Multiple Soft Tissue Swellings Research Articles

Case Series of Three Cases of Madura’s Foot with a Characteristic ‘Dot in Circle’ Sign: A Radiologist Perspective

Madura’s foot is a rare infectious granulomatous disease affecting the foot. The incidence of this disease has decreased in recent years due to improved living conditions. However, it can still be misdiagnosed by inexperienced surgeons as other similar conditions. Early and accurate diagnosis is crucial for optimal treatment and limb preservation. In this study, the authors present three unusual cases of Madura’s foot. A 23-year-old woman presented with swelling and draining sinuses in her left foot for six years. Imaging tests including Ultrasonography (USG), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) revealed the characteristic ‘dot in circle’ sign of Madura’s foot. However, her USG-guided biopsy did not confirm the diagnosis, and it was only through an excisional biopsy that actinomycetoma was confirmed. Another case involved a 60-year-old male with multiple soft tissue swellings on his right foot for 10 years, resulting in foot deformity. Radiographs showed multiple punched-out lytic lesions in the bones, while USG and MRI exhibited the typical ‘dot in a circle’ sign. Histopathological examination confirmed actinomycetoma. The third case involved a 36-year-old male with a chronic sinus discharging yellow pus and black granules on the volar side of his right foot. USG and MRI revealed the classic signs of Madura’s foot, and these findings were correlated with histopathological examination. The present cases confirm the specificity of the ‘dot-in-circle’ sign on MRI and USG, supported by histopathological correlation.

Radiological Pearls in Imaging of Maffucci Syndrome- A Case Report

Maffucci syndrome is a congenital mesodermal dysplasia. The disease is characterised by the presence of multiple soft tissue haemangiomas or slow flow venous malformations and enchondromas and was first described in 1881. This report aims to discuss the clinical and radiological findings of Maffucci syndrome in a 29-year-old female patient who presented with swelling in the right foot and foot deformity. The subsequent history taking and different imaging modalities helped to reach the diagnosis. On Ultrasonography (USG), phleboliths were visible and on Computed Tomography (CT), few calcific foci were noted in planter aspect of right foot in subcutaneous and intermuscular plane with soft tissue enhancement. Hence this case report showed that Maffucci syndrome can present as deformity of limb, multiple soft tissue swellings or with cranial nerve palsy which may suggest an intracranial lesion and close follow-up of patients is required as there are high chances of malignant transformation. Patient in this case was referred to the Neurosurgery Department and later on lost to follow-up.

Mature benign lipoblastoma: A rare case

We report here a case of lipoblastoma in a 14 year old boy along with a brief review of literature. He presented with multiple soft tissue swellings averaging 1 to 2 cm in maximum dimension over his right thigh and upper limbs with no other apparent constitutional symptoms. These were present since 2 years and were slowly enlarging. Ultrasonography revealed lipoid like density of these masses. Excision of one of his thigh swellings was carried out and histopathological examination revealed presence of lipoblasts in a myxoid background, which was unusual at this age of presentation. The final diagnosis was made as mature benign lipobastoma. Myxoid liposarcoma was considered as a differential diagnosis, however, it was ruled out on account of absence of any nuclear atypia or pleomorphism. Patient was subsequently discharged with no evidence of recurrence at the excision site even at one year of follow up.

Infantile Cortical Hyperostosis: Report of a Case with Observations on Clinical Manifestations, Radiology, and Pathology with a Late Follow-Up of Eight Years.

Purpose. The purpose of our study was to investigate clinical manifestations, roentgen images, histopathological studies, and evolution of the disease in patient displaying infantile cortical hyperostosis. Methods. Roentgenograms were made to evaluate a neonatal patient presenting multiple soft-tissue swellings. The initial radiographs insinuated that the disease had been present for some time in utero. Bone puncture biopsy of the tibia for histopathological observation and diagnosis conclusions was performed. Results. The disease was demonstrated radiographically by massive cortical diaphyseal thickening and also extensive periosteal new bone formation surrounding several bones. Results in blood count were as follows: discrete anemia, moderate leukocytosis, and elevated sedimentation rate. Histological pattern of tissue removed from tibia showed lamellar cortical bones and hyperplasia. Biopsy studies disclosed no evidence of neoplasia as well as of bacterial infection. Comments. Clinical manifestations in a neonatal patient displaying infantile cortical hyperostosis have gradually decreased. Radiograph findings have demonstrated complete recovery of bones manifested by the disease. The pathologic findings are in accordance with previous microscopic examination summarized by the literature. Total patient cure, without sequels, could be demonstrated.

