooth muscle soft tissue tumors which often occur on the extremities. They are rarely diagnosed preoperatively as clinical and radiological examination is often nonspecific and inconclusive. An 80-year-old male presented with a 10-year history of a progressively growing and symptomatic lesion on his right dorsal foot within the first intermetatarsal space. The preoperative diagnosis was suspected to be a neurogenic schwannoma arising from the deep peroneal nerve. Simple excision and histopathology confirmed a diagnosis of angioleiomyoma with nil recurrence or complications. The size of the angioleiomyoma was the second largest reported in literature to date. Angioleiomyomas are often misdiagnosed, and a degree of suspicion should be maintained in patients presenting with lower extremity growing soft tissue tumors.
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Affiliation(s)
- Kevin Ho
- Podiatric Medicine, The University of Western Australia, Perth, AUS.,Podiatric Surgery, Australasian College of Podiatric Surgeons, Perth, AUS
| | | | - Paul S Armanasco
- Podiatric Surgery, Australasian College of Podiatric Surgeons, Perth, AUS
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Hoffler HL, Steele RM, Long CS. Benign Schwannoma of the Lateral Plantar Nerve: A Case Report. J Am Podiatr Med Assoc 2020; 110:449534. [PMID: 33301588 DOI: 10.7547/20-038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Schwannomas are benign, encapsulated soft-tissue tumors that rarely present to the foot and ankle. These tumors are usually asymptomatic unless an increase in size or disruption of the nerve causes pain. We report a case of a painful mass along the lateral plantar nerve near the fourth metatarsal base that was surgically excised and confirmed as a benign schwannoma by means of histopathologic analysis. At the final follow-up of over 2 years, the patient reported no pain, neurologic deficits, or signs of recurrence. This case demonstrates an unusual location of a schwannoma arising from the lateral plantar nerve.
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Intramuscular Ganglion Cyst of the Flexor Hallucis Brevis Secondary to Muscle Tear: A Case Report. Diagnostics (Basel) 2020; 10:diagnostics10070484. [PMID: 32708727 PMCID: PMC7399892 DOI: 10.3390/diagnostics10070484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
In the current study, we present a case of an intramuscular ganglion cyst in the flexor hallucis brevis muscle (FHB) that arose secondary to a muscle tear. Through this study, we propose a possible aetiology for the development of intramuscular ganglionic cysts. A 50-year-old woman presented with acute pain and swelling over the right mid-plantar area after prolonged kneeling for scrubbing floors. Ultrasonography examination performed at 5 days after the onset of symptoms revealed a partial tear of the right FHB. Follow-up evaluations were conducted, with magnetic resonance imaging and ultrasonography, at 24 and 54 days after symptom onset. MRI revealed a ganglion cyst in the mid-portion of the FHB without connection to the adjacent joint capsule or tendon sheath. On the ultrasonography examination at 45 days after onset, at the same location where a tear was seen on the initial examination, an anechoic defect in the mid-portion of the FHB was observed, compatible with a ganglion cyst. Given the favourable natural evolution, no aspiration or surgery were performed. The patient was discharged with minimal symptoms. The results suggest that the intramuscular ganglion cyst can develop following a muscle tear.
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9
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Prevalence of Peyronie and Ledderhose Diseases in a Series of 730 Patients with Dupuytren Disease. Plast Reconstr Surg 2020; 145:978-984. [DOI: 10.1097/prs.0000000000006642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Hadian Y, Link D, Dahle SE, Isseroff RR. Ultrasound as a diagnostic and interventional aid at point-of-care in dermatology clinic: a case report. J DERMATOL TREAT 2018; 31:74-76. [PMID: 30592244 DOI: 10.1080/09546634.2018.1564231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ultrasound is currently underutilized in dermatology practice. However, ultrasound provides clinicians with precise and unique information on cutaneous and subcutaneous lesions, while minimizing costs and complications related to more common and invasive diagnostic methods. We report a patient who presented with a tender subcutaneous mass that was diagnosed and treated using point-of-care ultrasound-guidance at the dermatology clinic. Ultrasound revealed features consistent with a ganglion cyst, which was subsequently injected with triamcinolone acetonide under ultrasound-guidance with the resolution of symptoms upon follow-up one month later. Our study demonstrates the utility of ultrasound as an effective, time-efficient diagnostic and interventional aid that can modify dermatology practice.
