Soft-tissue osteochondroma in the calcaneal pad: a case report

Extraosseous osteochondroma of superficial fascia layer of the heel: A case report and review of literature

RATIONALE

Osteochondroma is a common benign bone tumor consisting of cartilage-covered bone confluent with the medullary canal of the epiphysis. Extraosseous osteochondroma shares the same appearance and histologic features as a typical osteochondroma but does not have any attachment to surrounding bone structures. Because of its low incidence, extraosseous osteochondroma is uncommon in clinical workups and thus prone to misdiagnosis. The diagnosis of extraosseous osteochondroma should be considered when there is a well-defined bony mass in the soft tissue with no direct continuity with the adjacent bone or joint. Here, we present a case of an imaging diagnosis of "calcified bursitis in the subcutaneous superficial fascial layer" and a postoperative pathological diagnosis of "extraosseous osteochondroma."

PATIENT CONCERNS

The patient was a 61-year-old man who had a right plantar heel mass for 2 years and recently visited the hospital because of discomfort in shoes.

DIAGNOSES

The patient was diagnosed with pathological examination.

INTERVENTIONS

After completing the relevant preoperative examination and preoperative preparation and excluding contraindications to surgery, surgery was performed under nerve block anesthesia.

OUTCOMES

We performed surgical resection, and the patient did not have obvious discomfort when discharged from the hospital. Auxiliary examination showed no abnormalities.

LESSONS

For foot tumors, we need to consider the possibility of extraosseous osteochondroma. After completing the auxiliary examination, we should determine the relationship between the tumor and its surrounding tissues and blood supply before surgery to avoid causing major trauma.

Extraskeletal Osteochondroma of the Great Toe in a Teenager

Osteochondromas are common, benign surface tumors of bone, composed of the cartilage-capped bone confluent with the medullary canal of the metaphyseal bone. Extraskeletal osteochondromas have the same gross appearance and histologic characteristics as a typical osteochondroma but do not have any boney attachment to the surrounding osseous structures. They are rare and most frequently reported in the middle-age and older adults. We present the first case of an extraskeletal osteochondroma of the foot reported in a teenager. Our patient was a 17-year-old male complaining of a slow-growing mass along the medial border of the great toe that he first noted at the age of 14 years. The increasing size of the mass and frequency of complaints with shoe wear prompted medical attention. Imaging studies showed an ossified 1-cm boney mass with trabecular detail, located on the medial aspect of the great toe at the level of the interphalangeal joint, without any connection to the surrounding structures. An excisional biopsy revealed a well-circumscribed, easily removable mass, which proved to be an extraskeletal osteochondroma both clinically and histologically.

Primary tumours of the calcaneus

The calcaneus is a rare location for the occurrence and development of primary tumour types. Clinicians are unfamiliar with calcaneal tumour types, which may result in a delay in diagnosis or a missed diagnosis, resulting in unnecessary morbidity and amputation. Heel pain and localized swelling of the ankle are the most common symptoms. X-ray is the first choice for a tentative diagnosis of a calcaneal tumour. The final diagnosis depends on a histological examination. The treatment of calcaneal tumour types varies depending on the Enneking system. The majority of patients with benign tumours heal, except for a few with a palindromia. For malignant tumours, the prognosis is comparatively poor, resulting in disability and a high rate of metastasis. This review describes the spectrum of calcaneal tumour types and specifically illustrates the epidemiology, symptomatology, imagology, histopathology and treatment options that may facilitate diagnosis and improve prognosis.

Extraskeletal osteochondroma of the medial arch of the foot

Extraskeletal osteochondromas are benign, slow growing, and often painless neoplasms. Although they are histologically similar to conventional osteochondromas, extraskeletal osteochondromas are not attached to a parent bone. When a well-defined osseous mass in the soft tissue without any direct continuity with the adjacent bone or joint is encountered, a diagnosis of extraskeletal osteochondroma should be strongly considered. It should be identified to avoid unnecessary aggressive surgical treatment. We present a patient with symptomatic extraskeletal osteochondroma of the medial arch of the foot. It was treated by local excision and no evidence of local recurrence clinically or radiographically after 51 months of follow-up.

