I was asked to biopsy this lesion in the left 1st metatarsal in a 62 year
old with recurrent metastatic breast cancer.
No symptoms directly attributle to the lesion.
Summary of imaging findings:
CT 12/08/2020 performed for medial pain following fall was normal.
1. X-ray 13/11/202 for pain post patellar fracture was normal.
2. MRI Left foot performed 18/01/2021 for ankle pain demonstrated.
Incidental lesion in the base of the first metatarsal which was angular and
irregular. Centrally on T1 it was isointense to marrow with a surrounding
sclerotic rim and the surrounding oedema. On the PD fat sat the centre
suppressed and was isointense again with the fatty marrow with a surrounding
hyperintense rim. Provisional diagnosis bone infarct.
3. X-ray at this time did not demonstrate the lesion.
4.CT performed at same time demonstrated the lesion as a low density (fat )
density lesion without a sclerotic rim provisional diagnosis intraosseous
lipoma.
5. PET scan of 04/03/2021 performed as staging of recurrent breast cancer
did not show any uptake in the lesion.
6, 09/06/2021 CT scan in biopsy mode failed to demonstrate lesion . High
resolution CT did demonstrate the lesion but it now has an intermediate
signal rim and has decreased in size when compared to the previous CT (15 x
9 x 13 mm previously 13 x 9 by 16 mm )
I spoke to the patient and explained that I did appreciate any aggressive
or suspicious features and we elected not to do biopsy.
The case was presented at our deoartmental case review meeting and the
concensus was leave alone.
My favoured diagnosis is intraossious lipoma.
Referrer unhappy and still wants biopsy!
Should I acquiesce or dig my heels in?
Metatarsal-lesion.pptx 