Myxochondroid metaplasia of the plantar foot: a distinctive pseudoneoplastic lesion resembling nuchal fibrocartilaginous pseudotumor and the equine digital cushion

Abstract

Cartilaginous tumors of soft tissue are uncommon, with benign chondromas of soft parts greatly outnumbering rare soft-tissue chondrosarcomas. Over the past several years, we have seen in consultation a distinctive, benign-appearing chondroid soft-tissue lesion of the plantar foot that differs in a number of respects from chondroma of soft parts. Herein we report our experience with this distinctive lesion. A retrospective review of all cases from the foot in our soft-tissue consultation and institutional surgical pathology archives identified 9 similar cases, most often previously coded as ‘fibroconnective tissue with chondroid metaplasia’. Six cases were submitted in consultation due to concern for a neoplastic process, in particular chondroma of soft parts or fibro-osseous pseudotumor of the digits. The patients were 4 young males (age range 8–16 years, mean 11.5 years) and 5 older patients, including 4 women and 1 man (age range 34–78 years, mean 56.4 years). All cases occurred in the subcutaneous plantar soft tissues of the feet, including four cases confined to the toes, and presented as non-specific, variably painful masses. Radiographic studies, available in six cases, did not show any evidence of bone involvement. Histologically, the lesions were characterized by a partially circumscribed, variably cellular proliferation of bland fibroblastic cells in a fibromyxoid background in areas showing distinct stromal basophilia and a chondroid appearance. Small foci of true cartilaginous metaplasia with lacuna formation were occasionally seen. Cartilaginous differentiation was confirmed in three cases with immunohistochemistry for S100 and ERG proteins. Intralesional cystic change was common, as were a variety of other reactive-appearing changes in the surrounding connective tissue. Characteristic morphological features of chondroma of soft parts and/or fibro-osseous pseudotumor of the digits were absent. Clinical follow-up (7 patients, 2–115 months, median 38 months) showed all patients to be without recurrent disease. We have identified a morphologically distinctive lesion of the foot that appears to represent a reactive, metaplastic process, presumably secondary to chronic mechanical stress. The morphological features of myxochondroid metaplasia of the plantar foot are reminiscent of those of nuchal fibrocartilaginous pseudotumor and the equine digital cushion, further suggesting a reactive/reparative etiology. Awareness of the unique features of this lesion should allow its ready distinction from other neoplastic and pseudoneoplastic (osteo) cartilaginous lesions of the feet.