Vaseenon Tanawat, Saengsin Jirawat, Pattamapaspong Nuttaya, Settakorn Jongkolnee, Pruksakorn Dumnoensun
Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Orthop Case Rep. 2017 Sep-Oct;7(5):75-79. doi: 10.13107/jocr.2250-0685.904.
Spindle cell hemangioma (SCH) of the bone (midfoot) is a rare disease, but it can cause symptomatic pain and invade surrounding tissues lead to limb deformities and functional loss.
We report the case of a 35-year-old woman who experienced a firm mass over the left midfoot for 5 years causing pain and numbness in the foot. Radiographs showed a geographic osteolytic lesion involving calcification of the base of the 2nd and 3rd metatarsals, cuneiforms bones and surrounding soft tissue. Magnetic resonance imaging revealed a lobulated mass in the midfoot containing tangles of tortuous blood vessels and dark foci characteristic of phleboliths. Wide resection of the 2nd and 3rd cuneiforms, metatarsal bones and surrounding tissues with a curved iliac bone graft reconstruction were performed. Histological assessment revealed a lesion composed of a vascular channel containing endothelial cells with smooth muscle but without cellular atypia. The definite diagnosis was spinal cell hemangioma. The pain resolved within 4 months. The foot was stable, and no recurrence was found at the 48 months follow-up.
This unusual disease, SCH of the midfoot responded favorably to wide resection and curved iliac bone grafting. It is suggested that this approach will provide a satisfactory functional result.
骨(中足)的梭形细胞血管瘤(SCH)是一种罕见疾病,但可引起症状性疼痛并侵犯周围组织,导致肢体畸形和功能丧失。
我们报告一例35岁女性病例,其左中足出现一个质地坚硬的肿块,持续5年,引起足部疼痛和麻木。X线片显示一个地图样溶骨性病变,累及第2、3跖骨基部、楔骨及周围软组织钙化。磁共振成像显示中足有一个分叶状肿块,内含迂曲血管团和静脉石特征性的暗区。对第2、3楔骨、跖骨及周围组织进行了广泛切除,并采用弯曲髂骨移植重建。组织学评估显示病变由一个血管通道组成,血管通道内含有内皮细胞和平滑肌,但无细胞异型性。明确诊断为梭形细胞血管瘤。疼痛在4个月内缓解。足部稳定,在48个月的随访中未发现复发。
这种不寻常的疾病,即中足SCH,对广泛切除和弯曲髂骨移植反应良好。建议这种方法将提供令人满意的功能结果。