The Foot 23 (2013) 166–168
Contents lists available at ScienceDirect
The Foot journal homepage: www.elsevier.com/locate/foot
Case Report
Calcaneal chondrosarcoma: A case report S. Suresh Babu a,∗ , G. Sudhakar b , Kopuri Ravi Kiran c , T.V. Suresh Babu c , M.U.S.K. Sridevi d a
Department of Orthopaedics, Dr. PSIMS & RF, India Department of Pathology, Siddhartha Medical College, Vijayawada 520008, India c Department of Orthopaedics, Dr. PSIMS & RF, Chinoutpalli, A.P, India d Suresh Ortho Clinic, Vijayawada 520010, A.P, India b
a r t i c l e
i n f o
Article history: Received 23 June 2013 Accepted 29 September 2013 Keywords: Calcaneum Chondrosarcoma
a b s t r a c t Chondrosarcoma is a rare malignant cartilaginous tumour of the bone. It commonly occurs in the pelvis, scapula proximal femur, and shoulder girdle .We present a case of a woman in her 56 years of age with chondrosarcoma of the calcaneum—a rare lesion that accounts for 0.5–2.97% of all chondrosarcomas of other sites. Treatment for chondrosarcoma is generally wide surgical excision. Chemotherapy or radiation is not effective for most of these lesions. Crown Copyright © 2013 Published by Elsevier Ltd. All rights reserved.
1. Case report A 56-year-old woman with an unremarkable medical history presented with an 18-month history of left heel innocent bump and 2 months of pain. The swelling of heel was gradual and progressive on the lateral aspect, and associated with pain following a trivial fall. Pain is localized to the lateral aspect of the heel increasing with the first few steps of weight bearing. She denied any history of fever, erythema, or sensory changes to the foot. Our review of the patient’s systems was negative for any systemic complaints. On physical examination of the left heel bump, the swelling was on poster lateral aspect of calcaneum, mild tender to palpation, firm to hard in consistency, with not much local raise of temperature, achilles tendon was intact (Fig. 1). Radiographs revealed a considerable cortical destruction, erosion, lytic lesion with pathological fracture. She refused to under go an incisional biopsy in her first visit. She came back after 6 months with progressive swelling clinically and progressive destruction radiologically (Fig. 2). An incisional biopsy was performed on lateral aspect of calcaneum, confirming a cartilaginous neoplastic process of high grade 2 chondrosarcoma that, when correlated with aggressiveappearing radiographic features, was consistent with a diagnosis of high grade chondrosarcoma (Fig. 3). Due to high aggressiveness of lesion based on (1) radiological soft tissue extension, (2) grade 2 histopathology, (3) as per literature review calcaneum is
∗ Corresponding author at: Suresh Ortho Clinic, #56-2-20 Koneru Satyanarayana Street, Krishna District, Patamata, Vijayawada 520010, India. Tel.: +91 09440219597. E-mail addresses: [email protected] (S. Suresh Babu), [email protected] (G. Sudhakar), [email protected] (K.R. Kiran), [email protected] (T.V. Suresh Babu), [email protected] (M.U.S.K. Sridevi).
known for recurrence and metastasis and (4) calcanectomy was disabling, supramalleolar amputation was done (Fig. 4). Subsequently immunohistochemistry, and histopathology proved the tumour as high grade chondrosarcoma (Fig. 5). 2. Discussion Primary chondrosarcoma (CHS) is the third most common primary malignancy of bone after myeloma/plasmacytoma and osteosarcoma, and accounts for 20% of malignant bone tumours in a large series [1]. The most common skeletal sites are pelvic bones, followed by proximal humerus, distal femur, and ribs. The small bones of hands and feet are rarely affected (
Contents lists available at ScienceDirect
The Foot journal homepage: www.elsevier.com/locate/foot
Case Report
Calcaneal chondrosarcoma: A case report S. Suresh Babu a,∗ , G. Sudhakar b , Kopuri Ravi Kiran c , T.V. Suresh Babu c , M.U.S.K. Sridevi d a
Department of Orthopaedics, Dr. PSIMS & RF, India Department of Pathology, Siddhartha Medical College, Vijayawada 520008, India c Department of Orthopaedics, Dr. PSIMS & RF, Chinoutpalli, A.P, India d Suresh Ortho Clinic, Vijayawada 520010, A.P, India b
a r t i c l e
i n f o
Article history: Received 23 June 2013 Accepted 29 September 2013 Keywords: Calcaneum Chondrosarcoma
a b s t r a c t Chondrosarcoma is a rare malignant cartilaginous tumour of the bone. It commonly occurs in the pelvis, scapula proximal femur, and shoulder girdle .We present a case of a woman in her 56 years of age with chondrosarcoma of the calcaneum—a rare lesion that accounts for 0.5–2.97% of all chondrosarcomas of other sites. Treatment for chondrosarcoma is generally wide surgical excision. Chemotherapy or radiation is not effective for most of these lesions. Crown Copyright © 2013 Published by Elsevier Ltd. All rights reserved.
1. Case report A 56-year-old woman with an unremarkable medical history presented with an 18-month history of left heel innocent bump and 2 months of pain. The swelling of heel was gradual and progressive on the lateral aspect, and associated with pain following a trivial fall. Pain is localized to the lateral aspect of the heel increasing with the first few steps of weight bearing. She denied any history of fever, erythema, or sensory changes to the foot. Our review of the patient’s systems was negative for any systemic complaints. On physical examination of the left heel bump, the swelling was on poster lateral aspect of calcaneum, mild tender to palpation, firm to hard in consistency, with not much local raise of temperature, achilles tendon was intact (Fig. 1). Radiographs revealed a considerable cortical destruction, erosion, lytic lesion with pathological fracture. She refused to under go an incisional biopsy in her first visit. She came back after 6 months with progressive swelling clinically and progressive destruction radiologically (Fig. 2). An incisional biopsy was performed on lateral aspect of calcaneum, confirming a cartilaginous neoplastic process of high grade 2 chondrosarcoma that, when correlated with aggressiveappearing radiographic features, was consistent with a diagnosis of high grade chondrosarcoma (Fig. 3). Due to high aggressiveness of lesion based on (1) radiological soft tissue extension, (2) grade 2 histopathology, (3) as per literature review calcaneum is
∗ Corresponding author at: Suresh Ortho Clinic, #56-2-20 Koneru Satyanarayana Street, Krishna District, Patamata, Vijayawada 520010, India. Tel.: +91 09440219597. E-mail addresses: [email protected] (S. Suresh Babu), [email protected] (G. Sudhakar), [email protected] (K.R. Kiran), [email protected] (T.V. Suresh Babu), [email protected] (M.U.S.K. Sridevi).
known for recurrence and metastasis and (4) calcanectomy was disabling, supramalleolar amputation was done (Fig. 4). Subsequently immunohistochemistry, and histopathology proved the tumour as high grade chondrosarcoma (Fig. 5). 2. Discussion Primary chondrosarcoma (CHS) is the third most common primary malignancy of bone after myeloma/plasmacytoma and osteosarcoma, and accounts for 20% of malignant bone tumours in a large series [1]. The most common skeletal sites are pelvic bones, followed by proximal humerus, distal femur, and ribs. The small bones of hands and feet are rarely affected (
