case_images: PMC4276302_01
case_images: Pretreatment: 5 x 5 cm ulcer on the medial left foot emanating a serosanginous discharge and similar ulcer present posteriorly along with blistering satellite lesions on the plantar surface of the foot.
case_images: CRIONM2014-657876.001.jpg
case_images: PMC4276302_01_CRIONM2014-657876.001.jpg
case_images: fig1
case_images: There were two major areas of ulceration in medial foot measuring approximately 5 x 5 cm that emanated a serosanguinous discharge (Figure 1), with blistering satellite lesions in the medial and lateral aspect of the foot.
case_images: Low power view showing extensive spindle cell proliferation involving dermis, subcutis, and deeper fibroadipose tissue.
case_images: CRIONM2014-657876.002.jpg
case_images: PMC4276302_01_CRIONM2014-657876.002.jpg
case_images: fig2
case_images: Microscopically, there was extensive spindle cell proliferation involving dermis, subcutis, and deeper fibroadipose tissue (Figure 2).
case_images: High power view showing multiple vascular sinuses lined by tufts of neoplastic endothelial cells.
case_images: CRIONM2014-657876.003.jpg
case_images: PMC4276302_01_CRIONM2014-657876.003.jpg
case_images: fig3
case_images: There were multiple vascular sinuses lined by tufts of neoplastic endothelial cells (Figure 3).
case_images: Positivity for vascular marker CD-31.
case_images: CRIONM2014-657876.004.jpg
case_images: PMC4276302_01_CRIONM2014-657876.004.jpg
case_images: fig4
case_images: Immunohistochemical stains revealed negative staining for cytokeratin while vascular markers CD31 (Figure 4), CD34, and D2-40 were strongly positive.
case_images: MRI of the left foot with contrast showing diffuse soft tissue T1 hypointense signal within both medial and lateral subcutaneous tissues, which is more prominent in the fat anterior to the Achilles tendon.
case_images: CRIONM2014-657876.005.jpg
case_images: PMC4276302_01_CRIONM2014-657876.005.jpg
case_images: fig5
case_images: FDG-PET and CT scan showing heterogeneous uptake in the medial and lateral foot with a more focal uptake in the medial foot, anterior to the Achilles tendon.
case_images: CRIONM2014-657876.006.jpg
case_images: PMC4276302_01_CRIONM2014-657876.006.jpg
case_images: fig6
case_images: Flourodeoxyglucose (FDG) PET and CT scan revealed heterogeneous uptake in the medial and lateral foot with a more focal uptake in the medial foot, anterior to the Achilles tendon (Figure 6).
case_images: Two months postradiation: marked diminishment of cutaneous ulceration with decline in discharge and drying of satellite nodules.
case_images: CRIONM2014-657876.007.jpg
case_images: PMC4276302_01_CRIONM2014-657876.007.jpg
case_images: fig7
case_images: At the end of two-month follow-up there was almost complete response and drying of the cutaneous ulceration and satellite nodules in his foot (Figure 7).