History of Present Illness:
A 52-year-old male presents to the podiatrist for 4 years of gradually worsening foot pain that is worse if he steps on a rock and that sometimes wakes him at night. He denies any fever, trauma or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal. Physical exam is otherwise normal except for a lump in the middle of the right plantar arch
Initial Diagnostic Testing:
- Imaging: See ultrasound below
What is the most likely diagnosis?
- A) Giant cell tumor
- B) pigmented villonodular synovitis
- C) neuroma
- D) fibroma
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What is the most likely diagnosis?
- A) Giant cell tumor
- B) pigmented villonodular synovitis
- C) neuroma
- D) fibroma
ANSWERS: Initially thought to be a plantar fibroma, for which surgery is not recommended. 10 years later was worse and causing foot numbness. MRI (images below) suggested tenosynovial giant cell tumor AKA pigmented villonodular synovitis (PVNS), or less likely gout or amyloidosis. Surgery was recommended. Surgical pathology showed it was actually a neuroma. Numbness was not reversible.
