Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature

World Journal of Surgical Oncology, Jan 2008

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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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. - 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)


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Theodoros B Grivas, Olga D Savvidou, Spyridon A Psarakis, Georgia Liapi, George Triantafyllopoulos, Ioannis Kovanis, Panagiotis Alexandropoulos, Vasiliki Katsiva. Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature, World Journal of Surgical Oncology, 2008, pp. 11, 6, DOI: 10.1186/1477-7819-6-11