Bone and Soft Tissue Tumors About the Foot and Ankle

A case report of arthroscopic treatment of a retro-patellar GCTTS causing anterior knee pain

INTRODUCTION AND IMPORTANCE

Giant cell tumor of tendon sheath (GCTTS) is a common soft tissue tumor in hands and feet; however, it is rare in knee joints.

CASE PRESENTATION

We present a case of a 52-year-old female who had a retropatellar tendon giant cell tumor (GCT) in the right knee, causing vague anterior knee pain.

CLINICAL DISCUSSION

Anterior knee pain is a challenging complaint in orthopedics due to the multiple causative reasons, the combination of several complex etiologies, and the lack of clear guidelines for an effective treatment.

CONCLUSION

This case report aims to shed light on unlikely pathologies in complex cases. GCTTS is a rare lesion to affect the retropatellar region. However, we must keep it in mind when dealing with challenging anterior vague knee pain complaints. A comprehensive examination is essential; surgical experience and extended follow-up are mandatory for avoiding complications.

Malignant Tumors of the Foot and Ankle

BACKGROUND

Surgical treatment is usually required for malignant foot and ankle tumors. In this study, we sought to review factors in treatment that may be associated with morbidity and mortality.

METHODS

All malignant foot and ankle tumors at our institution between April 1988 and April 2018 were retrospectively reviewed. The surgical modalities used and clinical outcomes of patients according to the anatomic location (Kirby zone) and clinical stage (Enneking system) of each tumor were described. Extent of surgical resection required, recurrence, and death rates were assessed.

RESULTS

Between April 1988 and April 2018, 80 patients with malignant tumors of the foot and ankle were treated at out institution. Mean age of patients was 42.6 (range, 3-89) years. Mean follow-up was 30.2 months (range, 24-120). Tumors were primary in 75 patients (94%) and metastatic from another organ in 5 patients (6%). Tumors originated from bone in 18 patients (22%) and from soft tissue in 63 patients (78%). Synovial sarcoma was the most common soft tissue tumor, and osteosarcoma was the most common osseous tumor.All patients had surgery to resect their tumor. Twenty-one (26%) had unplanned surgical procedures without initial biopsy at an outside institution prior to referral. Those patients were more likely to be treated with amputation or wide excison and free flap surgery (P < .01). The recurrence rate was 50% for the unplanned surgery group and 22% for the planned surgery group. Mortality rate was 10% for the unplanned group and 6% for the planned group. The recurrence and mortality rate was higher in the unplanned group (P = .03).

CONCLUSION

Our study suggests that unplanned initial surgeries are associated with higher recurrence and mortality rates and reinforces the notion that these patients should be referred for treatment at a center with specialized expertise in tumor management.

LEVEL OF EVIDENCE

Level, IV, retrospective case series.

Benign and Malignant Tumors in Child Foot

Bone tumors affecting pediatric foot are a rare occurrence. Most lesions are benign, but a thorough diagnostic evaluation must always be performed to rule out malignant tumors. Approach to benign lesions is conservative, from observation follow-up to curettage or mininvasive techniques. In malignant lesions, a wide resection must be performed and same protocols applied as in tumors affecting other skeletal sites. Reconstructive procedures should aim to mechanical stability and long-lasting results; joint motion restoring can be attempted when not negatively affecting stability. Amputation procedures should be considered as a still viable choice because of their good functional result in the foot.

Unusual multiloculated serpiginous ganglion of the foot

Ganglions are cystic lesion more commonly seen around the wrist joint. Gangliomas of plantar aspect of the foot are rare. We have presented a case of an unusual serpiginous ganglioma of the plantar aspect of the foot. Less literature is available regarding plantar foot gangliomas. The treatment is challenging because of occurrence of the lesion at weight bearing zone. Available options for treatment includes conservative with splint, intralesional injection,arthroscopic excision and open excision.