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Intraosseous lipoma of the calcaneus
The Foot 13 (2003) 51–52
Case report
Intraosseous lipoma of the calcaneus K.S. David-West∗ Orthopaedics, Royal Alexandra Hospital, Paisley, UK Received 12 March 2002; accepted 29 July 2002
Abstract I report a case of rare intraosseous lipoma of the calcaneus in a 60-year-old housewife, who initially had left heel pain, but at time of review she had no pain at all. The radiograph showed the classical radiological features of intraosseous lipoma. No surgery intervention was required and at last annual review she remained symptom free. © 2003 Elsevier Science Ltd. All rights reserved. Keywords: Intraosseous lipoma; Calcaneus
1. Case report A 60-year-old housewife was referred to our clinic by her general practitioner, with a provisional diagnosis of ‘calcaneal spur.’ She complained of left heel pain of 6 months duration. There was no history of trauma or weight loss. No significant past medical history. At the time of presentation to our clinic her symptoms had improved. On examination she was slightly tender over the heel centrally on the plantar surface, there was no deformity, redness or local warmth. Radiograph of her hind foot was taken (see Fig. 1). A lateral radiograph of the left foot shows a calcaneal spur and an osteolytic area with a well-defined, sclerotic border and a calcified central nidus, which are the classical features of intraosseous lipoma. She was reviewed again at the clinic after 6 months and remained asymptomatic with no changes on the repeat radiograph. She required no treatment.
Fig. 1. Lateral radiograph of calcaneus showing intraosseous lipoma.
Bone lipomas are classified according to site: 2. Discussion The intraosseous fatty tumour represents 0.1% of all primary tumours [1] and intraosseous lipoma of calcaneus accounts for 15% of all intraosseous lesions [2].
∗ Present address: 14 Kirkaig Avenue, Dean Park, Renfrew PA4 OYH, UK. Tel.: +44-141-561-2103; fax: +44-870-128-6550. E-mail address: [email protected] (K.S. David-West).
• Periosteal • Intracortical • Intraosseous or intramedullary [3]. The aetiology is unknown. The most accepted hypothesis is that it represents a benign neoplasm of marrow adipose tissue. An alternative hypothesis is that it could be a healed bone infraction secondary to trauma [1]. Two-thirds of the patients will present with pain and one-third will be asymptomatic and discovered incidentally
0958-2592/03/$ – see front matter © 2003 Elsevier Science Ltd. All rights reserved. PII: S 0 9 5 8 - 2 5 9 2 ( 0 2 ) 0 0 1 1 8 - 9
52
K.S. David-West / The Foot 13 (2003) 51–52
on radiograph [4]. Bilateral lesions have been reported but are very rare [2,5]. The classical radiological appearance is an osteolytic area with well-defined sclerotic border occasionally a central nidus of calcification, which helps to differentiate it from unicameral bone cyst. With this characteristic, accurate diagnosis can be made in 50% of calcaneal lipomata [4]. In cases where there is no central nidus, or where there is doubt about the diagnosis, computerised tomography (CT scan) is a useful investigation in making a diagnosis by measuring the attenuation of the lesion. Magnetic resonance imaging (MRI) can also be useful in making a diagnosis [6]. The histological features are, replacement of the bone marrow by adipose tissue, occasionally central core of fatty degeneration and often bone spicules [7]. Symptomatic cases can be treated by curettage and autogenous bone graft; no recurrence has been reported in the literature [3]. Differential diagnosis for intraosseous lipoma includes simple bone cyst, aneurysmal bone cyst, haemangioma of bone and chondroblastoma. Some surgeons believe
that surgical treatment should be carried out in all cases to prevent pathological fracture [6]. Our patient remained symptom free during the 1-year period of follow-up and no treatment was required.
References [1] Dahlin DC. Bone tumours: general aspects and data on 6221 cases. 2nd ed. Springfield: Charles C. Thomas Publisher; 1980. [2] Rosenblatt EM, Mollin J, Abdelwahab IF. Bilateral calcaneal intraosseous lipomas: a case report. Mt Sinai J Med 1990;57:174–6. [3] Greenspan A, Raiszadeh K, Riley GM, Matthews D. Intraosseous lipoma of the calcaneus. Foot Ankle Int 1997;18:53–6. [4] Ramos A, Castello J, Sartoris DJ, Greenway GD, Resnick D, Haghighi P. Osseous lipoma: CT appearance. Radiology 1985;157:615–9. [5] Tejero A, Arenas AJ, Sola R. Bilateral intraosseous lipoma of the calcaneus: a case report. Acta Orthop Belg 1999;65(4):527–75. [6] Joseph VG, Rodney MS, Nick S. Intraosseous lipoma of the calcaneus: a clinicopathologic study of three cases. J Foot Ankle Surg 1997;36(4):306–10. [7] Rhodes RD, Page JC. Intraosseous lipoma of the oscalcis. J Am Podiatr Assoc 1993;83(5):290–2.
