Nontraumatic Ankle Pain with Marked Calf Muscle Atrophy Caused by Hemagiopericytoma

Abstract

A 45-year-old man had had frequent clinic visits for left retro-malleolar pain with marked calf muscle atrophy since he was 14 years old. He underwent surgery after a lumbar herniated disc was diagnosed by a computed tomography scan in a local hospital; however, it was not effective at relieving his symptoms. Magnetic resonance imaging was arranged for his left ankle pain at the department of physical medicine and rehabilitation. A 0.5 cm mass was found at his left ankle and surgically removed. The pathology showed that it was a hemangiopericytoma, a rare tumor originating from either capillary or venule epithelia cells. This tumor is often found in lower extremities or retro-peritoneum. The incidence of recurrence is high and metastasis to lung, bone and liver has been reported in about 50% of patients. The patient is now regularly monitored at the Department of Plastic Surgery. The symptoms and signs have improved with continuous physiotherapy at the outpatient unit. Detailed medical history along with comprehensive physical evaluation in patients with long-term pain at unusual locations is highly recommended to keep both physicians and patients from being misled or receiving improper medical treatment.