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Affiliation(s)
- Yasmin Hadian
- Department of Dermatology, School of Medicine, University of California, Davis, CA, USA.,Dermatology Section, VA Northern California Health Care System, Mather, CA, USA
| | - Daniel Link
- Dermatology Section, VA Northern California Health Care System, Mather, CA, USA
| | - Sara E Dahle
- Department of Dermatology, School of Medicine, University of California, Davis, CA, USA.,Podiatry Section, VA Northern California Health Care System, Mather, CA, USA
| | - R Rivkah Isseroff
- Department of Dermatology, School of Medicine, University of California, Davis, CA, USA.,Dermatology Section, VA Northern California Health Care System, Mather, CA, USA
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11
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Rozis M, Papadelis E, Mavrogenis A, Koufos S, Polyzois V, Pneumaticos S. Salvage of the Foot for Recurrent Malignant Peripheral Nerve Sheath Tumor. J Foot Ankle Surg 2018. [PMID: 28623062 DOI: 10.1053/j.jfas.2017.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malignant peripheral nerve sheath tumors are rare soft tissue tumors accounting for 3% to 10% of all soft tissue tumors. They are strongly related to neurofibromatosis type 1, an autosomal dominant disease, and are characterized by aggressive biologic behavior, high local recurrence rates, and frequent metastases. Although the major nerves of the lower extremities are a common location of these tumors, scarce cases have been reported of malignant peripheral nerve sheath tumors involving the interdigital nerves of the foot. We report the case of a patient with non-neurofibromatosis type 1 and a recurrent malignant peripheral nerve sheath tumor of the first interdigital nerve of the foot treated successfully with limb salvage surgery with wide resection margins and reconstruction with an autogenous fibula graft.
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Affiliation(s)
- Meletis Rozis
- Orthopaedic Resident, Third Orthopaedic Department, University of Athens, KAT Hospital, Marousi, Greece.
| | - Eustratios Papadelis
- Consultant Orthopaedic Surgeon, Hampshire Hospitals, National Health Service Foundation Trust, London, United Kingdom
| | - Andreas Mavrogenis
- Assistant Professor of Orthopaedics, First Orthopaedic Department, University of Athens, Attikon Hospital, Chaidari, Greece
| | - Spyridon Koufos
- Orthopaedic Resident, Third Orthopaedic Department, University of Athens, KAT Hospital, Marousi, Greece
| | - Vasilios Polyzois
- Consultant Orthopaedic Surgeon, Third Orthopaedic Department, University of Athens, KAT Hospital, Marousi, Greece
| | - Spyros Pneumaticos
- Professor of Orthopaedics and Surgeon, Third Orthopaedic Department, University of Athens, KAT Hospital, Marousi, Greece
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12
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Toepfer A, Harrasser N, Recker M, Lenze U, Pohlig F, Gerdesmeyer L, von Eisenhart-Rothe R. Distribution patterns of foot and ankle tumors: a university tumor institute experience. BMC Cancer 2018; 18:735. [PMID: 30001718 PMCID: PMC6043962 DOI: 10.1186/s12885-018-4648-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bone and soft tissue masses of the foot and ankle are not particularly rare but true neoplasia has to be strictly differentiated from pseudotumorous lesions. Diagnosis is often delayed as diagnostic errors are more common than in other regions. Awareness for this localization of musculoskeletal tumors is not very high and neoplasia is often not considered. The purpose of this study is to provide detailed information on the incidence and distribution patterns of foot and ankle tumors of a university tumor institute and propose a simple definition to facilitate comparison of future investigations. METHODS As part of a retrospective, single-centre study, the data of patients that were treated for foot and ankle tumors between June 1997 and December 2015 in a musculoskeletal tumor centre were analyzed regarding epidemiologic information, entity and localization. Included were all cases with a true tumor of the foot and ankle. Exclusion criteria were incomplete information on the patient or entity (e.g. histopathological diagnosis) and all pseudotumoral lesions. RESULTS Out of 7487 musculoskeletal tumors, 413 cases (5,52%) of tumors of the foot and ankle in 409 patients were included (215 male and 198 female patients). The average age of the affected patients was 36 ± 18y (min.3y, max.92y). Two hundred sixty-six tumors involved the bone (64%), among them 231 (87%) benign and 35 (13%) malignant. There were 147 soft tissue tumors (36%), 104 (71%) were benign, 43 (29%) malignant. The most common benign osseous tumor lesions included simple bone cysts, enchondroma and osteochondroma. By far the most common malignant bone tumor was chondrosarcoma. Common benign soft tissue tumors included pigmented villo-nodular synovitis, superifcial fibromatosis and schwannoma whereas the most common malignant members were synovial sarcoma and myxofibrosarcoma. Regarding anatomical localization, the hindfoot was affected most often. CONCLUSIONS Knowledge of incidence and distribution patterns of foot and ankle tumors will help to correctly assess unclear masses and initiate the right steps in further diagnostics and treatment. Unawareness can lead to delayed diagnosis and inadequate treatment with serious consequences for the affected patient.
