Metastatic lesions of the foot and ankle

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.

A Study to Determine the Incidence and Distribution Patterns of Foot and Ankle Tumors in Bone and Soft Tissue

Objectives: The aim of this study is to determine the incidence and distribution patterns of foot and ankle tumors in bone and soft tissue in a university tumor institute, to help the correct evaluation of uncertain masses, to take the right steps in advanced diagnosis and treatment, and to contribute to future research.

Materials and methods: A retrospective analysis of a total of 164 foot and ankle cases examined by a multidisciplinary bone and soft-tissue tumors care team between January 2004 and December 2021 was performed from a database in which patient information was recorded in our tertiary university hospital. Thirty-three (20.1%) of 164 patients were discussed in the tumor council and evaluated as having the non-tumor disease. All of these patients were excluded from the study. A total of 131 patients diagnosed with tumors were included in this study.

Results: The lesion was determined as a benign tumor in 84 (64.1%) cases of 131 tumor patients included in the study. Of these 84 patients, 40 (47.6%) were identified as benign bone lesions and 44 (52.4%) as benign soft-tissue lesions. Malignancy was determined in 47 (35.9%) of 131 patients, affecting the bone in 14 (29.8%) patients and the soft tissue in 33 (70.2%). The malignant soft-tissue lesion most determined was malignant mesenchymal tumor in 10 (30.3%) patients, of which one had lung metastasis and one was determined with multiple metastases. Metastasis was detected in eight patients in total, including three metastatic malignant bone tumors and five metastatic malignant soft-tissue tumors.

Conclusions: Tumors involving the foot and ankle are not frequently encountered, and most tumors in this region are benign. The anatomic structure of the foot allows early diagnosis, but for diagnosis to be made, there must first be clinical suspicion. The first symptom is generally swelling. Early diagnosis can prevent several complications. Therefore, patients with foot and ankle complaints must be taken seriously and evaluated with advanced tests if necessary.

Tumours of the talus - A pictorial review

BACKGROUND

Primary bone tumours of the talus are a rare entity and seldom described in the literature. Due to this, often the diagnosis and management of such cases are delayed. This study aims to describe a spectrum of lesions identified within our department and provide a pictorial review with the goal to aid radiologists in the evaluation and diagnosis of such lesions.

MATERIALS & METHODS

A retrospective study was conducted within our department, identifying all talar lesions, confirmed on histopathological and radiological diagnosis.

RESULTS

Results revealed 75 cases of talar lesions. Benign tumours formed the bulk of the lesions identified accounting for 85% of all cases. The most common benign tumour was chondroblastoma (n = 23). Malignant tumours were detected in 6 cases. Other lesions included osteomyelitis and avascular necrosis.

CONCLUSION

We present a variety of tumours and tumour-like conditions of the talus. Radiologists as well as orthopaedic surgeons need to be aware of such lesions, to prompt early diagnosis and initiate management in timely fashion.

Tumors of the foot and ankle: a single-institution experience

Tumors of the foot and ankle are rare, and the particular clinicopathologic features, therapeutic approach, and outcomes in this setting are not well established. From January 2000 to December 2010, 72 patients with primary musculoskeletal tumors of the foot and ankle, both benign and malignant, were treated at a single institution. Of the 72 patients, 56% were female. The median age was 52 years. Of the 72 tumors, 62 (86.11%) were located in the foot and 10 were located in the ankle; 63 (87.5%) were soft tissue tumors and 9 (12.5%) were bone tumors. Overall, 56 (78%) were benign tumors and 16 (22%) were malignant tumors. The most frequent soft tissue and bone diagnosis was giant cell tumor. The median follow-up period was 49 months. The vast majority of the tumors were located in the foot. Benign tumors were dominant, outnumbering malignant tumors by more than 3 to 1. The diversity of the histologic benign types was evident, with giant cell tumor, angiomyoma, and lipoma the most frequent. Regarding the malignant tumors, a clear male predominance was present, the median age was 45 years, and the most frequent tumor was synoviosarcoma. The 9-year overall and disease-free survival rate was 65% and 40%, respectively.

Tumors of the foot and ankle: experience with 153 cases

BACKGROUND

Both primary and metastatic tumors in the foot and ankle have been reported as rare. The purpose of this study was to describe 153 cases of foot and ankle tumors from a 20-year experience in a tertiary referral center specializing in orthopaedic oncology. It is the largest reported series of both bone and soft tissue tumors in the foot and ankle.

