PMC8360742_01
Bilateral tendon xanthomas over Achilles tendon illustrating noticeable swelling (white arrows).
CRIOR2021-1932763.001.jpg
PMC8360742_01_CRIOR2021-1932763.001.jpg
fig1
No muscle wasting or neurovascular deficit was identified (Figure 1).
Soft tissue shadow (white arrows) posterior to the ankle in both legs (L: left leg; R: right leg).
CRIOR2021-1932763.002.jpg
PMC8360742_01_CRIOR2021-1932763.002.jpg
fig2
Ultrasound appearance of thickened Achilles tendon with focal hypoechoic areas. White arrows, thickened Achilles tendon.
CRIOR2021-1932763.003.jpg
PMC8360742_01_CRIOR2021-1932763.003.jpg
fig3
MRI scan of the lower limbs. Sagittal view: right (R) and left (L) tendon xanthomas (white arrows).
CRIOR2021-1932763.004.jpg
PMC8360742_01_CRIOR2021-1932763.004.jpg
fig4
T1- and T2-weighted images depicted striated appearance in sagittal sequences due to interposition of xanthoma between tendon fibres while illustrating speckled appearance in axial sequences. The xanthomas were focal with minimal infiltration into tendon tissues (Figure 4).
Surgically exposed lump.
CRIOR2021-1932763.005.jpg
PMC8360742_01_CRIOR2021-1932763.005.jpg
fig5
A midline incision was made over the lump, and the tendon was exposed up to tendo-muscular junction, carefully preserving the sural nerve, on the lateral side of the tendon and plantaris tendon (Figure 5).
After subtotal resection.
CRIOR2021-1932763.006.jpg
PMC8360742_01_CRIOR2021-1932763.006.jpg
fig6
Extensive intralesion subtotal resection was performed until the normal surrounding tendon tissue was approached (Figure 6).
Following the tendon repair.
CRIOR2021-1932763.007.jpg
PMC8360742_01_CRIOR2021-1932763.007.jpg
fig7
In both legs, we could preserve plantaris tendon (Figure 7).
Following skin closure.
CRIOR2021-1932763.008.jpg
PMC8360742_01_CRIOR2021-1932763.008.jpg
fig8
Local concentration of multinucleated giant cells, lipid-laden foamy macrophages along with connective tissue fragments, few inflammatory cells, and cyst macrophages with no malignant cells.
CRIOR2021-1932763.009.jpg
PMC8360742_01_CRIOR2021-1932763.009.jpg
fig9
Stance position (a) and standing on toes (b).
CRIOR2021-1932763.010.jpg
PMC8360742_01_CRIOR2021-1932763.010.jpg
fig10
Six weeks' postsurgery, she was completely independent when walking with ability to stand on toes without discomfort and was able to wear shoes without discomfort (Figure 10).
Ultrasound view: (a) right side; (b) left side. AP and longitudinal views illustrating no recurrence of xanthoma in Achilles tendon bilaterally (black arrow).
CRIOR2021-1932763.011.jpg
PMC8360742_01_CRIOR2021-1932763.011.jpg
fig11
Ultrasound scan assessments were performed at 1-year and 2-year visits which denoted scar tissue in the absence of recurrence (AP thickness was <4 mm on both Achilles tendons) (Figure 11).