Benign tumors and non-melanoma skin cancers in patients with Fanconi anemia

Fanconi anemia (FA) is an inherited bone marrow failure syndrome (IBMFS) characterized by pathogenic variants in the FA/BRCA DNA repair pathway genes. Individuals with FA have an elevated risk of developing myelodysplastic syndrome, acute myeloid leukemia, and solid tumors. Hematopoietic cell transplantation (HCT) is the most effective treatment for FA related bone marrow failure but can increase the risk of cancer development. Information on benign tumors and NMSC is lacking in patients with FA. Our objective was to characterize patients with FA enrolled in the National Cancer Institute IBMFS Study who have experienced non-melanoma skin cancers (NMSC) and/or benign tumors (BT). A total of 200 patients diagnosed with FA were enrolled in the Institutional Review Board approved study "Etiologic Investigation of Cancer Susceptibility in IBMFS: A Natural History Study" (NCT00027274). Through medical records review, we identified 30 patients with at least one NMSC, either squamous or basal cell carcinoma, or benign tumor. The remaining 170 patients comprised the control group. Out of 200 patients, 12 had NMSC, 25 had benign tumors, with an age range of 11-64 and 0-56 years, respectively. The median age at HCT was 30.5 years for NMSC patients, 9 years for benign tumor patients, and 9.1 years for controls. The most common genotype observed was FANCA, followed by FANCC and FANCI. Benign tumors spanned diverse anatomical locations. Early onset NMSC in patients with FA compared to the general population emphasizes the need for consistent monitoring in patients with FA, while the diverse anatomical locations of benign tumors underscore the importance of comprehensive surveillance for timely interventions in managing symptomatology and heightened cancer risk.

Spectrum of electrocardiographic abnormalities in a large cohort of cardiac masses

BACKGROUND

Cardiac masses represent a heterogeneous clinical scenario. Potential electrocardiographic (ECG) red flags of malignancy remain to be investigated.

OBJECTIVES

The purpose of this study was to describe the spectrum of ECG abnormalities in a large cohort of cardiac masses and to evaluate potential red flags suggestive of malignancy.

METHODS

This was an observational cohort study of 322 consecutive patients with a cardiac mass and available ECG at Bologna University Hospital. All masses were diagnosed by histologic examination or, in the case of cardiac thrombi, by radiologic resolution after proper anticoagulant therapy. Multivariable regression analysis was used to assess potential predictors of malignancy among ECG abnormalities. All-cause mortality at follow-up was evaluated.

RESULTS

Of 322 patients, 98 (30.4%) had malignant tumors. Compared with patients with benign masses, those with malignant tumors exhibited a higher heart rate, right-axis deviation, greater depolarization, repolarization abnormalities, and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (P = .014), bradyarrhythmias (P = .009), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; P <.001), low voltages (P = .001), and right-axis deviation (P = .025) were identified as independent predictors of malignancy. Considering these specific ECG alterations, a malignancy-oriented ECG was associated with higher mortality at follow-up (median 20.7 months).

CONCLUSION

ECG frequently is abnormal in cases of malignant cardiac tumors. Some specific ECG changes are strongly suggestive for malignancy and type of infiltration.

Superior scapular location: An overlooked albeit frequent finding in elastofibroma dorsi

PURPOSE

To explore the frequency of superior scapular elastofibroma dorsi in a large patient series with elastofibroma dorsi.

METHODS

136 chest CTs from January 2016 to July 2022 reporting elastofibroma dorsi were retrospectively analyzed. Three radiologists assessed the number, size, and location of elastofibroma dorsi. Continuous variables underwent two-tailed t-tests with p < 0.05. Inter-observer agreement was assessed by using Cohen's Kappa values.

RESULTS

In 136 patients (mean age, 75.9 +/- 9.8 years; 117 female), 330 elastofibroma dorsi were found. Six (4.4 %) patients had single, 87 (64 %) double, 22 (16.2 %) triple and 21 (15.4 %) quadruple lesions. All single and double lesions were in the inferior scapular regions. 43 (31.6 %) patients had superior scapular lesions in addition to inferior scapular elastofibroma dorsi. Inferior scapular elastofibroma dorsi was significantly larger than superior scapular elastofibroma dorsi. The probability of a right superior lesion was significantly higher in patients with a larger right inferior lesion. Inter-observer agreement was very good for experienced radiologist (κ = 94.1) and good for other radiologists (κ = 79.4 and κ = 78).

