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ankle and foot, leg

A painful skin lesion next to the toenail

Case Identification
Case ID Number: 
20110215TN
Benign/Malignant: 
Malignant
Clinical case information
Case presentation: 

The patient has a painful skin lesion on the dorsolateral surface of the left second toe, adjacent to the base of the left second toenail. The lesion does not have any visible pigmentation. It has a raised, red, scaly appearance with the overlying skin coming off in small flakes. It has been present at least one year, with slow growth.

Differential Diagnosis: 
Both benign and malignant lesions must be considered

A painless ankle mass in a 19 year old

Case Identification
Case ID Number: 
LP20120822
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A generally healthy 19-year-old woman presents with an 11 month history of a painless ankle mass.

Radiological findings:: 
The x-ray is normal other than a soft tissue density posterior to the ankle at the level of the talus. The mass has density similar to that of fact, no calcifications. The appearance of the ankle joint and subtalar joint are normal. The MRI shows a heterogeneous mass posterior to the subtalar joint and ankle joint at the level of the talus, which measures 60 x 70 x 20 mm. It has low signal intensity on both T1 and T2 weighted sequences. No gradient echo sequences were performed. There appears to be some magnetic susceptibility artifact in some of the sequences, but this is not commented on by the radiologist. The mass is adjacent to the flexor digitorum longus, peroneal tendons, and neurovascular bundle. It lies on the surface of the posterior talus and extends from it, but there is no definite bony damage.
Laboratory results:: 
No laboratory examinations are made.
Differential Diagnosis: 
A soft tissue mass adjacent to the bones of the ankle without calcification. Possibilities include sarcoma, benign soft tissue neoplasm, a reactive process such as a synovial mass or PVNS, and other.
Further Work Up Needed:: 
Biopsy is necessary.
Pathology results:: 
biopsy is pending.

A pregnant woman with a very large calf tumor

Case Identification
Case ID Number: 
20121210PM
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

A 26 year old woman who is 18 weeks pregnant with her 3rd child presents with a very large mass in the right leg. She is otherwise well and her medical history is unremarkable.

Radiological findings:: 
Xrays are normal, with no calcifications within the mass, and no change in nearby bones. There is mild demineralization of the femur and tibia from disuse. An MRI shows a mass, about 14 x 16 x 28 centimeters in size with mild to moderate heterogeneity, dark T1 anbd brigh T2, centered in the medial gastroc muscle, extending from the proximal popliteal fossa to the mid-distal calf. The neural and vascular structures are not encased, although the popliteal and posterior tibial artery were in contact with the proximal, anterior and medial portion of the mass for approximately 12 or 14 centimeters. PA Chest radiograph is interpreted as normal A resection with a marginal, unintentionally contaminated margin was performed. The lesion was very friable, and during the resection, semi-necrotic somewhat myxoid material oozed into the wound and contaminated the field during a portion of the dissection.
Laboratory results:: 
None available
Differential Diagnosis: 
Sarcoma, synovial versus myxoid liposarcoma or myxoid chondrosarcoma vs partially necrotic other sarcoma.
Pathology results:: 
pending
Treatment Options:: 
A resection with a marginal, unintentionally contaminated margin was performed. The lesion was very friable, and during the resection, semi-necrotic somewhat myxoid material oozed into the wound and contaminated the field during a portion of the dissection.
Special Features of this Case:: 
The patient was treated at the HEODRA hospital in Leon, Nicaragua

A slowly growing mass in the tibialis anterior tendon

Case Identification
Case ID Number: 
20100810SG
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This 42 year old woman is quite heavy. She has noticed a gradually enlarging swelling in the front of her right ankle.

Radiological findings:: 
The MRI shows an abnormality in the tibialis tendon.
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