case_images: PMC5887220_01
case_images: Pre-operative radiograph of large lytic lesion in the calcaneus
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case_images: Fig1
case_images: Upon referral new radiographs were obtained (Fig. 1).
case_images: Preoperative sagittal T1 image of the calcaneus showing solid lesion with fairly homogenous signal
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case_images: Fig2
case_images: Magnetic resonance imaging (MRI) showed a complex lesion in the anterior calcaneus with some surrounding edema and potential concern for cortical disruption (Figs. 2, 3).
case_images: Preoperative sagittal T2 image with some heterogeneity within the lesion surrounding bony edema, sclerotic border around the lesion, but with concern for cortical breakthrough in the subtalar joint
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case_images: Fig3
case_images: Magnetic resonance imaging (MRI) showed a complex lesion in the anterior calcaneus with some surrounding edema and potential concern for cortical disruption (Figs. 2, 3).
case_images: Axial CT scan of lesion preoperatively displaying concern for cortical destruction
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case_images: Fig4
case_images: There was cortical destruction along multiple sites at the margins of the lesion and slight scattered calcifications (Fig. 4).
case_images: H&E x200. The tumor consists of large epithelioid and spindle cells arranged in cords, clusters and as single cells within a myxoid to hyalinized stroma
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case_images: Fig5
case_images: The pathologic report revealed cords and clusters of epithelioid cells and foci of spindle cells in a myxochondroid matrix (Figs. 5, 6).
case_images: H&E x400. The tumor cells have moderately abundant eosinophilic cytoplasm with occasional cytoplasmic vacuoles. Nuclei are round with prominent nucleoli
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case_images: Fig6
case_images: The pathologic report revealed cords and clusters of epithelioid cells and foci of spindle cells in a myxochondroid matrix (Figs. 5, 6).
case_images: H&E x600. The vacuoles represent attempts at blood vessel formation and may contain red blood cell fragments
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case_images: Fig7
case_images: Some of the epithelioid cells contained vacuoles and rare erythrocyte (Fig. 7).
case_images: CAMTA1 immunohistochemical stain, x200. Tumor cell nuclei stain positively with antibody to CAMTA1 protein, a fusion protein unique to this tumor
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case_images: Fig8
case_images: Immunohistochemical stains identified CD31, CD34, and CAMTA1 (Figs. 8, 9).
case_images: CD34 immunohistochemical stain, x200. Tumor cells stain positively for endothelial marker CD34. This stain also highlights the anastomosing cord-like architecture of the tumor which recapitulates the formation of primitive blood vessels
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case_images: Fig9
case_images: Immunohistochemical stains identified CD31, CD34, and CAMTA1 (Figs. 8, 9).
case_images: Two-year post-operative follow-up radiograph of the calcaneus showing curettage and cementing with Steinman pin reinforcement. There has been so sign of recurrence of disease or failure of the construct despite full activity
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case_images: Fig10
case_images: CT scan and radiographs of the hindfoot at his 6 month and 3 year follow-up showed well fixed hardware without recurrence (Fig. 10).