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ankle and foot, leg

A 16 year old boy with left ankle sprain

Case Identification
Case ID Number: 
20091117AF
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient is 16, and he had a spraining injury to the left ankle, whereupon an x-ray of the ankle was taken. This showed a lesion in the left calcaneus.

Radiological findings:: 
The patient is relatively healthy, with no significant past or present illness. He plays football and is looking forward to participating if possible this coming fall. The patient has been noticing some discomfort in the foot but he is walking normally wearing regular shoes and does not have an appreciable limp. He does not feel a mass or swelling in the area. There is some tenderness on the left calcaneus which is not present on the right. No mass or expansion or swelling of the calcaneus is noted. The subtalar joint motion appears normal. Ankle motion is normal.

A 18 year old male had pain and swelling in the foot.

Case Identification
Case ID Number: 
20091106AD
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 18 year old male had pain and swelling in the foot. A biopsy of the calcaneal lesion is taken.The patient had a complete work-up. No abnormality was found in the lungs. A mass was noted in the ipsilateral popliteal fossa.

Image Reference: 

A 25-year-old man with persistent swelling after an ankle sprain.

Case Identification
Case ID Number: 
20091117AG
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient is a 25-year-old male who has a history of an ankle sprain some months ago. He has had persistent swelling in the ankle. He is working as a painter. There is pain in the ankle in the mornings and after workouts.

Radiological findings:: 
The patient is generally healthy and takes no prescription medicines or supplements. He has no allergies to medicines. He gives no history of previous surgery or illnesses. The rest of the review of systems is negative in detail. There is no significant family history. Examination of the foot shows there is a soft, slightly mobile, soft tissue mass in the anteromedial portion of the right ankle that measures approximately five by 3 cm and appears to be about 1 cm thick. It is nontender. There is synovitis and swelling in the ankle generally. There is pain and tenderness along the course of the posterior tendon behind the medial malleolus. The range of motion of the ankle is slightly reduced. The overall alignment and arch of the foot is preserved. The neurovascular status is normal. There is no skin lesion and no cafe au lait spots are seen. No popliteal or inguinal lymphadenopathy is palpated.

A 36 year old woman with a "thick foot"

Case Identification
Case ID Number: 
20110317TF
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This active and fit 36 year old woman has been practicing mixed martial arts and kickboxing. She says her right foot has been "thick" and swollen for about 6 months.

Radiological findings:: 
A soft tissue mass in the plantar aspect of the foot, dark on T1 and bright on T2, measures about 12 by 6 by 6 centimeters.
Laboratory results:: 
No labs were needed.
Differential Diagnosis: 
Soft tissue tumors, benign and malignant
Further Work Up Needed:: 
What additional physical examination steps should be taken? What imaging exams are needed to complete the work-up?
Pathology results:: 
See the images shown from the biopsy material. The immunohistochemistry images demonstrate that the tumor stains postitive for keratin (not shown), and positive for EMA (see image).
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