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Angelini A, Biz C, Cerchiaro M, Longhi V, Ruggieri P. Malignant Bone and Soft Tissue Lesions of the Foot. J Clin Med 2023; 12:3038. [PMID: 37109375 PMCID: PMC10146676 DOI: 10.3390/jcm12083038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed by a properly performed biopsy, is thus mandatory to avoid these pitfalls. The present article reviews the most common malignant bone and soft tissue lesions of the foot region, discussing their clinicopathological presentation, imaging features, and current concepts in treatment.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy (P.R.)
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Pacinian Corpuscles as a Diagnostic Clue of Ledderhose Disease—A Case Report and Mapping of Pacinian Corpuscles of the Sole. Diagnostics (Basel) 2022; 12:diagnostics12071705. [PMID: 35885610 PMCID: PMC9320595 DOI: 10.3390/diagnostics12071705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/04/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Plantar fibromatosis, known as Ledderhose disease, is a neoplastic disease characterized by a locally-aggressive bland fibroblastic proliferation. Although Pacinian corpuscles alterations are commonly described in palmar fibromatosis, there are still no references about Pacinian corpuscles alterations in the rarer plantar version. Methods: We present a case report where a wide cutaneous resection, including the plantar fascia was performed, allowing a detailed study of Pacinian corpuscles. Pacinian corpuscles were analyzed using immunohistochemistry for neurofilament proteins, S100 protein, CD34, vimentin, glucose transporter 1, epithelial membrane antigen, neural-cell adhesion molecule, actin, desmin, type IV collagen, and high-affinity neurotrophin Trk-receptors. Moreover, the density and the size of the corpuscles were determined. Results: A clear increase in the number (hyperplasia) of Pacinian corpuscles was evidenced in the Ledderhose disease plantar fascia in comparison with similarly aged normal subjects. Pacinian hypertrophy was not demonstrated, but a significant decrease in the number of corpuscular lamellae was noted, with a subsequent increase in the interlamellar spaces. Pacinian corpuscles from the pathological plantar fascia showed an abnormal structure and immunohistochemical profile, generally without identifiable axons, and also absence of an inner core or an intermediate layer. Moreover, other molecules related with trophic maintenance of corpuscles were also absent. Finally, a vascular proliferation was commonly noted in some corpuscles, which involved all corpuscular constituents. Conclusion: The observed Pacinian corpuscles hyperplasia could be considered a diagnostic clue of plantar fibromatosis.
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Nduka JC, Lam K, Chandrasekar CR. Diagnosing plantar fibromas - Beware of sarcomas. Foot (Edinb) 2021; 49:101736. [PMID: 33268229 DOI: 10.1016/j.foot.2020.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/11/2020] [Accepted: 08/29/2020] [Indexed: 02/04/2023]
Abstract
Plantar fibromas are a common diagnosis in orthopaedic foot clinic consultation, diagnosis of plantar fibroma is usually from history and examination, and radiological investigation may be needed to confirm diagnosis. Misdiagnosis, however, of plantar fibroma have been known to happen. The management of five cases of plantar soft tissue swellings were reviewed; the clinical presentation and radiological investigation findings of these cases are discussed with the aim of improving knowledge and awareness.
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Affiliation(s)
- Jude C Nduka
- Aintree University Hospital, Lower Lane, Liverpool L9 7AL, United Kingdom.
| | - Kimberly Lam
- Aintree University Hospital, Lower Lane, Liverpool L9 7AL, United Kingdom.
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The Epidemiology of Benign Proliferative Processes of the Skeletal System in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179338. [PMID: 34501928 PMCID: PMC8431108 DOI: 10.3390/ijerph18179338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/21/2021] [Accepted: 08/31/2021] [Indexed: 12/03/2022]
Abstract
A suspicion of a proliferative bone lesion in a child seems to be a major diagnostic problem for clinicians. There are no diagnostic and treatment algorithms described in the literature and no reliable cohort epidemiological data. Our study was conducted among 289 paediatric patients (0–18 years old) with an initial diagnosis of a bone tumour or tumour-like lesion. The study comprised a retrospective epidemiological analysis, an assessment of the concordance of the initial diagnoses with the histopathological diagnoses and an analysis of the specific locations of the various bone lesions. The results obtained have made it possible to formulate the following conclusions. (1) The most common proliferative bone lesion in children is osteochondroma; also common are fibrous dysplasia, non-ossifying fibromas and bone cysts. (2) Verifying the initial diagnosis by means of biopsy is essential. (3) Osteochondromas are typically located in the metaphyses of long bones, fibrous dysplasia in the femur and skull, cyst-like lesions in the proximal humerus and non-osteochondral fibromas exclusively in the lower limbs. What could improve the quality of treatment for children with primary proliferative bone diseases is the establishment of centres of paediatric orthopaedic oncology skilled in early diagnosis and prompt management.
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Fasciae of the musculoskeletal system: MRI findings in trauma, infection and neoplastic diseases. Insights Imaging 2019; 10:47. [PMID: 31001705 PMCID: PMC6473016 DOI: 10.1186/s13244-019-0735-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/18/2019] [Indexed: 02/07/2023] Open
Abstract
The fascial system is a continuum of connective tissues present everywhere throughout the body that can be locally involved in a large variety of disorders. These disorders include traumatic disorders (Morel-Lavallée lesion, myo-aponeurotic injuries, and muscle hernia), septic diseases (necrotizing and non-necrotizing cellulitis and fasciitis), and neoplastic diseases (superficial fibromatosis, desmoid tumors, and sarcomas). The current pictorial review aims to focus on these localized disorders involving the fasciae of the musculoskeletal system and their appearance at MRI.
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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: 31] [Impact Index Per Article: 5.2] [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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