A lesion in the talus of an 88 year old woman with 2 previous tumors

Case Identification

Case ID Number
20110208LT
Tumor Type
unknown tumor - bone
Body region
ankle and foot, leg
Position within the bone
central
Benign or Malignant
unknown

Clinical case information

Case presentation

This 88 year old woman has dementia, left ankle pain, and a lesion in the left talus. There was treatment for two different tumors approximately 10 years ago, but further details are not available. The local exam shows swelling and tenderness, but no redness, no old incisions or scars,and moderate tenderness generalized around the ankle. The patient is afebrile.

Radiological findings:
A destructive, permeative lesion is seen in the body, neck and head of the talus, with no matrix mineralization, no periosteal reaction, and a slightly displaced fracture of the talar neck. The lesion also appears to involve the calcaneus near the sinus tarsi. The articular spaces and cortical surfaces are largely preserved. There is generalized osteopenia. A CT scan shows how permeative the lesion is. No MRI or other imaging was deemed necessary prior to biopsy. An ultrasound was performed to rule out blood clots, which notes an enlarged node in the ipsilateral groin.
Laboratory results:
WBC normal, no left shift.
CRP 0.6
Differential Diagnosis
Primary bone tumor
Metastatic bone tumor from previous tumors?
Atypical infection
Further Work Up Needed:
Treatment plan needed.
Pathology results:
See the images shown.
1- 100x © 2011 bonetumor.org courtesy M. Misialek
2- 200x © 2011 bonetumor.org courtesy M. Misialek
3- 400x © 2011 bonetumor.org courtesy M. Misialek

4- 200x, immunohistochemical stain for CD20 © 2011 bonetumor.org courtesy M. Misialek
Treatment Options:
As an additional challenge, given the diagnosis, what orthopedic treatment is required?
Case Answer
Clinical Case Answer
Non Hodgkin lymphoma