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A very large forefoot tumor in a 70 year old woman

Case Identification
Case ID Number: 
Clinical case information
Case presentation: 

This 70 year old woman has a mildly painful right foot mass. The mass has forced the fourth and fifth metatarsals to bow outward and remodel.

Radiological findings:: 
The plain films show striking outward bowing of the fourth and fifth metatarsals due to the gradual enlargement of the mass. The fourth metatarsal also has an apex dorsal bowing deformity due to plantar pressure from the mass. The MRI shows a very large mass that extends from the plantar surface the foot up through the space between the fourth and fifth metatarsals and into the dorsal subcutaneous tissues.
Laboratory results:: 
No laboratory examinations were requested
Differential Diagnosis: 
This lesion has "indeterminate" features by MRI. This means that the diagnosis cannot be determined based on the MRI, as is possible with some soft tissue tumors such as lipoma and hemangioma. The differential diagnosis must be constructed from a set of soft tissue tumors that can cause this extensive growth, bone remodeling, and whose MRI features are strikingly heterogeneous such as seen on these MRI images.
Further Work Up Needed:: 
This patient needs staged biopsy followed by definitive surgical management, depending on the tumor type, grade, and stage.