International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
Osteosarcoma of the middle and distal phalanges of the little toe with a cancerous ulcer
Tomoya Matsunobu1, Hirofumi Bekki2, Katsumi Harimaya3, Yoshihiro Matsumoto4, Makoto Endo5, Kojiro Yoshitake6, Yoshinao Oda7, Yukihide Iwamoto8
1MD, PhD, Assistant professor, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
2MD, Graduate student, Department of Anatomic pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
3MD, PhD, Lecturer, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
4MD, PhD, Associate professor, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
5MD, Medical staff, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
6MD, Medical staff, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
7MD, PhD, Professor, Department of Anatomic pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.
8MD, PhD, Professor, Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka Japan.

Article ID: Z01201603CR10619TM
doi:10.5348/ijcri-201632-CR-10619

Address correspondence to:
Tomoya Matsunobu
Department of Orthopedic Surgery
Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi
Higashi-ku, Fukuoka 812-8582
Japan

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How to cite this article
Matsunobu T, Bekki H, Harimaya K, Matsumoto Y, Endo M, Yoshitake K, Oda Y, Iwamoto Y. Osteosarcoma of the middle and distal phalanges of the little toe with a cancerous ulcer. Int J Case Rep Images 2016;7(3):185–189.


Abstract
Introduction: Osteosarcoma (OS) is the most common malignant mesenchymal tumor of the bone, and mostly affects the long bones around the knee. Osteosarcoma of short tubular bones such as those of the foot is extremely rare and accounts for less than 1% of all cases. To the best of our knowledge, this is the first reported case of OS of the middle and distal phalanges of the little toe.
Case Report: A 20-year-old Japanese male presented at our hospital due to pain and swelling of his left little toe for over one year. Physical examination revealed a swollen little toe on his left foot with skin ulceration and degenerative nail. Various radiological imaging tests including X-ray, CT scan, Magnetic resonance imaging (MRI) scan, positron emission tomography (PET) scan with 18F-FDG and bone scintigraphy with 99mTc -MDP showed tumors in the distal and middle phalanges of the left little toe with extraosseous masses and without distant metastasis. Open biopsy showed pleomorphic osteogenic sarcoma. After disarticulation at the metatarsophalangeal joint of the little toe, the patient received adjuvant chemotherapy with high-dose methotrexate, doxorubicin, and cisplatin. No recurrence has been observed on 12-month follow-up.
Conclusion: Pleomorphic osteogenic sarcoma is rare in the feet so the initial diagnosis is often wrong, leading to delayed appropriate treatment. This case report emphasizes the need to add osteosarcoma in the differential diagnosis of the phalangeal bone tumors.

Keywords: Foot phalanges, Osteosarcoma, Short tubular bones, Skin ulcer


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Author Contributions
Tomoya Matsunobu – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hirofumi Bekki – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Katsumi Harimaya – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yoshihiro Matsumoto – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Makoto Endo – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kojiro Yoshitake – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yoshinao Oda – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Yukihide Iwamoto – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Tomoya Matsunobu et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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