Özmanevra Ramadan, Calikoglu Ece, Mocan Gamze, Erler Kaan
J Am Podiatr Med Assoc. 2019 Sep;109(5):393-396. doi: 10.7547/18-097.
Enchondroma is the most common benign cartilage bone tumor of the toes. In contrast, the foot is a rare region for chondrosarcoma, and the involvement of phalanges is extremely rare. In this article, we report an unusual case of intermediate chondrosarcoma involving the proximal phalanx of the great toe of a 52-year-old woman who was previously treated with curettage and bone grafting because of misinterpretation of enchondroma at a local hospital. She presented complaining of pain and swelling that she had experienced for a period of 1 year after the first operation. Radiography revealed a lytic lesion with a subtle punctuate calcification and endosteal scalloping in the proximal phalanx of the great toe. Gadolinium-enhanced magnetic resonance imaging confirmed soft-tissue involvement and cortical destruction. Staging evaluation with computed tomographic scan of the chest, abdomen, and pelvis was performed to ensure that there was no metastatic disease. Subsequently, a bone biopsy was performed, and the diagnosis was grade 2 chondrosarcoma. The patient was informed about the recurrence of the lesion and the clinical context on the basis of tumor biology of chondrosarcoma and was offered the option of either amputation or wide resection. She preferred the latter. The patient was treated with wide resection and underwent reconstruction with cement and Kirschner wire. She remains free of disease after 1 year of follow-up.
内生软骨瘤是脚趾最常见的良性软骨骨肿瘤。相比之下，足部是软骨肉瘤的罕见发病部位，累及趾骨的情况极为罕见。在本文中，我们报告了一例不寻常的中级软骨肉瘤病例，该病例发生在一名52岁女性的拇趾近节趾骨，她曾因当地医院将内生软骨瘤误诊而接受刮除术和骨移植治疗。她因首次手术后持续1年的疼痛和肿胀前来就诊。X线检查显示拇趾近节趾骨有一个溶骨性病变，伴有细微的点状钙化和骨内膜扇贝样改变。钆增强磁共振成像证实有软组织受累和皮质破坏。进行胸部、腹部和骨盆的计算机断层扫描分期评估以确保没有转移性疾病。随后进行了骨活检，诊断为2级软骨肉瘤。根据软骨肉瘤的肿瘤生物学特性，告知患者病变复发情况和临床背景，并提供截肢或广泛切除的选择。她选择了后者。患者接受了广泛切除，并使用骨水泥和克氏针进行重建。随访1年后她仍无疾病复发。
