PMC6410423_01
Swelling of 5 x 9 cm over the lateral aspect of the left ankle joint with discolored skin and no signs of inflammation.
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fig1
On clinical examination, there was a 5 x 9 cm swelling over the lateral aspect of the left ankle joint (Figure 1), which was well defined, nonmobile, firm to hard in consistency, and nontender.
Anteroposterior X-ray of the left ankle joint showing a radiopaque mass with dense homogenous calcification over the lateral aspect of the ankle joint.
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fig2
The ankle joint appeared normal, and there were no pressure erosions over the lower end of the fibula (Figure 2).
FNAC (Pap stain x40) showing foci of calcium deposits with numerous highly refractile rhomboid-shaped crystals.
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fig3
Considering the benign nature of the condition, a FNAC was done, and smears showed dense deposits of calcium with numerous refractile radiating rhomboid-shaped crystals which were seen against amorphous material (Figure 3).
Ovoid-shaped mass measuring 7 x 5.5 x 4 cm reddish white in color after surgical removal.
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fig4
Intraoperatively, an ovoid-shaped mass, reddish white in color and measuring 7 x 5.5 x 4 cm, was noted underneath the peroneal tendon overlying the capsule (Figure 4).
Biopsy: (a) (H&E stain x200) large globular deposits of calcium with rhomboid-shaped crystals surrounded by mild inflammatory reaction; (b) (H&E stain x400) CPPD crystals along with minimal lymphocytic infiltration and foci of calcification.
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fig5
The mass obtained was subjected to a histopathological examination, which confirmed the FNAC findings and showed large areas of calcium deposition with plenty of rhomboid-shaped refractile crystals (Figure 5).