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Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany. .,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany. .,Kantonspital St. Gallen, Klinik für Orthopädische Chirurgie und Traumatologie, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Maximiliane Recker
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany
| | - Ulrich Lenze
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Florian Pohlig
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Ludger Gerdesmeyer
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Sektion für Onkologische und Rheumatologische Orthopädie in der Klinik für Unfallchirurgie, Arnold Heller Strasse, D-24105, Kiel, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
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Lee JW, Joo MW, Sung JK, Ahn JH, Kang YK. Origin of Satellite Ganglion Cysts with Effusion in the Flexor Hallucis Longus Tendon Sheath around the Hallux. Clin Orthop Surg 2018; 10:94-98. [PMID: 29564053 PMCID: PMC5851861 DOI: 10.4055/cios.2018.10.1.94] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background To describe the clinical and magnetic resonance imaging findings of ganglion cysts with effusion in the flexor hallucis longus tendon sheath around the hallux to evaluate their origin. Methods Patients with recurrent or painful ganglion cysts around the hallux with effusion in the flexor hallucis longus tendon sheath who underwent surgical treatment at St. Vincent's Hospital from February 2007 to August 2016 were investigated. Surgical indication was a painful or recurrent mass caused by the cystic lesions. Those without effusion of the flexor hallucis longus tendon sheath were excluded. We assessed the clinical and magnetic resonance imaging findings. Results Magnetic resonance imaging findings in all patients showed several ganglion cysts around the hallux and large fluid accumulations within the flexor hallucis longus tendon sheath. Regarding the location, six ganglion cysts were on the dorsomedial aspect, one on the plantar medial aspect, seven on the plantar lateral aspect, and one in the toe pulp. Ten patients showed joint effusions in both the metatarsophalangeal and interphalangeal joints, two in the metatarsophalangeal joints, and three in the interphalangeal joints. There were communication stalks with a tail shape or abutment between ganglion cysts with surrounding joint effusions. Intraoperatively, connections between ganglion cysts, the synovial cyst of the flexor hallucis longus tendon sheath, and surrounding joints were seen. Conclusions Synovial fluid accumulation in the metatarsophalangeal or interphalangeal joint supplies the synovial cyst of the flexor hallucis longus tendon sheath and subsequently ganglion cysts in the hallux. In clinical practice, the surgeon should carefully check surrounding joints with tendon sheaths to prevent recurrence of the ganglion cysts around the hallux.