CONCLUSION

In contrast to current belief, superior scapular elastofibroma dorsi accompanying the typical inferior scapular lesions is not uncommon and can even manifest bilaterally. To the best of our knowledge, this is the first case series reporting prevalence of quadruple elastofibroma dorsi.

Surgery for benign nail tumor

The vast majority of tumors in the nail apparatus have a different clinical presentation and course from their equivalents on the skin. Some, such as onychomatricoma and onychopapilloma, are unique to the nail and others, such as superficial acral fibromyxoma, have a tropism for the nail apparatus. As a rule, benign lesions respect the general architecture of the nail apparatus, whereas malignant tumors are destructive. Treatment is always surgical and good knowledge of the anatomy and the procedures is mandatory in order not to induce postoperative nail dystrophy.

An analytical and comparative study of swallowing in a tumor-infected oesophagus: a mathematical model

This study discusses non-steady effects encountered in peristaltic flows in oesophagus. The purpose of this communication is to evolve a mechanism to diagnose tumor in an oesophagus mathematically. The tumor is modelled by generic bump function of certain height and width. The method of solution follows long wavelength and low-Reynolds number approximations for unsteady flow, while integrations have been performed numerically in order to plot graphs, which reveal various characteristics of the flow. The goal is to assess how pressure varies across the tumor's width. The spatial, as well as temporal, dependence of pressure has been studied in the laboratory frame of reference. The pressure distribution for tumor-infected oesophagus is compared with that of normal oesophagus. An intensified pressure is obtained in the presence of tumor. The interruption while swallowing through benign oesophageal tumor is confirmed by an abrupt pressure rise across the tumor's width. Tumor position also plays a significant role whether it is at contraction or relaxation of walls. Additionally, wall-shear-stress, volumetric flow rate and streamlines have also been described and compared with that without tumor growth. The expressions corresponding to all the physical quantities are computed numerically. Further, this model may also be implemented to the two-dimensional channel flow for an industrial application.

Tumor localization is the important factor for recovery time of postoperative facial nerve paralysis in benign parotid surgery

OBJECTIVE

Facial nerve paralysis is the most problematic complication of surgery for parotid tumors. This study aimed to examine the progress of recovery from postoperative transient facial nerve paralysis (POFNP).

METHODS

Participants were 203 patients who developed POFNP after benign parotid surgery. A Kaplan-Meier showed the progress of recovery from paralysis. Factors involved in recovery were examined. For factors for which a significant difference was found, recovery from paralysis was examined over time.

RESULTS

Rates of recovery from paralysis were as follows: 28.6% of patients at 1 month, 58.3% at 3 months, 85.9% at 6 months, and 95.1% at 12 months after surgery. Deep lobe tumors were shown to be significantly associated with delayed recovery from paralysis. The relationship between tumor location and the time of recovery from was that deep lobe tumors had a significantly worse recovery from paralysis at 4 and 5 months after surgery.

CONCLUSION

Patients who develop POFNP must be informed about the progress of recovery and factors involved in recovery from paralysis. We believe that the results of the present study are a useful reference to that end.

Evaluation of diode laser efficacy in treating benign oral soft tissue masses: A case series

INTRODUCTION AND IMPORTANCE

The diode laser, with a wavelength ranging from 810 to 980 nm, is a modern treatment modality that offers significant advantages in the management of benign oral soft tissue masses. Therefore, this report aimed to assess the efficacy of diode laser application for excisional biopsy of such masses.

CASE PRESENTATION

Three female patients, aged 9, 39, and 45 years, visited the Oral Medicine Clinic with complaints of painless masses in the oral cavity persisting for two to three months. Their intraoral examination showed the presence of pedunculated or sessile exophytic lesions with a smooth surface. The lesions appeared as single, pink to red protrusions located in various sites, including the left buccal mucosa, right lateral border of the tongue, and lower gingiva.

