PMC5061111_01
Clinical pictures of the right heel showed a 7 x 10 x 6 cm lobulated mass over the right heel: (A) Lateral view. (B) Posterior view.
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On physical examination, there was a 7 x 10 x 6 cm fungating lobulated mass over the right heel (Fig. 1)which was tender (visual analog scale of 2-3) on palpation.
A: lateral view radiograph of ankle showed a radiolucent lesion occupying the right calcaneous. B: magnetic resonance imaging was consistent with solid mass derived from calcaneal bone expanding to the soft tissue. C: there was small area of cystic component, most probably secondary aneurismal bone cyst.
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Ankle radiograph showed an expanded osteolytic lesion in the right calcaneus (Fig. 2A). There was small area of cystic component, most probably secondary aneurysmalbone cyst (Fig. 2B, C).
The histologic section reveals tumor consist of numerous multinucleated giant cells, and area of secondary aneurysmal bone cyst (HE, 40x) B. The multinucleated giant cells contain nuclei showing similar feature to those of mononuclear stromal cells (HE, 400x).
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Soft tissue defect was covered by sural flap (Fig. 3).
The pictures showed surgical procedures from wide excision to bone and soft tissue reconstruction. (A) tumor excision; (B) post excision of the tumor; (C) femoral head allograft; (D) femoral head insertion to change the calcaneus; (E) achilles tendon lengthening; (F) achilles tenodesis; (G) soft tissue coverage with sural flap; and (H) complete surgery.
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The previous biopsy was reviewed by our pathologist which was consistent with GCT of bone with secondary ABC (Fig. 4A, B).
Five months follow up after the surgery, (A) Clinical pictures (B) Radiographic pictures.
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He was able to walk partial weight bearing with axial crutches (Fig. 5).