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Soft Tissue Tumors of the Foot and
Ankle Questions and Correct Answers
2025-2026 Graded A
"SCARE tumors" - ANS-synovial sarcoma -clear cell sarcoma -angiosarcoma -rhabdosarcoma -epithelioid sarcoma malignant tumors that occur in younger age group (20-40 yrs) anemia can be seen in pts with what types of soft tissue tumors - ANSwith early malignant tumors such as Ewing's sarcoma, angiosarcoma, fibrous histiocytoma benign fat tumors include - ANS-lipoma -angiolipoma benign fibrous tumors include - ANS-periungual fibromas (can sometimes be seen in tuberous sclerosis) -plantar fibroma/fibromatosis -desmoid tumor benign neural soft tissue tumors include - ANS-neurofibroma -schwannoma (neurilemoma)
benign soft tissue in muscle - ANSleiomyoma (smooth m) rhabdomyoma (skeletal m) benign synovial soft tissue tumors include - ANS-ganglion (most common in foot) -giant cell tumor of tendon sheath -mucoid cyst (mucinous cyst) -synovial cyst -pigmented villonodular synovitis -synovial chondromatosis - multiple cartilaginous nodules benign vascular soft tissue tumors include - ANS-glomus -hemangioma clincal evaluation of ganglion - ANS-freely movable -nonpainful -translucent upon illumination -usually attached to a tendon or joint capsule clinical workup of a soft tissue tumor: primary - ANS-palpate it -x-rays -CT/MRI -biopsy complciations of surgical removal of plantar fibroma - ANS-recurrence: 33%
dx of glomus tumor - ANSdoppler etiology of kaposi's sarcoma - ANS-mixed vascular structures etiology of plantar fibromatosis - ANS-trauma -genetics -medications: B-blockers, Phenytoin is assoc with fibrous tissue disorders, vitamins/supplements (supplements containing glucosamine/chondroitin or amino acid L-lysine, or vit. C) fibrosarcoma - ANS-malignant -enlarging painless mass in extremities or trunk (often in foot) p ganglion tumors - ANS-mucoid degeneration in the area of a joint or joint capsule or tendon sheath -most freq location: dorsum of foot -aspiration can confirm the dx (yellow, jelly type fluid) -can be stationary in size, inc or decrease, or spontaneously dissolve giant cell tumor of tendon sheath - ANS-arises from the synovial lining of tendon sheaths but can also occur distal to synovial tissue -common in hands and feet -small painless mass that slowly inc in size -can invade adjacent structures and cause pain; can cause changes in bone -well circumscribed
-tx: excision glomus tumor - ANS-benign tumor of vascular soft tissue -peak incidencce in 20-40 yrs -common in fingers -if subungual, more common in females 3: -bright red-bluish color beneath nail bed, pain, worse with cold or pressure ->1cm in diameter glomus tumor classic triad - ANS-spontaneous pain -cold hypersensitivity -pressure tenderness to tip of toe (or finger) know this hemangioma MRI - ANS-classic presentation: "bag of worms" (vessels with slow moving blood in the center) -int T1, low/high T hemangiomas - ANS-benign vascular tumor -represents hamartomatous malformations of normal vascular tissue -#1 soft tissue tumor in children how are soft tissue tumors classified - ANS-according to the direction/differentiation of the tumor cells
malignant vascular soft tissue tumors include - ANS-kaposi's sarcoma -angiosarcoma and variants -lymphangiosarcoma massive localized lymphedema - ANS-occurs in morbidly obese ppl usually over 300 lbs -overlying skin has "peau d'orange" appearance metastasis workup for soft tissue tumor (if you suspect a tumor has metastasized) - ANS-bone scan -CXR, CT of chest, abdomen, pelvis -basic chemistry to include Ca, Phosphorus, LFTs, electrophoresis most benign soft tissue tumors occur in what age group? malignant age group? exceptions? - ANS-benign: 20-40 yrs -malignant: 40+ -except "SCARE" tumors and peripheral nerve sheath tumors most benign tumors of soft tissue occur in what age group - ANSbenign: 20-40 yrs except "SCARE" tumors and peripheral nerve sheath tumors most common benign soft tissue tumor in adults - ANSlipoma most common benign soft tissue tumor in foot - ANSganglion
most common malignant soft tissue tumor in children - ANSrhabdomyosarcoma most common malignant soft tissue tumor in foot - ANSsynovial sarcoma
most common sarcoma in children - ANSrhabdomyosarcoma most common soft tissue tumor in children - ANShemangioma most common soft tissue tumor in foot and in whole body - ANSmc in foot - ganglion mc in whole body - lipoma most common tumor of neurogenic origin - ANSneurofibroma most malignant soft tissue tumors occur in what age group - ANSmalignant: 40 yrs + MRI findings for fibromatosis - ANST1 low T2 low MRI findings for ganglion - ANSlow T high T MRI findings for hemangioma - ANS-intermediate/high T
