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Presented by Edward McCarthy, M.D. and prepared by Jon Davison, M.D.
Case 4: A 30-year-old man had pain in his heel for six months.
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1. Question
Week 221: Case 4
A 30-year-old man had pain in his heel for six months. A radiograph demonstrated a bubbly lytic lesion occupying most of his calcaneus.mages/JMD_5-15-05_SPWC/Case_4/2.jpg
mages/JMD_5-15-05_SPWC/Case_4/3.jpgCorrect
Answer: Desmoplastic fibroma
Histology: none provided
Discussion: Desmoplastic fibroma is the intraosseous counterpart of fibromatoses. This is a non-metastasizing, but locally aggressive lesion consisting of brown spindle cells in a heavily collagenized matrix.
The lesion is not a fibrosarcoma because there is no “herringbone” pattern of cellular spindle cells. In addition, this lesion lacks nuclear atypia which is present in fibrosarcoma.
The lesion is not fibrous dysplasia. There is no woven bone present in this lesion typical of the fibroosseous nature of the fibrous dysplasia.
The lesion is not a malignant fibrous histiocytoma. Malignant fibrous histiocytoma is a cellular, high-grade sarcoma with significant nuclear atypia.
Incorrect
Answer: Desmoplastic fibroma
Histology: none provided
Discussion: Desmoplastic fibroma is the intraosseous counterpart of fibromatoses. This is a non-metastasizing, but locally aggressive lesion consisting of brown spindle cells in a heavily collagenized matrix.
The lesion is not a fibrosarcoma because there is no “herringbone” pattern of cellular spindle cells. In addition, this lesion lacks nuclear atypia which is present in fibrosarcoma.
The lesion is not fibrous dysplasia. There is no woven bone present in this lesion typical of the fibroosseous nature of the fibrous dysplasia.
The lesion is not a malignant fibrous histiocytoma. Malignant fibrous histiocytoma is a cellular, high-grade sarcoma with significant nuclear atypia.
