Metatarsal leiomyosarcoma masquerading as acute osteomyelitis - A diagnostic trap unveiled by vigilant clinical, radiologic and pathologic analysis

The Foot
Louis Tsun Cheung Chow

Abstract

Due to overlapping clinical and radiological features, the differentiation between osteomyelitis and bone tumor can be challenging. A 48-year-old lady presented with intermittent left foot pain for a few months. Plain radiographs showed an osteolytic lesion affecting the proximal diaphysis of the left fourth metatarsal bone, with thinning and irregularities of the cortex and focal periosteal reaction. Ultrasonography revealed diffuse subcutaneous edema in the dorsum of the left foot, cortical irregularities along the mid-shaft of the left fourth metatarsal bone, and surrounding periosteal collection. Computed tomography showed medullary expansion along the shaft and base of the left fourth metatarsal bone with cortical irregularities and defects suggestive of cloaca, and focal mild periosteal new bone formation. The clinico-radiologic diagnosis was acute osteomyelitis with periosteal collection. During open biopsy, the finding of intramedullary fleshy tissue in the absence of significant inflammatory edema and purulent discharge, and subsequent negative culture result prompted a review of the histologic slides which was initially reported as benign fibroblastic tissue proliferation. Careful analysis of the histomorphology discl...Continue Reading

Citations

Oct 30, 2019·Archives of Pathology & Laboratory Medicine·Grace Y Wang, David R Lucas
Apr 23, 2016·APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica·Louis T C Chow
Mar 23, 2018·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Andrea VeljkovicAlastair Younger

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