PMC5887220_01
Pre-operative radiograph of large lytic lesion in the calcaneus
13569_2018_92_Fig1_HTML.jpg
PMC5887220_01_13569_2018_92_Fig1_HTML.jpg
Fig1
Upon referral new radiographs were obtained (Fig. 1).
Preoperative sagittal T1 image of the calcaneus showing solid lesion with fairly homogenous signal
13569_2018_92_Fig2_HTML.jpg
PMC5887220_01_13569_2018_92_Fig2_HTML.jpg
Fig2
Magnetic resonance imaging (MRI) showed a complex lesion in the anterior calcaneus with some surrounding edema and potential concern for cortical disruption (Figs. 2, 3).
Preoperative sagittal T2 image with some heterogeneity within the lesion surrounding bony edema, sclerotic border around the lesion, but with concern for cortical breakthrough in the subtalar joint
13569_2018_92_Fig3_HTML.jpg
PMC5887220_01_13569_2018_92_Fig3_HTML.jpg
Fig3
Magnetic resonance imaging (MRI) showed a complex lesion in the anterior calcaneus with some surrounding edema and potential concern for cortical disruption (Figs. 2, 3).
Axial CT scan of lesion preoperatively displaying concern for cortical destruction
13569_2018_92_Fig4_HTML.jpg
PMC5887220_01_13569_2018_92_Fig4_HTML.jpg
Fig4
There was cortical destruction along multiple sites at the margins of the lesion and slight scattered calcifications (Fig. 4).
H&E x200. The tumor consists of large epithelioid and spindle cells arranged in cords, clusters and as single cells within a myxoid to hyalinized stroma
13569_2018_92_Fig5_HTML.jpg
PMC5887220_01_13569_2018_92_Fig5_HTML.jpg
Fig5
The pathologic report revealed cords and clusters of epithelioid cells and foci of spindle cells in a myxochondroid matrix (Figs. 5, 6).
H&E x400. The tumor cells have moderately abundant eosinophilic cytoplasm with occasional cytoplasmic vacuoles. Nuclei are round with prominent nucleoli
13569_2018_92_Fig6_HTML.jpg
PMC5887220_01_13569_2018_92_Fig6_HTML.jpg
Fig6
The pathologic report revealed cords and clusters of epithelioid cells and foci of spindle cells in a myxochondroid matrix (Figs. 5, 6).
H&E x600. The vacuoles represent attempts at blood vessel formation and may contain red blood cell fragments
13569_2018_92_Fig7_HTML.jpg
PMC5887220_01_13569_2018_92_Fig7_HTML.jpg
Fig7
Some of the epithelioid cells contained vacuoles and rare erythrocyte (Fig. 7).
CAMTA1 immunohistochemical stain, x200. Tumor cell nuclei stain positively with antibody to CAMTA1 protein, a fusion protein unique to this tumor
13569_2018_92_Fig8_HTML.jpg
PMC5887220_01_13569_2018_92_Fig8_HTML.jpg
Fig8
Immunohistochemical stains identified CD31, CD34, and CAMTA1 (Figs. 8, 9).
CD34 immunohistochemical stain, x200. Tumor cells stain positively for endothelial marker CD34. This stain also highlights the anastomosing cord-like architecture of the tumor which recapitulates the formation of primitive blood vessels
13569_2018_92_Fig9_HTML.jpg
PMC5887220_01_13569_2018_92_Fig9_HTML.jpg
Fig9
Immunohistochemical stains identified CD31, CD34, and CAMTA1 (Figs. 8, 9).
Two-year post-operative follow-up radiograph of the calcaneus showing curettage and cementing with Steinman pin reinforcement. There has been so sign of recurrence of disease or failure of the construct despite full activity
13569_2018_92_Fig10_HTML.jpg
PMC5887220_01_13569_2018_92_Fig10_HTML.jpg
Fig10
CT scan and radiographs of the hindfoot at his 6 month and 3 year follow-up showed well fixed hardware without recurrence (Fig. 10).