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Affiliation(s)
- Jung Woo Lee
- Division of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Wook Joo
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Kyeong Sung
- Department of Diagnostic Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Hoon Ahn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Koo Kang
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Sakamoto A, Okamoto T, Matsuda S. Persistent Symptoms of Ganglion Cysts in the Dorsal Foot. Open Orthop J 2018; 11:1308-1313. [PMID: 29290868 PMCID: PMC5721324 DOI: 10.2174/1874325001711011308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/25/2017] [Accepted: 11/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background A ganglion is a common benign cystic lesion, containing gelatinous material. Ganglia are most commonly asymptomatic, except for a lump, but symptoms depend on the location. A dorsal foot ganglion is typically painful. On the dorsal foot, the dorsalis pedis artery and the medial branch of the deep peroneal nerve are located under the fascia. Objective Five female patients of average age 45.8 ± 20 years (range, 12 to 60 years) with a painful ganglion in the dorsal foot were analyzed. Results Average lesion size was 2.94 ± 1.1 cm (range, 1.5 to 4.0 cm) and patients had experienced pain for a median of 2-3 years (range, 6 months to 3 years). Four patients had a single cystic lesion and 1 patient had developed multiple cystic lesions over the time that were associated with hypoesthesia. In 3 cases, symptomatic lesions were located deep beneath the fascia and were resected. In 2 cases, the depth of the non-resected lesions was shallow. Conclusion The cause of a painful dorsal foot ganglion can be attributed to its location in the thin subcutaneous tissue over the foot bone, in addition to its proximity to a nearby artery and nerve. Mild symptoms caused by a dorsal foot ganglion seem to be persistent, and the deeper the location, the more likely is the need for resection. To avoid nerve injury, anatomical knowledge is prerequisite to any puncturing procedure or operation performed.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan
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Kissel JA, Wong C. Ganglion cyst of the wrist treated with electroacupuncture: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2017; 61:269-276. [PMID: 29430057 PMCID: PMC5799836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To illustrate the clinical management of a ganglion cyst presenting on the right dorsal wrist. CLINICAL FEATURES A 38-year-old female complaining of a symptomatic right dorsal wrist ganglion of four years duration. INTERVENTION AND OUTCOME The patient was treated with high-frequency electroacupuncture in six consecutive treatments over a four week period and reported symptomatic improvement and a decrease in the size of the cyst following therapeutic intervention. CONCLUSION Ganglion cysts of the wrist are rather common benign connective tissue masses with variable treatment interventions. Electroacupuncture may be a novel and non-invasive conservative approach for the treatment of ganglion cysts. Further evaluation of the efficacy is warranted.
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Olaoye IO, Adesina MD. Solitary massive lipoma in the planter aspect of great toe presenting as two masses. SAGE Open Med Case Rep 2017; 5:2050313X17730265. [PMID: 28959448 PMCID: PMC5593210 DOI: 10.1177/2050313x17730265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/16/2017] [Indexed: 12/04/2022] Open
Abstract
Lipoma is rare in the planter aspect of the toes, and only few cases of massive lipoma have been reported in this site. The differential diagnosis of masses in the foot and toes is wide, and clinical diagnosis may be challenging. Access to magnetic resonance imaging, a standard diagnostic investigation for such soft tissue masses of the foot and toes, may be limited in some practice, requiring a reliance on clinical signs. We report a solitary massive lipoma in the planter aspect of the right great toe that appeared as two masses and with modification of typical clinical signs of lipoma.
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Mondal K, Mandal R, Khan K, Chakraborty J. Pitfalls in the cytological diagnosis of tenosynovial giant cell tumor: An illustration of eight discordant cases. Diagn Cytopathol 2017; 46:250-257. [PMID: 28941190 DOI: 10.1002/dc.23825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/09/2022]
Abstract
Tenosynovial giant cell tumor (TSGCT) is a highly recurrent benign tumor of the extremities. Wide local excision is usually sufficient to achieve its recurrence-free outcome. However, that needs a confident pre-operative cytological diagnosis as TSGCT. Aspirates from this tumor express the characteristic polymorphic cytological pattern, enough to impose a definite diagnosis. However rarely so, inadequate sampling from smaller tumors or due to faulty techniques, and selective sampling from topographic clusters of any individual component may lead to wrong interpretation. An unorthodox location near the larger limb joints further complicates the diagnostic misery on occasions. Such tumors are amenable to incomplete removal and risk for future recurrence. In this report, we describe eight cases of TSGCTs that were cytologically diagnosed otherwise. The cytological features of these discrepant tumors and the factors attributable to such dilemma are elaborated. Finally, a possible remedy has been proposed at conclusion in order to avoid future inconveniences.
