A Long-Standing Painful Mass On The Foot…. Malignant or Benign?
A 52-year-old male presented to the outpatient department with complaints of a painful, palpable mass on her left foot. The patient elaborated that he had first noticed the swelling back in November 2016 out of the blue without any preceding trauma, a warning, or a similar event.
The patient explained that the mass was painful and the pain radiated to the first and second toes (hallux and second digit) of his left foot. The pain was burning in character, associated with a tingling sensation. The pain did not improve with any of the pain remedies, including the analgesics, neither the pain had any particular pattern. He would feel discomfort at any time during the day.
The patient was concerned about malignancy; therefore, he wanted to rule out the possibility of the mass being cancerous.
On physical examination, inspection revealed was a soft, palpable mass on the anterior aspect of the left foot immediately distal to the level of the ankle joint. Bounding dorsalis pedis pulse was seen along the anterior surface of the foot, making aneurysm a differential diagnosis. The mass did not completely transilluminate under the light.
A working diagnosis of aneurysm of the dorsalis pedis artery was made as the mass was pulsatile along the dorsum of the foot.
The patient was advised to opt fr an excisional biopsy so a definitive diagnosis can be made. After consent, the patient was taken to the operating room where an excisional biopsy of the soft tissue mass was performed. The sample was sent for histopathological evaluation. The pre-op course was uneventful, and so was the surgery and the post-operative period. The patient had no subsequent complications and had recovered fully till his 3-month follow-up.
Histopathological analysis revealed a diagnosis of vascularized fibroma with a blood clot inside.