MATERIALS AND METHODS

Between 1986 and 2006, a retrospective chart review was performed of a total of 2,660 tumors surgically treated in all anatomic sites by a single surgeon at a musculoskeletal tumor referral center.

RESULTS

One hundred fifty-three patients (5.75%) with bone and/or soft tissue tumors of the foot and ankle were treated. There were 84 women and 69 men. The patients' ages ranged from 1 to 84, with a median age of 30 and mean of 33.2. The tissue types included 80 soft tissue and 73 bone tumors. Overall, 60 (39.2%) were malignant, and 93 (60.8%) were benign. The most common diagnosis was giant cell tumor. In addition, giant cell tumor was the most common bone tumor, while pigmented villonodular synovitis and giant cell tumor of the tendon sheath were the most common soft tissue tumors.

CONCLUSION

The incidence of tumors of the foot and ankle in this series of a single surgeon over a 20-year practice was 5.75%. The results of this study reaffirm that awareness, correctly diagnosing, and appropriately treating or referring to an orthopaedic oncologist may help with an improved outcome for patients.

Acrometastasis to the foot: three case reports with primary colon cancer

Acrometastasis (metastasis to the hand or foot) is a rare occurrence; however, bone is a common site of metastatic disease, which occurs in up to 30% of patients with malignancy. Although acrometastasis is rare, a high clinical suspicion must exist, especially in evaluating a patient with a known history of cancer. The diagnosis may be difficult and prolonged, which may ultimately affect the patient's outcome. Misdiagnosis of acrometastasis seems to be a common problem. Early diagnosis and treatment is important for improving quality of life in these patients. The authors report 3 cases of acrometastasis from a rare source, the colon.

Metastases to bones of the foot: a case series, review of the literature, and a systematic approach to diagnosis

Metastatic lesions to the bones of the foot are rare but pose a challenge to the treating surgeon because of variation in presentation. Cases may present as a painful or swollen toe or as an infection resistant to antibiotics, or they may mimic inflammatory arthropathy. As such, diagnosis may be delayed. Also, with the advent of new therapies for certain cancers, patients living longer have time to develop metastases. The incidence of metastases to the foot is changing. The senior author (HD) has managed 3 consecutive cases of tumorous lesions metastasizing to the foot. Patients included 1 man and 2 women, with an average age of 76.7 years (range, 57-88 years). Open biopsy was performed in 2 cases, whereas true-cut needle biopsy was performed in 1 case. The average follow-up was 16.2 months (range, 8.5-29 years). The pattern and incidence of foot metastases may be changing. Early and accurate diagnosis may help improve patient survival. A working protocol is presented here that can help in diagnosing such lesions.

Prostate cancer metastases to the leg, ankle, and foot

Metastases to the bones of the lower extremities from prostate carcinomas are rare and are usually associated with diffuse metastatic disease or primary tumors of the abdomen and lungs. I present the case of a patient who presented with lower leg pain and had undiagnosed prostate carcinoma. Unlike previous reports of prostate carcinoma, this rare case includes magnetic resonance imaging, histology, and medical management. This case is unique in its presentation and has not been described previously in the literature.

Metastatic skeletal disease of the foot: case reports and literature review

BACKGROUND

Metastatic disease of the skeleton occurs in at least 20% to 30% of patients with malignancy, but metastasis to the foot and hand (acrometastasis) is extremely rare (0.007% to 0.3%). Metastases to the feet are even rarer and have been reported in half to one-third the rate for hand metastases. Failure to recognize these lesions has led to delayed diagnosis and/or inappropriate treatment. The purpose of this report is to highlight the clinical and radiologic features that aid in the diagnosis and potential treatment of this condition along with a pertinent review of the literature.

MATERIALS AND METHODS

In a retrospective review of 694 patients with histologically proven metastatic skeletal disease (January 1988 to January 2007), 14 cases of metastatic lesions to the foot were identified.

RESULTS

The most frequent primary site was in the genito-urinary system in eight patients and the most common bones involved were the calcaneus and the talus in six patients each. All patients died after a mean survival of 14.8 (range, 1 to 54) months after diagnosis of metastases.

CONCLUSION

Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot, especially if suspicious radiographic changes are present in an older patient. The common primary sites are the genito-urinary, lungs, breast, and the colo-rectum. Treatment is usually palliative to reduce pain and maintain function.

