PMC9209653_01
(A) Old X-ray showing the clinically silent lesion at the age of 6 years. (B) Clinical picture showing the mass covered with areas of hyperkeratosis. (C) New X-ray at time of presentation showed increased size of the lesion. (D-F) Preoperative CT section of the lesion.
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F1
Plain X-ray demonstrated a neoformation in the context of soft tissue with calcifications inside and undefined limits (Figure 1A). At the time of presentation local examination revealed moderate oedema and hyperkeratosis in the posterior-medial side of the right hindfoot with evidence of a hard, firm mass measuring about 20 mm in diameter (Figure 1B). CT scan (Figures 1D-F) showed the mass to be made of mixed bone and non-ossified areas.
(A) Intraoperative image of the excision of the mass. (B) Picture of the sample measuring approximately 2.5 x 1.5 x 2 cm. (C) Section of the lesion as seen with optic microscopy and Hematoxylin & Eosin staining. The specimen shows "mixed fibrous-adipose dermo-epidermal tissue with foci of stromal osseous metaplasia", as confirmed also by pathology report.
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F2
A complete excision of the mass was performed through a small lesion-centered incision (Figures 2A,B). Histopathological examination confirmed the lesion to be made of "multiple foci of stromal osseous metaplasia.", thus supporting the diagnosis of HO (Figure 2C).
Xray 6 months after surgery confirming complete excision of the lesion without residual pathology.
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F3
Timetable reporting relevant data from the episode of care.
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F4