CLINICAL DISCUSSION

Excisional biopsy of the masses was carried out in the patients using the diode laser. The surgical procedures ranged from 10 to 20 min, with minimal intraoperative bleeding and precise cutting, while no pain was reported. Postoperatively, at two weeks and four months follow-up, the intraoral wounds exhibited excellent healing without complications such as pain, bleeding, swelling, scarring, infection, or mass recurrence. The clinical diagnosis of irritational fibroma (two cases) and fibrous epulis were confirmed by histopathological examination.

CONCLUSION

Diode laser emerges as a highly efficacious method for the excisional biopsy of benign oral soft tissue masses, providing intraoperative and postoperative advantages over scalpel surgery.

A Rare Melanotic Neuroectodermal Tumor of Infancy in a 3-month-old Child: A Case Report

A rare case of melanotic neuroectodermal tumor of infancy (MNTI) occurring in a 3-month-old male child affecting the left maxilla is described. Computed tomography showed the benign expansile type of lesion affecting the left maxilla. The lesion was surgically excised completely. Histopathology confirmed the diagnosis of melanotic neuroectodermal tumor. Almost 6 months of follow-up showed no recurrence.

How to cite this article

Patankar SA, Pawar SR, Sharma R, et al. A Rare Melanotic Neuroectodermal Tumor of Infancy in a 3-month-old Child: A Case Report. Int J Clin Pediatr Dent 2024;17(1):79-81.

A giant peripheral ossifying fibroma of the mandible: A rare case report

INTRODUCTION

Peripheral ossifying fibroma (POF) is an unusual localized, reactive benign gingival growth. POF is usually small in size, it's measure <2 cm in diameter, but rarely reaches important sizes. The aim of this work was to present a rare case report of a giant peripheral ossifying fibroma of the mandible measuring >2 cm in diameter, misdiagnosed as peripheral myxoma.

CASE PRESENTATION

We present the case of a 42-year-old woman with a large peripheral ossifying fibroma in the oral cavity measuring 6 × 4 cm in diameter. The patient presented with an asymptomatic, slowly growing gingival mass in the left anterior and posterior region of the mandible. It gradually increased in size for more than two years. The patient had a mild mental deficit; however, we performed biopsy surgery, which revealed a peripheral myxoma, and then treated the tumor by excision under local anesthesia. The final histopathological examination revealed a peripheral ossifying fibroma.

CLINICAL DISCUSSION

This case report shows that POF can grow and reach unusual dimensions that may contribute to occlusal problems. The diagnosis of POF is based on clinical and radiographic features. The histopathological examination of the biopsy specimen can misdiagnose the lesion; therefore, the final diagnosis is based on the histopathological examination of the complete excised lesion.

CONCLUSION

POF is usually small, but can reach a larger size. The histopathological examination of the entire lesion is of paramount importance to make a final diagnosis.

Intramuscular intercostal lipoma in the left axillary tail: A case report and discussion

Intercostal lipomas are rare benign tumors that predominantly occur in the subcutaneous tissue. However, intramuscular intercostal lipomas are exceedingly uncommon and pose diagnostic challenges due to their atypical presentation. Here, we present a case report of an intramuscular intercostal lipoma located in the left axillary tail, along with a comprehensive discussion of its clinical features, diagnostic evaluation, and management options.

Cavernous hemangioma in the bladder of an 8-year-old boy

An isolated intravesical cavernous hemangioma of the bladder represents a rare occurrence, frequently posing challenges in distinguishing it from rhabdomyosarcoma. In this context, we present a case involving an 8-year-old male child diagnosed with a cavernous hemangioma of the bladder, which on MRI closely resembles the findings of rhabdomyosarcoma. Under such circumstances, the utilization of slow-flow images in contrast-enhanced MRI holds promise as a potentially valuable tool for discriminating between cavernous hemangioma and rhabdomyosarcoma in similar clinical scenarios.

Serous ovarian cystadenofibroma and review of the literature: Report of a case

INTRODUCTION AND IMPORTANCE

Ovarian cystadenofibroma is a relatively rare benign tumor (Groutz et al., 1994) that develops from the ovarian epithelium and stroma. This tumor can be solid, cystic, or semi-solid, depending on the fraction of epithelium and stroma it contains and the secretory activity of the epithelium that composes it.

