Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature
World Journal of Surgical Oncology
Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature
Theodoros B Grivas 1
Olga D Savvidou 1
Spyridon A Psarakis 1
Georgia Liapi 0
George Triantafyllopoulos 1
Ioannis Kovanis 1
Panagiotis Alexandropoulos 1
Vasiliki Katsiva 0
0 Department of Radiology, General Hospital of Nikea-Pireus , Greece
1 Orthopaedic and Pathology department, "Thriasio" General Hospital , G. Gennimata Avenue, Magula, 19600 Greece
Background: Soft tissue tumors of the feet are uncommon and there have been very few reports of large series in the literature. These tumors continue to present the clinician with one of the most difficult problems in medicine. Case presentation: We present a case of a large multilobular noninfiltrating angiolipoma at the plantar surface of the forefoot. Only three cases occurring at the foot have been previously described. We report this new case due to unusual location of the tumor, the long duration (25 years) of its existence and the unique surgical approach for the tumor excision. Conclusion: Surgical excision is the treatment of choice and adjuvant radiotherapy is indicated in select cases.
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Background
Benign lipomatous lesions involving soft tissue are
common musculoskeletal masses (almost 50% of all
soft-tissue tumors) though they are rare in the foot. They are
classified into nine distinct diagnoses: lipoma,
lipomatosis, lipomatosis of nerve, lipoblastoma or
lipoblastomatosis, angiolipoma, myolipoma of soft tissue, chondroid
lipoma, spindle cell lipoma and pleomorphic lipoma,
and hibernoma [1].
Angiolipomas are benign neoplasms and have been first
described by Bowen in 1912 [2], but were first established
as a distinct entity in 1960 by Howard and Helwig [3]. The
presence of fibrinous microthrombi is a distinctive feature
that differentiates angiolipomas from other lipomas.
Sometimes the tumor may be more aggressive and invade
the contiguous bone and adjacent soft tissues [4]. We
report here a case of angiolipoma of the foot.
Case presentation
A 47-year-old man was admitted to our department with
a soft nodular mass at the plantar surface of the forefoot
(figure 1). He complained of disabling and painful gait
until he was unable to walk and had difficulty putting his
shoes on. The patient noticed for the first time the nodule
TFihgeusroeft1nodular mass at the plantar surface of the forefoot
The soft nodular mass at the plantar surface of the forefoot.
25 years ago but during the preceding 12 months the size
of the nodule had increased markedly.
Physical examination revealed a tender soft-solid nodule.
A corn was developed at the overlying skin. No tingling or
numbness was present. Neurological consultation was
negative. Past medical and familiar history, as well as
general examination was negative.
Radiographs of the foot and computer tomography (CT)
demonstrated a soft-tissue lesion with no osseous
involvement. Magnetic resonance imaging (MRI) revealed a
welldefined mass located at the plantar forefoot with no
apparent bone infiltration, (figure 2). The sagittal
T1weighted image revealed a lobulated, encapsulated, fatty
mass (signal intensity identical to subcutaneous fat) with
multiple hypointense nodules and septa in the
subcutaneous layer of the forefoot, underneath the plantar
aponeurosis, (figure 3). The corresponding sagittal T1-weighted
contrast enhanced image, revealed that the non-fatty
component does not show any apparent enhancement, (figure
4). Finally the coronal STIR image through the phalanges
showed signal suppression of the fatty component and
iFmMnifagilsgtusnrraeleoticoc2anrtedsoantatnhceepimlanagtainrgfo( MreRfoI)ortewv eitahlendoaawppeallr-ednetfinbeodne
Magnetic resonance imaging (MRI) revealed a well-defined
mass located at the plantar forefoot with no apparent bone
infiltration.
high intensity of the non-fatty component, (figure 5). The
above assessment was not diagnostic for the pathology,
although the duration and the rough imaging of the
nodule were not implicating a malignancy.
Marginal surgical excision was performed. The nodule was
excised via a plantar approach using a longitudinal
incision dictated by the morphology of the corn (figure 6).
The location of the presented lesion warranted the use of
TFihgeusraegi3ttal T1-weighted image
The sagittal T1-weighted image. A lobulated, encapsulated,
fatty mass with multiple hypointense nodules and septa in the
subcutaneous layer of the forefoot, underneath the plantar
aponeurosis.
iTFmhigaeugecroerr4esponding sagittal T1-weighted contrast enhanced
The corresponding sagittal T1-weighted contrast enhanced
image. The non-fatty component does not show any
apparent enhancement.
a plantar approach. Macroscopically the nodule
measuring 7 4 4 cm was encapsulated and multilobular
having a vascular pedicle which was cauterized, (figure 7, 8).
The mass was totally resected without the need to sacrifice
the surrounding structures. The cut s (...truncated)