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A 57-year-old woman who has a lesion in the talus bone

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

The patient is a very pleasant 57-year-old woman who has pain and a lesion in the talus bone. She was initially seen by a variety of practitioners, including one who gave her an injection for gout or for arthritis. The patient is generally healthy.

Radiological findings:: 
The patient has had tonsillectomy, and a benign tumor removed from the right breast. She does not smoke. In the family there is high blood pressure in the brother and diabetes and a brother. There is no other contributory history. Examination of the left ankle shows diffuse swelling. The range of motion is preserved. There is diffuse tenderness, but no definite mass is palpable. There is a faint mild lesion in the neck of the talus, that was visible on the original xrays taken months ago. MRI films show a mass in the neck of the talus which appears to have arisen in bone or adjacent to bone. A bone scan shows there are two areas of increased uptake, one in the talus and one in the hip. A CT scan of the abdomen is shown.
Differential Diagnosis: 
Possibilities include pigmented villonodular synovitis, giant cell tumor of bone, and malignancy, among others.
Further Work Up Needed:: 
Clearly biopsy is going to be necessary in order to decide on the appropriate course of treatment. I do not believe that biopsy and removal in one stage is an appropriate choice.
Pathology results:: 
See images.
Special Features of this Case:: 
Lesions in the foot may arise from pathology elsewhere. The clinician needs to maintain a broad perspective.
Image Reference: