Puthanveetil Dhrushith Etakkepravan, Anilkumar S D, Paul Arun Joseph, Prasannan Praveen K, Sajeevkumar Harikrishnan
Department of Orthopaedics, Sree Uthradom Thirunal Academy of Medical Sciences, Thiruvananthapuram, Kerala, India.
Department of Orthopaedics, KIMS Multispeciality Hospital, Kottayam, Kerala, India.
J Orthop Case Rep. 2025 Apr;15(4):26-30. doi: 10.13107/jocr.2025.v15.i04.5432.
Most soft-tissue tumors in the foot and ankle are benign. While lipomas are the most prevalent type of soft-tissue tumor, intra-articular lipomas are exceptionally rare. Most documented intra-articular lipomas involve the knee joint, and there have been only a few case reports of an intra-articular lipoma in the ankle.
We present the case of a 77-year-old woman with a recurrent, progressively enlarging ankle mass that had persisted for 19 years following surgery 15 years prior. At present, the swelling is limiting her range of motion. On examination, a firm, non-tender mass was observed on the medial side of the left ankle joint without any signs of inflammation. The mass was non-compressible, immobile, and did not transilluminate. The clinical diagnosis suggested a soft-tissue ganglion. A radiograph showed soft-tissue opacity over the anteromedial aspect of the tibiotalar joint. Magnetic resonance imaging (MRI) revealed a well-defined, multilobulated, encapsulated lesion at the tibiotalar joint's medial side, with intra- and extra-articular components. The patient underwent surgical excision of the tumor, and histopathological examination confirmed the presence of mature adipose tissue consistent with an intra-articular lipoma with fibrous septa. At the follow-up visit, the patient reported a complete resolution of symptoms and had no further complaints.
An intra-articular lipoma of the ankle is an extremely rare tumor. Clinical examination is essential in diagnosing the lesion. MRI is primordial for both differential diagnosis and preoperative planning. Depending on the tumor size, an excision can be performed through open arthrotomy or arthroscopy.
足踝部的大多数软组织肿瘤是良性的。脂肪瘤是最常见的软组织肿瘤类型，而关节内脂肪瘤极为罕见。大多数已报道的关节内脂肪瘤累及膝关节，踝关节内关节脂肪瘤仅有少数病例报告。
我们报告一例77岁女性患者，其踝关节肿物复发且逐渐增大，15年前手术后持续存在19年。目前，肿胀限制了她的活动范围。检查时，在左踝关节内侧观察到一个质地坚硬、无压痛的肿物，无任何炎症迹象。肿物不可压缩、固定不动且不透光。临床诊断提示为软组织腱鞘囊肿。X线片显示胫距关节前内侧软组织密度增高。磁共振成像（MRI）显示胫距关节内侧有一个边界清晰、多叶状、有包膜的病变，有关节内和关节外成分。患者接受了肿瘤手术切除，组织病理学检查证实存在成熟脂肪组织，符合伴有纤维间隔的关节内脂肪瘤。随访时，患者报告症状完全缓解，无进一步不适。
踝关节内关节脂肪瘤是一种极其罕见的肿瘤。临床检查对病变诊断至关重要。MRI对鉴别诊断和术前规划都至关重要。根据肿瘤大小，可通过切开手术或关节镜进行切除。