Calcaneal tumors and tumor-like conditions

Approximately 3% of osseous tumors occur in the foot and ankle. Solitary bone cysts, chondroblastoma, intraosseous lipoma, osteoid osteoma, chondrosarcoma, and Ewing's sarcoma seem to have a predilection for the calcaneus. Biopsy is often a crucial step in management. Tumor-like conditions, such as cysts, reactive lesions, and osteomyelitis, must be considered during evaluation. Treatment is often observation or curettage of benign lesions and resection or amputation for malignancies.

Metastatic prostate carcinoma to the foot with magnetic resonance imaging and pathologic correlation

Metastases to the bones of the foot from prostate carcinomas are rare and usually are associated with diffuse metastatic disease. The authors encountered a patient who presented with prostate carcinoma metastases limited to the right foot. Magnetic resonance imaging correlation in this case demonstrated normal marrow signal in the surrounding bones of the foot and increased vascularity of the foot.

Oat cell carcinoma metastasis to the foot

Initial isolation from the foot of a highly malignant primary bronchogenic carcinoma, small cell carcinoma (oat cell carcinoma), was identified via excisional biopsy from the right foot of a 42-year old nonsmoking Caucasian female. This patient denied any pertinent prior medical history, other than persistent pain in her right foot for approximately 1 year before seeking care. Incidental trauma prompted her to seek care, which consisted of immobilization via a wooden shoe. When symptoms persisted, her primary care physician referred her to my office for further evaluation.

Tumors of the foot and ankle: analysis of 196 cases

A retrospective assessment was performed on 196 tumors of the foot and ankle [out of 1786 bone and soft tissue tumor cases, (10.9%)] between March 1986 and March 1996 in the Ankara University Department of Orthopedics and Traumatology Tumor Section. Mean age was 28 years (range 3 to 75 years). Of the 196 foot and ankle tumor cases, 171 (87.2%) were benign, and 25 (12.8%) were malignant. One hundred ninety-four (98.9%) were primary tumors and 2 (1.1%) were metastatic tumors. One hundred thirty-six (69.4%) originated from bone, whereas 60 (30.6%) originated from soft tissue. The most frequent foot and ankle tumors were osteosarcoma among malignant osseous tumors, squamous cell carcinoma among malignant soft tissue lesions, solitary exostosis among benign osseous tumors, and xanthoma and giant cell tumor among benign soft tissue tumors. Mean follow-up time was 21.3 months (12 to 90 months). One hundred forty (71.4%) of the patients underwent various operations while the remaining 56 (28.6%) were treated conservatively. Of the 140 surgical cases, 13 (9.3%) had a recurrence, 3 (2.1%) died, and 124 (88.6%) had a clinical cure. For most of the patients who required surgery, nonaggressive procedures were sufficient while amputations were required for 14 patients.

Bronchogenic carcinoma with metastases to the foot: a report of two cases

Pedal metastases from a primary sarcoma or carcinoma are rare occurrences. The hallux appears to be one area with which these have been identified. Two case reports of metastasis from the lung to the foot are described.

Magnetic resonance diagnosis of an occult metastatic colon carcinoma of the calcaneus

This is a case report which shows the potential benefit of magnetic resonance imaging in accurately visualizing occult metastatic lesions to bone. The case involves a relatively young patient with metastatic colon carcinoma to the calcaneus who ultimately required amputation.

Metastatic tumors of the foot and ankle

In a review of the Mayo Clinic files, 17 biopsy-proven cases of metastatic tumors of the foot and ankle were found; 4 additional cases were considered to have metastatic disease on the basis of clinical and radiographic evidence but no histological confirmation was available. Lung, kidney, and colon were the most common sites of the primary tumors. The patients survived as long as 28 months after discovery of the metastasis. Treatment consisted of individualized combinations of orthotics, surgery, and radiotherapy to maintain mobility. In 9 of these 17 cases, no primary lesion was identified at the time the metastasis was diagnosed. Metastatic tumors of the foot present special problems in diagnosis and management.

Myxoid chondrosarcoma of the os calcis: a case report

This case report of a myxoid chondrosarcoma of the os calcis is presented because of its rarity. The clinical, roentgenographic, and pathological features are discussed, and the difficulty in diagnosis is elaborated.