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Affiliation(s)
- Krishnendu Mondal
- Department of Pathology, North Bengal Medical College and Hospital, Darjeeling, India
| | - Rupali Mandal
- Department of Pathology, North Bengal Medical College and Hospital, Darjeeling, India
| | - Kalyan Khan
- Department of Pathology, North Bengal Medical College and Hospital, Darjeeling, India
| | - Jasashwi Chakraborty
- Department of Pathology, North Bengal Medical College and Hospital, Darjeeling, India
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Abstract
Most of tumours of the foot are tumour-like (synovial cyst, foreign body reactions and epidermal inclusion cyst) or benign conditions (tenosynovial giant cells tumours, planta fibromatosis). Malignant tumours of the soft-tissue and skeleton are very rare in the foot and their diagnosis is often delayed with referral to specialised teams after initial inappropriate procedures or unplanned excisions. The adverse effect of these misdiagnosed tumours is the increasing rate of amputation or local recurrences in the involved patients. In every lump, imaging should be discussed before any local treatment. Every lesion which is not an obvious synovial cyst or plantar fibromatosis should have a biopsy performed. After the age of 40 years, chondrosarcoma is the most usual malignant tumour of the foot. In young patients bone tumours such as osteosarcoma or Ewing’s sarcoma, are very unusually located in the foot. Synovial sarcoma is the most frequent histological diagnosis in soft tissues. Epithelioid sarcoma or clear cell sarcoma, involve more frequently the foot and ankle than other sites. The classic local treatment of malignant conditions of the foot and ankle was below-knee amputation at different levels. Nowadays, with the development of adjuvant therapies, some patients may benefit from conservative surgery or partial amputation after multidisciplinary team discussions. The prognosis of foot malignancy is not different from that at other locations, except perhaps in chondrosarcoma, which seems to be less aggressive in the foot. The anatomy of the foot is very complex with many bony and soft tissue structures in a relatively small space making large resections and conservative treatments difficult to achieve.
Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160078. Originally published online at www.efortopenreviews.org
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Affiliation(s)
- E Mascard
- Necker University Hospital, 75015 Paris, France
| | - N Gaspar
- Department of Pediatrics, Institute Gustave Roussy, 94805 Villejuif, France
| | - L Brugières
- Department of Pediatrics, Institute Gustave Roussy, 94805 Villejuif, France
| | - C Glorion
- Orthopedic Surgery Department, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - S Pannier
- Orthopedic Surgery Department, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - A Gomez-Brouchet
- Laboratoire d'anatomie et cytologie pathologiques, Institut Universitaire du Cancer de Toulouse- Oncopole, 1 avenue Irène Joliot-Curie. 31059 Toulouse Cedex 9, France
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Robinson C, Kocialkowski C, Bhosale A, Pillai A. Intratendinous ganglion cyst of the extensor digitorum longus tendon: A case report. Foot (Edinb) 2016; 27:46-9. [PMID: 26481788 DOI: 10.1016/j.foot.2015.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/31/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Ganglion cysts are benign lesions, common in the hand and wrist. Intratendinous ganglion, however, are rare. We present the first reported case of an intratendinous ganglion cyst in an extensor digitorum longus (EDL) tendon of the foot. CASE REPORT A 35-year old presented with a left-sided painful dorsolateral foot swelling. Ultrasound suggested a ganglion cyst in proximity to the EDL tendon of the 5th toe. Two distinct swellings were identified on surgical exploration, including a 6×1cm ganglion lying within the EDL tendon substance that had resulted in tendon splitting. The lesions were excised and EDL tendon repaired. Histological analysis confirmed that both lesions were ganglion cysts. Post-operative recovery was uneventful. DISCUSSION Intratendinous ganglion cysts are rare lesions that pose a unique set of diagnostic and treatment challenges. Unlike conventional ganglion, their diagnosis may not be possible until surgical exploration. They have been reported to increase the risk of spontaneous tendon rupture. As such, a lower operative threshold should be applied to prevent their progression. A high index of suspicion should be applied to any ganglion reported radiologically to be in close contact with tendons. If diagnosed upon surgical exploration, it is essential that the operating surgeon is prepared to appropriately modify the procedure to involve primary tendon repair, tendon transfer or tenodesis.
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Affiliation(s)
- Cal Robinson
- University of Manchester, Manchester, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom.
| | | | - Abhijit Bhosale
- University Hospital of South Manchester, Manchester, United Kingdom.
| | - Anand Pillai
- University Hospital of South Manchester, Manchester, United Kingdom.
