Make the Diagnosis: Lifelong Left Foot Pain

(MedPage Today) -- Case Study: A twenty-seven-year-old man presented with lifelong left foot pain that had begun as a ?blood blister? on the plantar aspect of the second metatarsal head at the age of one year. The lesion had originally been diagnosed as a benign ?birthmark? that would spontaneously regress, but over the years it had become progressively painful. Multiple conventional wart treatments had failed to improve symptoms or eliminate the lesion. The pain had increased during the months prior to presentation. Physical examination revealed a tender lesion under the left second metatarsal head composed of petechiae or punctate lesions, surrounded by a callus measuring 2 × 2 cm (shown here). Radiographs and magnetic resonance imaging (MRI) demonstrated a 15 × 19 × 24-mm lobular lesion with extension into the subcutaneous tissue. Surgeons removed the entire mass. After two weeks of non-weight-bearing in a walking boot, the patient was able to wear his normal footwear and begin weight-bearing. Histopathology of the specimen revealed subcutaneous portions that contained shaggy, lobulated, yellow adipose tissue streaked with gray. Microscopic sections showed hyperkeratosis, papillomatosis, and acanthosis with dilated vascular papillae. What is the diagnosis?
Source: MedPage Today Radiology - Category: Radiology Source Type: news