Case report
Intraosseous lipoma of the calcaneus K.S. David-West∗ Orthopaedics, Royal Alexandra Hospital, Paisley, UK Received 12 March 2002; accepted 29 July 2002
Abstract I report a case of rare intraosseous lipoma of the calcaneus in a 60-year-old housewife, who initially had left heel pain, but at time of review she had no pain at all. The radiograph showed the classical radiological features of intraosseous lipoma. No surgery intervention was required and at last annual review she remained symptom free. © 2003 Elsevier Science Ltd. All rights reserved. Keywords: Intraosseous lipoma; Calcaneus
1. Case report A 60-year-old housewife was referred to our clinic by her general practitioner, with a provisional diagnosis of ‘calcaneal spur.’ She complained of left heel pain of 6 months duration. There was no history of trauma or weight loss. No significant past medical history. At the time of presentation to our clinic her symptoms had improved. On examination she was slightly tender over the heel centrally on the plantar surface, there was no deformity, redness or local warmth. Radiograph of her hind foot was taken (see Fig. 1). A lateral radiograph of the left foot shows a calcaneal spur and an osteolytic area with a well-defined, sclerotic border and a calcified central nidus, which are the classical features of intraosseous lipoma. She was reviewed again at the clinic after 6 months and remained asymptomatic with no changes on the repeat radiograph. She required no treatment.
Fig. 1. Lateral radiograph of calcaneus showing intraosseous lipoma.
Bone lipomas are classified according to site: 2. Discussion The intraosseous fatty tumour represents 0.1% of all primary tumours [1] and intraosseous lipoma of calcaneus accounts for 15% of all intraosseous lesions [2].
∗ Present address: 14 Kirkaig Avenue, Dean Park, Renfrew PA4 OYH, UK. Tel.: +44-141-561-2103; fax: +44-870-128-6550. E-mail address: [email protected] (K.S. David-West).
• Periosteal • Intracortical • Intraosseous or intramedullary [3]. The aetiology is unknown. The most accepted hypothesis is that it represents a benign neoplasm of marrow adipose tissue. An alternative hypothesis is that it could be a healed bone infraction secondary to trauma [1]. Two-thirds of the patients will present with pain and one-third will be asymptomatic and discovered incidentally
0958-2592/03/$ – see front matter © 2003 Elsevier Science Ltd. All rights reserved. PII: S 0 9 5 8 - 2 5 9 2 ( 0 2 ) 0 0 1 1 8 - 9
52
K.S. David-West / The Foot 13 (2003) 51–52
on radiograph [4]. Bilateral lesions have been reported but are very rare [2,5]. The classical radiological appearance is an osteolytic area with well-defined sclerotic border occasionally a central nidus of calcification, which helps to differentiate it from unicameral bone cyst. With this characteristic, accurate diagnosis can be made in 50% of calcaneal lipomata [4]. In cases where there is no central nidus, or where there is doubt about the diagnosis, computerised tomography (CT scan) is a useful investigation in making a diagnosis by measuring the attenuation of the lesion. Magnetic resonance imaging (MRI) can also be useful in making a diagnosis [6]. The histological features are, replacement of the bone marrow by adipose tissue, occasionally central core of fatty degeneration and often bone spicules [7]. Symptomatic cases can be treated by curettage and autogenous bone graft; no recurrence has been reported in the literature [3]. Differential diagnosis for intraosseous lipoma includes simple bone cyst, aneurysmal bone cyst, haemangioma of bone and chondroblastoma. Some surgeons believe
that surgical treatment should be carried out in all cases to prevent pathological fracture [6]. Our patient remained symptom free during the 1-year period of follow-up and no treatment was required.
References [1] Dahlin DC. Bone tumours: general aspects and data on 6221 cases. 2nd ed. Springfield: Charles C. Thomas Publisher; 1980. [2] Rosenblatt EM, Mollin J, Abdelwahab IF. Bilateral calcaneal intraosseous lipomas: a case report. Mt Sinai J Med 1990;57:174–6. [3] Greenspan A, Raiszadeh K, Riley GM, Matthews D. Intraosseous lipoma of the calcaneus. Foot Ankle Int 1997;18:53–6. [4] Ramos A, Castello J, Sartoris DJ, Greenway GD, Resnick D, Haghighi P. Osseous lipoma: CT appearance. Radiology 1985;157:615–9. [5] Tejero A, Arenas AJ, Sola R. Bilateral intraosseous lipoma of the calcaneus: a case report. Acta Orthop Belg 1999;65(4):527–75. [6] Joseph VG, Rodney MS, Nick S. Intraosseous lipoma of the calcaneus: a clinicopathologic study of three cases. J Foot Ankle Surg 1997;36(4):306–10. [7] Rhodes RD, Page JC. Intraosseous lipoma of the oscalcis. J Am Podiatr Assoc 1993;83(5):290–2.