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20
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Lui TH. Arthroscopic ganglionectomy of the foot and ankle. Knee Surg Sports Traumatol Arthrosc 2014; 22:1693-700. [PMID: 22648747 DOI: 10.1007/s00167-012-2065-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the efficacy of arthroscopic ganglionectomy in the management of ganglia of the foot and ankle. METHODS From 2006 to 2010, arthroscopic ganglionectomy was performed for 89 ganglia in the foot and ankle of 88 patients. Clinical and intra-operative details were reviewed retrospectively. RESULT Ganglion stalk was identified in 6 % of the cases. The overall rate of presence of pathology was 26 %. The overall rate of recurrence or residual lesion was 12 % with high recurrent rate for extensor tendon ganglia and toe pulp ganglia. CONCLUSIONS Arthroscopic ganglionectomy of the foot and ankle ganglion by either internal drainage or complete resection is a feasible approach. Good results can be achieved in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China,
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21
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Woitzik E, Kissel J. Ganglion cyst of the foot treated with electroacupuncture: A case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2013; 57:310-315. [PMID: 24302778 PMCID: PMC3845479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To present the clinical management of a ganglion cyst presenting on the dorsolateral aspect of the foot. CLINICAL FEATURES A 45-year-old female cyclist complaining of ganglion cyst following training period. INTERVENTION AND OUTCOME Patient was treated with high-frequency electroacupuncture in four consecutive sessions over four weeks, and reported resolution of the cyst following therapeutic intervention. CONCLUSIONS Ganglion cysts of the foot are relatively rare connective tissue tumours with variable treatment approaches. Electroacupuncture may be a novel and non-invasive conservative approach for the treatment of ganglion cysts. Further evaluation of the efficacy of such treatment is warranted.
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Affiliation(s)
- Erin Woitzik
- Division of Graduate Studies, Sports Sciences, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada M2H 3J1
| | - Jaclyn Kissel
- Instructor, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Canada M2H 3J1
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Ganglion cysts in the paediatric wrist: magnetic resonance imaging findings. Pediatr Radiol 2013; 43:1622-8. [PMID: 23877503 DOI: 10.1007/s00247-013-2751-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 06/09/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The majority of published literature on ganglion cysts in children has been from a surgical perspective, with no dedicated radiologic study yet performed. OBJECTIVE Our aim was to assess the magnetic resonance (MR) imaging appearance of ganglion cysts in a series of paediatric MR wrist examinations. MATERIALS AND METHODS Ninety-seven consecutive paediatric MR wrist examinations were retrospectively reviewed for the presence of ganglion cysts. Only those studies with wrist ganglia were included. Cysts were assessed for location, size, internal characteristics and secondary effect(s). RESULTS Forty-one ganglion cysts (2-32 mm in size) were seen in 35/97 (36%) patients (24 female, 11 male), mean age: 13 years 11 months (range: 6 years 3 months-18 years). The majority were palmar (63.4%) with the remainder dorsal. Of the cysts, 43.9% were related to a wrist ligament(s), 36.6% to a joint and 17.1% to the triangular fibrocartilage complex. Of the patients, 91.4% had wrist symptoms: pain (n=29, 82.9%), swelling (n=7, 20%) and/or palpable mass (n=4, 11.4%); 71.4% patients had significant additional wrist abnormalities. CONCLUSION Ganglion cysts were frequently found in children referred for wrist MRI.
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Lumps and bumps around the foot and ankle: an assessment of frequency with ultrasound and MRI. Skeletal Radiol 2013; 42:1051-60. [PMID: 23385516 DOI: 10.1007/s00256-013-1575-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/03/2012] [Accepted: 01/06/2013] [Indexed: 02/02/2023]
Abstract
Benign and malignant tumours and tumour-like conditions frequently present as lumps in the foot and ankle. Although definitive histological diagnosis cannot be ascertained short of a biopsy, most entities can be confidently characterised on ultrasound and/or MRI. Masses in the foot and ankle present with lump, pain, paraesthesia, restricted mobility or a combination of these. In this review we have focussed on the relative frequency of masses in the foot and ankle that present as focal lumps, with a brief description of their typical appearance on ultrasound and MRI. Ganglions were the largest group in our series representing 24 % of the masses, followed by tendon- and ligament-related lesions and, bony lesions representing 16 % and 11 % of the masses respectively.
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Casal D, Bilhim T, Pais D, Almeida MA, O'Neill JG. Paresthesia and hypesthesia in the dorsum of the foot as the presenting complaints of a ganglion cyst of the foot. Clin Anat 2010; 23:606-10. [DOI: 10.1002/ca.20997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jakowski JD, Mayerson J, Wakely PE. Fine-needle aspiration biopsy of the distal extremities: a study of 141 cases. Am J Clin Pathol 2010; 133:224-31. [PMID: 20093231 DOI: 10.1309/ajcpbwjp3cg6jzka] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.
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