LEVELS OF EVIDENCE

Therapeutic, Level IV, Case study.

Metatarsal stress fractures secondary to soft-tissue osteochondroma in the foot: case report and literature review

Soft-tissue osteochondromas are rare, benign tumours developing in the soft tissues. Diagnosis is challenging however, as the differential includes malignancy. As simple excision is curative, early recognition by clinical and radiological evaluation will help avoid unnecessary surgery. A 43-year-old gentleman presented to us with a painful lump on the plantar aspect of his foot. Initial imaging suggested bony involvement of the lesion, raising concerns of malignancy. Further investigation demonstrated the bony abnormalities to be stress fractures, caused by altered forces due to the lump. The lump was excised and histologically confirmed to be a soft-tissue osteochondroma. Soft-tissue osteochondromas have not previously been reported in association with stress fractures. We present this case, a literature review and a list of differential diagnoses highlighting the importance of considering soft-tissue osteochondroma when evaluating a well-defined, osseous, soft-tissue mass in the extremity, and the difficulties in making this diagnosis.

Large soft tissue osteochondroma of the heel: a case report and literature review

Soft tissue osteochondromas are the rare tumors of the foot. We present an unusual case of a 30-year-old woman who had a large osteochondroma originating from the soft tissue in the heel region. She made an uneventful recovery following excision. No recurrence was noted at 36 months follow-up. To the best of authors' knowledge, such presentation has not been reported before in the English language-based medical literature.

Soft-tissue osteochondroma of the heel pad: a case report and review of literature

Extraskeletal osteochondroma of the foot are rare benign cartilaginous tumours. We present a case of soft-tissue osteochondroma in the heel pad superficial to the postero-inferior aspect of the calcaneus. We propose the pathogenesis of this lesion might be related to metaplasia in the plantar aponeurosis as described in literature, or it may be a fracture of the calcaneal osteochondroma, growing and presenting as soft-tissue lesion in the heel pad.

Resection and reconstruction of an osteochondroma of the hallux: a review of benign bone tumors and a description of an unusual case

Osteochondroma, which is also known as exostosis, is the most common benign bone tumor. Although foot and hand surgeons frequently encounter the subungual exostosis, exostoses commonly localize to other areas of the skeleton as well. In this review, we describe the clinical and diagnostic imaging characteristics of benign bone tumors and, in particular, the osteochondroma and its surgical management. We also report the case of a patient who experienced an unusual pedal digital osteochondroma-like lesion.

LEVEL OF CLINICAL EVIDENCE

4.

Giant extraskeletal osteochondroma of the plantar midfoot arch

Osteochondromas found within the soft tissue without osseous or intra-articular involvement are better described as extraskeletal osteochondromas. They are slow-growing, benign, osseous tumors, and are often misdiagnosed as conventional osteochondromas. Though extraskeletal osteochondromas are rare, they typically affect the digits of the hands or feet. We present a patient with a giant symptomatic extraskeletal osteochondroma that developed in the plantar medial longitudinal arch of the foot. To the authors' knowledge, this is the largest isolated extraskeletal osteochondroma in the arch of the foot identified in the literature. The diagnosis of an extraskeletal osteochondroma should be considered when a well-defined osseous mass occurs in the soft tissue.

Soft tissue osteochondroma: case report and immunohistochemistry for parathyroid hormone–related protein

Surface lesions of bone usually present little diagnostic dilemma because the majority are conventional osteochondromas. Other surface bone lesions include periosteal chondroma, periosteal chondrosarcoma, and parosteal osteosarcoma. Mineralized soft tissue lesions such as myositis ossificans, synovial chondroma, and synovial sarcoma may present in a similar fashion when they occur in a juxtaarticular position. The soft tissue osteochondroma or paraarticular osteochondroma may simulate some of these more aggressive tumors, and its recognition is important to avoid overtreatment. A case of an 11-year-old male with a soft tissue osteochondroma is reported to illustrate the characteristic radiographic and histological features of this rare entity. No prior reports have examined soft tissue osteochondroma for expression of parathyroid hormone related protein, an established cartilage tumor proliferative mitogen.