| Popis: |
A 46-year-old man presented to the authors’ hospitalwith pain and swelling on the medial side of the left foot.When he was 26 years old,a pain had suddenly developedinhisleftfootwithoutanyobviouscause.Thepainalwaysoccurred when he got cold and could be relieved bysoaking in hot water.Five years later,the patient went to alocal clinic as the pain had become more severe and wasoccurring more frequently than before. He was treatedwithIbuprofen,andthepainwasrelieved.Attheageof 43years, he had a surgical excision with a diagnosis of syn-ovialcystbecausehissymptomcouldnotbecontrolledbydrugs.Oneyearlater,becauseof recurrenceof symptoms,he underwent another surgical excision, and pathologicalexamination resulted in a diagnosis of nodular synovitis.However,his symptoms were not eliminated,and affectedhim repeatedly after the second operation. He describedthathisfootgraduallybecamemoreenlargedandswollen,andthatthiswasaccompaniedbyunendurablepainwhileweightbearinginthelastfewmonthsbeforeadmissiontothe authors’ hospital.On admission, physical examination revealed a small,tender, circumscribed, hard mass on the medial side ofthe swollen left foot. The skin was not involved, neitherwas venous dilatation found. The blood supply and sen-sation in the toes of the left foot were normal, whilemovement was impaired. No enlarged local lymph nodeswere found. Radiographs showed bony erosion and peri-osteal reaction in the medial aspect of the second meta-tarsal and the proximal aspect of the first metatarsalbones (Fig. 1). No obvious abnormalities were found onchest radiograph. Incision biopsy and MRI of the leftfoot were performed. A large lobulated soft tissue massmeasuring 7 cm ¥ 5.5 cm ¥ 6 cm was identified. Themass straddled the first to the fourth metatarsal bone(Fig. 2a,b). The histology result was consistent with syn-ovial sarcoma (Fig. 3). Immunochemistry results of epi-thelial membrane antigen (EMA) staining (Fig. 4a) andvideo intensification microscopy (VIM) (Fig. 4b) werepositive and those of CD-34, CD-68, CD-117,Actin, Des,S-100 were all negative, which further supported thediagnosis. The patient underwent left proximal tibialamputation. After the operation, he received adjuvant |
Plný text