[image: 51F 5mos lump.jpg]
The mass is dark T1, PD, T2 and avidly enhances.
It’s mostly in the intermuscular fat plane between the Add Hallucis and
interossei above and the Flexor Digitorum below, with a thin distal
extension between the MT junction of the 2nd and 3rd ray Flexor
Digitorum….touching the plantar fascia (maybe?)
[image: 51F 5mos lump (1).jpg]
[image: 51F 5mos lump (2).jpg]
[image: 51F 5mos lump (3).jpg]
[image: 51F 5mos lump (4).jpg]
[image: 51F 5mos lump (5).jpg]
I think the signal and enhancement pattern favor GCCTS…
but I don’t want to “under-think” this and miss something.
IS there a chance this could be a very peculiar plantar fibroma (I doubt
it, though it would be most excellent—-I’ve not seen one dissect far from
the fascia or enhance quite this avidly).
More importantly, can this be a sarcoma? I think of synovial sarcoma in
the foot—-I have never seen it so uniformly and extensively dark,
dark….could be mineralized…but this seems alot—–
Should I recommend XRs? CT?
What would you include in the differential diagnosis?
Would you recommend additional imaging prior to excision?
Thanks.
Hilary
PS Happy Holidays…we’ve had so many lately!
1 thought on “51F 5 months plantar forefoot lump. MRI. No XR available. Please Help.”
hilary.umans
Thanks to all those who shared their opinions.
I discussed the case with the referring podiatrist who told me that she
first got an US first at a highly regarded imaging center——it was reported
as hypo echoic with minimal vascularity…..they thought it might be
intramuscular and recommended this MRI. Oddly, they didn’t bother to
measure it, so I don’t know if it’s grown.
The mass is painless….she said that the patient wouldn’t have known it was
there if she hadn’t gotten a pedicure and the pedicurist (is that a word?)
felt it.
I have recommended XR to look for mineralization and suggested Orthopedic
Oncologic consultation and biopsy.
I offered a DDx of GCTTS, fibromatosis, extraperitoneal desmoid,
fibrosarcoma and, less likely, synovial sarcoma.
Bill Breidahl shared an article from AJR 2020:215;178-173 on Desmoplastic
Fibroma, An Uncommon Tumor with a Fairly Characteristic MR
Appearance—that Mark Murphey anchored….these images are strikingly
similar—-I wonder what Mark thinks?
I’ve warned the DPM that I will bother her in another month or so to get
follow up on this case…so we shall see.
I discussed the case with the referring podiatrist who told me that she
first got an US first at a highly regarded imaging center——it was reported
as hypo echoic with minimal vascularity…..they thought it might be
intramuscular and recommended this MRI. Oddly, they didn’t bother to
measure it, so I don’t know if it’s grown.
The mass is painless….she said that the patient wouldn’t have known it was
there if she hadn’t gotten a pedicure and the pedicurist (is that a word?)
felt it.
I have recommended XR to look for mineralization and suggested Orthopedic
Oncologic consultation and biopsy.
I offered a DDx of GCTTS, fibromatosis, extraperitoneal desmoid,
fibrosarcoma and, less likely, synovial sarcoma.
Bill Breidahl shared an article from AJR 2020:215;178-173 on Desmoplastic
Fibroma, An Uncommon Tumor with a Fairly Characteristic MR
Appearance—that Mark Murphey anchored….these images are strikingly
similar—-I wonder what Mark thinks?
I’ve warned the DPM that I will bother her in another month or so to get
follow up on this case…so we shall see.
Hilary
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