CASE PRESENTATION

We report the case of a 58-year-old multiparous patient who consulted for pelvic pain and for whom an MRI was requested, objectifying the presence of a mass of ovarian origin. The patient had been menopausal since the age of 51 and was not taking hormone replacement therapy. She had comorbid hypertension for 4 years under treatment. Preoperative ultrasound showed an ovarian-appearing, finely echogenic mass, site of endocystic vegetation, measuring 8.48 mm × 7.30 mm long axis.

CLINICAL DISCUSSION

The mechanism underlying this hyperestrogenism is considered to be hypersecretion of the hormone by the tumor itself.

CONCLUSION

cystadenofibromas had morphologic imaging features of malignancy on CT or MR images. On histology, solid components in the cystic tumors were correlated with fibrous stromas that occasionally made a false positive result for malignancy on imaging.

Aneurysmal bone cyst of the clavicle: A case report

INTRODUCTION

An aneurysmal bone cyst (ABC) is a locally aggressive primary bone neoplasm. ABC of the clavicle is rare with only a few reported cases in the literature.

PRESENTATION OF CASE

We report the case of a 10-year-old boy who presented with an ABC at the right acromial end of the clavicle. The patient underwent intralesional curettage and allogenic bone grafting. Moreover, the patient's arm was placed in a sling for 2 weeks postoperatively. The patient had a satisfactory outcome after 11 years, with excellent Toronto Extremity Salvage, Quick-Dash, and Musculoskeletal Tumor Society scores.

DISCUSSION

Clavicular ABCs are uncommon. Early diagnosis helps to prevent pathological fractures. Adjuvant therapies might help decrease recurrence.

CONCLUSION

ABC should be considered an important differential diagnosis for clavicular swelling and masses. The best results can be achieved using curettage and void-filled bone grafts.

LEVEL OF EVIDENCE: 4

Indium chloride bone marrow scintigraphy for hepatic myelolipoma: A case report

BACKGROUND

As hepatic myelolipoma is rarely encountered, its radiological diagnosis using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) is challenging. Hepatic myelolipoma is similar to fat-contained hepatic lesions seen in hepatocellular carcinoma and angiomyolipoma. Therefore, further development of techniques to diagnose hepatic myelolipoma is warranted.

CASE SUMMARY

A 44-year-old obese man was found to have a hepatic lesion during his medical checkup. The lesion was 50 mm × 57 mm in size and was detected in segment 8 (S8) of the liver by US. The patient was diagnosed with hepatic lesion 20 years ago, but it was left unresolved. The patient had no symptoms, liver dysfunction, hepatitis virus antibody, or tumor marker elevation. Plain CT showed a well-defined lesion in S8 of the liver. The central and peripheral areas of the lesion primarily exhibited fat density and hypodensity, respectively. MRI revealed a capsule-like structure. Biopsy was performed to address the probability of hepatocellular carcinoma. The lesion was pathologically confirmed as a myelolipoma. Bone marrow scintigraphy performed using ¹¹¹InCl₃ revealed accumulation of the radiopharmaceutical in the soft tissue component, except in the fat-dominant part of the tumor, as well as in the surrounding liver parenchyma due to the presence of reticuloendothelial cells in the liver.

CONCLUSION

This is the first report on the diagnosis of hepatic myelolipoma using ¹¹¹InCl₃ scintigraphy. The effectiveness of bone marrow scintigraphy for diagnosing hepatic myelolipoma might be limited. As radiopharmaceuticals accumulate in both hematopoietic and reticuloendothelial cells, the accumulation of radiopharmaceuticals in the lesion is obscure.

Effective surgical management of glomus tympanicum tumor using diode laser: A case report study

INTRODUCTION

Glomus tympanicum is an extremely rare benign paraganglioma of the middle ear. The distinctive features of these tumors include their propensity for recurrence following treatment and their remarkably vascular nature, posing significant challenges to surgeons and necessitating the development of effective surgical techniques.

CASE PRESENTATION

A 56-year-old female presented with pulsatile tinnitus persisting for a year. Examination revealed a pulsating red mass in the lower section of the tympanic membrane. Computed tomography confirmed the presence of a mass occupying the middle ear, which was diagnosed as a glomus tympanicum tumor. The patient underwent surgical excision of the tumor, followed by diode laser application for coagulation at the site of the tumor. Histopathological examination confirmed the clinical diagnosis.

