Nov 12, 2014
PRESENTATION
Case Study: A ninety-one-year-old man presented with pain, tenderness, and swelling in the right foot and difficulty walking. The patient’s history included coronary artery disease, non-insulin-dependent diabetes mellitus, osteoarthritis, BPH, and asthma. During the previous six months, a community podiatrist had attributed the foot pain to peripheral vascular disease, hammer-toe deformities, and gout.
At the time of referral, the patient reported a maximal pain score of 6 on a 10-point visual analog scale. Localized gross swelling of the right forefoot measured 3 × 3 cm and was centered at the base of the third phalanx, with a tender nonmobile nodule palpable on the dorsal surface. The dorsalis pedis pulse was nonpalpable on the right lower extremity, and pitting edema was present. White blood-cell count, hemoglobin, hematocrit, platelet count, and alkaline phosphatase levels were normal. Radiographs of the whole foot (A) and of the right third toe (B), shown here, revealed lytic changes involving the proximal phalanx of the third digit, with an associated extraosseous soft-tissue mass abutting the adjacent digits. MRI revealed a 2.9 × 2.4 × 2.7 cm septated mass of the proximal phalanx of the third toe; the normal marrow signal was entirely replaced by tumor.
What is the diagnosis?
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