Detaillierte Beitrags-Information
| Beitragstitel | Pearls and pitfalls in diagnosis and treatment of foot and ankle tumours: Delayed diagnosis and interdisciplinary treatment of a pleomorphic leiomyosarcoma - a case report |
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| Beitragscode | P107 |
| Autoren | |
| Präsentationsform | Poster |
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| Abstract |
Introduction: True neoplasia of the musculoskeletal system is rare, soft tissue sarcomas (STS) account for only 1% of all malignancies. Correct diagnosis is often delayed and unplanned resection of STS is not uncommon. This case report demonstrates the prolonged course towards correct diagnosis of a pleomorphic leiomyosarcoma of the ankle and its interdisciplinary therapy. Case report: A 45-year old male presented with a mostly asymptomatic soft tissue mass on the lateral side of his right ankle joint, he had first noticed five years ago. Magnet resonance imaging showed an inhomogeneous soft tissue mass with a partial pseudocapsular margin. The report suggested a pigmented villonodular synovitis (PVNS) although specific susceptibility weighted imaging had not been performed. A single stage resection was planned. After the case was transferred to the responsible foot & ankle and tumour specialist, due to discrepancies a bioptical verification was performed first. The histopathology report noted a desmoid tumour not matching the clinical or radiological findings. Another institute’s opinion was obtained, where a leiomyosarcoma was diagnosed. Only a third institute, however, was able to grade the mass as moderately differentiated pleomorphic leiomyosarcoma. After an interdisciplinary musculoskeletal tumour board discussion, the tumour was resected included parts of the joint capsule and the anterior talofibular ligament (ATFL). Until final confirmation of complete resection, negative-pressure wound therapy was applied. Secondary reconstruction of the unstable ankle joint was performed with a gracilis muscle flap and an anterior talofibular ligament reconstruction with an autologous gracilis-tendon. Therefore, the reinforced graft tendon was fixated in a blind drill hole at the insertion site of the original ATFL on the talar neck. At the origin, the tendon then was passed and fixated through a transfibular tunnel. Adjuvant radiotherapy (60 Gray/ 30 sessions) started 6 weeks after discharge. Conclusion: Due to the unspecific appearance of foot and ankle STS, early diagnosis is often missed. Diagnostic errors resulting in unplanned resections are not uncommon, even amongst experienced radiologists, pathologists and orthopaedic surgeons. Any doctor involved in the diagnostic and therapeutic process of unclear lumps and bumps around the foot and ankle has to take true neoplasia into consideration. If in doubt, early referral to a specialist centre is necessary. |