DISCUSSION

Glomus tympanicum tumors are rare neoplasms that arise in the middle ear. The surgical management of these tumors varies depending on the size and extent of the lesion. Various techniques are available for excision, including bipolar cautery and laser. Laser has emerged as an effective method for reducing tumor mass and controlling intraoperative bleeding, with positive indications after surgery.

CONCLUSION

Based on our case report, laser can be considered an effective and safe method for excision of glomus tympanicum, with positive indications for controlling intraoperative bleeding and reducing tumor mass.

Radiomics and machine learning for predicting the consistency of benign tumors of the central nervous system: A systematic review

PURPOSE

Predicting the consistency of benign central nervous system (CNS) tumors prior to surgery helps to improve surgical outcomes. This review summarizes and analyzes the literature on using radiomics and/or machine learning (ML) for consistency prediction.

METHOD

The Medical Literature Analysis and Retrieval System Online (MEDLINE) database was screened for studies published in English from January 1st 2000. Data was extracted according to the PRISMA guidelines and quality of the studies was assessed in compliance with the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).

RESULTS

Eight publications were included focusing on pituitary macroadenomas (n = 5), pituitary adenomas (n = 1), and meningiomas (n = 2) using a retrospective (n = 6), prospective (n = 1), and unknown (n = 1) study design with a total of 763 patients for the consistency prediction. The studies reported an area under the curve (AUC) of 0.71-0.99 for their respective best performing model regarding the consistency prediction. Of all studies, four articles validated their models internally whereas none validated their models externally. Two articles stated making data available on request with the remaining publications lacking information with regard to data availability.

CONCLUSIONS

The research on consistency prediction of CNS tumors is still at an early stage regarding the use of radiomics and different ML techniques. Best-practice procedures regarding radiomics and ML need to be followed more rigorously to facilitate the comparison between publications and, accordingly, the possible implementation into clinical practice in the future.

Giant Tracheal Fibroepithelial Polyp Treated Successfully by High-Frequency Electrocautery Ablation

Endotracheal fibroepithelial polyp is a rare disease in the airways. This report describes a rare case of a tracheal giant fibroepithelial polyp. A 17-year-old woman was admitted to the hospital with severe acute respiratory failure. Chest computed tomography revealed a tumor located below the epiglottis. Endotracheal bronchoscopic examination showed a giant polyp. This endotracheal polyp was removed with ablation, by using high-frequency electricity through flexible bronchoscopy under intravenous anesthesia. The patient has had a good recovery after the intervention and at long-term follow-up. We herein describe and discuss the appropriate therapeutic approach and also review the pertinent literature.

Intratendinous ganglion cyst of extensor indicis propius tendon: A case report

INTRODUCTION AND IMPORTANCE

The intratendinous ganglion cyst is an extremely rare entity. Thus, the global incidence has not been reported yet. The literature search showed scarce case reports and none has reported its occurrence in extensor indicis propius (EIP) tendon. The benign nature and the region at the dorsal hand mimic to the more common dorsal wrist ganglion. However, the surgical treatment arises significant risk to the function and may require subsequent tendon graft or tendon transfer.

CASE PRESENTATION

A 51-year-old-female presented with 4 years history of a slow-growing lump over the dorsal region of the right hand with discomfort during finger motions. The ultrasonography confirmed the diagnosis of dorsal wrist ganglion.

CLINICAL DISCUSSION

Intraoperatively, unlike the common presentation which is the well encapsulated mass originating from the carpal joint, the mass was found within the EIP tendon sheath and infiltrate the tendon substance. Surgical debulking was done and left the tendon partially intact. The frayed part was trimmed to ensure a smooth gliding. On the 6 month follow up, patient was symptom-free without any recurrence.

CONCLUSION

The intratendinous growth of a ganglion must be identified preoperatively for a proper management plan and inform consent. The intratendinous ganglion cysts frequently weaken the tendon. Hence, surgical excision is necessary with the preparation of secondary tendon reconstruction.

