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ankle and foot, leg

11 year old girl with left ankle sprain

Case Identification
Case ID Number: 
20091105ER
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This 11 year old girl presented to the local emergency room after she sprained her ankle in soccer. In your office 4 days later, she has local tenderness and swelling at the level of the joint line anterior to the distal part of the fibula.

Treatment for this patient consisted of 1) functional rehabilitation for the ankle sprain. 2) Observation with follow-up exams and radiographs for the tumor. See below for follow-up radiographs one year later and two years later. Click on the images for a better view.

Radiological findings:: 
The lesion is still present, but no growth or progression has occurred. Longitudinal growth of the bone has made the lesion seem to move away from the growth plate. The lesion shows no evidence of progression or aggressive behavior. It seems to have become smaller, but this is likely to be due to relative increase in size of the tibia due to continued growth. The lesion seems to have moved farther away from the growth plate. This lesion is likely to involute after skeletal maturity
Special Features of this Case:: 
In this case, it was felt that the tumor had no causal relationship with the sprained ankle, and that this lesion did not pose a threat of pathological fracture that was high enough to warrant surgical treatment. The patient was allowed to continue to play soccer and participate fully in gym class.
Image Reference: 

Aggressive digital papillary adenoma / adenocarcinoma - Foot and Ankle

Aggressive digital papillary adenocarcinoma is a rare cutaneous tumor of eccrine sweat gland origin that occurs on the plantar surfaces of the digits in the hand and foot.
This tumor affects men more than women, with a mean age at presentation of 52 yrs (range: 19-83 yrs).
It can have an indolent clinical course without symptoms or change for years. The average tumor size is 1.7 cm and the mas may be present from 2 months to 15 years. Pain is a frequent presenting complaint.
Aggressive surgical re-resection or amputation if necessary to avoid local recurrence.

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A 27 year old man with a 3 month history of swelling of the dorsum of the foot

Case Identification
Case ID Number: 
20091105BR
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This 27 year old man presented with a 3 month history of swelling of the dorsum of the foot. He was healthy, working full time, and afebrile. Exam of the right foot showed a mildly tender, diffuse swelling of the area near the talus and navicular, without fluctuance or erythema. Laboratory exam was significant for a normal white cell count and an ESR of 25.

Image Reference: 

A 15 year old patient with pain and a bump on his left shin for one or two years

Case Identification
Case ID Number: 
20091117AH
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

The patient is 15, and he has had pain and a bump on his left shin for one or two years. He has been taking aspirin once in the morning and once at night, which controls the pain effectively. The pain is worse at night and in the first thing in the morning.

Radiological findings:: 
The patient has no other significant medical history. Examination of the left tibia shows a fusiform thickening of the tibia about mid shaft on the medial side. There is no redness minimal swelling and minimal or no tenderness. There is no regional or central lymphadenopathy. The knee joint and ankle joint nearby are normal.
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