PMC7210905_01
(a and b) Showing swelling at presentation and (c) showing swelling fungating with sloughing of skin after 2 weeks.
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F1
A swelling of 5*4*2 cm size which was tender was present over the posterolateral aspect of heel extending anteriorly covering lateral malleolus, posteriorly extending to the area of tendoachilles insertion to the calcaneus, superiorly 5 cm above whole of the lateral malleolus, and inferiorly 2 cm above the heel (Fig. 1). The swelling increased in size and turned into a fungating mass with sloughs hanging from the surface within 2-week duration after the presentation (Fig. 1).
(a) X-ray showing soft-tissue mass on posterior aspect of calcaneum with a lytic area. (b-e) Magnetic resonance imaging showing hyperintense lesion in T1 as well as T2-weighted images in posteroinferior aspect of calcaneum.
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F2
X-ray showed large soft-tissue shadow over heel with loss of soft-tissue planes and a lytic lesion over the posterior aspect of the calcaneus with destruction of the posterior tuberosity of calcaneus (Fig. 2a). T2 and T1 images (Fig. 2b-e). The mass invaded calcaneus posteriorly with encasement of tendoachilles.
Intraoperative picture showing mass eroding into calcaneum.
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F3
The tumor mass was found to be eroding into the posterior aspect of calcaneum with the involvement of the insertion site of tendoachilles (Fig. 3).
Granulation tissue covering calcaneum after 48 h of vacuum-assisted closure therapy.
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F4
The wound gradually decreased in size with 5 days of continuous vacuum-assisted closure therapy at 125 mmHg (Fig. 4), and it healed with secondary intention with regular dressing within 4 weeks.
(a) At lower power, numerous pale tangible body macrophages are seen, producing a "starry sky" appearance (b) At high power, tumor cells have multiple small nucleoli and high mitotic index.
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F5
In microscopy, the tumor showed sheets of tumor cells intermediate to large cells with moderate amount of amphophilic to eosinophilic cytoplasm and the nuclei appeared to be vesicular with multiple conspicuous nucleoli with some cells showing eccentrically located nuclei and nuclear membrane irregularities (Fig. 5).
Immunohistochemistry panel, (a) ALK positive, (b) CD30 positive, (c) ki67 positive, and (d) leukocyte common antigen positive.
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F6
Immunohistochemistry showed ALK, CD30, CD99, EMA, ki67, and leukocyte common antigen positivity (Figs. 6 and 7).
Immunohistochemistry panel, (a) EMA positive, (b) CD99 positive, (c) CD3 negative.
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F7
Immunohistochemistry showed ALK, CD30, CD99, EMA, ki67, and leukocyte common antigen positivity (Figs. 6 and 7).