Perineurial malignant peripheral nerve sheath tumor in the setting of multiple soft tissue perineuriomas: A rare presentation of an uncommon tumor

Perineurioma is an uncommon soft tissue tumor with characteristic histological and immunohistochemical features. Herein, this tumor is presented within a rare clinical setting, in a 45-year-old gentleman, with multiple soft tissue swellings and a previous history of surgical excision of a thigh mass. Four years back, he developed multiple soft tissue tumor swellings for which he lately underwent multiple wide excisions, elsewhere that were reported as multiple dermatofibrosarcoma protuberans (DFSPs). Histopathological review of the thigh and axillary tumor showed a perineurioma (EMA+, S100-P-ve, CD34-ve, low MIB1), whereas the recurrent leg mass disclosed a high-grade perineurial malignant peripheral nerve sheath tumor (MPNST) (EMA+, CD56+, S100-P-, high MIB1, CD34-ve, p53+ve). Within four months of post-excision, he developed additional swellings, and died of respiratory insufficiency. This case forms the first documented case of perineurial MPNST with multiple, metachronous soft tissue perineuriomas. Available literature review of perineurial MPNSTs and diagnostic implications are discussed herewith.

MULTIPLE LOCALIZED GIANT CELL TUMOR OF THE TENDON SHEATH (GCTTS) AFFECTING A SINGLE TENDON: A VERY RARE CASE REPORT AND REVIEW OF RECENT CASES

Giant cell tumors of the tendon sheath (GCTTS) are very common. More recently, a small number of case reports have identified the presence of multifocal GCTTS in the hand. These case reports have identified the presence of a maximum of two simultaneous lesions of a giant cell tumor affecting the same tendon sheath. We present an exceptionally rare case of simultaneous multiple localized GCTTS in which five lesions were identified on a single tendon simultaneously. This number of lesions on a single tendon has never been previously reported. A 37-year-old tree surgeon initially complained of pain in the region of the base of the ring and little fingers. A month later, he developed multiple soft tissue swellings at these sites and a soft tissue mass in the center of the palm relating to the left ring finger. A magnetic resonance imaging (MRI) scan suggested multiple GCTTS. These masses were excised completely without MRI evidence of a recurrence. Multiple GCTTS should be a differential diagnosis of multiple soft tissue swellings in the hand with an MRI scan and complete excision being the appropriate imaging and treatment modality respectively.

Langerhans cell histiocytosis in a 5-month-old presenting with biparietal masses

Langerhans cell histiocytosis (LCH) is a rare proliferative disorder that occurs most commonly in the pediatric population as a result of pathological clonal proliferation of Langerhans cells with subsequent damage and destruction to surrounding tissue. Clinically, LCH presents in a variety of ways, which often results in prolonged time to diagnosis and subsequently poorer outcomes. In this case report, the authors describe an unusually early presentation of multisystem LCH in a patient at birth, which resulted in a 5-month delay to diagnosis and treatment. This patient presented both atypically young and with an uncommon initial manifestation of multisystem disease with multiple soft-tissue swellings rather than early skin involvement. Additionally, this patient had an unusual radiographic appearance with biparietal skull destruction on initial skull radiographs and biparietal soft-tissue lesions on CT resembling cephalohematoma at 3 months of age. The clinical and radiological evaluation, pathology, and treatment strategies are discussed, with particular attention paid to the importance of further workup of atypical nonresolving cephalohematomas to prevent disease progression and poorer outcomes.