T2 hyperintense centrally with hypointense rim MRI of plantar fibroma - ANS-can tell you if it is still growing -don't take out if it is still growing = greater chance of recurrence -only take out when it's stable mucoid cyst - ANS-arises from synovial lining of adjacent tendon or joint -often found adjacent to nails, toes, fingers -F>M -ages 40- -etiology unknown -tx: excision -soft (diff between this and neurofibroma is neurofibromas are hard) myositis ossificans - ANS-age 10-40 trauma (sports) -typical: young adult sustains trauma and within days develops soft tissue mass that becomes firm/hard over 4-6 wks -at 6+ weeks can see mineralization -tx - observation; may excise if symptomatic -MC in achilles tendon area or arch neurofibrama- - ANS-benign spindle shaped tumor cells of peripherla nerves -single or multiple -located in dermis or subq -10% assoc with von Recklinghausen's disease ("cafe ole spots") and present with multiple lesions
-can be assoc with scoliosis, local gigantism, tibial pseudoarthritis periungual fibromas - ANS-benign -common in the toes -single or multiple -bleed easily when cut -can cause nail deformity due to pressure -tx: excision; can re-occur pertinent history for a soft tissue tumo - ANS-how long has it been present (quick growing, large tend to be malignant) -is it causing pain? usually no -hx of trauma or foreign bodies? -systemic signs or lab findings? -hx of cancer/family hx? physical exam of a soft tissue tumor - ANS-palpate lesion -palpate LNs -firm lesions >5cm in diameter are assumed to be malignant pigmented villonodular synovitis - ANS-often occurs around joints, tendon sheaths, or bursal linings -intermittent edema ocurs, minimal discomfort -aspiration: bloody or brownish fluid with little/no decrease in size bc of residual capillary thickening plantar fibroma features - ANS-can be painful on WB
-can cause rigid hammertoes schwannoma - ANS-benign tumor of nerve sheath origin (schwann cell) -peak incidence 40-50 yrs old -solitary, well encapsulated, and on surface of peripheral n. -+ tinel sign, assoc nerve symptoms soft tissue sarcomas - ANS-little separates one from the other with respect to clinical appearance, staging, or rec treatment -chest xray should be done to rule out distinct metastasis when suspicious of a sarcoma -CT and MRI also recommended specific soft tissue lesions arise from what tissues - ANSany of the mesenchymal tissues: -fibrous -vascular -neural -synovial -muscular -misc rarely cartilaginous or osseous origin symptoms and treatment of kaposi's sarcoma - ANS-pain -tx: combo of excision, radiation, chemo
synovial chondromatosis - ANS-multiple cartilaginous or osteocartilaginous nodules -embedded in synovium and some loose bodies in the joint -results from chondral metaplasia of the synovial tissue -xrays may show calcifications synovial cyst - ANS-fluid filled cyst arising from synovial lining of a tendon or joint -tx: excision synovial sarcoma x-ray findings - ANS-malignant -can show mineralization at periphery topical treatment for plantar fibromas - ANS-verapamil (Ca channel blocker)
- blocks Ca ions fro entering into scar tissue cells, therby stimulating the production of collagenase -collagenase breaks down collagen formation and remodels it -a lot of side effects -need to order LFT treatment of desmoid tumor - ANS-radiation therapy -NSAIDs -chemotherapy -sx excision treatment of ganglion - ANS-aspiration, followed by steroid injection (long acting - Triamcinolone)
triad for tuberous sclerosis - ANSfacial angiofibromas mental deficiency seizures tuberous sclerosis - ANS-multisystem disease where pts develop fibromas anywhere on the body (brain, toes, skin, etc.) -triad: facial angiofibromas, mental deficiency, seizures -multiple perinugual fibromas on the toes know the triad tx of glomus tumor - ANSexcision tx of pigmented villonodular synovitis - ANS-when bone is involved, a synovectomy is done -radiation therapy used in conjunction -recurrence common tx of synovial chondromatosis - ANSsynovectomy and excision of all bodies complciations: recurrence, DJD types of hemangiomas - ANS-cavernous -capillary portwine type most common at birth, regress spontaneously -mixed type
what is the best soft tissue diagnostic test - ANSMRI - best for soft tissue detail and for defining marrow involvement in osseous lesions what is the most common sarcoma found in the foot - ANSsynovial sarcoma *** what is the most common tumor of neurogenic origin - ANSneurofibroma when should you assume a soft tissue tumor to be malignant? - ANSif it is firm and >5cm where do soft tissue tumors form - ANS-in CT (muscles, tendons, fat, skin) -can also form in bones x-ray findings of a hemangioma - ANS-benign -can contain phleboliths (calcifications of small blood vessels) x-ray findings of a lipoma - ANS-benign -can contain islands of mature bone x-ray of soft tissue tumors - ANS-can detect mineralization in the soft tissue lesion and changes to underlying bone -both benign and malignant tumors can undergo mineralization xray of glomus tumor - ANS-well marginated, bony erosion over the dorsal aspect of the distal phalanx -bony erosion may indicate malignancy, but glomust tumors are benign
