Module 44, General Orthopaedist Level
A 6 year old female presented to Outpatient Clinic with mass in her
left foot which the mother says has been getting bigger and causes pain
when the child walks for more than a few steps. There was firm tender mass
within the planter arch area of the left foot. the mass was approximately
6.5 x l7 cm. It involved virtually the entire arch of the foot. An xray
was obtained which demonstrated normal bones and no calcification in the
soft tissues. Further history demonstrated that she had an excision biopsy
of mass of the left foot. Intra-operative finding revealed a fatty vascular
tumor at the planter aspect of the medial left foot which was infiltrative
and adherent to the medial plantar artery the medial planter nerve, the
flexor hallucis longus as well as the flexor tendon of the second, third,
and fourth toes. The pathology report was a benign lesion. She then was
followed 3 months later with a lower extremity arteriogram with transcatheter
embolisation of left foot arteriovenous malformation. The current MRI is
above.
Question 44A
This
now probably represents a malignant transformation of the previous soft
tissue hemangioma.
Question 44B
A
repeat excision is the next step in the treatment of this lesion.
Question 44C
Soft
tissue hemangioma is very rare to arise in childhood.
Question 44D
Most
hemangioma occur in the subcutaneous tissue and rarely cross the muscle
fascial plane.
Question 44E
There
are two forms of hemangioma with the capillary form often present with
soft tissue calcification.
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