case_images: PMC8360742_01
case_images: Bilateral tendon xanthomas over Achilles tendon illustrating noticeable swelling (white arrows).
case_images: CRIOR2021-1932763.001.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.001.jpg
case_images: fig1
case_images: No muscle wasting or neurovascular deficit was identified (Figure 1).
case_images: Soft tissue shadow (white arrows) posterior to the ankle in both legs (L: left leg; R: right leg).
case_images: CRIOR2021-1932763.002.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.002.jpg
case_images: fig2
case_images: Ultrasound appearance of thickened Achilles tendon with focal hypoechoic areas. White arrows, thickened Achilles tendon.
case_images: CRIOR2021-1932763.003.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.003.jpg
case_images: fig3
case_images: MRI scan of the lower limbs. Sagittal view: right (R) and left (L) tendon xanthomas (white arrows).
case_images: CRIOR2021-1932763.004.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.004.jpg
case_images: fig4
case_images: T1- and T2-weighted images depicted striated appearance in sagittal sequences due to interposition of xanthoma between tendon fibres while illustrating speckled appearance in axial sequences. The xanthomas were focal with minimal infiltration into tendon tissues (Figure 4).
case_images: Surgically exposed lump.
case_images: CRIOR2021-1932763.005.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.005.jpg
case_images: fig5
case_images: A midline incision was made over the lump, and the tendon was exposed up to tendo-muscular junction, carefully preserving the sural nerve, on the lateral side of the tendon and plantaris tendon (Figure 5).
case_images: After subtotal resection.
case_images: CRIOR2021-1932763.006.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.006.jpg
case_images: fig6
case_images: Extensive intralesion subtotal resection was performed until the normal surrounding tendon tissue was approached (Figure 6).
case_images: Following the tendon repair.
case_images: CRIOR2021-1932763.007.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.007.jpg
case_images: fig7
case_images: In both legs, we could preserve plantaris tendon (Figure 7).
case_images: Following skin closure.
case_images: CRIOR2021-1932763.008.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.008.jpg
case_images: fig8
case_images: Local concentration of multinucleated giant cells, lipid-laden foamy macrophages along with connective tissue fragments, few inflammatory cells, and cyst macrophages with no malignant cells.
case_images: CRIOR2021-1932763.009.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.009.jpg
case_images: fig9
case_images: Stance position (a) and standing on toes (b).
case_images: CRIOR2021-1932763.010.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.010.jpg
case_images: fig10
case_images: Six weeks' postsurgery, she was completely independent when walking with ability to stand on toes without discomfort and was able to wear shoes without discomfort (Figure 10).
case_images: Ultrasound view: (a) right side; (b) left side. AP and longitudinal views illustrating no recurrence of xanthoma in Achilles tendon bilaterally (black arrow).
case_images: CRIOR2021-1932763.011.jpg
case_images: PMC8360742_01_CRIOR2021-1932763.011.jpg
case_images: fig11
case_images: Ultrasound scan assessments were performed at 1-year and 2-year visits which denoted scar tissue in the absence of recurrence (AP thickness was <4 mm on both Achilles tendons) (Figure 11).