Intraoral healing type of pyogenic granuloma (A benign vascular tumor): A case report

Pyogenic granulomas represent tumor-like lesions affecting the skin and the oral cavity. This classic definition can be somewhat misleading because such lesion is not associated with infection and lacks any clinical evidence of pus or histological evidence of actual granulation tissue. This case report describes a surgical excision of the growth to exclude angiomatous proliferation. The patient reported a chief complaint of localized gingival overgrowth since 4 months. Intraoral examination revealed an irregular, sessile exuberant growth in respect to labial aspect and interdental gingiva of 31, 32, and 33, measuring about 1.6 × 1.1 cm. Based on the clinical findings, the case was provisionally diagnosed as "pyogenic granuloma". A treatment was planned for the patient. A surgical excision was done irt 31, 32, 33, and the tissue was sent for histopathological examination, which was suggestive of a healing type of pyogenic granuloma.

Clinico-histopathological review of 255 patients who underwent parotidectomy for pleomorphic adenoma: a 10-year retrospective study-a proposal for an optimal diagnostic and therapeutic algorithm for patients with recurrent pleomorphic adenoma

PURPOSE

Pleomorphic adenoma (mixed tumor) is the most common neoplasm of the parotid gland and one of the most frequent types of salivary gland tumor, generally with benign behavior and relatively slow growing. The adenomas could arise from the superficial, deep or from both superficial and deep parotid's lobes.

METHODS

The aim of this review is to retrospectively analyze the surgical management of patients with pleomorphic adenoma of the parotid gland performed at the Department of Otorhinolaryngology (Department of Sense Organs of "Azienda Policlinico Umberto I" in Rome), from 2010 to 2020, with a focus on the percentage of recurrence and on the complication related to surgery to suggest an optimal diagnostic and therapeutic algorithm for patients with recurrent pleomorphic adenoma. The analysis of the complications observed in case of different surgical approaches was performed using the X² test.

RESULTS

The choice of a surgical approach (superficial parotidectomy-SP, total parotidectomy-TP, extracapsular dissection-ECD) depends on several elements, such as the location and the size of the adenoma, the availability of existing technical facilities and the professional experience of the surgeon. A transient facial palsy was present in 37.6%, 2.7% reported a permanent facial nerve palsy, 1.6% developed a salivary fistula, 1.6% a post-operative bleeding and 2.3% showed Frey Syndrome.

CONCLUSION

The surgical management of this benign lesion is required, even in asymptomatic cases, to prevent the progressive growing and to reduce the risk of malignant transformation. The goal of surgical excision is to obtain the complete resection to minimize the risk of tumor recurrence and avoiding facial nerve disability. Therefore, an accurate preoperative study of the lesion and the choice of the most appropriate surgical treatment are essential to minimize the rate of recurrence.

Recurrent schwannoma of digital nerve on both hands: A very rare case report

INTRODUCTION AND IMPORTANCE

Schwannoma is the most common benign tumor of peripheral nerves and usually occurs solitary with a very low risk of recurrence. Schwannoma of the hand, particularly involving the digital nerve, is sporadic and most commonly leads to a misdiagnosis due to its rarity. Histopathology remains the gold standard diagnostic, however, with a thorough physical examination and radiologic imaging, this benign tumor can be managed well with the preservation of nerve function.

CASE PRESENTATION

We reported a rare case of digital nerve schwannomas on the bilateral hands of a 52-year-old white male with one recurrent mass on the right hand despite a previously complete debulking of the mass.

CLINICAL DISCUSSION

Intraoperatively, we removed lobulated whitish-yellow masses and left the nerve origin of the tumor intact (common palmar digital nerve and ulnar-side digital nerve). The histopathology supported the diagnosis of schwannoma. At the one-year follow-up, there is no recurrence and the patient remains asymptomatic.

CONCLUSION

Determining differential diagnosis by both clinical and preoperative imaging is essential, especially in the case of recurrence and multiple tumorous lesions. Malignancy or malignant degeneration should still be kept in mind. Complete removal is needed to prevent recurrence followed by a long-term follow-up.

Surgical treatment of a hindfoot plantar leiomyoma: A case study

Leiomyomas within the foot are rare and are difficult to diagnose with only the radiographic and clinical picture. They are benign, slow growing, and very rarely cause pain. We present an unusual case of a dermatology referral patient complaining of callus formation on the plantar aspect of the foot as well as shoe discomfort. The mass was believed to be a lipoma or a fibroma but after surgical excision was found to be a leiomyoma. Our case highlights the rarity of this diagnosis and presents a unique surgical technique utilizing a medial approach to the plantar hindfoot for lesion removal.